Investigation Update: Outbreak of Human Salmonella Typhimurium Infections Associated with Contact with Water Frogs

CDC is collaborating with public health officials in many states to investigate a multistate outbreak of human Salmonella serotype Typhimurium infections due to contact with water frogs including African Dwarf Frogs. Water frogs commonly live in aquariums or fish tanks. Amphibians such as frogs and reptiles such as turtles, are recognized as a source of human Salmonella infections.  In the course of routine assessment, a number of cases with the same strain have been identified over many months. As of 11:59pm EST on December 9, 2009, 50 individuals infected with the outbreak strain of Salmonella Typhimurium have been reported from 25 states.

ADVICE TO CONSUMERS

• Always wash hands thoroughly with soap and water after touching any amphibian (e.g., frog) or reptile (e.g, turtle), their housing, or anything (for example, food) that comes in contact with them or their housing.   Adults should assist young children with hand washing.  
• Watch for symptoms of Salmonella infection, such as diarrhea, fever, and abdominal cramps.  Call your health care provider if you or a family member have any of these symptoms.

Persons who should avoid contact with amphibians and reptiles and their habitats (e.g., aquarium, fish tank, or terrarium)

• Persons at increased risk for serious infection from salmonellosis are children < 5 years old, elderly persons, and persons with weakened immune systems.
• These persons should avoid contact with amphibians (e.g., frogs) and reptiles (e.g., turtles) and anything that comes in contact with them (e.g., aquarium, habitat, and water).
• Keep amphibians and reptiles out of homes with children < 5 years old or people with weakened immune systems.

Placement and maintenance of habitats

• Amphibians (e.g., frogs) and reptiles (e.g., turtles) should not be kept in child-care centers.
• Habitats containing amphibians or reptiles should not be kept in a child’s bedroom, especially children aged < 5 years.
• Do not allow amphibians or reptiles to roam freely through the house, especially in food preparation areas.
• Keep amphibians and reptiles out of kitchens and other areas where food and drink is prepared or served to prevent contamination.
• Habitats and their contents should be carefully cleaned outside of the home. Use disposable gloves when cleaning and do not dispose of water in sinks used for food preparation or for obtaining drinking water.
• Do not bathe animals or their habitats in your kitchen sink. If bathtubs are used for these purposes, they should be thoroughly cleaned afterward. Use bleach to disinfect a tub or other place where reptile or amphibian habitats are cleaned.
• Children aged <5 years should not clean habitats.

• Always wash hands thoroughly with soap and water after cleaning habitats.

LEARN MORE

To learn more about the outbreak, read the complete update on the CDC Salmonella website. To learn about other recent outbreaks and incidents, visit the CDC Recent Outbreaks and Incidents page.

 Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)

Like many Westerners, I suppose, I have never had much contact with acupuncture and Oriental Medicine (OM) and only thought of it vaguely as a folk art that worked more or less by accident.  I’ve since come into a much closer relationship with Oriental Medicine and have found that it makes sense to me in terms of my own profession, computer modeling. 

A truism about any model of the real world, computer or otherwise, is that it is wrong.  All models are abstractions of the world, and therefore inaccurate.  The question is, can you do useful work with a bad model, and the answer is of course, yes, as long as you remember that the model is not reality.  You can get insight into the real system by working with the simpler model.

Western science has created a model of the human body through the powerful technique of scientific analysis, taking the system apart and understanding each piece in detail.  To paraphrase an excellent author on understanding OM, The Web That Has No Weaver by Ted J. Kaptchuk,

Western medicine is concerned mainly with identifying and controlling disease.  The Western physician starts with a symptom, and then looks for a cause.

Pre-scientific people created models, too.  It’s what we humans do.  The ancient Chinese observed people for thousands of years and created a model along the lines of their Daoist philosophy of the balance of opposites in nature, Yin and Yang.  Again paraphrasing Kaptchuk,

The Chinese physician looks at everything about a person, all psychological and physiological characteristics, in order to see what is not in balance.  The question is not “Is X causing Y?” but “What is the relationship between X and Y?”  They do not look for a specific disease or cause to treat, but rather to discern the configuration of the signs and symptoms and then to bring that configuration into balance, to restore harmony.

The limitation of the analytic approach is that by focusing on the details it can miss the complex balances and flows that arise between the parts.  The ancient Chinese built their model through synthesis of the entire person and their relationship with the world.  Western medical science is just beginning to understand how important the mind is to health, and how personality does not stop at the skin.  The limitation of synthesis is that it remains largely an art, the human system seen as a whole is so complex that the experienced practitioner may not be aware of the thousands of tiny signs they are synthesizing into their sense of the balance and energy in the patient.

OM’s human model is in no way a simpler model.  Although it describes using simple opposites – hot/cold, dry/damp, Yin/Yang – each balance has its opposite within it, Yin within Yang, to potentially infinite regress.  And although it uses words that have been translated into the English words  such as heart or liver, these describe abstract functions in the model that are not related to any actual body part.

Where a Western physician might see 6 patients with similar symptoms and diagnose the same condition in each, an OM physician will see 6 very different individuals each in a different state of balance and would likely treat each very differently.  But because it sees each person as unique, it cannot be codified into cut-and-dried rules and taught as Western medicine is taught.  Western medicine has developed powerful techniques to treat severe illnesses.   My friends in OM would say, if you have pneumonia go see a Western doctor, but if you have a problem of systemic balance, such as chronic pain, fertility, recurring headaches, go see a person trained in observing your whole self.

As an abstract model, OM represents the human being better in some ways than others.  No doubt some parts are very poor representations.  But as a holistic model, you can’t carve off some parts and leave the whole intact.  OM is an incredibly sophisticated and complex model of the human system built through close observation of people over thousands of years.  In the hands of an experienced practitioner it can achieve results that are simply not possible using the analytic techniques of Western medicine.  The strengths and weaknesses of each approach should be understood and valued for what they are.

 So – why post THAT on this blog.  It’s not news to anyone in the area and the weather has changed, the fire is moving east and the ash is retreating.

I’m addressing this because of the huge affect this fire had, and is continuing to have, on my patients.  Several patients have come in for musculoskeletal appointments and have ended up getting treatments for respiratory complaints (and the musculoskeletal treatments too – that’s one of the powers of Traditional Oriental Medicine, I can do both at once!).  They’ve been physically and mentally tired, almost feeling they were coming down with something but with no specific symptoms.  This is due to their Qi not circulating well throughout their bodies.

In Traditional Oriental Medicine (T.O.M.) the Lungs govern Qi and respiration.  They’re responsible for inhaling Qi from the atmosphere, combining it with the Qi received from food and spreading the resultant useable Qi throughout the entire body.  The Lungs are called the tender organ because they are the most external organs and they connect the body to the outside world.  The Lungs are easily attacked by external pathogenic factors, in this case smoky, ashy, hot air.  When the air we’re taking in is poor quality, we tire easily.  Of course, when we’re breathing good air and eating garbage we get tired easily, but that’s another discussion.

Anyone with allergies/asthma or COPD should have a plan in place for fire season as should people with cardiac disease.  The easiest to follow recommendation is to stay inside with windows and doors closed, and run the A/C to filter out the gunk.  But even people with no cardio-pulmonary disease need to take care not to exhaust themselves.  The impact of the smoke is insidious and it would be easy to ignore the body’s signals to SLOW DOWN but it is very important to take it easy.

T.O.M. states that anytime the seasons change we need to take care to slow down and reflect on what our bodies are going through.  Add in a natural disaster and everyone can really benefit from some meditativetime.  I suggest doing something positive for yourself, especially something you’ve been putting off.  Go get a massage, visit a healthcare practitioner, read that book you’ve been putting off, go out to a special meal with friends or loved ones.  Whatever it is, take this time to slow down.  It will allow your body to adjust to the season change as well as recovering from the fire.

T.O.M. also has a long list of foods that are beneficial for the Lung system.  Some simple foods you may want to consider adding into your diet right now include apples, especially the sour ones like pippins; yogurt; tofu, tempeh and soybeans; rose hip tea; black tea; honey and barley malt.  For a more complete recommendation, make an appointment to see me or your local practitioner of Traditional Oriental Medicine.

For specific smoke related information, visit this page on the US Department of Agriculture Forest Service’s website:  Wildland Fire Smoke.  And for those of you in fire-prone areas, here’s a goldmine of information:  InciWeb Incident Information System

That said, most folks don’t really know HOW to wash their hands – here’s a step-by-step guide.  It doesn’t take any longer than the way you’re doing it now, it just gets you better results.  Also, for LA residents, what with the drought and all, some modifications can be made as long as you really scrub your hands and rinse them thoroughly

1. Wet hands with warm running water
2. Apply soap
3. Rub hands together for at least 20 seconds, including between your fingers and under fingernails (if you’re at home have a nail brush handy, if not do the best you can)
4. Rinse hands thoroughly under warm running water
5. Dry hands, dispose of towel

When should you wash your hands?

1. Before preparing food, eating or drinking
2. Before and after touching your body (including rubbing your eyes, scratching that mosquito bite or blowing your nose)
3. Before and after changing bandages
4. After using the restroom (before too if your job or hobbies get your hands dodgy)
5. If you don’t wear rubber gloves while doing them, after you do your household chores, especially cleaning the bathroom, changing the bedding and doing laundry
6. After coughing or sneezing

What about hand sanitizers?  Yes, good idea to have around as long as they’re a high quality, alcohol based product.  Personally, since I’m using them all day, I prefer EO brand with their organic alcohol and jojoba.  But any quality product will do the trick.

Wash with hand sanitizers the same way you do with soap and water.  Put enough in your hands that you can coat all surfaces of your hands with product, then rub your hands briskly for 20 seconds, including between the fingers and under nails.  If you end up with too much, wipe your hands with a clean paper towel.

So what’s all the fuss about?  The fuss is that most people have no idea how long 20 seconds is, and most germs are pretty tough.  The friction and the soap or hand sanitizer are used to break the cell wall of the germ.  It’s not enough for your hands to look clean, you need them to really BE clean or you won’t be protecting yourself.

Be your own best advocate.  Anytime you go to a health professional or body care professional make sure the people working on you wash their hands before they touch you.  And, of course, if someone is giving you a manicure or pedicure, make sure they’re using clean instruments.