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How to Keep Yourself Safe from Infectious Diseases
Dr. Phuong Trinh
Stories about infectious diseases now dominate the news. Today’s health professionals are on the front lines treating new and re-emerging diseases at a time when resistance to antibiotics is also a growing problem. What can we all do to protect ourselves? Dr. Phuong Trinh, an infectious disease specialist who has been practicing in Montgomery County for nearly 30 years, provides some perspective on a few of the infectious diseases making headlines today, the importance of taking antibiotics wisely, and overall disease prevention.
Q: As an infectious disease specialist, what is the most common infection you see in this area?
A: I see a lot of patients who have Lyme disease or symptoms that are misdiagnosed as Lyme disease. Lyme disease is the most common tick-borne disease in the U.S. Although the first symptom of Lyme disease is usually a rash, other symptoms can mimic the flu, making Lyme disease difficult to diagnose in some cases. Lyme disease is a bacterial infection that is treated successfully with antibiotics. With timely, appropriate therapy, the majority of patients will experience complete recovery from Lyme disease.
There is some controversy surrounding what many now refer to as “chronic Lyme disease.” Some patients come to me believing they are experiencing chronic subjective symptoms such as joint pains and fatigue that may be associated with Lyme disease, when, in reality, they are actually just seeing the normal signs of aging or simply sleep issues that are accounting for or aggravating their symptoms. Patients should know that “chronic Lyme disease” has not been proven to exist in clinical studies and that prolonged courses of antibiotics have not been shown to help and may, in fact, be potentially harmful. While the Internet can be a great tool to research your symptoms and condition, be careful which websites you visit and what you read. Talk to your doctor about what other medical conditions might explain your chronic symptoms.
Q: What new infectious diseases are Americans now being exposed to given the increase in global travel?
A: In the national capital region, we see more imported infections resulting from a more international population. These include malaria, tuberculosis (TB) and hepatitis B.
Malaria is transmitted to people by mosquitoes. Although this disease is not typically associated with living in the U.S., we are seeing more of these cases here as more people travel to or relocate to this country. Malaria is not transmitted person to person.
TB has re-emerged as a potential threat to Americans, although the majority of TB cases are in other countries, and those who have TB in the U.S. are most often immigrants.
Hepatitis B is another contagious disease that affects many more individuals outside the U.S. than in this country. Still, the CDC estimates that there could be more than one million people with chronic hepatitis B in the U.S.
The bottom line is that air travel has made the world a much smaller place, and we must take this into consideration. While we can worry about all of these diseases, we have little control. What we do have control over is our own everyday health.
Q: Should we be worried about Ebola?
A: Even though it has been front-page news for months now, the risk of the general population in the U.S. being infected with Ebola is extremely small. You are much more likely to get the flu than Ebola, and the flu can be deadly for the very young, the elderly and those with weakened immune systems. That’s why flu shots are so important!
Q: What do parents need to know about enterovirus D68?
A: The majority of children who are exposed to an enterovirus will not suffer life-threatening symptoms. Although enterovirus D68 has been around for some time, doctors are seeing a greater number of children affected this year. Children with asthma are more prone to developing complications from enterovirus D68. If your child has a history of asthma and develops any symptoms of this illness, call your doctor right away. Don’t wait to see what happens.
Q: When is it appropriate to take an antibiotic?
A: Commonly used antibiotics are only helpful when dealing with a bacterial infection. They do not work for viral infections. Ninety percent of upper-respiratory infections are viral, not bacterial, and therefore would not benefit from the use of antibiotics.
Q: What is antibiotic resistance, and why has it become a problem?
A: Antibiotics are given for too many common conditions. The result is that bacteria have become resistant to many antibiotics. One example of this is Methicillin-resistant Staphylococcus aureus (MRSA). Although the MRSA strain has been out there since the 1960s, it has only become a problem recently, as there are now a number of antibiotics that are ineffective against it.
Another example is a common hospital-acquired infection called Clostridium difficile. This infection can lead to damage to the colon or even death. The infection is more common in older patients as well as those who require prolonged use of antibiotics. In an effort to prevent this and similar types of infections, hospitals across the country are now re-evaluating the way antibiotics are prescribed.
There is growing evidence that the overuse of antibiotics in food-producing animals has also contributed to resistance. Government agencies such as the FDA and the CDC are studying this issue closely as the negative impact on human health becomes clearer.
Q: What can patients do to prevent antibiotic resistance?
A: Although we cannot always control what is in our food, we can control what drugs we put in our bodies voluntarily. Because antibiotic use in and of itself drives resistance, it’s important to know what you have, to listen to your doctor, and not to insist on being prescribed an antibiotic for a viral infection such as a cold or the flu. In general, the less exposure we all have to antibiotics, the better off we will be.
For a proven bacterial infection such as strep throat, Lyme disease, TB and some forms of pneumonia, it’s very important to take the antibiotic as prescribed for the full course of treatment.
Q: Is the use of antibacterial soaps a good idea or are they ultimately harmful?
A: There is no proof that the antibacterial ingredients found in many soaps and cleaners are helpful. In fact, germs may become resistant to the sanitizing agents in these products. On the other hand, the alcohol-based foams that are used in hospitals today are effective. Although the ideal way to wash your hands is to use soap and water, an alcohol-based hand sanitizer that contains at least 60 percent alcohol is a good alternative if soap and water are not available.
Q: What vaccinations can help us prevent infection?
A: Vaccinations are crucial to preventing illness and staying healthy. Unfortunately, there is a general distrust about vaccinations throughout the population, and this has had a detrimental effect on vaccination rates.
According to the CDC, influenza contributes to the deaths of between 3,000 and 49,000 people every year. Less than half the population currently gets the annual flu vaccine even though the vaccine is the best protection against the flu. Anyone over the age of six months should get the flu vaccine every year. The vaccine can be delivered as a shot or a nasal spray, and there is a high-dose shot available for those over age 65.
There are also a number of bacterial infections that can be prevented through immunization. These include meningitis, diphtheria, pertussis (whooping cough) and tetanus. We are seeing that immunity for pertussis is falling off in adults. The Tdap vaccine is a one-time booster for adults to protect against tetanus, diphtheria and pertussis.
Individuals over the age of 50 should also receive the pneumonia vaccine, and those over the age of 60 should receive the shingles vaccine.
Q: When should someone stay home from work or school?
A: To reduce the spread of infection, it’s important to stay home when you don’t feel well. I tell my patients that if they don’t feel well enough to do their job, they should stay home. If you feel sick, it’s better to get checked out early than to delay seeking medical care. Your temperature is a key indicator for your physician. If you are running a fever of 101º F or higher, you may have a bacterial infection and you would potentially benefit from the use of antibiotics. When calling your doctor, it’s important to convey your symptoms accurately. For example, a high fever and a cough with phlegm or mucus are good reasons for your doctor to want to see you quickly.
Q: What everyday habits will help keep us safe?
A: To help prevent the transmission of illnesses, keep your vaccinations up to date, wash your hands frequently, sneeze or cough into your arm and avoid contact with sick people.
If you or a loved one requires a hospitalization, understand what the treatment is for and what medications are being prescribed and why. Ask questions. Understanding your own health issues as well as what treatment is prescribed and why will lead to better outcomes.
About Dr. Phuong Trinh
Dr. Trinh graduated from the Massachusetts Institute of Technology and received his medical degree from the University of Maryland School of Medicine. He completed his internship and residency in internal medicine at the Medical College of Pennsylvania Hospital and a fellowship in infectious diseases at Washington Hospital Center. Dr. Trinh is board-certified in internal medicine and infectious disease.
Dr. Trinh’s practice, Montgomery Infectious Disease Associates, is located at 8630 Fenton Street in Silver Spring. The phone number is 301-588-2525.