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Air travel spreads infections globally, but health advice from inflight magazines can limit that

<p>“Travel safe, travel far, travel wide, and travel often,” <a href="https://thoughtcatalog.com/matthew-kepnes/2014/01/53-travel-quotes-to-inspire-you-to-see-the-world/">says</a> <a href="https://www.nomadicmatt.com/">Nomadic Matt</a>, the American who quit his job to travel the world, write about it and coach others to do the same.</p> <p>But there’s a downside to all this travel, with its unprecedented volume of passengers moving from one side of the world to the other, largely by plane.</p> <p>There’s the risk of those passengers spreading infectious diseases and microorganisms resistant to multiple drugs (superbugs) around the world.</p> <p>Yet, our recently published <a href="https://www.sciencedirect.com/science/article/pii/S1477893919301218">research</a> into health advice provided by inflight magazines shows plane passengers are given practically no advice on how to limit the spread of infectious diseases.</p> <p>Should we be worried about the part air travel plays in spreading infectious diseases? And what can we do about it?</p> <p><strong>How big is the risk?</strong></p> <p>Low airfares and a series of social and economic factors have made global air travel more common than ever. According to the Australian government department of infrastructure, transport, cities and regional development the <a href="https://www.bitre.gov.au/publications/ongoing/files/International_airline_activity_CY2018.pdf">number of passengers taking international scheduled flights in 2018 was 41.575 million</a>. But the International Air Transport Association projects passenger demand will <a href="https://www.iata.org/pressroom/pr/Pages/2019-02-27-02.aspx">reach 8.2 billion by 2037</a>.</p> <p>There are many examples of infectious diseases spread via international flying. The World Health Organization documented <a href="https://www.who.int/ith/mode_of_travel/tcd_aircraft/en/">transmission of tuberculosis</a> (TB) on board commercial aircraft during long-haul flights during the 1980s.</p> <p>Research published in 2011 documents the <a href="https://wwwnc.cdc.gov/eid/article/17/7/10-1135_article">transmission of influenza</a> on two transcontinental international flights in May 2009.</p> <p>More recently, the current <a href="https://theconversation.com/why-people-born-between-1966-and-1994-are-at-greater-risk-of-measles-and-what-to-do-about-it-110167">global outbreak of measles</a> in many countries, including the Philippines and the United States, gave rise to the risk of transmission during international travel. In a recent case a <a href="https://www.health.nsw.gov.au/Infectious/alerts/Pages/measles-alert-january.aspx">baby</a> too young to be vaccinated who had <a href="https://www.smh.com.au/national/nsw/measles-alert-after-infectious-baby-flew-from-manila-went-to-central-coast-20190603-p51tzs.html">measles</a> returned from Manilla in the Philippines to Sydney, exposing travellers on that flight to infection.</p> <p>Then there is the risk of transmitting antimicrobial-resistant organisms that cause disease, such as <a href="https://theconversation.com/explainer-what-is-tb-and-am-i-at-risk-of-getting-it-in-australia-75290">multi-drug resistant TB</a>.</p> <p>Recently, patients in Victoria and New South Wales were identified as carrying the drug-resistant fungus <a href="https://www2.health.vic.gov.au/about/news-and-events/healthalerts/candida-auris-case-detected-in-victoria"><em>Candida auris</em></a>, which they acquired overseas.</p> <p><a href="https://www.ncbi.nlm.nih.gov/pubmed/27890665">One study</a> estimates that over 300 million travellers visit high-risk areas, such as the western Pacific, Southeast Asia and Eastern Mediterranean, each year worldwide, and more than 20% return as new carriers of resistant organisms.</p> <p>These popular destinations, as well as the Middle East, have high rates of drug resistant organisms.</p> <p><strong>How is this happening?</strong></p> <p>Aircraft move large volumes of people around the world swiftly. But what sets them apart from buses and trains is that passengers are close together, in confined spaces, for a long time. This increases the risk of transmitting infections.</p> <p>Passengers interact with high-touch surfaces, such as tray tables, headsets, seats and handles. We cough, sneeze and touch multiple surfaces multiple times during a flight, with limited opportunities to clean our hands with soap and water.</p> <p>Many infections, such as gastroenteritis and diarrhoea, are spread and contracted by touch and contact.</p> <p><strong>What can we do about it?</strong></p> <p>Providing plane travellers with relevant health advice is one way to limit the spread of infectious diseases via air travel.</p> <p>This would include information and advice on routine hand washing with soap and water, or using alcohol-based hand rubs, and other basic measures including cough etiquette, such as coughing into your elbow and covering your nose and face.</p> <p><a href="https://academic.oup.com/jtm/article/4/2/102/1847252">Researchers</a> have looked at the role commercial websites and travel agencies might play in providing that advice. And since the 1990s, airline magazines have been <a href="https://academic.oup.com/jtm/article/4/2/102/1847252">highlighted</a> as an underused source of traveller health advice. More than 20 years on, we discovered little has changed.</p> <p>In our recent study, published in the journal <a href="https://www.sciencedirect.com/science/article/pii/S1477893919301218">Travel Medicine and Infectious Disease</a>, we looked at the content of inflight magazines from 103 airlines issued during January 2019.</p> <p>Of the 47 available online, only a quarter (11) included an official section on passengers’ general health and well-being, of which only two contained information related to infection control and the preventing infectious diseases.</p> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=450&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=450&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=450&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=566&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=566&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/284424/original/file-20190717-173366-w48bmn.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=566&amp;fit=crop&amp;dpr=3 2262w" alt="" /></a><figcaption><span class="caption">Inflight magazines have a potential audience of billions. So why not include advice on hand hygiene and coughing etiquette?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1424594042?src=vUDfEziJwFDV7GZr5OYMRA-1-2&amp;studio=1&amp;size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure> <p>The first magazine, from a UAE-based airline, had an official section on passenger health and well-being that included very limited relevant content. It advised passengers “with blood diseases or ear, nose and sinus infections should seek medical advice before flying”.</p> <p>There was no further explanation or information, nor were there any strategies to prevent these or other infections.</p> <p>The second magazine, from a USA-based airline, contained general travel health advice, but none specifically about infectious diseases.</p> <p>However there was a full-page, colour advertisement next to the health section. This contained images of many disease causing microorganisms on passengers’ tray tables and advocated the use of a disinfectant wipe for hands and other inflight surfaces.</p> <p>The slogan “because germs are frequent fliers” was displayed across the tray table. This was accompanied by information about the use and effectiveness of disinfectant wipes for hand hygiene and disinfecting surfaces during air travel, public transport use, and in hotels and restaurants.</p> <p>Inflight magazines are valuable assets for airlines and are the source of considerable advertising revenue. They are read by potentially billions of passengers every year. The results of this study show that they are a greatly underused source of information about infection control and measures to prevent the spread of infectious diseases.</p> <p>Airlines should also provide health advice to passengers in other media, in particular video screens, about infection prevention and basic control measures such as hand hygiene, cough etiquette and personal hygiene.</p> <p>Such advice should be provided before, during and after the flight. It could also include destination-related advice for particularly risky travel routes and destinations.</p> <p><strong>More information for passengers</strong></p> <p>Airlines providing health advice to passengers is just one way to limit the spread of infectious diseases and antimicrobial-resistant organisms around the world via air travel.</p> <p>This would need to sit alongside other measures, such as <a href="https://wwwnc.cdc.gov/travel/page/travel-industry-information-center">information and guidelines</a> provided to those who travel via the sea.</p> <p>The simple, low-cost measures highlighted in our research could go a long way to help passengers stay healthy and avoid illness from infectious diseases. At the same time, these measures could reduce the impact of outbreaks of infectious diseases for airlines and society as a whole.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/120283/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em>Writen by Ramon Zenel Shaban and </em><em>Cristina Sotomayor-Castillo</em><em>. Republished with permission from <a href="https://theconversation.com/air-travel-spreads-infections-globally-but-health-advice-from-inflight-magazines-can-limit-that-120283" target="_blank" rel="noopener">The Conversation</a>.</em></p> <p><em>Image: Getty Images</em></p>

International Travel

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Dissecting Stevie Wonder’s Superstition, 50 years after we first heard its infectious grooves

<p>On October 24 1972, Stevie Wonder released his 15th album Talking Book and the world heard the infectious grooves and seamless vocal delivery of the song Superstition for the very first time.</p> <p>Superstition reached number one in the Billboard Hot 100 and on the soul singles chart. </p> <p>The song has been covered by an astounding number of artists, from <a href="https://www.youtube.com/watch?v=dbxmmFsofA4">Mel Torme</a>to <a href="https://www.youtube.com/watch?v=0dNNl79_2Yc">Stevie Ray Vaughan and Macy Gray</a>, French musician <a href="https://www.youtube.com/watch?v=NzwiyeLvZwg">Tété</a> and a unique mashup from <a href="https://www.youtube.com/watch?v=7QLSNwFBFyI">Pomplamoose</a>.</p> <p>Superstition is frequently played at gigs and gatherings all over the globe because the bass riff and driving drum groove have so much <a href="https://www.youtube.com/watch?v=DUIpSe7lcto">dance appeal</a> – a mix of the unexpected syncopation and repetition of the chorus hook. The song feels alive.</p> <h2>A simple structure</h2> <p>The listener can’t help but respond directly to the infectious opening groove played by Wonder. </p> <p>Three key instruments forge the captivating and carefully arranged funk groove in the introduction: the <a href="https://en.wikipedia.org/wiki/Clavinet">Hohner Clavinet</a> (an electronic harpsichord – more on this later), drums and the <a href="https://en.wikipedia.org/wiki/Moog_synthesizer">Moog bass</a>. The cohesion is musical magic. </p> <p>Superstition’s recording engineer Malcolm Cecil <a href="https://openvault.wgbh.org/catalog/V_D5482985134149A5927DED9849248EF">recalled</a> how Wonder recorded the entire song on drums first, with no reference other than the song in his head, then the keyboard bass part, and then the Clavinet. </p> <p>This illustrates how complete his conceptualisation of the song was prior to recording. </p> <p>The song’s structure is simple. The introduction sets up the familiar groove with its static harmony, pulsing bass and keyboard riff. </p> <p>The verse proceeds over the same static harmony, with a new bass riff introduced halfway through, effecting a shift to a higher dynamic level. </p> <p>The chorus releases the tension with a sophisticated cadence, reflecting jazz sensibilities and revealing the breadth of Wonder’s musical knowledge. </p> <p>This structure is repeated, followed by an instrumental version of the chorus. Then there’s a final verse and chorus before a long instrumental section built on the verse riff leads to the final fade out.</p> <h2>Unexpected instruments</h2> <p>One of the most memorable parts of the song is the signature played on the Hohner Clavinet.</p> <p>A <a href="https://www.youtube.com/watch?v=c7CY6aJtegc">Clavinet</a> looks like an electric keyboard, but it is an electro-mechanical string instrument originally developed for the performance of classical harpsichord and clavichord music.</p> <p>Like the <a href="https://en.wikipedia.org/wiki/Hammond_organ">Hammond organ</a> of the 1930s, it was soon discovered and adopted by many contemporary musicians.</p> <p>Wonder had already used the instrument on I Was Made to Love Her (1967), Shoo-Be-Doo-Be-Doo-Da-Day (1968) and I Don’t Know Why (1969). According to music journalist <a href="https://www.goodreads.com/book/show/2722025-innervisions">Martin Horn</a>, Wonder wanted to use the Clavinet on Superstition to “full effect” to “show off”. Wonder had described the instrument as “funky, dirty, stinky”.</p> <p>In some ways, the Clavinet is doing the job a guitarist might normally do. It plays the single note riff at the core of Wonder’s song, and chord parts similar to what you would hear from a strummed guitar. But there are also several other barely audible tracks of clavinet, which subtly add to the texture. </p> <p>Superstition’s bass line is played on an analog synthesiser called <a href="https://www.youtube.com/watch?v=YX0XPdmSfXI">TONTO</a> (The Original New Timbral Orchestra). This is an extraordinary collection of electronics which filled an entire room, adding to the song with a totally unique sonic palette – akin to a PVC pipe hit with a thong.</p> <h2>Standing the test of time</h2> <p>The contributions from the horn parts are also integral, played by Steve Madaio on trumpet and Trevor Lawrence on the tenor saxophone. </p> <p>The horns first appear playing in unison with the bass line in the second half of the verse, emphasising the lift in energy. They play long notes in the chorus emphasising the melody, then reinforce the rhythmic figure at the crest of resolution. </p> <p>Their part culminates in a powerful instrumental hook answering the vocal hook, “superstition ain’t the way”. These parts are repeated in the ensuing verses and choruses.</p> <p>After the final chorus the horns cycle through a sequence containing the verse riff, the chorus hook and a short passage of long notes adapted from the chorus melody. </p> <p>The melody of Superstition is very singable. Wonder’s delivery is fluid and highly expressive. He sings relatively short phrases, allowing the keyboard riffs to fill the space at the end of each phrase. </p> <p>It isn’t until the chorus that Wonder delivers the first effortless vocal lick on “suffer”. His vocal delivery remains understated, with occasional punctuated phrases, gravel tones and a scream within the horn part. </p> <p>The song ends with a long 50 second fade out, reinforcing the riff. </p> <p>Superstition and Wonder’s vocal delivery is so dependable, groovy and secure musically. The listener feels free to give themselves over fully, to trust Wonder completely and lose themselves for a moment. </p> <p>Superstition stands the test of time.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/dissecting-stevie-wonders-superstition-50-years-after-we-first-heard-its-infectious-grooves-189551" target="_blank" rel="noopener">The Conversation</a>. </em></p>

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Subway Monkeypox case "really concerning"

<p dir="ltr">A photo of a man who very clearly had Monkeypox and is standing in close proximity to others has gone viral. </p> <p dir="ltr">The image was shared to <a href="https://mobile.twitter.com/arturohenriques/status/1553322937402507264" target="_blank" rel="noopener">Twitter</a> by a Spanish doctor Arturo Henriques who “cautiously” approached the man and questioned why he was not isolating if he had Monkeypox.</p> <p dir="ltr">He said the man was only told to wear a mask by his doctor and nothing else to which Dr Henriques tried to explain that lesions on the body were most contagious. </p> <p dir="ltr">Dr Henriques then asked a nearby passenger if she was worried about catching Monkeypox which she laughed off saying she wasn’t gay and straight people don’t need to be concerned. </p> <p dir="ltr">This prompted a response from Paul Griffin, Director of Infectious Diseases at Mater Health Services, Associate Professor of Medicine at the University of Queensland.</p> <p dir="ltr">Professor Griffin said it was “really concerning” to see people not taking the disease seriously and need to isolate if they have it. </p> <p dir="ltr">"It's really disappointing, isn't it? I mean, it's actually really concerning," he told <a href="https://au.news.yahoo.com/disturbing-monkeypox-photo-train-warning-virus-myth-005219552.html" target="_blank" rel="noopener">Yahoo News Australia</a>.</p> <p dir="ltr">"But if people don't take that seriously and don't isolate themselves, well, that can certainly facilitate the spread and make something that we should be able to control much more challenging.</p> <p dir="ltr">"While it's really important, we identify who is at greatest risk and we try and modify that risk by approaching those groups and giving them the right advice, we need to be really careful that we don't be discriminatory or stigmatising.”</p> <p dir="ltr">Monkeypox spreads through close skin-to-skin physical contact with someone who has symptoms, such as when you are having sex, or by direct contact with contaminated objects, such as bedding, towels or clothes.</p> <p dir="ltr">​​Many of the cases are in men who have sex with men and have been acquired overseas.</p> <p dir="ltr">Some of the symptoms include: rashes, lesions or sores, particularly in areas that are hard to see such as the genitals, anus or anal area or on the face, arms and legs, ulcers, lesions or sores in the mouth, fever, headache, muscle aches, backache, swollen lymph nodes, chills and/or exhaustion.</p> <p dir="ltr"><em>Image: Twitter</em></p>

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Delta variant more infectious than Wuhan strain, study finds

<p><span style="font-weight: 400;">A new study from the UK has found that the Delta strain of COVID-19 is eight times less sensitive to vaccine antibodies than the original Wuhan strain.</span></p> <p><span style="font-weight: 400;">The study also found that changes to the spike protein in the Delta variant improved its ability to replicate and enter cells, in comparison to the Kappa variant.</span></p> <p><span style="font-weight: 400;">The authors say this might explain how the Delta strain has become the most dominant variation of the disease.</span></p> <p><span style="font-weight: 400;">The study, published in the journal </span><em><a rel="noopener" href="https://www.nature.com/articles/s41586-021-03944-y" target="_blank"><span style="font-weight: 400;">Nature</span></a></em><span style="font-weight: 400;">, compared the mutated Delta variant against the mutated Wuhan-1 variant which was used to develop the vaccines.</span></p> <p><span style="font-weight: 400;">The team, led by Ravindra Gupta, a professor of clinical microbiology at the Cambridge Institute of Therapeutic Immunology and Infectious Disease, also analysed infections of 130 healthcare workers across three hospitals in Delhi, India, over six weeks.</span></p> <p><span style="font-weight: 400;">Though each of the workers studied had received both doses of the AstraZeneca vaccine, the researchers found that the vaccine was less effective against the Delta variant than other variants.</span></p> <p><span style="font-weight: 400;">“By combining lab-based experiments and epidemiology of vaccine breakthrough infections, we’ve shown that the Delta variant is better at replicating and spreading than other commonly-observed variants,” Professor Gupta </span><a rel="noopener" href="https://www.cam.ac.uk/research/news/spread-of-delta-sars-cov-2-variant-driven-by-combination-of-immune-escape-and-increased-infectivity" target="_blank"><span style="font-weight: 400;">said</span></a><span style="font-weight: 400;">.</span></p> <p><span style="font-weight: 400;">Joint senior author Dr Patha Rakshit from the National Centre for Disease Control, Delhi, India, said: “The Delta variant has spread so widely to become the dominant variants worldwide because it is faster to spread and better at infecting individuals than most other variants we’ve seen.</span></p> <p><span style="font-weight: 400;">“It is also better at getting around existing immunity - either through previous exposure to the virus or vaccination - though the risk of moderate to severe disease is reduced in such cases.”</span></p> <p><span style="font-weight: 400;">Professor Anurag Agrawal from the CSIR Institute of Genomics and Integrative Biology, Delhi, India and joint senior author said the infection of healthcare workers with the Delta variant could have severe consequences.</span></p> <p><span style="font-weight: 400;">“Although they themselves may only exhibit mild COVID, they risk infecting individuals who have suboptimal immune responses to vaccination due to underlying health conditions - and these patients could then be at risk of severe disease,” Professor Agrawal said.</span></p> <p><span style="font-weight: 400;">With their findings, Gupta and his colleagues say we will need to develop strategies for boosting the effectiveness of vaccines against variants of COVID-19.</span></p> <p><span style="font-weight: 400;">“We urgently need to consider ways of boosting vaccine responses against variants among healthcare workers,” Professor Agrawal added.</span></p> <p><span style="font-weight: 400;">“[This research] also suggests infection control measures will need to continue in the post-vaccine era.”</span></p>

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What is a super spreader? An infectious disease expert explains

<p><em>As the </em><a href="https://www.linkedin.com/pulse/dr-tom-frieden-former-cdc-director-latest-scientific-novel-frieden/"><em>emerging Wuhan</em></a><em> </em><a href="https://theconversation.com/us/topics/coronavirus-5830"><em>coronavirus outbreak</em></a><em> dominates the daily news, you might be wondering just how the pathogen is working its way around the world. This virus travels from place to place by infecting one person at a time. Some sick people might not spread the virus much further, but it looks like some people infected with the novel coronavirus are what epidemiologists call “super spreaders.”</em></p> <p><a href="https://scholar.google.com/citations?user=k4UBB88AAAAJ&amp;hl=en&amp;oi=ao"><em>Elizabeth McGraw</em></a><em>, the director of the <a href="https://www.huck.psu.edu/institutes-and-centers/center-for-infectious-disease-dynamics">Center for Infectious Disease Dynamics</a> at Pennsylvania State University, explains just what that means and why super spreaders can be crucial to a disease’s transmission.</em></p> <p><strong>What is a super spreader?</strong></p> <p>Researchers currently estimate that a person carrying the Wuhan coronavirus will, on average, <a href="https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-coronavirus/">infect approximately 2.6 people</a>.</p> <p>Recent reports out of Wuhan also cite a case of a single patient who <a href="https://www.cnn.com/2020/01/23/health/wuhan-virus-super-spreader/index.html">infected 14 health care workers</a>. That qualifies him as a super spreader: someone who is responsible for infecting an especially large number of other people.</p> <p>During an emerging outbreak, epidemiologists want to determine whether super spreaders are part of the picture. Their existence can accelerate the rate of new infections or substantially expand the geographic distribution of the disease.</p> <p>In response to super spreaders, officials can recommend various ways to limit their impact and slow the spread of disease, depending on how the pathogen is transmitted. Pathogens transmitted via air droplets, contaminated surfaces, sexual contact, needles, food or drinking water will require different interventions. For example, the recommendation for face masks would be specific to airborne transmission, while hand-washing and surface sterilization are needed for germs that can live for a while on surfaces.</p> <p><strong>What are the characteristics of a super spreader?</strong></p> <p>Whether someone is a super spreader or not will depend on some combination of the pathogen and the patient’s biology and their environment or behavior at the given time. And in a society with so much global connectivity, the ability to move pathogens rapidly across great distances, often before people are even aware they are sick, helps create environments ripe for super spreading.</p> <p>Some infected individuals might shed more virus into the environment than others because of how their immune system works. Highly tolerant people do not feel sick and so may continue about their daily routines, inadvertently infecting more people. Alternatively, people with weaker immune systems that allow very high amounts of virus replication may be very good at transmitting even if they reduce their contacts with others. Individuals who have more symptoms – for example, coughing or sneezing more – can also be better at spreading the virus to new human hosts.</p> <p>A person’s behaviors, travel patterns and degree of contact with others can also contribute to super spreading. An infected shopkeeper might come in contact with a large number of people and goods each day. An international business traveler may crisscross the globe in a short period of time. A sick health care worker might come in contact with large numbers of people who are especially susceptible, given the presence of other underlying illnesses.</p> <p><strong>When have super spreaders played a key role in an outbreak?</strong></p> <p>There are a number of historical examples of super spreaders. The most famous is <a href="https://www.history.com/news/10-things-you-may-not-know-about-typhoid-mary">Typhoid Mary</a>, who in the early 20th century purportedly infected 51 people with typhoid through the food she prepared as a cook. Since Mary was an asymptomatic carrier of the bacteria, she didn’t feel sick, and so was not motivated to use good hand-washing practices.</p> <p>During the last two decades, super spreaders have started a number of measles outbreaks in the United States. Sick, unvaccinated individuals visited densely crowded places like schools, hospitals, airplanes and theme parks where they <a href="https://doi.org/10.1001/jamapediatrics.2019.4357">infected many others</a>.</p> <p>Super spreaders have also played a key role in the outbreaks of other coronaviruses, including SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). <a href="http://www.taipeitimes.com/News/world/archives/2004/02/23/2003099824/1">A traveler sick with SARS and staying in a Hong Kong hotel</a> infected a number of overseas guests who then returned home and introduced the virus into four other countries.</p> <p>For both SARS and MERS, super spreading <a href="https://doi.org/10.1186/s12916-015-0450-0">commonly occurred in hospitals</a>, with scores of people being infected at a time. In South Korea in 2015, one MERS patient infected over 80 other patients, medical personnel and visitors in a crowded emergency department over a three-day period. In this case, <a href="http://www.cidrap.umn.edu/news-perspective/2016/07/patient-proximity-key-korean-mers-super-spreader-event">proximity to the original patient</a> was the biggest risk factor for getting sick.</p> <p><strong>Can super spreading occur in all infectious diseases?</strong></p> <p>Yes. Some scientists estimate that in any given outbreak, 20% of the population is usually responsible for <a href="https://doi.org/10.1038/438293a">causing over 80% of all cases of the disease</a>. Researchers have identified super spreaders in outbreaks of diseases from those caused by bacteria, such as tuberculosis, as well as those caused by viruses, including measles, <a href="https://doi.org/10.3947/ic.2016.48.2.147">MERS</a> and <a href="https://www.eurekalert.org/pub_releases/2017-02/osu-dw021017.php">Ebola</a>.</p> <p>The good news is that <a href="https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/investigations/control.html">with the right</a> <a href="https://www.who.int/csr/disease/ebola/training/infection-prevention/en/">control practices</a> <a href="https://www.who.int/csr/bioriskreduction/infection_control/publication/en/">specific to how</a> <a href="https://www.who.int/ith/2020-24-01-outbreak-of-Pneumonia-caused-by-new-coronavirus/en/">pathogens are transmitted</a> – hand-washing, masks, quarantine, vaccination and so on – the transmission rate can be slowed and epidemics halted.</p> <p><em>Written by Elizabeth McGraw. Republished with permission of </em><a href="https://theconversation.com/what-is-a-super-spreader-an-infectious-disease-expert-explains-130756"><em>The Conversation.</em></a></p>

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