I am Dr. Kelly Reynolds, a microbiologist and expert on germs (like the flu virus) and how they spread. AMA

My roomate has the flu. How can I possibly survive this situation?

The best way to avoid catching the flu from another member of your household is to isolate that member to as few rooms as possible and be diligent about disinfecting surfaces that the ill person has contacted. While flu viruses can spread through aerosol droplets (i.e, coughing and sneezing), they tend to stay very localized in the air and only for a short time. You are much more likely to come in contact with the virus when you touch contaminated surfaces where they can survive for hours to days!. So...surface disinfecting and handwashing are your best defenses.

Thank you all for the great questions and discussion. Stay well!

Kelly Reynolds, PhD

Which is the worst "disease factory" from an epidemiological standpoint, elementary, high school, college or work?

The worst disease factory is the location where people are in contact with one another and the fewest germ prevention interventions are in place. Elementary schools are a likely first choice as the germiest place. However, through extensive education and outreach in these areas, we see very high awareness among teachers and school administrators about germ prevention. Due to increased handwashing and surface disinfecting practices, our schools may be some of the cleanest environments around- but we should ask ourselves when was the last time we disinfected our own kitchen or desk???

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Good point- similarly faucet handles, light switches and doorknobs! How does one get out of the bathroom without recontaminating their hands??? The key is routine disinfectant use on commonly touched surfaces. While the areas will not be sterilized, the goal is to reduce your risk of exposure by reducing the germ count on the surfaces around you and on your hands. Sponges, cell phones, remote controls are hot spots for decon in the home!

How does one get out of the bathroom without recontaminating their hands

Luckily, more and more places that I have worked are switching to "touch-less" rest rooms... urinals that flush automatically, or are no-flush, and sinks and soap dispensers that are motion activated. Beyond preventing the spread of germs (and reducing employee sick time as a result), there's a cost savings from having measured amounts dispensed rather than a person using the sink and not turning it off when he leaves.

The only thing we have to touch, after we do our business, is the door handle. I grab a paper towel and cover my hand when opening it.

Me too! Great advice. Just remember that we come in to contact with germs in our own home more than any other place. (sources include contaminated meat/produce/water; pets; shoes; hands; infected people in the home; dirty laundry, etc.)

Since automatic towel dispensers are not common in the home (yet!) keep in mind the importance of surface cleaning/disinfecting. I keep a bottle of disinfecting wipes under every sink in my home. They make the process of routine surface disinfecting quick and easy.

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The flu vaccine is proven to dramatically reduce morbidity (illness) and mortality (death) rates in a population. The Centers for Disease Control and Prevention (CDC) lists vaccination as the best preventative measure for the flu.

Hello and thanks for doing the AMA.

I have always wondered how plasmids get incorporated into a bacterial genome in a sporadic fashion.

I'm always hearing about bacteria picking up or dropping a new plasmid and becoming either resistant or susceptible to certain drugs. Where are they getting all these plasmids?

Bacteria share genetic information in a variety of ways- including horizontal and vertical transfer. Plasmids are highly mobile genetic sequences. If a mobile sequence carries a genetic code for antibiotic resistance, or some other virulence factor that provides a competitive advantage, those mobile strains can be picked up in the environment by other bacteria in close proximity. These exchanges can occur anywhere bacteria are in close contact. Antibiotic resistance genes can be found in regions of no human antibiotic use. Some bacteria inherently produce these genes.

Any tips for an undergrad who's going to start researching soon?.

Find a good mentor! I love spending time with my students. Someone new to research helps me to keep ideas fresh and current. Good luck with your work!

Bacteria share genetic information in a variety of ways- including horizontal and vertical transfer. Plasmids are highly mobile genetic sequences. If a mobile sequence carries a genetic code for antibiotic resistance, or some other virulence factor that provides a competitive advantage, those mobile strains can be picked up in the environment by other bacteria in close proximity. These exchanges can occur anywhere bacteria are in close contact. Antibiotic resistance genes can be found in regions of no human antibiotic use. Some bacteria inherently produce these genes.

Will there one day be a flu that we cannot protect against?

Vaccinations are highly effective against flu viruses. Thus, we will likely be able to develop a vaccine against a newly mutated flu virus. Until a vaccine can be developed and distributed, there will be victims. That's why we should focus on other methods of germ control- stay away from others as much as possible when sick. Wear a facemask if you are coughing to prevent aerosol spread. Think of high-touch, infrequently disinfected surfaces and decontaminate them routinely and finally wash hands frequently.

I'm sorry, but your verification doesn't seem to be working. It just leads to a blank page for me.

EDIT: You got your verification fixed!

I'm curious to your opinion on flu vaccinations.

I find a fair number of people where I live who don't get flu vaccinations for various reasons. Some still believe vaccinations are potentially dangerous (aftermath of Swine Flu and Autism rumors I think), while others think they are worthless.

I'm the son of two nurses and my parents tell me that there is sort-of a scenario where people don't get flu shots and end up without the flu because the majority of the people around them have flu shots (my father put it that these people are leeching off the fact that the people around them have had flu shots, so the chance of infection is less likely) which leads them to believe that they aren't worth getting. So as word spreads, more and more people don't vaccinate themselves or their kids. My parents are afraid that this apathy is going to lead to a widespread outbreak of flu in the region. My Mom in particular is worried that a lot of kids are going to get sick.

So, I was just wondering what another professional, one who is probably more versed in this field than my parents, felt about vaccinating children (and adults) to help prevent the spread of flu virus.

Perhaps the best evidence I can give you related to my opinion on flu vaccination is that all three of my kids are vaccinated every year against seasonal flu. The "herd immunity" you describe is absolutely true. As you also rightly point out, this is only helpful to the unvaccinated person if everyone around them is also vaccinated- a potentially risky bet.

How do you know a patient actually has the flu, and not something else like a cold?

While I'm not an MD, one of the classic signs of the flu is fever and achy joints. The flu can be more severe and has a higher likelihood of progressing to more severe complications, such as pneumonia. If you have the flu, it is important to see your doctor who may prescribe medication to shorten the duration of the illness, which can lasf for a week or more.

I have always been taught that "nothing" can be given for a viral infection to shorten duration. What can a doctor give to shorten the duration of illness of the flu virus (opposed to the common cold)?

It is true that antibiotics are not effective against viruses. For some viral infections, medications are available that shorten the duration of the illness. There are several medications available that minimize flu symptoms and duration but they must be started at the first sign of illness. If you experience flu-like symptoms, see your doctor immediately.

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Hand sanitizers are highly effective at reducing the level of bacteria on your hands but they are not as effective against viruses compared to washing hands with soap and water. Increased dirt on hands can prevent contact between the sanitizer gel and the bacteria.

What are the germiest places in the house? I know the bathroom is one, but anywhere else I should sanitize if one of my kids is sick?

Belive it or not, the bathroom is typically the LEAST germiest place in the house. This is because most of us recognize the potential for germs in the bathroom and we use disinfectants to reduce the contamination. I find far more germs in kitchens.

Did you know that 10% of household dishrags contain Salmonella (food poisoning bacteria); 32% contain E. coli (an indicator of fecal contamination) and during flu season, 60% are positive for influenza??? Yikes! Using the dishrag, you may think you are cleaning but if you are not using a disinfectant that kills germs (like Clorox bleach) you are probably just spreading germs to more sites around the kitchen.

I'm starting University next year and have always shown an interest in microbiology. What differences are there from taking the subject directly as opposed to plain Biology?

Thank you for doing this AMA, your timing couldn't have been better for me!

I too started out as a biology major and planned a career in medicine but developed a passion for microbiology. Where biology includes macrosystems (such as the human body, animals, plants), microbiology focuses specifically on the microscopic bacteria, viruses, protozoa and fungal cells. Viruses can infect and kill plants and even bacteria and protozoa. They are considered the most important factor in keeping bacteria from taking over the world!

Which is better: Standard cleaning/hand washing, or nearly OCD-like cleaning and sanitizing of yourself and other areas. Ie is it better to have a few germs and build up a tolerance, or should you strive to be as germ-free as possible?

In general reliance on "building tolerance" is not an effective public health management tool. This is evidenced by the 1 billion colds suffered in the U.S. each year (and that is just one example).

Routine handwashing and disinfecting is key to reducing risks of illness. This is not OCD-cleaning- it is smarter disinfecting. Target the hot spots in your home- frequently touched sites- and do a quick wipe down weekly as a routine or daily if someone in the home is sick or contamination is likely (such as when preparing raw foods).

We've had outbreaks of h1n1 swine flu and h5n1 avian flu (i think) before, and the common flu is a different influenza strain; my question is do any of these strains mutate enough for them to end up being a completely new strain we haven't experienced, or is the constant problem with the flu resultant from much smaller mutations in its viral makeup?

The influenza virus has many different hosts (birds, pigs, people and more!). The flu virus has relatively loose receptors in that different strains can cross the species barrier and infect multiple species. H5N1 (avian influenza) primarily infects birds but has rarely caused infection in humans. The concern is that H5N1 strains could "mix" genetic material (i.e., receptor sites) with other well adapted human strains and create a super-flu bug. A completely new strain is not as big of a concern currently as a highly virulent bird strain mixing with a highly spreadable human strain.

Have you ever seen the show "the walking dead"? If so remember the episode when the scientist explained how the disease infects the host and how it works? Could something like this ever happen and if not, what would be the most realistic way a disease or virus or something could turn people into "walking dead"?

Interesting question. I have not seen the show you referenced but the effect you describe would require a virus that affected our cognitive skills but left the motor skills intact. Luckily, such an event is still science-fiction!

So how do germs and viruses start? My parents used to always blame my colds on me being outside in the cold without a jacket. Science tells us it is jsut because we are inside with sick people so it spreads more easily. But how does it start?

Viruses have evolved over time with their hosts. As long as there has been life, there have been viruses to infect that life! So, your question is really, how did life start. (I wish I knew the answer to that one too!)

I work for the company who manufactures FluMist, the attenuated live flu nasal vaccine, but do not have a science background. What are your thoughts on the mist vs. the shot?

Scientist answer: Both the FluMist and shot are vaccines approved by the Food and Drug Administration and recommended by the CDC as the best way to minimize your risk of the flu.

Mom answer: my kids would trade a mist in the nose for the shot any day!

Some one told me to load up on vitamin D during flu season, does this make any sense to you? Also, when a person first comes down with the flu, how long are they contagious?

Vitamin D is an essential nutrient and Vitamin D deficiencies have been linked to an increase in a variety of health problems, including microbial infections. Since I am not an MD, I prefer you talk to your doctor about appropriate Vitamin D doses.

When a person comes down with the flu, they are contagious several days before symptoms occur and usually several days after. Some people (typically those already immunocompromised) can shed the virus for weeks after their symptoms subside.

Since we cannot always avoid influenza-infected people (some do not even know they are sick), we must rely on the primary personal defenses against microbes. Handwashing, surface disinfecting and vaccination.

Is it true that if you put a cut onion next to your bed when you are sick that it will absorb germs and help you get better?

Nope.

What precautions can we take to avoid getting sick on an airplane? Is it true a sick person on a plane can get everyone around them within 4 rows sick if they cough and sneeze?

Airplanes are a concern for many who travel. The close proximity to others, recycled air and rarely cleaned but heavily used surfaces are primary germ spreading conditions.

In other countries, use of face masks (the inexpensive kind available at any drug store) is common during peak outbreak events. US residents appear more reluctant. Face masks are one effective defense to minimize exposure to aerosols.

Your highest risk of germs on planes is from your own hands. Be sure to wash them frequently while on travel- especially before eating and be aware not to touch your face with unclean hands as germs spread by contact with the eyes, nose, and mouth.

Finally, it is a good idea to do a quick wipe down with a disinfecting wipe. The tray tops, arm rests, call/light button and seat belt fastener are good targets. Clorox makes some handy travel disinfecting wipes that I always throw in my purse while traveling.

Save some for the remote control in the hotel room too!

Very Cool AMA thank you!

I am wondering how helpful are immune booster like thymuril and probiotics? I used to get sick all the time, back in august had Hand Foot Mouth and Strep at the same time. Then after that horrible experience, I started taking thymuril + other vitamins in it with probiotics, then after one course of probiotic I just take thymuril now. Have not been seriously ill since, feel under the weather now actually but seemingly fighting it off before it really kicks in.

In general, probiotics are shrouded in controversy and scepticism mainly due to the fact that some manufacturers have made inappropriate and unsupported claims as to their benefits related to a wide range of health symptoms.

For most probiotics, the requisite scientific evaluation that a FDA tested medication would have to endure has not been done. First check with your doctor about the safety of any vitamins or probiotics you are taking (as the famous toxicologist Paracelsus explained, "the dose makes the poison"- in other words, everything is poisonous at some level).

With your doctors approval, if a treatment works for you, do it.