UNICEF urges political heads to commit to firm ODF targets

Mole (S/R), Feb. 19, GNA – The United Nations Children’s Fund (UNICEF) has called on political heads at the regional and local levels to commit to firm Open Defecation (OD) targets.

They are also to work with Assemblies through Assembly Members to mobilise the citizenry to take ownership of sanitation to achieve the targets.

Madam Margaret Gwada, Chief of UNICEF Field Office, Tamale, who made the call, expressed the need for Metropolitan, Municipal and District Assemblies to enact by-laws and sanctions to correct defaulting citizens.

She said this would help to achieve the President’s agenda of a “Clean Ghana,” “A Ghana without filth, a Ghana where children do not lose their lives to preventable diseases such as diarrhoea and polio”.

She was speaking at the Ministers’ Sanitation Summit held at Mole in the Savannah Region, which was a lesson-learning platform to deepen dialogue in the fight against OD as well as share experiences and ideas on dealing with the menace.

It was also to share and receive feedback from amongst the various regions and to come up with constructive ideas and suggestions on the way forward to improve on basic sanitation in the country.

It was organised by the Northern Regional Coordinating Council in collaboration with the Ministry of Local Government and Rural Development, and the Ministry of Sanitation and Water Resources together with its development partners including UNICEF and Canada.

It was attended by some Regional Ministers and Deputy Regional Ministers from five regions in the north, and the Central and Greater Accra Regions and officials from the Ministries of Sanitation and Water Resources, and Local Government and Rural Development, Metropolitan, Municipal and District Chief Executives, Regional Community Development Officers, Regional Environmental Health Officers from those regions and development partners including UNICEF, Canada and the coalition of NGOs in water and sanitation.

According to the 2017 Multiple Indicator Cluster Survey (MICS), one out of five Ghanaians defecated in the open.

Data from the Environmental Health and Sanitation Unit indicates that Northern Region moved from five per cent Open Defecation Free (ODF) coverage in June, 2016 to about 58% in July, 2019.

Madam Gwada attributed the strides in the area of ODF to commitment of leadership to timely release of funds towards sanitation initiatives and behavioural change, hence, her call on the political heads to commit to firm ODF targets.

Mr Michael Gyato, Deputy Minister for Sanitation and Water Resources urged Assemblies to sensitise their people to pick plastic rubbers scattered in their surroundings to help improve sanitation practices in their communities.

Mr John Benam, Deputy Northern Regional Minister said the government had demonstrated commitment towards improving on basic sanitation in the country and called on development partners “To lean on that and work assiduously to achieve more ODF with resources within our reach.”

Mr Eric Chimsi, Development Officer, at Canada expressed the need to institute measures for the effective and sustainable supply of durable sanitation and hand hygiene solutions to accelerate progress towards country-wide ODF by the year 2030.

Mr Attah Arhin, Water, Sanitation and Hygiene (WASH) Technical Coordinator of World Vision Ghana called on development partners to renew their commitment to the WASH sector and the suggested to government to fully release budgetary allocations towards the sector to achieve set targets.

GNA (Ghana News Agency)
By Albert Futukpor, GNA

Study: To slow an epidemic, focus on handwashing

Improving the rate of handwashing at just 10 major airports could significantly slow the spread of a viral disease, researchers estimate.

A new study estimates that improving the rates of handwashing by travelers passing through just 10 of the world’s leading airports could significantly reduce the spread of many infectious diseases. And the greater the improvement in people’s handwashing habits at airports, the more dramatic the effect on slowing the disease, the researchers found.

The findings, which deal with infectious diseases in general including the flu, were published in late December, just before the recent coronavirus outbreak in Wuhan, China, but the study’s authors say that its results would apply to any such disease and are relevant to the current outbreak.

The study, which is based on epidemiological modeling and data-based simulations, appears in the journal Risk Analysis. The authors are Professor Christos Nicolaides PhD ’14 of the University of Cyprus, who is also a fellow at the MIT Sloan School of Management; Professor Ruben Juanes of MIT’s Department of Civil and Environmental Engineering; and three others.

People can be surprisingly casual about washing their hands, even in crowded locations like airports where people from many different locations are touching surfaces such as chair armrests, check-in kiosks, security checkpoint trays, and restroom doorknobs and faucets. Based on data from previous research by groups including the American Society for Microbiology, the team estimates that on average, only about 20 percent of people in airports have clean hands — meaning that they have been washed with soap and water, for at least 15 seconds, within the last hour or so. The other 80 percent are potentially contaminating everything they touch with whatever germs they may be carrying, Nicolaides says.

“Seventy percent of the people who go to the toilet wash their hands afterwards,” Nicolaides says, about findings from a previous ASM study. “The other 30 percent don’t. And of those that do, only 50 percent do it right.” Others just rinse briefly in some water, rather than using soap and water and spending the recommended 15 to 20 seconds washing, he says. That figure, combined with estimates of exposure to the many potentially contaminated surfaces that people come into contact with in an airport, leads to the team’s estimate that about 20 percent of travelers in an airport have clean hands.

Improving handwashing at all of the world’s airports to triple that rate, so that 60 percent of travelers to have clean hands at any given time, would have the greatest impact, potentially slowing global disease spread by almost 70 percent, the researchers found. Deploying such measures at so many airports and reaching such a high level of compliance may be impractical, but the new study suggests that a significant reduction in disease spread could still be achieved by just picking the 10 most significant airports based on the initial location of a viral outbreak. Focusing handwashing messaging in those 10 airports could potentially slow the disease spread by as much as 37 percent, the researchers estimate.

They arrived at these estimates using detailed epidemiological simulations that involved data on worldwide flights including duration, distance, and interconnections; estimates of wait times at airports; and studies on typical rates of interactions of people with various elements of their surroundings and with other people.

Even small improvements in hygiene could make a noticeable dent. Increasing the prevalence of clean hands in all airports worldwide by just 10 percent, which the researchers think could potentially be accomplished through education, posters, public announcements, and perhaps improved access to handwashing facilities, could slow the global rate of the spread of a disease by about 24 percent, they found. Numerous studies (such as this one) have shown that such measures can increase rates of proper handwashing, Nicolaides says.

“Eliciting an increase in hand-hygiene is a challenge,” he says, “but new approaches in education, awareness, and social-media nudges have proven to be effective in hand-washing engagement.”

The researchers used data from previous studies on the effectiveness of handwashing in controlling transmission of disease, so Juanes says these data would have to be calibrated in the field to obtain refined estimates of the slow-down in spreading of a specific outbreak.

The findings are consistent with recommendations made by both the U.S. Centers for Disease Control and the World Health Organization. Both have indicated that hand hygiene is the most efficient and cost-effective way to control disease propagation. While both organizations say that other measures can also play a useful role in limiting disease spread, such as use of surgical face masks, airport closures, and travel restrictions, hand hygiene is still the first line of defense — and an easy one for individuals to implement.

While the potential of better hand hygiene in controlling transmission of diseases between individuals has been extensively studied and proven, this study is one of the first to quantitatively assess the effectiveness of such measures as a way to mitigate the risk of a global epidemic or pandemic, the authors say.

The researchers identified 120 airports that are the most influential in spreading disease, and found that these are not necessarily the ones with the most overall traffic. For example, they cite the airports in Tokyo and Honolulu as having an outsized influence because of their locations. While they respectively rank 46th and 117th in terms of overall traffic, they can contribute significantly to the spread of disease because they have direct connections to some of the world’s biggest airport hubs, they have long-range direct international flights, and they sit squarely between the global East and West.

For any given disease outbreak, identifying the 10 airports from this list that are the closest to the location of the outbreak, and focusing handwashing education at those 10 turned out to be the most effective way of limiting the disease spread, they found.

Nicolaides says that one important step that could be taken to improve handwashing rates and overall hygiene at airports would be to have handwashing sinks available at many more locations, especially outside of the restrooms where surfaces tend to be highly contaminated. In addition, more frequent cleaning of surfaces that are contacted by many people could be helpful.

The research team also included Demetris Avraam at the University of Cyprus and at Newcastle University in the U.K., Luis Cueto-Felgueroso the Polytechnic University of Madrid, and Marta Gonzalez at the University of California at Berkeley and MIT. The work was supported by startup company Smixin Inc and MIT International Science and Technology Initiatives.

By David L. Chandler | MIT News Office
February 6, 2020

What to do next to control the 2019-nCoV epidemic?

The 2019 novel coronavirus (2019-nCoV) infection can lead to acute resolved or fatal pneumonia. On the basis of knowledge of other coronaviruses, the main route of human-to-human transmission of 2019-nCoV is probably through respiratory droplets. As of Feb 4, 2020, statistical data show that the outbreak constitutes an epidemic threat in China, where the exponential increase in patients has reached 20438 confirmed cases, with 2788 (13·64%) patients in critical condition and 425 (2·08%) deaths; 23214 additional suspected cases have also been identified so far. The most affected city, Wuhan, and related regions in Hubei province of China have reported 13522 confirmed patients (66·16% of total cases) and 414 deaths from 2019 nCoV infection (97·41%of total deaths in China). 632 patients with confirmed infection have recovered and have been discharged from hospital. However, the downward turning point for new cases of infection has not been observed yet (figure). Notably, 159 confirmed cases have been reported in 23 other countries beyond China, including Japan, Thailand, Singapore, South Korea, Australia, the USA, Malaysia, and Germany. Because of the seriousness of this outbreak, WHO declared it a public health emergency of international concern on Jan 30, 2020, followed by the USA announcing a public health emergency on Jan 31, 2020.

During the epidemic, rapid and robust research is important to help guide clinical practices and public health policies. Zhu and colleagues sampled bronchoalveolar-lavage fluid from three patients and used next-generation sequencing and PCR to characterise the virus, and they identified the pathogen of this outbreak as a novel coronavirus that falls within the subgenus Sarbecovirus of the genus Betacoronavirus and confirmed the cytopathic effects (structural changes in host cells) of this virus.1 Their achievement not only improves methods of diagnosis confirmation in clinics but also promotes the study of the underlying mechanisms of viral infection.2 Subsequently, collaborations between Chinese and international scientists have rapidly unmasked some additional virological features of 2019-nCoV. A specific viral nucleic acid assay using RT-PCR was quickly developed for the diagnosis of 2019-nCoV infection.3,4Additionally, human angiotensin-converting enzyme 2 has been shown to be the putative receptor for the entry into host cells by use of bioinformatic prediction methods and in-vitro testing.2,5,6 Furthermore, bats are speculated to be the original host of this zoonotic virus, but whether an intermediate host facilitated the viral infection in humans is still unknown.7 Lastly, evidence of person-to-person transmission is accumulating,8,9 with an estimated R0 of 2·2 (95% CI 1·4–3·9),10 and the assessment of the full extent of this mode of transmission is urgently needed.

In The Lancet, two retrospective studies from Wuhan Jin Yin-tan Hospital have recently provided the first-hand evidence of epidemiological, clinical, laboratory, radiological imaging, and outcomes among 41 patients11 and 99 patients.12 Of 99 patients with 2019-nCoV pneumonia,12 the average age was 55·5 years (SD 13·1) and 50 (51%) patients had chronic diseases. Clinical manifestations were fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). In view of the findings from both studies, as well as accumulated clinical experience, the next crucial step would be to identify the proper treatment for patients infected with 2019-nCoV.

No fully proven and specific antiviral treatment for the coronavirus exists. Guidance from China’s National Health Commission suggests taking an anti-HIV drug combination of lopinavir and ritonavir and inhaling a dose of nebulised interferon α for the antiviral therapy.13Many efforts, including several clinical trials, such as NCT04246242 and NCT04252664, are in progress to screen existing antiviral drugs to identify those that could be specific and efficient against 2019-nCoV. Notably, the first reported use of remdesivir, in the first diagnosed patient with 2019-nCoV infection in the USA,14 has encouraged additional clinical study of this medication.

More importantly, patients in critical conditions often develop serious complications, such as acute respiratory distress syndrome (17 [17%] of 99 patients),12and thus medical groups should include physicians with expertise in both infectious diseases and critical care. It is noteworthy that patients in critical condition often show a reduction in peripheral blood lymphocytes.11,12 Whether immune cells infiltrate into the lungs and then cause serious lung lesions (as occurred in patients with severe acute respiratory syndrome [SARS])15 is not clear. Therefore, it is important to understand the lung microenvironment and the map of immune responses against 2019-nCoV infection, which might help to define clinical stages and uncover the pathogenesis of the disease. Recent data showed that mostdeaths were due to respiratory failure;11,12 however, no reports of lung pathology in patients who died from 2019-nCoV infection have been reported so far. Notably, elderly men with 2019-nCoV infection and other underlying diseases often have a higher fatality rate than that of elderly women or younger and more healthy patients;11,12more studies are needed to determine the associated influencing factors underlying this finding.

The development of more efficient and quicker methods for the detection of viral nucleic acids is needed to ensure the accuracy of diagnosis. Several challenges remain for basic research, including viral mutation rateand transmission, infectivity dynamics, and viral infection-associated pathogenicity in vivo. Some evidence has suggested that the virus can spread during the incubation period9,16 and is detectable during the convalescent period.16 Notably, the virus was found in the loose stool of a patient in the USA,14 suggesting potential transmission through the faecal–oral route. It is of high priority to ascertain whether persistent asymptomatic carriers of 2019-nCoV exist and to reach an accurate definition of when a patient can be considered cured. Moreover, no certainty exists about the source of the outbreak, and a prophylactic vaccine is still under development.

WHO has acknowledged the efforts made by the Chinese Government to investigate and contain the outbreak.17 For example, authorities rapidly initiated the first measures to isolate Wuhan, which were then extended to the whole Hubei province, stranding 35 million residents during the heavy-travel Chinese Spring Festival holidays. At the same time, the two new-built hospitals in Wuhan have been put into use, with 2600 beds for the confirmed and suspected patients with pneumonia. The decision makers also extended the holiday period and postponed school openings. Additionally, at least 68 medical teams, including more than 8000 physicians and nurses, from other provinces and cities went to the most affected Hubei province to fight against the disease side by side with the local medical staff.18 The Chinese Government has initiated at least 13 research programmes as an emergency measure to study the different aspects of the outbreak such as the diagnosis, treatment, and prevention of 2019-nCoV-associated disease.19 Novel therapeutic approaches, including treatment with allogeneic mesenchymal stem cells, are expected to progress to clinical trials involving patients with 2019-nCoV infection in a critical condition when the projects meet both ethical requirements and the principle of informed consent (eg, NCT04252118). Furthermore, therapeutic drugs, protective equipment, and charitable funds from inside and outside of China are transported to the epidemic area to support the response. All these measures are aimed to maximise prevention and minimise the occurrence of new infections, which will help the in-time diagnosis and treatment of patients and protect the healthy population against viral infection not only in China but also in the rest of the world. China also faces other challenges, including asymptomatic carriers with 2019-nCoV might be a new potential source of infection; there will be a huge increase in people returning from trips after the Chinese Spring Festival vacation; and it may be difficult to control the outbreak due to the lack of adequate medical resources in epidemic communities and rural areas of Hubei province.

First-line medical staff and scientists in China have had a leading role in fighting the outbreak of 2019-nCoV-associated pneumonia. The basic and essential strategies that we should stick to remain the early detection, early diagnosis, early isolation, and early treatment of the disease. With the huge efforts from medical professionals to treat patients, substantial public health prevention measures, and accelerated research, we hope the downward turning points for both new cases of 2019-nCoV and the resulting fatal events might come soon.

We declare no competing interests.

*Fu-Sheng Wang, Chao Zhang

www.thelancet.comVol 395 February 8, 2020

Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing 100039, China

Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; published online Jan 24. DOI:10.1056/NEJMoa2001017.

Zhou P, Yang X, Wang X, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; published online Feb 3. DOI:10.1038/s41586-020-2012-7.

Corman VM, Landt O, Kaiser M, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020; 25: 2000045.

WHO. Laboratory testing of human suspected cases of novel coronavirus (nCoV) infection: interim guidance, 10 January 2020. Geneva: World Health Organization, 2020.

Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci 2020; published online Jan 21. DOI:10.1007/s11427-020-1637-5.

Letko MC, Munster V. Functional assessment of cell entry and receptor usage for lineage B β-coronaviruses, including 2019-nCoV. bioRxiv 2020; published online Jan 22. DOI:10.1101/2020.01.22.915660 (preprint).

Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019novel coronavirus: implications for virus origins and receptor binding. Lancet2020; published online Jan 30. https://doi.org/10.1016/S0140-6736(20)30251-8.

Phan LT, Nguyen TV, Luong QC, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med 2020; published online Jan 28. DOI:10.1056/NEJMc2001272.

Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; published online Jan 24. https://doi.org/10.1016/S0140-6736(20)30154-9.

Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; published online Jan 29. DOI:10.1056/NEJMoa2001316.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; published online Jan 24. https://doi.org/10.1016/S0140-6736(20)30183-5.

Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; published online Jan 29. https://doi.org/10.1016/S0140-6736(20)30211-7.

Chu CM. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004; 59: 252–56.

Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; published online Jan 31. DOI:10.1056/NEJMoa2001191.

de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: recentinsights into emerging coronaviruses. Nat Rev Microbiol 2016; 14: 523–34.

Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020; published online Jan 30. DOI:10.1056/NEJMc2001468.

Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol 202; published online Jan 29. DOI:10.1002/jmv.25689.

Huaxia. 68 medical teams sent to Hubei to aid coronavirus control. 2020.Xinhuanet, Feb 3, 2020. http://www.xinhuanet.com/english/2020-02/03/c_138752003.htm (accessed Feb 4, 2020).

Ministry of Science and Technology of the People’s Republic of China. Emergency scientific programs on prevention and control of the novel coronavirus-induced pneumonia. Jan 25, 2020. http://www.most.gov.cn/kjbgz/202001/t20200125_151233.htm (accessed Feb 4, 2020).

Antibacterial Soap? You Can Skip It, Use Plain Soap and Water

When you buy soaps and body washes, do you reach for products labeled “antibacterial” hoping they’ll keep your family safer? Do you think those products will lower your risk of getting sick, spreading germs or being infected?

According to the U.S. Food and Drug Administration (FDA), there isn’t enough science to show that over-the-counter (OTC) antibacterial soaps are better at preventing illness than washing with plain soap and water. To date, the benefits of using antibacterial hand soap haven’t been proven. In addition, the wide use of these products over a long time has raised the question of potential negative effects on your health.

After studying the issue, including reviewing available literature and hosting public meetings, in 2013 the FDA issued a proposed rule requiring safety and efficacy data from manufacturers, consumers, and others if they wanted to continue marketing antibacterial products containing those ingredients, but very little information has been provided. That’s why the FDA is issuing a final rule under which OTC consumer antiseptic wash products (including liquid, foam, gel hand soaps, bar soaps, and body washes) containing the majority of the antibacterial active ingredients—including triclosan and triclocarban—will no longer be able to be marketed.

Why? Because the manufacturers haven’t proven that those ingredients are safe for daily use over a long period of time. Also, manufacturers haven’t shown that these ingredients are any more effective than plain soap and water in preventing illnesses and the spread of certain infections. Some manufacturers have already started removing these ingredients from their products, ahead of the FDA’s final rule.

“Following simple handwashing practices is one of the most effective ways to prevent the spread of many types of infection and illness at home, at school and elsewhere,” says Theresa M. Michele, MD, of the FDA’s Division of Nonprescription Drug Products. “We can’t advise this enough. It’s simple, and it works.”

The FDA’s final rule covers only consumer antibacterial soaps and body washes that are used with water. It does not apply to hand sanitizers or hand wipes. It also does not apply to antibacterial soaps that are used in health care settings, such as hospitals and nursing homes.

What Makes Soap ‘Antibacterial’

Antibacterial soaps (sometimes called antimicrobial or antiseptic soaps) contain certain chemicals not found in plain soaps. Those ingredients are added to many consumer products with the intent of reducing or preventing bacterial infection.

Many liquid soaps labeled antibacterial contain triclosan, an ingredient of concern to many environmental, academic and regulatory groups. Animal studies have shown that triclosan alters the way some hormones work in the body and raises potential concerns for the effects of use in humans. We don’t yet know how triclosan affects humans and more research is needed.

“There’s no data demonstrating that these drugs provide additional protection from diseases and infections. Using these products might give people a false sense of security,” Michele says. “If you use these products because you think they protect you more than soap and water, that’s not correct. If you use them because of how they feel, there are many other products that have similar formulations but won’t expose your family to unnecessary chemicals. And some manufacturers have begun to revise these products to remove these ingredients.”

How do you tell if a product is antibacterial? For OTC drugs, antibacterial products generally have the word “antibacterial” on the label. Also, a Drug Facts label on a soap or body wash is a sign a product contains antibacterial ingredients.

Triclosan and Health Concerns

Triclosan can be found in many places today. It has been added to many consumer products—including clothing, kitchenware, furniture, and toys—to prevent bacterial contamination. Because of that, people’s long-term exposure to triclosan is higher than previously thought, raising concerns about the potential risks associated with the use of this ingredient over a lifetime.

In addition, laboratory studies have raised the possibility that triclosan contributes to making bacteria resistant to antibiotics. Some data shows this resistance may have a significant impact on the effectiveness of medical treatments, such as antibiotics.

The FDA and the Environmental Protection Agency (EPA) have been closely collaborating on scientific and regulatory issues related to triclosan. This joint effort will help to ensure government-wide consistency in the regulation of this chemical. The two agencies are reviewing the effects of triclosan from two different perspectives.

The EPA regulates the use of triclosan as a pesticide, and is in the process of updating its assessment of the effects of triclosan when it is used in pesticides. The FDA’s focus is on the effects of triclosan when it is used by consumers on a regular basis in hand soaps and body washes. By sharing information, the two agencies will be better able to measure the exposure and effects of triclosan and how these differing uses of triclosan may affect human health.

The EPA reevaluates each pesticide active ingredient every 15 years. The EPA’s Final Work Plan for the triclosan risk assessment can be found in docket EPA-HQ-OPP-2012-0811.

More on the FDA’s Rule

The FDA’s rule doesn’t yet apply to three chemicals (benzalkonium chloride, benzethonium chloride and chloroxylenol). Manufacturers are developing and planning to submit new safety and effectiveness data for these ingredients.

With the exception of those three ingredients that are still under study, all products that use the other 19 active ingredients will need to change their formulas or they will no longer be available to consumers. Manufacturers will have one year to comply with the rule.

This rule doesn’t apply to hand sanitizers. The FDA recently issued a final rule on OTC hand sanitizers and will continue to review the three active ingredients commonly used in hand sanitizers. To learn about the difference between consumer hand sanitizers and consumer antibacterial soaps, visit our consumer information page.

Consumers, Keep Washing with Plain Soap and Water

So what should consumers do? Wash your hands with plain soap and water. That’s still one of the most important steps you can take to avoid getting sick and to prevent spreading germs.


Hand Hygiene Day: It’s in your hands – prevent sepsis in health care

Sepsis is a life-threatening complication from infection that arises when an infection alters the body’s normal response, causing injury to tissues and organs. Each year, sepsis can cause up to 6 million deaths globally – most of which are preventable.

Sepsis is the most preventable cause of death and disability in Europe. According to the Global Sepsis Alliance, more than 3.4 million individuals develop sepsis every year in the WHO European Region, and 700 000 of these patients do not survive. An additional one third of survivors die within the following year, and many face lifelong consequences, such as physical, psychological and cognitive challenges.

The financial burden due to sepsis has been calculated to be more than US$ 24 billion, representing 6.2% of total hospital costs in 2013. Studies in Europe and Canada estimated the daily costs of hospital care of a septic patient to be between €710 and €1033 in 2000 (equivalent to about US$ 645 and US$ 939, respectively).

On Hand Hygiene Day, observed annually on 5 May, WHO calls on health facilities to prevent health care-associated sepsis through hand hygiene and infection prevention and control (IPC) action. By working together to each play our part, we can prevent sepsis and save millions of lives every year.

To stop sepsis, prevent infection

The first step to stopping sepsis is implementing measures that prevent infections from occurring. The second is preventing infections from evolving into sepsis. In both communities and health-care facilities, this requires early detection of sepsis signs and symptoms and appropriate antibiotic treatment.

In health-care settings, sepsis may result from health care-associated infections. This makes it all the more important for health workers to practise good IPC measures, including effective hand hygiene. Washing hands properly prevents infections and, in turn, reduces the risk of sepsis in health-care facilities.

This year’s Hand Hygiene Day campaign follows a resolution, adopted in May 2017 by the Seventieth World Health Assembly, recognizing sepsis as a global health priority and calling for improved prevention, diagnosis and clinical management of sepsis. It emphasizes 5 calls to action for 5 target audiences:

• health workers: “Take 5 moments to clean your hands to prevent sepsis in health care”;
• IPC leaders: “Be a champion in promoting hand hygiene to prevent sepsis in health care”;
• health facility leaders: “Prevent sepsis in health care, make hand hygiene a quality indicator in your hospital”;
• ministries of health: “Implement the 2017 WHA sepsis resolution. Make hand hygiene a national marker of health care quality”; and
• patient advocacy groups: “Ask for 5 moments of clean hands to prevent sepsis in health care”.

It is also vital to ensure that health workers can recognize, diagnose and rapidly treat sepsis. Despite its tragic impact, sepsis is frequently underdiagnosed at an early stage when it is still potentially reversible.

The evolution of an infection to sepsis can be prevented through early detection of the signs and symptoms, followed by prompt medical care and especially treatment with appropriate antimicrobials. This is crucial to increasing the chances of surviving sepsis. In the case of antimicrobial-resistant infections, which are becoming increasingly common, a patient’s condition can deteriorate rapidly, further underscoring the need for early diagnosis.

Working towards a sepsis-free world

It is possible to envision a world free from sepsis, but this vision will only become a reality through concerted action taken by a range of actors. On Hand Hygiene Day, it is time to collectively commit to raising awareness about the proven approaches to preventing infection, and to encourage everyone – particularly health workers – to recognize that stopping sepsis is in their hands.


Hand hygiene is key to preventing the flu, but researchers say it’s going to take more than just hand sanitizer

Colder months on the way, there will be more chances for infections to spread. Before flu season is fully underway, it’s a great time to think about what we all can do to prevent the highly contagious virus.

A new study has revealed that hand sanitizer alone isn’t completely effective in killing the bacteria that spreads the flu from person-to-person. Researchers say more drastic measures need to be taken to help stop the infection.

“The physical properties of mucus protect the virus from inactivation,” said researcher Dr. Ryohei Hirose. “Until the mucus has completely dried, infectious [influenza A virus] can remain on the hands and fingers, even after appropriate antiseptic hand rubbing.”

Keeping hands clean

Based on previous studies, the researchers learned that ethanol-based disinfectants (EBDs) like hand sanitizer aren’t the most effective in stopping the spread of the flu virus. With that in mind, they set out to discover how consumers can do their best to keep the infection to a minimum.

Dr. Hirose and his team ran various tests with infected mucus and EBDs. One of their primary goals was to be able to minimize the spread of the flu at doctors’ offices, as germs are easily transmitted among sick patients.

The researchers learned that EBDs tend to struggle to deactivate the flu virus when infected mucus is wet, mainly due to its thickness. In one trial, they discovered that it took at least four minutes of exposure to the EBD for it to do the trick, as anything under the four-minute mark didn’t kill the germs of the flu virus.

Ultimately, what this means for consumers is that when they use hand sanitizer to stay virus-free, the product doesn’t work instantly, and so the risk of developing the flu remains.

Preventing flu outbreaks

However, the researchers did explain that EBDs tend to work differently if a consumer came into contact with infected mucus that was wet versus dry. Hand sanitizer can more easily attack the virus when the mucus is dry, killing the germs in up to 30 seconds.

The researchers encourage consumers not to underestimate the power of simply washing their hands with antibacterial soap, as doing so can also kill the flu germs in under one minute.

“These findings will greatly contribute not only to the development of a more effective method of preventing [influenza A virus] outbreaks, but also to the advancement of current hand hygiene and contact infection prevention strategies,” the researchers wrote.

By Kristen Dalli
Published 09/19/2019 | ConsumerAffairs

Hand-hygiene to tackle the spread of disease through air transport

A research study aims to identify the effects of hand washing on the global spread of infectious diseases. Preliminary results show that the frequency with which we now embark upon air travel has increased the rate of contagion, but something as simple as hand washing can decrease the chances of a mass spread.

Transmission of bacteria, pathogens and viruses often cause epidemics that spread rapidly in all over the world. The transmission of bacteria is accelerated through physical contact between humans and is strengthened when a dense population is concentrated in confined spaces with lack of proper hygiene and efficient air ventilation. After an outbreak, infectious and bacterial diseases diffuse, when the infected individuals are incorporated into the population transmitting pathogens to susceptible individuals.

Airports play a major role in such transmissions, as they contribute on a daily mixture of people from all over the world, where some of them carrying endemic infections and bacteria from their country of origin. Also, at airports and inside aircraft there are numerous highly contaminated surfaces which are frequently touched by the passengers. Self-service check-in screens, gate bench armrests and water fountain buttons at airports, as well as seats, tray tables and handles of lavatories in aircraft, have high microbial contamination1.

Past epidemics show how infectious diseases spread rapidly around the world through the air transportation network. Examples include the widespread influenza, the severe acute respiratory syndrome (SARS) and several others. SARS initial outbreak occurred on February 2003, where a guest at a hotel in Hong Kong, transmitted an infection to 16 other guests in a single day. These guests seeded outbreaks in Hong Kong, Toronto, Singapore and Vietnam, and within few weeks the disease became an epidemic affecting over 8,000 people in 26 countries across five continents2. For the H1N1 flu, which caused about 300,000 deaths worldwide, the timeline was similar with SARS, as the initial outbreak reported in Veracruz, Mexico on April 2009 and within few days the infection appeared in the U.S. and in Europe, while two months later the WHO and the CDC declared the disease as a pandemic.

A research study aims to identify the effects of hand washing on the global spread of infectious diseases. Preliminary results show that the frequency with which we now embark upon air travel has increased the rate of contagion, but something as simple as hand washing can decrease the chances of a mass spread.

Transmission of bacteria, pathogens and viruses often cause epidemics that spread rapidly in all over the world. The transmission of bacteria is accelerated through physical contact between humans and is strengthened when a dense population is concentrated in confined spaces with lack of proper hygiene and efficient air ventilation. After an outbreak, infectious and bacterial diseases diffuse, when the infected individuals are incorporated into the population transmitting pathogens to susceptible individuals.

Airports play a major role in such transmissions, as they contribute on a daily mixture of people from all over the world, where some of them carrying endemic infections and bacteria from their country of origin. Also, at airports and inside aircraft there are numerous highly contaminated surfaces which are frequently touched by the passengers. Self-service check-in screens, gate bench armrests and water fountain buttons at airports, as well as seats, tray tables and handles of lavatories in aircraft, have high microbial contamination.

Past epidemics show how infectious diseases spread rapidly around the world through the air transportation network. Examples include the widespread influenza, the severe acute respiratory syndrome (SARS) and several others. SARS initial outbreak occurred on February 2003, where a guest at a hotel in Hong Kong, transmitted an infection to 16 other guests in a single day. These guests seeded outbreaks in Hong Kong, Toronto, Singapore and Vietnam, and within few weeks the disease became an epidemic affecting over 8,000 people in 26 countries across five continents2. For the H1N1 flu, which caused about 300,000 deaths worldwide, the timeline was similar with SARS, as the initial outbreak reported in Veracruz, Mexico on April 2009 and within few days the infection appeared in the U.S. and in Europe, while two months later the WHO and the CDC declared the disease as a pandemic.

The right resource allocation is key in improving passenger flow at your airport. But without an holistic view on the operations, inefficient or even counter-productive decisions are easily made. In this webinar Dassault Systèmes explain how a passenger flow model can be used to determine the optimal resource plan at your airport.

The spread of epidemics does not only affect the global public health, but it has also huge socio-economic effects which are not restricted in the countries that are directly affected by the disease. In the case of a pandemic, a massive economic global cost is generated as a result of the reduction of various goods and services consumption, the reduction of tourism and transactions of foreign capitals, and the increase of operating expenditures for several businesses. Even the relatively short-lived SARS epidemic in 2003 which led to the cancellation of numerous flights, the closure of schools and a huge panic in Asian markets, cost the world around $40 billion.

Hypothetical scenarios of global pandemics give estimations on the economic effects. A mild pandemic it is estimated to cost the world 1.4 million lives and a reduction of the total output by nearly one per cent or approximately $330 billion during the first year. In a worsen pandemic scenario, a massive global economic slowdown is expected to occur, with more than 142 million deaths and a shrinking of developing countries’ economies by half. The loss in output in this scenario could reach $4.4 trillion, 12.6 per cent of global GDP in the first year. In the most severe scenario where markets shut down entirely, cost shocks play a much larger role in the GDP losses.

Until today, there is no absolute effective method for preventing the spread of a disease during an outbreak, epidemic, or pandemic as the effectiveness of a prevention is specific on the severity, virulence and other characteristics of the disease. Even vaccination is not sufficient as requires experiments, time and money. On the other hand, hand-hygiene is considered by both CDC and WHO as the most effective and cost-efficient prevention mechanism against a potential pandemic. Frequent and effective hand washing with water and soap significantly reduces the number of bacteria on hands, while hand sanitisers do not have the expected results3.

While hand-hygiene is the most effective mechanism, the capacity of hand washing facilities in public areas is limited only to wash basins at washrooms. Scientific research shows that hand washing with soap prevents disease in a more straightforward and cost-effective way than any single vaccine or medical treatment4. In addition, the wider public is not aware of the impact of hand-hygiene against a global disease propagation. New “smart” technologies aim to increase the capacity of facilities even outside washrooms, to enhance the solutions for room and surface sterilisation and to aware and boost air travellers to wash their hands more effective and frequently. Examples of smart technologies exploration include an antimicrobial system from Airbus that, when is injected on to surfaces will eliminate most of the viruses and pathogens5, a prototype self-sanitising lavatory from Boeing, that will kill 99.99 per cent of pathogens using ultraviolet light6, autonomous robotic systems for dirt detection and cleaning of contaminated surfaces7 and touch-free hand washing stations from Smixin that are able to kill at least 95 per cent of germs and viruses8 in seconds while using 90 per cent less water and 60 per cent less soap than conventional methods.

Smixin AG is currently funding a scientific research conducted by researchers at University of Cyprus (UCY), the Massachusetts Institute of Technology (MIT) and the University of California Berkeley (UC Berkeley) to investigate contagion dynamics through the world air transportation network and to analyse the impact of hand-hygiene behavioural changes of air travellers against the spreading of epidemics worldwide. The study uses well-established methodologies9,10, applies simulations to track travelling agents and their hand-washing activity and analyse the expansion of flu-type epidemics through the world air-transportation network. From the simulation results, the early-time spreading power of the major airports in the world under different hand-hygiene scenarios is measured, and effective and cost-efficient strategies of hand-hygiene policy implementations are identified.

The researchers, using data-driven calculations, first conclude that if we were able to go through all the airports in the world and estimate how many people have cleaned hands, we would find out that mostly one out of five people are cleaned at any given moment in time (i.e. 20 per cent of airport population). This is translated to hand washing engagement rate among the non-cleaned individuals equal to 0.12 per hour (i.e. every hour about 12 per cent of the non-cleaned individuals are washing their hands).

Preliminary results reveal that, if we are able to increase the level of hand cleanliness at all airports in the world (3,650 airports) from 20 per cent to 30 per cent (equivalent to increasing the hand washing engagement rate from 0.12 to 0.21 per hour), either by increasing the capacity of hand washing and/or by increasing the awareness among individuals and/or by giving the right incentives to individuals, a potential infectious disease will have a worldwide impact that is about 21.2 per cent smaller compared to the impact that the same disease would have with the 20 per cent level of hand-cleanliness (or 0.12 per hour hand washing engagement rate). Increasing the level of hand-cleanliness to 60 per cent (or equivalently the hand washing engagement rate among non-cleaned individuals to 0.73 per hour) at all airports in the world would have a reduction of 64.6 per cent in the impact of a potential disease spreading. One step further, the project identifies the 10 most important airports11, for which increasing the level of hand cleanliness (or hand washing engagement rate) only at those, the impact of the disease spreading would decrease by nine per cent to 37 per cent.

In the second phase of the project, the team aims to design and implement randomised control experiments to examine individual behavioural changes on the adoption and engagement with smart-tech hand washing systems in public places. The experiment will take place in a major international airport where Smixin stations will be set up and the behaviours of air travellers in the use of the systems will be tracked. In addition, the digital screens of the systems will be devised to display hygiene promoting messages that will give insights on how awareness can potentially change the behaviour of humans in the adoption of smart hand washing technologies.

This research can potentially shape the way policymakers design and implement strategic interventions based on promoting hand-washing in airports that will lead to the restriction of any infection within a confined geographical area at the early days of an outbreak and inhibit the expansion as a pandemic.



Zhao B, Dewald C, Hennig M, Bossert J, Bauer M, Pletz MW, Jandt, KD, (2018). Microorganisms @materials surfaces in aircraft: Potential risks for public health? – A systematic review. Travel Medicine and Infectious Disease.

Peiris JSM, Guan Y, Yuen KY, (2004). Severe acute respiratory syndrome. Nature Medicine, 10: S88–S97.

Purdue University, (2000). Hand sanitizers no substitute for soap and water. https://www.purdue.edu/uns/html4ever/000211.Almanza.sanitizers.html

Wayne Combs, Ph.D., Community Health Nurse, U.S. Army Public Health CommandFebruary 1, 2013 https://www.army.mil/article/95551/handwashing_the_do_it_yourself_vaccine

Airbus, (2018). A330neo Family: Powering into the future. https://www.airbus.com/content/dam/corporate-topics/publications/backgrounders/Backgrounder-Airbus-Commercial-Aircraft-A330neo-E.pdf

Boeing, (2016). The Airplane Bathroom That Cleans Itself. http://www.boeing.com/features/2016/03/self-clean-lavatory-03-16.page

Bormann R, Weisshardt F, Arbeiter G, Fischer J., (2013). Autonomous dirt detection for cleaning in office environments. IEEE International Conference on Robotics and Automation, p. 1260–7.


Nicolaides C, Cueto-Felgueroso L, Gonzalez MC, Juanes R, (2012). A metric of influential spreading during contagion dynamics through the air transportation network. PLoS ONE, 7(7): e40961.

Nicolaides C, Cueto-Felgueroso L, Juanes R, (2013). The price of anarchy in mobility-driven contagion dynamics. J. R. Soc. Interface, 10: 20130495




Christos Nicolaides is a Lecturer (US equivalent of tenure-track Assistant Professor) at the Department of Business Administration at University of Cyprus (UCY). He has also a second research appointment as a Digital Fellow at the Initiative on the Digital Economy at the Massachusetts Institute of Technology (MIT). Before joining UCY, Christos spent three years as a Postdoctoral Fellow at MIT Sloan School of Management funded by the James McDonnell Foundation. He has a PhD in Civil and Environmental Engineering from Massachusetts Institute of Technology, MSc in Applied Mathematics from Imperial College London and BSc in Physics from University of Thessaloniki. His research focus on applying mathematical, statistical and computational tools to large-scale empirical and data driven research questions with applications in identification of social influence that is mediated, amplified, or directed by interactive technologies as well as the prediction of disease spreading at global scale through transportation networks.

Demetris Avraam is a Postdoctoral Researcher at the Department of Business and Public Administration at University of Cyprus (UCY). He holds a BSc in Mathematics from the Aristotle University of Thessaloniki (Greece) and an MSc and a PhD in Mathematical Sciences from the University of Liverpool (UK). Before joining UCY, he worked as an Associate Lecturer in Mathematics at the School of Science of University of Central Lancashire (Cyprus campus) and as a Research Associate (data science-statistician) at the Data to Knowledge Research Group based at the School of Social and Community Medicine of University of Bristol (UK) and at the Institute of Health and Society of Newcastle University (UK). His research focuses on applying mathematics and data sciences in biology, medicine and social sciences with interests in network science, survival analysis, epidemic modelling, anonymisation statistical methodologies, secure multi-party computations, data synthesis and data visualisations. Demetris is also a recognised member of the international Core Development Team of DataSHIELD, a software infrastructure that allows privacy-preserving federated analysis of individual-level data from multiple sources.

Jean-Michel Deckers is CEO of Smixin AG and sponsor of this research. Smixin is committed to improve health and sustainability through preventing disease. By developing connected, efficient and economic hand washing systems, Smixin is a strong advocate of hand washing around the globe, but also provides a controlled hand washing process, accessible for everyone. Their unique handwash solutions deliver the highest standards of sanitation with a minimum of time, soap and water. By applying IoT technology to the systems, Smixin grants their clients instant data access and enable behaviour change. Smixin is in close contact with authorities and airports to create more opportunities to wash hands while air travelling.

CDC (Centers for Disease Control and Prevention) on: 2019 Novel Coronavirus (2019-nCoV), Wuhan, China

This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance.


CDC is closely monitoring an outbreak of respiratory illness caused by a novel (new) coronavirus (named “2019-nCoV”) that was first detected in Wuhan City, Hubei Province, China and which continues to expand. Chinese health officials have reported thousands of infections with 2019-nCoV in China, with the virus reportedly spreading from person-to-person in many parts of that country. Infections with 2019-nCoV, most of them associated with travel from Wuhan, also are being reported in a growing number of international locations, including the United States.

Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with MERS and SARS.

Source and Spread of the Virus

Chinese health authorities were the first to post the full genome of the 2019-nCoV in GenBankexternal icon, the NIH genetic sequence database, and in the Global Initiative on Sharing All Influenza Data (GISAIDexternal icon) portal, an action which has facilitated detection of this virus. CDC posted the full genome of the 2019-nCoV virus detected in the first and second U.S. patients to GenBank.

2019-nCoV is a betacoronavirus, like MERS and SARs, all of which have their origins in bats. The sequences from U.S. patients are similar to the one that China initially posted, suggesting a likely single, recent emergence of this virus from an animal reservoir.

Early on, many of the patients in the outbreak of respiratory illness caused by 2019-nCov in Wuhan, China had some link to a large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Chinese officials report that sustained person-to-person spread in the community is occurring in China. Learn what is known about the spread of newly emerged coronaviruses.

READ MORE: www.cdc.gov

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases. A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.

Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.

Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.



Surveillance and case definitions

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Clinical management for suspected novel coronavirus

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Ecoli rates soaring despite ministers' pledges to wage war on superbugs

The number of people contracting potentially deadly E.coli infections has risen sharply, despite a Government pledge to wage “war on superbugs”.

Official figures show the number of infections have risen by more than a third since 2013.

Experts said shortages of nurses could be fuelling the trend, with rushed staff paying insufficient attention to infection control.

In 2016, then-health secretary Jeremy Hunt promised to halve so-called gram-negative bloodstream infections – two thirds of which are E. coli cases – by 2020.

But the figures show that since then, E. coli infections have actually increased by nearly 5,000 cases per year.

In 2018/19, 43,242 cases of E. coli infection were recorded – a 34 per cent rise from 32,309 cases six years before.

The figure is a 13 per cent increase since Mr Hunt pledged to crack down on the problem.

And overall rates, compared with the population, have risen by 29 per cent since 2012/13, from 60.4 cases per 100,000 people to 77.7 cases per 100,000.

“Superbug” versions of the bacteria, which are hard to treat because they are resistant to antibiotics, have also seen “consecutive increases” every year, a report found.

The reports, from Public Health England (PHE), show infections were most common in people over the age of 85 and around one in six cases took hold while the patient was in hospital.

Officials warned up to half of patients with E. coli infections had recently interacted with healthcare workers, including in care homes.

E. coli (or Escherichia coli) bacteria are common and mostly live harmlessly in the bowel but can cause infections like food poisoning or cystitis.

Some strains produce toxins which can trigger serious illness if they get into the bloodstream, potentially causing kidney failure or death.

Infections can be spread through contact with contaminated food or water, unhygienic facilities or a lack of personal hygiene.

The PHE report says: “In order to reduce infection rates further, control efforts in the hospital setting must be maintained or strengthened, while increasing focus on interventions in the community and the interface between hospital and community infection control teams improved.”

In his November 2016 announcement, Mr Hunt revealed plans to “dramatically reduce” infections in the NHS to save lives, saying: “Like a many-headed hydra the curse of dangerous infections comes back to haunt us in different ways despite our progress since 2010.”

At the time, E. coli infections killed more than 5,500 patients a year and cost the NHS around £2billion annually.

Prof Hugh Pennington, Emeritus professor of bacteriology at the University of Aberdeen, said most hospital-acquired infections entered the bloodstream through intravenous (IV) lines – tubes used to carry medicines or fluids into the body – which needed to be carefully looked after to prevent infection.

He said shortages of nurses could be fuelling the problem, with too few staff to attend to increasingly unwell elderly patients.

“Common sense says that the fewer nurses you have per patient the more likely it is that something like an IV line will not be as well looked after as it should be,” he said.

The Government has pledged to increase nursing numbers by 50,000, amid warnings of widespread shortages.

In November a survey of more than 8,000 nurses found six in ten felt too busy to provide the level of care to patient that they want to give.

The figure is up from 43 per cent, when the Royal College of Nursing asked the question a decade ago.

Prof Mark Enright, professor of medical microbiology at Manchester Metropolitan University, said Mr Hunt’s target had been “ambitious”.

“Failure to meet these targets could be due to a lack of effective social care in the elderly and inappropriate antibiotic prescribing both in and out of hospital,” he said.

Some E. coli bacteria have evolved to become “superbugs” which are resistant to at least two forms of commonly-used antibiotics. Antibiotic resistance has been named by the World Health Organisation as one of the biggest threats to global health.

Bacteria in up to one in seven E. coli cases recorded in 2018 were resistant to a combination of two common antibiotics, a separate PHE report found.

And 0.04 per cent – around a dozen cases – were resistant to all four known drugs to treat the infection.

“While this proportion is small, patients who fall into this category will have very limited treatment options available,” the report warns.

Dr Susan Hopkins, deputy director, national infection service, at PHE, said:“Our data monitoring in support of the UK’s National Action Plan on Antimicrobial Resistance shows cases of MRSA and C. difficile bloodstream infections are low and cases of E.coli infections have remained stable in the most recent year.

“Inappropriate GP prescribing has reduced, but there can be no complacency and we continue to support the NHS and the government’s effort to cut gram negative infections.”

By Laura Donnelly, Health Editor Rosie Taylor

Published 29. December 2019  telegraph.co.uk/news/2019/12/29