JCCC: Happy Birthday To Me.... Hand Sanitizers, Flu Shots, etc.

BrettGlass

In a hilarious 2012 JCCC promotional video, Storm DiCostanzo finds hand sanitizer to be so important that he stops in mid-flight from the ominous towel monkeys to apply it, making sure to rub his hands for the amount of time it takes him to sing "Happy Birthday." Twice.



(Perhaps more ominous than the towel monkeys would be concerns about having to pay royalties for singing the song in a video. But YouTube owner Google is such a serious copyright scofflaw -- and there's so much material on the site that's just blatantly pirated -- that he probably doesn't have to worry.)

Ironically, the the only active ingredient in the hand sanitizer Storm uses -- distributed by Holland America from dispensers throughout the ship -- is ethyl alcohol, which doesn't nuke the most common cruise-ruining pathogen: Norovirus. It also doesn't do a thing to prevent flu.

This thread is for discussion of hand sanitizers, sanitary wipes, and other products that one can use on a cruise to reduce the chances of getting sick. 2013 is starting out as a peak year for flu, Norovirus, and whooping cough, so cruisers will all want to take appropriate precautions. (Among other things, this means getting a flu shot ASAP, so you'll be immune by the time you board.)

Atelerix

Speaking of immunity, even if you are so robustly healthy that a case of the flu won't bother you much, getting vaccinated against flu (and other stuff) is quite the humanitarian gesture since it helps provide "herd immunity" for the rest of us.  If you don't get the flu, you can't be a vector spreading it to those near and dear to you.  And some of us near (maybe not dear) to you have weak immune systems and could REALLY be bothered by the little flu you pass on to us.

My post-transplant immune system thanks you for your attention.

SapphireMind

You also need to get a TDaP booster if you have not had one in the last 5 years (that is for pertussis/whooping cough)  If you have any hesitation about getting a flu vaccine, try and put it aside.  Influenza, true flu, is a miserable horrible disease.  I've gotten it twice, once without being vaccinated and once with.  The time I got it after being vaccinated was a MUCH milder case than the other time I got it.  Getting a flu shot cannot give you the flu.  Getting vaccinated against Hepatitis A never hurts either (unlike Hep B, Hep A is a food borne illness)

I find the thing about purell interesting, I hadn't heard about it.  Looking up on the interwebz, it seems that the glycerin (stuff used to keep it from destroying your skin) may be what protects the norovirus.  Ethyl alcohol will kill it, but may need more contact time or higher concentration.  Hmm.  CDC seems to say that no hand sanitizer (regardless of the formulation) can effectively kill norovirus at this point. 

No matter what, if your hands are visibly soiled, you should wash them with soap and water and really rub.  It's the rubbing that gets the germs off more than the soap. 

http://www.doh.state.fl.us/chd/bay/Documents/Norovirus.pdf

I'm very interested in this topic as I will likely still be immune suppressed and plan to limit going off the ship to reduce my risk of picking up tropical diseases and food poisoning. 

BrettGlass

I make up my own hand sanitizer that consists of 90% isopropanol, plus quaternary ammonium compounds (quats) and a germination stimulator. Isopropanol is very effective against most bacteria but is said to be only somewhat effective against some viruses, and only in high concentrations at that. It's also completely gone once your hands dry. But quats linger for hours and are effective against viruses. The germination stimulator is intended to open bacterial spores so that they become vulnerable to the other two ingredients. I'm not using any glycerin or gelling agent.

I'll be bringing some of this on JCCC3, along with "Wet Ones" antibacterial wipes (which contain benzethonium chloride and are effective against both bacteria and viruses -- including Norovirus). I want to be able to sing "Happy Birthday To Me" (the ship will, as it happens, set sail on my birthday) without being sick!

SapphireMind

I was reading that the benzethonum chloride isn't that much better for enveloped virus (like norovirus)

I would suggest against doing a germination stimulator - spores like that, such as c diff, really need to be removed via mechanical separation (soap and water handwashing) and I would fear that stimulation could potentially make them more infectious. 

I'll have to read more on the quaternary ammonium. 

The other thing to consider is that your normal flora (the bacteria that live on your hands normally) is actually your *best* defense against pathogens.  That's the other way that handwashing wins, because it typically does not destroy the flora, but when you start killing everything on your skin, you open yourself up to be colonized with pathogens instead of harmless symbiotes. 

SapphireMind

Ok, so that's more like the wipes we use at work to wipe down bedspots/workstations.    I have to wear gloves to handle those wipes or my skin starts to break down pretty quickly. 

BrettGlass

Benzethonium chloride, which is one type of quaternary ammonium compound, is effective against Norovirus. See (among other sources) Wikipedia.

Germination stimulators are becoming more and more common in hand sanitizers because there isn't any downside (the spore would be infectious if ingested anyway, and once it germinates you have a better chance of killing the bacterium).

As for native flora: from all the sources I can find, it appears that they matter in your gut and lungs, but not on your hands. I can find no evidence that existing bacteria on hands confer any benefit. Your mileage may vary, but I intend to keep my hands as germ-free as possible!

SapphireMind

I think what I had read was just that using it in a hand sanitizer was not as effective. 

I'm not sure about the stimulator still.  It can be infectious if ingested, but if you germinate it, I would think it could potentially have other modes of transmission available possibly?  I work in a hospital and I've not heard of using germination stimulators for hand hygiene.

I do know a lot about skin flora though    I'm a Neonatal NP and our babies have altered skin flora which increases their risk of disease (among other things) and while your gut flora is incredibly important, so is your skin.  There should be no "normal flora" in your lungs, though there is in your trachea/upper respiratory tract.

http://www.cehs.siu.edu/fix/medmicro/normal.htm
http://www.ncbi.nlm.nih.gov/books/NBK7617/
http://content.karger.com/ProdukteDB/Katalogteile/isbn3_8055/_81/_21/Biofunctional_Textiles_02.pdf  good article, interesting to note their chart on effectiveness of topical hand sanitizers. 
http://en.wikipedia.org/wiki/Skin_flora

BrettGlass

Had read through a couple of those sources already. BTW, one more positive theory about the germination stimulator is that because it causes the spore to germinate in an environment where it wasn't intended to germinate, the organism isn't prepared to grow there. (Clostridium Difficile, for example, expects to germinate in your gut, where there's a lot of predigested food available.) So, it might well just die even without an antiseptic present. But we want to make sure we nuke it, of course, so all of the preparations I've seen which try to stimulate germination also have antibacterial compounds in them.

As for babies: yes, it's theorized that keeping them in an environment which is too sterile might cause their immune systems to develop improperly. (Obviously, there's a balancing act here.) Fortunately, none of us were born yesterday, so when formulating my sanitizer my main concern is what will keep an adult healthy. ;-)

joelr

This may be a silly question, but what about just thoroughly washing your hands?

BrettGlass

Washing hands is essential! It's the only thing that will get dirt off them, and it will reduce the bacteria count somewhat. It'll also get rid of nasties like ascaris eggs if you scrub well. But research has shown that soap does not remove all pathogens. Before eating, I wash up and then use a shpritz of sanitizer.

SapphireMind

Well, even for us grownups, having skin flora is important    It's definitely more established than the babies though. 

You can also get hospital-grade type bleach wipes to wipe down items in your room if you are concerned. 

BrettGlass

You bet! That's one thing the Wet Ones towelettes are good for. (They're also good for hands.) Or a can of "scrubbing bubbles" cleaner.

Bry

These bacteria really sound serious.

Kathleen

Gold Bond makes an antimicrobial hand sanitizing lotion that has benzethonium chloride in it. For the last two cruises, I carried a little bottle of regular alcohol-based sanitizer and a little trial-size bottle of the Gold Bond lotion everywhere and used them both often (along with washing my hands frequently), and I avoided illness both times. The additional benefit of the lotion is that my hands stayed nice and moisturized!

SapphireMind

@Bry - it's not too bad really, it's just when you have a lot of people in a small area, the chances for sharing germs is higher.  So hand hygiene is your friend.  Norovirus is just a stomach virus - unpleasant but not dangerous typically.  But it will put the kibosh on a lot of activities for a couple of days   

ProfBeard

Funny, I was just thinking at the end of last week "I should probably get a flu shot to keep from getting sick leading up to and on the cruise..." and then the hivemind comes up with the same thing.  OK, off to get shot then.

Spooner

I'm getting my shot after work today. It takes about 2 weeks after you get it to be protected, so if you get it anytime in the next 10-12 days you should be good to go.

dndgirl

Our office always get us flu shots as soon as they become available.  I've been covered for months, now.  Yay!

I will look into getting that Gold Bond lotion that @Kathleen talked about.  I have this sanitizer from The Body Shop that touts it has no Triclosan and other stuff that requires a Sherlock Holmes magnifier to read.  Mainly I got it because it comes in some nice scents.

BrettGlass

Just checked the CDC site, and here are the pages listing recommended vaccinations for our ports of call:

http://wwwnc.cdc.gov/travel/destinations/netherlands-antilles.htm

http://wwwnc.cdc.gov/travel/destinations/usvirgin-islands.htm

What they recommend, pretty much, is that you get a shot for typhoid (especially if you're going to dine on the islands) and make sure you're up to date on DPT (diptheria/pertussis/tetanus), polio, and MMR (measles/mumps/rubella). They do not list hepatitis A or B as prevalent in the Caribbean,  but mention these shots as being generally good to have if you're a world traveler.

Myself, I figure that there's a greater risk of being infected by other cruisers on the boat than catching something on an island. I'm going to get DPT for sure (it's been 10 years), and look into MMR because I think I'm due for a booster based on the CDC's recommended adult vaccine schedule. I'll get others, such as typhoid, if the nurse at the local public health clinic recommends them. (I've already had a flu shot; I do it every year, religiously, in October.)

SapphireMind

Hmm.  Not planning on going off ship, but I may booster up my typhoid. 

AngerMonkey

@bry Really, I'm going to step in here as a biologist and say EVERYTHING WILL BE FINE. 
A. Wash your hands and B. don't touch your face (rub eyes, chew fingernails, etc.) Really. And C. get a flu shot if you haven't. Oh, D. keep the alcohol based sanitizers around to fight the bacteria. No, it doesn't kill viruses (nothing KILLS viruses, they're not actually alive) but washing your hands regularly will dislodge/disrupt them and the RNAses on your skin will do the rest-  SIDE NOTE: Trust me, getting lab equipment RNAse free is a multi-day event involving ovens and proteinase sprays. It's a persistent little enzyme BECAUSE it is so important to your immune system. You're covered in it. ETA: Yes, Norovirus is a retrovirus (RNA inside, no DNA.)

This will be cruise #5 for me (honeymoon, JCCC1 and 2, and a trip with my elderly, diabetic mother) on multiple lines and I have not had any problems. The boat is EXTREMELY cognizant of the fact that large numbers of people + traveling from all over X smallish spaces = germs. The smell of bleach is basically my scent memory for every boat-based vacation of my life. If you DO feel puny one day, hie thee to the medical officer, and then spend a day enjoying your cabin's TV until you feel better.

autojim

What @AngerMonkey said. I've done multiple cruises with immunocompromised traveling companions and that protocol is pretty much spot-on.

BrettGlass

@AngerMonkey True: technically speaking, viruses aren't alive. They're more like "undead." There are only a few that eat your brains, though. ;-)

BrettGlass

P.S. -- Just got back from the public health clinic, and boy, they put me through the gauntlet. They updated me on DPT (or TDaP; they transpose the letters but it's the same assortment of organisms), MMR, Hepatitis A and B (I'll have to come back for boosters to complete the series later), and typhoid -- a series of 4 capsules you have to take every other day. (They insisted on the typhoid when I mentioned that I knew a resident of St. Thomas who might take me on a private tour and feed me local food.) Between now and the cruise, my immune system will be working overtime to build up immunity to all of those things at once.

They also gave me the usual warnings about not drinking the water, drinking beverages out of sealed containers only (and checking the seals to make sure they didn't refill containers with tap water), not accepting ice, not eating raw salads or fruit without thick skins, etc. when on the islands. They also warned me against swimming or snorkeling in areas of the ocean which might be contaminated by sewage flowing out from a sewer system.

Again, I'm more worried about some young kid on the ship, who just has to see Shrek and the Kung Fu Panda even if he's sick, spreading crud than I am about being infected on an island. But at least I am now ready for nearly anything the nurse thought I might encounter.

SapphireMind

They won't give you the typhoid shot?  It's a lot easier   

I vote no on anyone getting sick in general, just in case you wonder 

Chaosdreamer

Has everyone seen today's xkcd?

BrettGlass

Randall is intentionally misinterpreting the claim on the label for humorous effect. It is intended to mean that the sanitizer kills 99+% of all species of bacteria.

Angelastic

A couple of people said that, but apparently Randall got it right.

Though there's little point being bothered by the remaining bacteria count, considering there are more bacterial cells in a human than human cells.

BrettGlass

BTW, just started taking the typhoid vaccine capsules today. For those who aren't bio-geeks, typhoid is a super-nasty form of salmonella, and I will be infecting myself with a genetically engineered, weakened form of the bug four times. As @SapphireMind notes, it's much more of a bother than a shot, but the advantage is that the body is reacting to real, living bacteria in your gut -- where an actual infection would be -- rather than just protein fragments shot into your arm. The pack of capsules cost me $40 (tax-deductible, because I have an HSA) at the local public health clinic; figured it was worth it, especially since the nurse was so concerned that I might need it. Immunity lasts 5 years -- more than twice the duration of the immunity I'd get from the injection.

Colleenky

@Bry Heehee! @EverybodyElse: http://www.jonathancoulton.com/wiki/Bacteria

Getting back to the topic at hand, something a speech therapist suggested was to swab the inside of your nose with Polysporin. Not only does it kill the nasty buggies, but it also keeps the inside of your nose moist, preventing abrasions that might let the buggies into your system. Especially important in circulated air environments, like planes.

Theanderblast

Or if you're really worried: this nice suit

Bry

Thanks, @Colleenky I was worried I'd have to go to extreme measures like asking for help identifying these five species:

Angelastic

Oh geez, how did I miss that?

BrettGlass

@Theanderblast I wonder if that hazmat suit would be acceptable attire for Formal Night.

SapphireMind

I think it would be @BrettGlass

My official appointment with my hepatologist was today and I told him of my plans for cruise.  Luckily he did not have an issue with it.  Said I shouldn't get the typhoid booster, (I'm just under 5 years anyway and not going off ship most likely) no raw seafood (Ack!  no sushi!) and he'd feel better if I skipped the fresh fruits and veggies, even on the ship, as they are the biggest vectors of things to make my liver angry.

And he said I could have 1 (one) piña colada on my trip    (but still no tylenol!  *LOL*)

Bry

@SapphireMind Shoulda asked for a scrip for 1 (one) piña colada p.o.

SapphireMind

@Bry ; I wonder if it would be covered by health insurance??   

keeksg

The most important thing to me - if you are sick, PLEASE distance yourself from the rest of the group until you're feeling better (that's 24-48 hours after you were last sick)!! I realise you paid for a nice cruise, and you'd like to participate, but take some responsibility for yourself and the well-being of everyone you encounter (and everyone who passes through the space you just left).

This message brought to you by someone not impressed at the passenger spewing norovirus-infected puke all over the shuttle bus on the way to the airport in December. Stay home dammit!

BrettGlass

[BUMP]

BrettGlass

This just in. Two cruises on two Royal Caribbean ships have suffered from norovirus outbreaks during the month of January:

http://www.examiner.com/article/royal-caribbean-flu-dozens-of-passengers-end-up-sick-on-trip

http://abcnews.go.com/International/wireStory/281-passengers-ill-aboard-royal-caribbean-ship-21848833

Fortunately, neither of them was the Indigestion (oops, I mean Independence) of the Seas, which will host JCCC4.

But still, guys: be careful. I won't be there this year to hand out bottles of "JoCo-San" (my homebrewed extra strength hand sanitizer), but it's easy to obtain good sanitizers with persistent disinfectants. Also, try to favor hot foods and drinks, as they are not likely to contain infectious virus particles.

SapphireMind

There's increasing evidence that the only thing that really deals with noro is handwashing.  wash hands.  Please wash hands.  And wash again.  If you get sick, be honest and don't fight the quarantine.  (saw someone getting huffy about it when I was in the med bay last year)

Remember, water, soap scrub, water, then don't touch dirty stuff!

And get your flu shot.  The flu this year is particularly nasty.  IMO the flu shot doesn't fully cover it (they have to guess on strains to immunize against) but if it provides you ANY protection, it is more than worth it.  Myself and others I know that have gotten flu A this year have been severely ill, nearly to the point of hospitalization (and saying nurses were thinking they maybe needed to go to the hospital means it's *serious* *LOL*)

BrettGlass

Yes, hand washing and flu shots are important! Last year, I also brought aboard a big can of "Scrubbing Bubbles" cleaner and did a really thorough job of going over our cabin's bath, as well as other surfaces including the TV remote. (Studies have shown that the remotes in hotel rooms are, for some reason, among the most germ-ridden objects in them.) The hand sanitizer I brew contains the same active ingredients as that cleaner -- quaternary ammonium compounds, or "quats," and alcohol -- but in a solution that's much more friendly to hands and noses.
 
Most of the sanitizers listed by the EPA as effective against noroviruses and flu viruses use quats as the active ingredient. You can still get "cruise crud" or norovirus via airborne transmission, of course, but it's less likely than from direct contact.

keeksg

Norovirus is not airborne, unless you happen to be right next to someone when they get sick and breathe in the particles. 

bort

Give me a quarantine, my kindle, room service and a legitimate reason to be completely antisocial, and this will be a very relaxing vacation indeed. Come at me, bro.

e: let me also point out that Immodium owns and bringing enough for your buddies can make you a hero. This goes for benadryl/aspirin (might even save a life!), band aids and other medicine cabinet essentials.

villicious

@keeksg Do you have a source on that? Everything I have read about norovirus is that its entire DNA is devoted to creating opportunities for it to aerosolize (thanks to projectile vomiting and explosive diarrhea). So, no, you don't get it from a sick person breathing on you, but it's extremely sturdy so you could very easily get it from walking past where someone has vomited and now the vomit has been cleaned up, long after they did so. The CDC's page links to multiple case-studies about airborne transmission.

keeksg

The research I've done (various web sites, primarily Britis/NHS) state that while it is airborne immediately after someone has vomited, the particles settle on surfaces pretty quickly, at which point it is not considered "airborne" transfer, but contact-based. It is not considered an airborne virus overall.

Fizzgig

*looking at dry hands*  Make sure to take heavy duty hand moisturizer for all the hand washing so you don't create broken skin. Anyone have a recommendation on a "heavy duty moisturizer" that coats without that nuisance of waiting forever for the lotion to absorb?

Re: the flu shot--All 3 in my household have now had flu shot varietals (nose or shot, all with added H1N1 goodness) and the OMG HEADACHE!!1! flu.  I'm putting our semi-fast recovery down to the shot or Flunase.  I got my shot at the sick people store and came home with the free sample of flu, which took me out of commission for a week.  Husband and kiddo got the flu a month later and recovered over a long weekend.  Please please PLEASE get a flu shot!  The high fever and unbelievably painful headache suck...  I was seriously thinking kiddo and the husband might be having their first migraines, if it wasn't for their mutual timing and their high fevers.

2 more business trips and then I'm swapping bags to head out to the cruise...  Yay!

AuntiLaura

My wife's good friend who lives in Albuquerque got the flu. She is now in the ICU with pulmonary failure. 51.

wash your hands. get a shot

anotherjen

My favorite hand moisturizer is Eucerin (or store brand equivalent). Yes, it's a bit thick/greasy, but it actually works, unlike the more watery versions like Lubriderm.

kate

Oh my gosh, if we're talking random hand lotions, L'Occitane's Shea Butter Hand Cream is the best I have ever encountered.