Multicenter European study: Bleach use in homes linked to higher childhood infection rate

8 Apr

Medline Plus has some good basic information on infectious diseases:

Infectious diseases kill more people worldwide than any other single cause. Infectious diseases are caused by germs. Germs are tiny living things that are found everywhere – in air, soil and water. You can get infected by touching, eating, drinking or breathing something that contains a germ. Germs can also spread through animal and insect bites, kissing and sexual contact. Vaccines, proper hand washing and medicines can help prevent infections.
There are four main kinds of germs:
• Bacteria – one-celled germs that multiply quickly and may release chemicals which can make you sick
• Viruses – capsules that contain genetic material, and use your own cells to multiply
• Fungi – primitive plants, like mushrooms or mildew
• Protozoa – one-celled animals that use other living things for food and a place to live
NIH: National Institute of Allergy and Infectious Diseases http://www.nlm.nih.gov/medlineplus/infectiousdiseases.html

A multicenter European study questioned whether the cleaning agent bleach is a potential cause in the rise of childhood infections.

Science Daily reported in Passive exposure to bleach at home linked to higher childhood infection rate:

Passive exposure to bleach in the home is linked to higher rates of childhood respiratory and other infections, suggests research published online in Occupational & Environmental Medicine.
Although modest, the results are of public health concern in light of the widespread use of bleach in the home, say the researchers, who call for further more detailed studies in this area.
The researchers looked at the potential impact of exposure to bleach in the home among more than 9000 children between the ages of 6 and 12 attending 19 schools in Utrecht, The Netherlands; 17 schools in Eastern and Central Finland; and 18 schools in Barcelona, Spain.
Their parents were asked to complete a questionnaire on the number and frequency of flu; tonsillitis; sinusitis; bronchitis; otitis; and pneumonia infections their children had had in the preceding 12 months. And they were asked if they used bleach to clean their homes at least once a week.
Use of bleach was common in Spain (72% of respondents) and rare (7%) in Finland. And all Spanish schools were cleaned with bleach, while Finnish schools were not.
After taking account of influential factors, such as passive smoking at home, parental education, the presence of household mould, and use of bleach to clean school premises, the findings indicated that the number and frequency of infections were higher among children whose parents regularly used bleach to clean the home in all three countries.
These differences were statistically significant for flu, tonsillitis, and any infection.
The risk of one episode of flu in the previous year was 20% higher, and recurrent tonsillitis 35% higher, among children whose parents used bleach to clean the home.
Similarly, the risk of any recurrent infection was 18% higher among children whose parents regularly used cleaning bleach.
This is an observational study, so no definitive conclusions can be drawn about cause and effect. Furthermore, the authors highlight several caveats to their research…. http://www.sciencedaily.com/releases/2015/04/150402210901.htm

Citation:

Passive exposure to bleach at home linked to higher childhood infection rate
Date: April 2, 2015

Source: BMJ
Summary:
Passive exposure to bleach in the home is linked to higher rates of childhood respiratory and other infections, suggests new research.
Domestic use of bleach and infections in children: a multicentre cross-sectional study
1. Lidia Casas1,2,3,4,
2. Ana Espinosa2,3,4,5,
3. Alícia Borràs-Santos2,3,4,
4. José Jacobs6,
5. Esmeralda Krop6,
6. Dick Heederik6,
7. Benoit Nemery1,
8. Juha Pekkanen7,8,
9. Anne Hyvärinen7,
10. Martin Täubel7,
11. Jan-Paul Zock9,2,3
+ Author Affiliations
1. 1Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
2. 2Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
3. 3CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
4. 4University Pompeu Fabra (UPF), Barcelona, Spain
5. 5Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
6. 6Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
7. 7Department of Health Protection, National Institute for Health and Welfare (THL), Kuopio, Finland
8. 8Department of Public Health, University of Helsinki, Helsinki, Finland
9. 9Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
1. Correspondence to Lidia Casas, Department of Public Health and Primary Care—Centre for Environment and Health, KU Leuven, Herestraat 49, Leuven 3000, Belgium; lcasas@creal.cat
• Received 12 November 2014
• Revised 23 January 2015
• Accepted 3 February 2015
• Published Online First 2 April 2015
Abstract
Objective To report the effects of bleach use at home on the frequency of infections in 9102 school-age children participating in the HITEA project.
Methods Parents of pupils aged 6–12 years from schools in Barcelona province (Spain), Utrecht province (the Netherlands) and Eastern and Central Finland were administered a questionnaire including questions on the frequency of infections (influenza, tonsillitis, sinusitis, otitis, bronchitis and pneumonia) in the past 12 months and bleach use at home. We developed multivariable mixed-effects multilogistic regression models to obtain relative risk ratios (RRR) and their 95% CI per country, and combined the RRR using random-effects meta-analyses.
Results Bleach use was common in Spain (72%, n=1945) and uncommon in Finland (7%, n=279). Overall, the prevalence of infections (recurrent or once) was higher among children of bleach users. Significant combined associations were shown for influenza only once (RRR=1.20, 95% CI 1.04 to 1.38), recurrent tonsillitis (RRR=1.35, 95% CI 1.07 to 1.71) and any infection (RRR=1.18, 95% CI 1.01 to 1.38).
Conclusions Passive exposure to cleaning bleach in the home may have adverse effects on school-age children’s health by increasing the risk of respiratory and other infections. The high frequency of use of disinfecting irritant cleaning products may be of public health concern, also when exposure occurs during childhood.
http://oem.bmj.com/content/early/2015/02/20/oemed-2014-102701.abstract?sid=be3e084d-bc00-418d-b157-10ad9ed25e2f

Here is the press release:

Public Release: 2-Apr-2015 Passive exposure to bleach at home linked to higher childhood infection rate
Effects modest, but widespread use of bleach adds up to public health concern, say researchers
BMJ

Passive exposure to bleach in the home is linked to higher rates of childhood respiratory and other infections, suggests research published online in Occupational & Environmental Medicine.
Although modest, the results are of public health concern in light of the widespread use of bleach in the home, say the researchers, who call for further more detailed studies in this area.

The researchers looked at the potential impact of exposure to bleach in the home among more than 9000 children between the ages of 6 and 12 attending 19 schools in Utrecht, The Netherlands; 17 schools in Eastern and Central Finland; and 18 schools in Barcelona, Spain.

Their parents were asked to complete a questionnaire on the number and frequency of flu; tonsillitis; sinusitis; bronchitis; otitis; and pneumonia infections their children had had in the preceding 12 months. And they were asked if they used bleach to clean their homes at least once a week.

Use of bleach was common in Spain (72% of respondents) and rare (7%) in Finland. And all Spanish schools were cleaned with bleach, while Finnish schools were not.

After taking account of influential factors, such as passive smoking at home, parental education, the presence of household mould, and use of bleach to clean school premises, the findings indicated that the number and frequency of infections were higher among children whose parents regularly used bleach to clean the home in all three countries.

These differences were statistically significant for flu, tonsillitis, and any infection.
The risk of one episode of flu in the previous year was 20% higher, and recurrent tonsillitis 35% higher, among children whose parents used bleach to clean the home.

Similarly, the risk of any recurrent infection was 18% higher among children whose parents regularly used cleaning bleach.

This is an observational study, so no definitive conclusions can be drawn about cause and effect. Furthermore, the authors highlight several caveats to their research.

For example, they didn’t have any information on the use of other cleaning products used in the home, and only basic information was gathered on the use of bleach in the home, making it difficult to differentiate between exposure levels.

But their findings back other studies indicating a link between cleaning products and respiratory symptoms and inflammation, they say.

And they add: “The high frequency of use of disinfecting cleaning products, caused by the erroneous belief, reinforced by advertising, that our homes should be free of microbes, makes the modest effects reported in our study of public health concern.”

By way of an explanation for the associations they found, they suggest that the irritant properties of volatile or airborne compounds generated during the cleaning process may damage the lining of lung cells, sparking inflammation and making it easier for infections to take hold. Bleach may also potentially suppress the immune system, they say.
###
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

This is an observational study and there are many limitations, so no firm linkages can be made. In the WebMD article, Day2Night: How Mom Can Stop Germs: Is Dirt Good for Kids? Written by Lisa Zamosky, reviewed by Roy Benaroch, MD postulated that kids could use a little more dirt in their lives.

According to Zamosky:

A mounting body of research suggests that exposing infants to germs may offer them greater protection from illnesses such as allergies and asthma later on in life.
This line of thinking, called the “hygiene hypothesis,” holds that when exposure to parasites, bacteria, and viruses is limited early in life, children face a greater chance of having allergies, asthma, and other autoimmune diseases during adulthood.
In fact, kids with older siblings, who grew up on a farm, or who attended day care early in life seem to show lower rates of allergies.
Just as a baby’s brain needs stimulation, input, and interaction to develop normally, the young immune system is strengthened by exposure to everyday germs so that it can learn, adapt, and regulate itself, notes Thom McDade, PhD, associate professor and director of the Laboratory for Human Biology Research at Northwestern University.
Exactly which germs seem to do the trick hasn’t yet been confirmed. But new research offers clues.
In a recent study, McDade’s team found that children who were exposed to more animal feces and had more cases of diarrhea before age 2 had less incidence of inflammation in the body as they grew into adulthood.
Inflammation has been linked to many chronic adulthood illnesses, such as heart disease, diabetes, and Alzheimer’s.
“We’re moving beyond this idea that the immune system is just involved in allergies, autoimmune diseases, and asthma to think about its role in inflammation and other degenerative diseases,” McDade says. “Microbial exposures early in life may be important… to keep inflammation in check in adulthood….” http://www.webmd.com/parenting/d2n-stopping-germs-12/kids-and-dirt-germs

Obviously, more research must be completed, but moderate exposure to a variety of germs maybe be helpful to developing immune systems.

Resources:

Common Childhood Infections

http://pediatrics.about.com/od/childhoodinfections/

Infections

http://kidshealth.org/parent/infections/

Overview of Bacterial Infections in Childhood

http://www.merckmanuals.com/home/childrens_health_issues/bacterial_infections_in_infants_and_children/overview_of_bacterial_infections_in_childhood.html

9 Childhood Illnesses: Get the Facts

http://www.webmd.com/children/features/childhood-illnesses-get-the-facts

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