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Ask Smithsonian: Whats the Difference Between Bacteria and Viruses?

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Opinion | Is the Drive for Success Making Our Children Sick? (Published 2016)

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Across the country, children are experiencing depression, anxiety and even physical strain because of the pressures of school.

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Rabies is caused by a virus. A virus is a very tiny germ. You can only see that germ if you have a special microscope. Here´s a picture of the rabies virus:

Scientists have discovered more than 300 viruses in animals. Some won´t hurt you. Others cause disease. The common cold and measles are caused by viruses. So are the flu, chickenpox, and AIDS.

Viruses cannot eat food or grow on their own, but they can make more of themselves if they live inside the cells of other organisms, called "hosts".

The viruses attack those host cells and make more of themselves. Then the viruses move on to other host cells and do it all over again.

The rabies virus wants to make its home in a nerve cell, the smallest part of our central nervous system. The central nervous system is made up of our brain and spinal cord and all the other parts of our bodies that control everything we do from breathing to walking.

When there´s a bite from an animal with rabies, the virus attaches to a healthy nerve cell. Then the virus multiplies, making a lot more viruses like itself. Those viruses move on and attach to other nerve cells until eventually they get to the brain. There the virus can cause the brain to swell, and the person with rabies may go into a coma and die.

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Rabies is caused by a virus. A virus is a very tiny germ. You can only see that germ if you have a special microscope. Here´s a picture of the rabies virus: Scientists have discovered more than 300 viruses in animals. Some won´t hurt you. Others cause disease.

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History is dotted with epidemics and plagues, but a certain number of them stand out as unique for their severity and impact on future generations. This is a list of the worst plagues in man's recorded history.

SEE ALSO: 10 Of Human History's Most Atrocious Plagues

The first signs of plague in Moscow appeared in late 1770, which would turn into a major epidemic in the spring of 1771. The measures undertaken by the authorities, such as creation of forced quarantines, destruction of contaminated property without compensation or control, closing of public baths, etc., caused fear and anger among the citizens. The city's economy was mostly paralyzed because many factories, markets, stores, and administrative buildings had been closed down. All of this was followed by acute food shortages, causing deterioration of living conditions for the majority of the Muscovites. Dvoryane (Russian nobility) and well-off city dwellers left Moscow due to the plague outbreak. On the morning of September 17, 1771, around 1,000 people gathered at the Spasskiye gates again, demanding the release of captured rebels and elimination of quarantines. The army managed to disperse the crowd yet again and finally suppressed the riot. Some 300 people were brought to trial. A government commission headed by Grigory Orlov was sent to Moscow on September 26 to restore order. It took some measures against the plague and provided citizens with work and food, which would finally pacify the people of Moscow.

The Great Plague of Marseille was one of the most significant European outbreaks of bubonic plague in the early 18th century. Arriving in Marseille, France in 1720, the disease killed 100,000 people in the city and the surrounding provinces. However, Marseille recovered quickly from the plague outbreak. Economic activity took only a few years to recover, as trade expanded to the West Indies and Latin America. By 1765, the growing population was back at its pre-1720 level. This epidemic was not a recurrence of the European Black Death, the devastating episodes of bubonic plague which began in the fourteenth century. Attempts to stop the spread of plague included an Act of Parliament of Aix that levied the death penalty for any communication between Marseille and the rest of Provence. To enforce this separation, a plague wall, the Mur de la Peste, was erected across the countryside (pictured above).

The Antonine Plague (also known as the Plague of Galen, who described it), was an ancient pandemic, of either smallpox or measles, brought back to the Roman Empire by troops returning from campaigns in the Near East. The epidemic claimed the lives of two Roman emperors - Lucius Verus, who died in 169, and his co-regent who ruled until 180, Marcus Aurelius Antoninus, whose family name, Antoninus, was given to the epidemic. The disease broke out again nine years later, according to the Roman historian Dio Cassius, and caused up to 2,000 deaths a day at Rome, one quarter of those infected. Total deaths have been estimated at five million. The disease killed as much as one-third of the population in some areas, and decimated the Roman army. The epidemic had drastic social and political effects throughout the Roman Empire, particularly in literature and art. (Pictured above is a plague pit containing the remains of people who died in the Antonine Plague.)

The Plague of Athens was a devastating epidemic which hit the city-state of Athens in ancient Greece during the second year of the Peloponnesian War (430 BC), when an Athenian victory still seemed within reach. It is believed to have entered Athens through Piraeus, the city's port and sole source of food and supplies. The city-state of Sparta, and much of the eastern Mediterranean, was also struck by the disease. The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Modern historians disagree on whether the plague was a critical factor in the loss of the war. However, it is generally agreed that the loss of this war may have paved the way for the success of the Macedonians and, ultimately, the Romans. The disease has traditionally been considered an outbreak of the bubonic plague in its many forms, but re-considerations of the reported symptoms and epidemiology have led scholars to advance alternative explanations. These include typhus, smallpox, measles, and toxic shock syndrome.

The Italian Plague of 1629-1631 was a series of outbreaks of bubonic plague which occurred from 1629 through 1631 in northern Italy. This epidemic, often referred to as Great Plague of Milan, claimed the lives of approximately 280,000 people, with the cities of Lombardy and Venice experiencing particularly high death rates. This episode is considered one of the last outbreaks of the centuries-long pandemic of bubonic plague which began with the Black Death. German and French troops carried the plague to the city of Mantua in 1629, as a result of troop movements associated with the Thirty Years' War (1618-1648). Venetian troops infected with the disease retreated into northern and central Italy, spreading the infection. Overall, Milan suffered approximately 60,000 fatalities out of a total population of 130,000.
SEE ALSO: 10 Twisted Facts About The Dancing Plagues
Before the European arrival, the Americas had been largely isolated from the Eurasian-African landmass. First large-scale contacts between Europeans and native people of the American continents brought overwhelming pandemics of measles and smallpox, as well as other Eurasian diseases. These diseases spread rapidly among native peoples, often ahead of actual contact with Europeans, and led to a drastic drop in population and the collapse of native American cultures. Smallpox and other diseases invaded and crippled the Aztec and Inca civilizations in Central and South America in the 16th century. This disease, with loss of population and death of military and social leaders, contributed to the downfall of both American empires and the subjugation of American peoples to Europeans. Diseases, however, passed in both directions; syphilis was carried back from the Americas and swept through the European population, decimating large numbers.

The Great Plague (1665-1666) was a massive outbreak of disease in England that killed 75,000 to 100,000 people, up to a fifth of London's population. The disease was historically identified as bubonic plague, an infection by the bacterium Yersinia pestis, transmitted through fleas. The 1665-1666 epidemic was on a far smaller scale than the earlier "Black Death" pandemic, a virulent outbreak of disease in Europe between 1347 and 1353. The Bubonic Plague was only remembered afterwards as the "great" plague because it was one of the last widespread outbreaks in England. Although the disease causing the epidemic has historically been identified as bubonic plague and its variants, no direct evidence of plague has ever been uncovered. Some modern scholars suggest that the symptoms and incubation period indicate that the causal agent may have been a disease similar to a viral hemorrhagic fever. (Pictured above is a list of mortalities from the time of the plague.)

The Plague of Justinian was a pandemic that afflicted the Byzantine Empire, including its capital Constantinople, in the years 541-542 AD. The most commonly accepted cause of the pandemic is bubonic plague, which later became infamous for either causing or contributing to the Black Death of the 14th century. Its social and cultural impact is comparable to that of the Black Death. In the views of 6th century Western historians, it was nearly worldwide in scope, striking central and south Asia, North Africa and Arabia, and Europe as far north as Denmark and as far west as Ireland. The plague would return with each generation throughout the Mediterranean basin until about 750. The plague would also have a major impact on the future course of European history. Modern historians named it after the Eastern Roman Emperor Justinian I, who was in power at the time and himself contracted the disease. Modern scholars believe that the plague killed up to 5,000 people per day in Constantinople at the peak of the pandemic. It ultimately killed perhaps 40 percent of the city's inhabitants. The initial plague went on to destroy up to a quarter of the human population of the eastern Mediterranean.

The "Third Pandemic" is the name given to a major plague pandemic that began in the Yunnan province (pictured above) in China in 1855. This episode of bubonic plague spread to all inhabited continents, and ultimately killed more than 12 million people in India and China alone. According to the World Health Organization, the pandemic was considered active until 1959, when worldwide casualties dropped to 200 per year. The bubonic plague was endemic in populations of infected ground rodents in central Asia, and was a known cause of death among migrant and established human populations in that region for centuries; however, an influx of new people due to political conflicts and global trade led to the distribution of this disease throughout the world. New research suggests Black Death is lying dormant.

The Black Death (also known as The Black Plague or Bubonic Plague), was one of the deadliest pandemics in human history, widely thought to have been caused by a bacterium named Yersinia pestis (Plague), but recently attributed by some to other diseases. The origins of the plague are disputed among scholars. Some historians believe the pandemic began in China or Central Asia in the late 1320s or 1330s, and during the next years merchants and soldiers carried it over the caravan routes until in 1346 it reached the Crimea in southern Russia. Other scholars believe the plague was endemic in southern Russia. In either case, from Crimea the plague spread to Western Europe and North Africa during the 1340s. The total number of deaths worldwide is estimated at 75 million people, approximately 25 to 50 million of which occurred in Europe. The plague is thought to have returned every generation with varying virulence and mortalities until the 1700s. During this period, more than 100 plague epidemics swept across Europe.

(This article is licensed under the GFDL because it contains quotations from Wikipedia.)

SEE ALSO: 8 Fascinating Facts About Plague Doctors

Jamie is the founder of Listverse. When he's not doing research for new lists or collecting historical oddities, he can be found in the comments or on Facebook where he approves all friends requests!

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Top 10 Worst Plagues In History - Listverse

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History is dotted with epidemics and plagues, but a certain number of them stand out as unique for their severity and impact on future generations. This

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The best step you can take to prevent influenza (flu) and its potentially serious complications is getting a yearly flu vaccine.

Flu Vaccine Benefits:
While flu vaccines vary in how well they work, flu vaccination is the best way to prevent flu and its potentially serious complications.

Flu vaccines prevent millions of illnesses, tens of thousands of hospitalizations and thousands of deaths every season.

Flu vaccines are safe. Hundreds of millions of flu vaccines have been safely given to Americans for more than 50 years.

CDC kicks off the 2019-2020 seasonal flu vaccination campaign on Thursday, September 26 at 10 a.m. at the National Foundation for Infectious Disease (NFID) press conference in Washington, D.C.

Vaccination helps protect women during and after pregnancy. A CDC multi-year, multi-country study showed it reduced the risk of flu hospitalization among pregnant women by 40% on average. Flu vaccination during pregnancy also helps protects babies from flu for the first several months after birth when they are too young to be vaccinatedFlu vaccination can lower the risk of serious outcomes from heart disease and diabetes.

Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.

While some people who get vaccinated do still get sick, there is a growing amount of data showing that vaccination makes illness less severe, helping to prevent serious outcomes.

For more information, visit What are the benefits of flu vaccination?

CDC kicks off the 2019-2020 seasonal flu vaccination campaign on Thursday, September 26 at 10 a.m. at the National Foundation for Infectious Disease (NFID) press conference in Washington, D.C.

What flu vaccines are available this season?
For the 2019-2020 flu season, options include:

CDC and its Advisory Committee on Immunization Practices (ACIP) recommend providers use any licensed, age-appropriate flu vaccine with no preference for one vaccine over another.
Where to Get Vaccinated:
Flu vaccines are offered in many locations, including doctor's offices, clinics, health departments, pharmacies, and college health centers, as well as by many employers, and even in some schools. To find flu vaccine in your area, use the HealthMap Vaccine Finder.

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Everything you need to know about the flu illness, including symptoms, treatment and prevention.

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When she was 9 years old, Ann Albright went to the doctor with odd flulike symptoms. She was exhausted. She had to go to the bathroom frequently in the middle of the night. She was always thirsty. Even her vision was blurry.

After a few tests, the doctor pulled Albright's mother aside.

"I still remember it very vividly," says Ann Albright, now more than 40 years later. "My mom left the room with the doctor and came back in with tears running down her cheeks."

The verdict: diabetes, a disease that affects the way people process food.

At the time, the 1960s, the diagnosis meant that young Ann would never have the carefree childhood her mother wanted for her. For the rest of her life, she would have to give herself shots several times a day. She would need to be very careful about what she ate. And she might not realize all of her dreams in life.

"In the era I was diagnosed, most people were told they'd have a shorter life span," Albright says. "As a little girl with diabetes moving into adulthood, I wondered would I be able to have kids? Would I be able to have a life?"

Science has come a long way since then, says Albright, partly as a result of her own efforts: She's now a doctor and diabetes researcher at the Centers for Disease Control and Prevention in Atlanta. Since her diagnosis, researchers have developed better technologies, more effective medicines and a sharper understanding of how diabetes works.

Despite the advances, though, scientists still can't answer a lot of basic questions about what causes diabetes. There still is no cure. And living with the disease remains difficult.

"Everything changes" after a diabetes diagnosis, says Ali Reed, a pediatric endocrine fellow at the University of California, San Francisco. "Life becomes more complicated."

What's more, diabetes is on the rise - in both adults and kids. One version of the disease, called type 2 diabetes, is increasing at an especially alarming rate.

Scientists have linked type 2 diabetes with obesity. So now, more than ever, doctors are urging young people to start developing healthy habits as early as possible.
Breakdown
Diabetes refers to a group of diseases, but there are two main kinds: type 1 and type 2. In both types, the trouble begins with the body's ability to deal with sugar.

Sugar is the body's main fuel source. When you eat, your digestive system breaks down your food into basic parts, including proteins, fats and a simple sugar called glucose. Glucose gets absorbed through the intestines. From there, it enters the bloodstream. Circulating blood delivers glucose to all the cells, which convert it into energy.

At least, that's what's supposed to happen. In people with diabetes, however, sugar can't get from the bloodstream into the cells. A hormone, or messenger molecule, called insulin is normally responsible for that transfer. But in diabetics, insulin doesn't do its job.

As a result, sugar builds up in the bloodstream. When levels of sugar in the blood stay high, the condition is called chronic. And for reasons scientists don't yet understand, chronically high blood sugar can lead to blindness, kidney damage, limb amputations, heart attacks and more.

"It's not a death sentence, but it's a very serious disease," Albright says.
Two types
Exactly how diabetes affects a patient's life depends in part on which type of diabetes a person has. There are important differences between the two main types.

Type 1 diabetes is the kind Albright has. In this version of the disease, the body stops producing insulin. Symptoms usually begin in kids or teenagers.

After they're diagnosed and for the rest of their lives, type 1 diabetics need to regularly test their blood sugar levels with a pinching tool that draws a little blood. They also have to give themselves shots of insulin several times a day to control blood sugar levels. So far, scientists don't know how to prevent type 1 diabetes.

Type 2 diabetics make insulin, but their bodies don't use the hormone properly. Type 2 diabetes is far more common than type 1, and most people who have type 2 are adults. These days, though, more and more kids are coming to their doctors with symptoms of type 2 diabetes.

Doctors already know that adults who develop type 2 diabetes tend to be overweight or obese. And as kids have become increasingly overweight, the disease has started appearing at younger and younger ages.

Shorrocks/iStockphoto

As recently as a decade ago, type 2 diabetes was called "adult-onset" because kids just didn't get it.

"When this disease we used to only see in adults started happening in adolescents, it was just shocking to people," Albright says. "Pediatricians just didn't know what to do."
Healthy living
Doctors already knew that adults who develop type 2 diabetes tend to be overweight or obese. (Scientists can't yet explain why.) And as kids have become increasingly overweight, the disease has started appearing at younger and younger ages.

In the United States, two out of three adults are now overweight, according to the CDC. Nineteen percent of kids between the ages of 6 and 11 are overweight, compared with 7 percent just 20 years ago. Over the same period, the proportion of overweight teens rose from 5 percent to 17 percent.

(You can find out whether you are overweight by plugging numbers into a calculator at an online site. Also, see the sidebar "Understanding Body Mass Index" at the bottom of this article.)

Like their type 1 peers, type 2 diabetics have to monitor blood sugar levels. But they often rely on drugs instead of insulin shots. Frequently, they can get the disease under control by simply exercising more and eating reasonable portions of healthy foods.

"We now know that we can prevent or postpone type 2 diabetes by having [adults] at very high risk lose 5 to 7 percent of their body weight," Albright says.

Scientists don't yet know whether the same is true for overweight kids. The trend is so new that CDC researchers are still working to gather basic information about how the disease works in young people.

But it can't hurt to play soccer instead of video games, and to choose fruits and vegetables over junk food.

"There's no harm in having healthier lifestyle habits," Albright says. "Get to know what's going into your body. Make it fun."
Seeking answers
Weighing more than you should doesn't mean you're doomed to develop diabetes. The disease is far more complex than that. And while research has come a long way, plenty of questions remain.

Doctors don't know, for example, why certain ethnic groups have particularly high rates of diabetes, including American Indians, Hispanics and African Americans. Nor can doctors say for sure why the chances of getting diabetes go up if your parents or siblings have it.

Both relationships suggest that genes play a role in setting people up for diabetes. But something in the environment has to push those genes into action, and scientists aren't sure what those triggers are. It's also not clear which genes are involved.

"People spend their whole careers trying to understand this stuff," Albright says.

If you learn you have diabetes, don't despair. There's plenty you can do to live a long and healthy life. Also, know you're not alone.

Reed encourages all newly diagnosed kids to go to one of the nation's many diabetes camps. It can be hugely reassuring, she says, to be surrounded by other kids who feel like you do.

"It's really amazing," Reed says. "It's a very supportive and tolerating environment for kids who are often the only ones at their school with diabetes. At diabetes camp, everyone is going through it together."
Going Deeper:

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When she was 9 years old, Ann Albright went to the doctor with odd flulike symptoms. She was exhausted. She had to go to the bathroom frequently in the middle

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Is it those holiday parties filled with people eating together? We're not sure, but we keep hearing about new clusters of people getting poisoned by their meals.

The latest outbreak sickened at least 120 people in Boston, most of them students at Boston College.

This included eight members of the college's basketball team. The team is scheduled to play Providence this evening, and as of this morning, it's unclear whether the game will happen.

Most of the sick students reported eating at a nearby Chipotle Mexican Grill. (The college updated the number of students sickened from 80 to 120 students at 12:26 p.m. on Wednesday.)

This provoked suspicions of a link to an earlier outbreak of E. coli poisoning in the Pacific Northwest traced to Chipotle restaurants there.

It appears, however, that the two outbreaks are unrelated. According to preliminary tests, the Boston College students were sickened by another disease-causing organism, called norovirus.

Norovirus is sometimes overlooked, because it is less likely to kill you than disease-causing forms of E. Coli or salmonella. But it is by far the most common source of foodborne illness, according to the U.S. Centers for Disease Control and Prevention.

Chipotle has closed the restaurant near Boston College while the investigation continues. Government inspectors cited the company for allowing an employee to work there while ill last week, although the illness was not specified. Norovirus is highly contagious and is generally spread from person to person. (For more on what it's like when this nasty bug strikes, read Emily Sohn's essay over at Shots.)

On the other side of the country, meanwhile, prominent food safety lawyer Bill Marler tells us by email that an outbreak of foodborne illness has dampened spirits in his own office building. Last week, 200 people complained that they didn't feel well after a catered event in that building. Three went to the hospital. They were infected with norovirus.

Today, all the restaurants in that building are closed, including a Starbucks. "People look a bit uncomfortable on crowded elevators," Marler writes.

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Chipotle Faces Another Foodborne Illness Outbreak, This Time In Boston

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Is it those holiday parties filled with people eating together? We're not sure, but we keep hearing about new clusters of people getting poisoned by their meals. The latest outbreak sickened at least 120 people in Boston, most of them students at Boston College. This included eight members of the college's basketball team.

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aerosol A group of tiny particles suspended in air or gas. Aerosols can be natural, such as fog or gas from volcanic eruptions, or artificial, such as smoke from burning fossil fuels.

agent A compound or activating form of energy (such as light or other types of radiation) that has a role to play in getting something done.

air masses Large volumes of air, sometimes covering many hundreds or thousands of square kilometers (square miles), that typically have a consistent temperature or water-vapor content. Air masses are often classified by their source, such as continental, arctic or tropical. Air masses and other weather systems are steered across Earth's surface by jet streams and by differences in atmospheric pressure.

CandidaA genus of yeasts that are ubiquitous across the globe. More than 20 species have been linked to disease in people and animals.

cell The smallest structural and functional unit of an organism. Typically too small to see with the naked eye, it consists of watery fluid surrounded by a membrane or wall.

chemistry The field of science that deals with the composition, structure and properties of substances and how they interact with one another. Chemists use this knowledge to study unfamiliar substances, to reproduce large quantities of useful substances or to design and create new and useful substances.

climate The weather conditions prevailing in an area in general or over a long period.

clot (in medicine) A collection of blood cells (platelets) and chemicals that collect in a small region, stopping the flow of blood.

computer model A program that runs on a computer that creates a model, or simulation, of a real-world feature, phenomenon or event.

current A fluid body - such as of water or air - that moves in a recognizable direction.

DNA (short for deoxyribonucleic acid) A long, double-stranded and spiral-shaped molecule inside most living cells that carries genetic instructions. In all living things, from plants and animals to microbes, these instructions tell cells which molecules to make.

environment The sum of all of the things that exist around some organism or the process and the condition those things create for that organism or process. Environment may refer to the weather and ecosystem in which some animal lives, or, perhaps, the temperature, humidity and placement of components in some electronics system or product.

epidemic A widespread outbreak of an infectious disease that sickens many people (or other organisms) in a community at the same time. The term also may be applied to non-infectious diseases or conditions that have spread in a similar way.

fungus (plural: fungi) One of a group of single- or multiple-celled organisms that reproduce via spores and feed on living or decaying organic matter. Examples include mold, yeasts and mushrooms.

haze Fine liquid or solid particles scattered through the atmosphere that make it hard to see. Haze can be caused by harmful substances such as air pollutants or by water vapor.

heart attack Permanent damage to the heart muscle that occurs when one or more regions of it become starved of oxygen, usually due to a temporary blockage in blood flow.

infection A disease that can spread from one organism to another. It's usually caused by some sort of germ.

nucleus Plural is nuclei. (in biology) A dense structure present in many cells. Typically a single rounded structure encased within a membrane, the nucleus contains the genetic information.

organ (in biology) Various parts of an organism that perform one or more particular functions. For instance, an ovary is an organ that makes eggs, the brain is an organ that interprets nerve signals and a plant's roots are organs that take in nutrients and moisture.

outbreak The sudden emergence of disease in a population of people or animals. The term may also be applied to the sudden emergence of devastating natural phenomena, such as earthquakes or tornadoes.

Pacific The largest of the world's five oceans. It separates Asia and Australia to the west from North and South America to the east.

particle A minute amount of something.

pathologist Someone who studies disease and how it affects people or other infected organisms.

pediatrics A field of medicine that has to do with children and especially child health. A doctor who works in this field is known as a pediatrician.

physics The scientific study of the nature and properties of matter and energy. Classical physics is an explanation of the nature and properties of matter and energy that relies on descriptions such as Newton's laws of motion

red blood cell Colored red by hemoglobin, these cells move oxygen from the lungs to all tissues of the body. Red blood cells are too small to be seen by the naked eye.

tissue Any of the distinct types of material, comprised of cells, which make up animals, plants or fungi. Cells within a tissue work as a unit to perform a particular function in living organisms. Different organs of the human body, for instance, often are made from many different types of tissues. And brain tissue will be very different from bone or heart tissue.

toxin A poison produced by living organisms, such as germs, bees, spiders, poison ivy and snakes.

vaccine A biological mixture that resembles a disease-causing agent. It is given to help the body create immunity to a particular disease. The injections used to administer most vaccines are known as vaccinations.

virus Tiny infectious particles consisting of RNA or DNA surrounded by protein. Viruses can reproduce only by injecting their genetic material into the cells of living creatures. Although scientists frequently refer to viruses as live or dead, in fact no virus is truly alive. It doesn't eat like animals do, or make its own food the way plants do. It must hijack the cellular machinery of a living cell in order to survive.

weather Conditions in the atmosphere at a localized place and a particular time. It is usually described in terms of particular features, such as air pressure, humidity, moisture, any precipitation (rain, snow or ice), temperature and wind speed. Weather constitutes the actual conditions that occur at any time and place. It's different from climate, which is a description of the conditions that tend to occur in some general region during a particular month or season.

yeast One-celled fungi that can ferment carbohydrates (like sugars), producing carbon dioxide and alcohol. They also play a pivotal role in making many baked products rise.

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Hunting the mysterious source of a global illness

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Doctors and scientists around the world are scouring the environment for the elusive cause of Kawasaki disease, a harmful childhood illness.

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(for more about Power Words, click here)

cell The smallest structural and functional unit of an organism. Typically too small to see with the naked eye, it consists of watery fluid surrounded by a membrane or wall. Animals are made of anywhere from thousands to trillions of cells, depending on their size. Some organisms, such as yeasts, molds, bacteria and some algae, are composed of only one cell.

development (v. develop) In biology, the growth of an organism from conception through adulthood, often undergoing changes in chemistry, size and sometimes even shape.

epidemic A widespread outbreak of an infectious disease that sickens many people (or other organisms) in a community at the same time. The term also may be applied to non-infectious diseases or conditions that have spread in a similar way.

fetus (adj. fetal ) The term for a mammal during its later-stages of development in the womb. For humans, this term is usually applied after the eighth week of development.

flu Short for influenza. A highly contagious viral infection of the respiratory passages causing fever and severe aching. It often occurs as an epidemic.

Guillain-Barré Pronounced Gee-YAHN Bur-RAY. A rare condition that begins as the body's immune system attacks peripheral nerves, causing weakness or tingling in the lower extremities. In severe cases, total paralysis can result. Three to 5 percent of people with Guillain-Barré die from complications, scientists estimate. The syndrome is thought to be a complication of several infectious diseases, including HIV, dengue, influenza and Zika.

hippocampus A seahorse-shaped region of the brain. It is thought to be the center of emotion, memory and the involuntary nervous system.

immune system The collection of cells and their responses that help the body fight off infections and deal with foreign substances that may provoke allergies.

infection A disease that can spread from one organism to another. It's usually caused by some sort of germ.

journal (in science) A publication in which scientists share their research findings with the public. Some journals publish papers from all fields of science, technology, engineering and math, while others are specific to a single subject. The best journals are peer-reviewed: They send out all submitted articles to outside experts to be read and critiqued. The goal, here, is to prevent the publication of mistakes, fraud or sloppy work.

mature (verb) The process of growth and development that occurs as an individual moves toward adulthood.

microcephaly A condition that leaves babies with abnormally small heads and partially developed brains.

nerve A long, delicate fiber that communicates signals across the body of an animal. An animal's backbone contains many nerves, some of which control the movement of its legs or fins, and some of which convey sensations such as hot, cold, pain.

neuroscience Science that deals with the structure or function of the brain and other parts of the nervous system. Researchers in this field are known as neuroscientists.

risk The chance or mathematical likelihood that some bad thing might happen. For instance, exposure to radiation poses a risk of cancer. Or the hazard - or peril - itself. Among cancer risks that the people faced were radiation and drinking water tainted with arsenic.

STEM An acronym (abbreviation made using the first letters of a term) for science, technology, engineering and math.

stem cell A "blank slate" cell that can give rise to other types of cells in the body. Stem cells play an important role in tissue regeneration and repair.

symptom A physical or mental indicator generally regarded to be characteristic of a disease. Sometimes a single symptom - especially a general one, such as fever or pain - can be a sign of any of many different types of injury or disease.

syndrome Two or more symptoms that together characterize a particular disease, disorder or social condition.

ventilator (in medicine) A device used to help a person breathe - take in oxygen and exhale carbon dioxide - when the body cannot easily do that on its own.

virus Tiny infectious particles consisting of RNA or DNA surrounded by protein. Viruses can reproduce only by injecting their genetic material into the cells of living creatures. Although scientists frequently refer to viruses as live or dead, in fact no virus is truly alive. It doesn't eat like animals do, or make its own food the way plants do. It must hijack the cellular machinery of a living cell in order to survive.

womb Another name for the uterus, the organ in mammals in which a fetus grows and matures in preparation for birth.

Zika A viral disease that can be transmitted to humans via mosquitoes. About 20 percent of infected people get sick. Symptoms include a slight fever, rash and pinkeye and usually fade quickly. A growing body of evidence suggests that the virus could also cause a devastating birth defect - microcephaly. Evidence suggests it may also cause neurological conditions such as Guillain-Barré syndrome.

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Zika can damage the brains of even adults

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The Zika virus can damage a developing baby's brain. The infection can also kill off an important type of cells in adult brains, a new mouse study finds.

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Part One in an NPR Ed series on mental health in schools.
You might call it a silent epidemic.

Up to one in five kids living in the U.S. shows signs or symptoms of a mental health disorder in a given year.

So in a school classroom of 25 students, five of them may be struggling with the same issues many adults deal with: depression, anxiety, substance abuse.

And yet most children - nearly 80 percent - who need mental health services won't get them.

Whether treated or not, the children do go to school. And the problems they face can tie into major problems found in schools: chronic absence, low achievement, disruptive behavior and dropping out.

Experts say schools could play a role in identifying students with problems and helping them succeed. Yet it's a role many schools are not prepared for.

Educators face the simple fact that, often because of a lack of resources, there just aren't enough people to tackle the job. And the ones who are working on it are often drowning in huge caseloads. Kids in need can fall through the cracks.
"No one ever asked me"
Katie is one of those kids.

She's 18 now. Back when she was 8, she had to transfer to a different school in Prince George's County, Md., in the middle of the year.

"At recess, I didn't have friends to play with," she recalls. "I would make an excuse to stay inside with the teachers and finish extra work or do extra credit."

We're not using Katie's last name to protect her privacy. She's been diagnosed with bulimia and depression.

She says that in the span of a few months, she went from honor roll to failing. She put on weight; other kids called her "fat." She began cutting herself with a razor every day. And she missed a ton of school.

"I felt like every single day was a bad day," she says. "I felt like nobody wanted to help me."

Katie says teachers acted like she didn't care about her schoolwork. "I was so invisible to them."

Every year of high school, she says, was "horrible." She told her therapist she wanted to die and was admitted into the hospital.

During all this time, she says, not a single principal or teacher or counselor ever asked her one simple question: "What's wrong?"

If someone had asked, she says, she would have told them.
Who should have asked?
We talked to educators, advocates, teachers and parents across the country. Here's what they say a comprehensive approach to mental health and education would look like.
The family
The role: The first place to spot trouble is in the home, whether that trouble is substance abuse, slipping grades or a child who sleeps too much. Adults at home - parents, siblings, other relatives - are often the first to notice something going on.

The reality: Many families do not know what to look for. Sometimes a serious problem can be overlooked as "just a phase." But it's those sudden changes - angry outbursts, declining grades, changes in sleeping or eating - that can signal problems. When something unusual crops up, families can keep in close touch with the school.
The teacher
The role: During the week, many students see their teachers even more than their own families. Teachers are in a prime spot to notice changes in behavior. They read essays, see how students relate with other kids and notice when they aren't paying attention.

The reality: Teachers already have a ton on their plates. They're pressured to get test scores up, on top of preparing lessons and grading assignments. Plus, many teachers receive minimal training in mental health issues. But when they do see something concerning, they can raise a flag.
The social worker
The role: Social workers act like a bridge. If teachers come to them with a concern - maybe a child is acting withdrawn - one of the first things they'll do is call home. They see each child through the lens of their family, school and community. They might learn that a family is going through a divorce or homelessness.

The reality: There aren't enough of them. According to one model, every school should have one social worker for every 250 students. The reality is that in some schools, social workers are responsible for many more.
The counselor
The role: In some schools, counselors focus solely on academics: helping students pick classes and apply to college. But in others, they also act a lot like social workers, serving as a link to families and working with students who need support.

The reality: Like school social workers, there just aren't enough counselors. On average nationwide, each counselor is responsible for nearly 500 students. The American School Counselor Association recommends a caseload nearly half that size.
The special education teacher
The Role: Special education teachers may start working with students when a mental health problem affects the ability to do school work. They are primarily responsible for working on academic skills.

The reality: Again, there aren't enough of them. Nearly every state has reported a shortage of special education teachers. Half of all school districts say they have trouble recruiting highly qualified candidates.
The school psychologist
The Role: Here's one job that, on paper, is truly dedicated to student mental health. School psychologists are key players when it comes to crisis intervention and can refer students to outside help, such as a psychiatrist.

The reality: If you sense a pattern here, you're right. In the U.S., there is just one school psychologist for every 1,400 students, according to the most recent data available from the National Association of School Psychologists.
The school nurse
The role: Most any school nurse will tell you, physical and mental health are tough to separate. That puts nurses in a prime spot to catch problems early. For example: A kid who comes into the nurse's office a lot, complaining of headaches or stomach problems? That could be a sign of anxiety, a strategy to avoid a bully, or a sign of troubles at home.

The reality: The U.S. Department of Health and Human Services recommends at least one nurse for every 750 students, but the actual ratio across the country can be much higher.
The principal
The role: As the top dogs in schools, principals make the big decisions about priorities. They can bring in social-emotional, anti-bullying and suicide-prevention programs.

The reality: Principals also have a lot on their plates: the day-to-day management of student behavior, school culture and teacher support.
Getting help, and "excited for life"
Katie says things started to turn around for her when she met a nurse at the Children's National Health System in Washington, D.C., who finally showed interest in what was wrong.

Now, she's begun college and wants to be a pediatric nurse.

"I'm doing a lot better now" she says. " Obviously, I mean, I'm a lot happier. I'm excited for school. I'm excited to graduate. I'm excited for life."

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Mental Health In Schools: A Hidden Crisis Affecting Millions Of Students

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Part One in an NPR Ed series on mental health in schools. You might call it a silent epidemic. Up to one in five kids living in the U.S. shows signs or symptoms of a mental health disorder in a given year.

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How to Wash Your Hands – Read the Science Behind the Recommendations

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CDC recommends washing your hands in a specific way to avoid getting sick and spreading germs. Learn why each of the 5 handwashing steps – wet, lather, scrub, rinse, and dry – is important.

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Newsela | Instructional Content Platform

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Newsela is an Instructional Content Platform that supercharges reading engagement and learning in every subject.

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SPARTANBURG, S.C. - On a hot summer day last month, Sydney, 15, and Laney, 8, were enjoying their last two weeks of freedom before school started. The sisters tried to do flips over a high bar at a local playground.

"You've got to pull your hips into the bar, like you've got to kick up like that," explained their mother, Selena.

"I tried to kick! I did this - you told me not to stick out," said Laney indignantly.

Both girls have been diagnosed with mental illnesses - Sydney with bipolar disorder and Laney with a similar illness called disruptive mood dysregulation disorder. The family asked that their last name not be used to protect the girls' privacy.

School has been a real challenge for them. That's not unusual for the 1 in 5 children with a mental illness. They often suffer anxiety, difficulty focusing and social challenges. Half of them drop out of high school, in part because many schools don't manage to meet their needs.

Selena has spent the past eight years trying to get the girls the resources to help them succeed. Like a lot of parents of kids with mental health issues, she's had to be her children's biggest advocate.

"It's definitely a journey. It wasn't easy," she said, even though she's a school guidance counselor herself.

"I used to cry the night before, because I didn't want to go to school."

Sydney describes class as "boring, distracting. It's hard to pay attention. It's overwhelming." She struggles to focus or process information, which makes her so anxious and depressed that she often has to leave school in the middle of the day.

She wants to be a rock star like Courtney Love. Every so often she pretends to take drag from a bubble gum cigarette. But she's an extremely sensitive kid, and school has been a painful experience.

"I used to cry the night before, because I didn't want to go to school," she said.

Laney on the other hand is a ball of chaotic energy. At school, she often gets frustrated and acts out. Sometimes, she is sent home.

Schools do not all screen students for mental health issues, and the practice varies widely across states. Even if students are successfully identified, many areas lack the community-based mental health treatment options that would be needed to help them. Just 38 percent of youth with a mood disorder such as depression or bipolar disorder receive treatment services. In 2014, the federal government announced $48 million in new grants to support teachers, schools and communities in recognizing and responding to mental health issues. Still, many students' mental health problems continue to go unidentified and untreated.

When Selena first noticed the girls were having problems, she took them to the doctor. Sydney started taking medication at the age of 7 and Laney at just 4, but it wasn't a quick fix.

"The brain is complex," said Selena. "It's not like you just take a medicine and it fixes it." It took years to get the girls' diagnoses and prescriptions right.

Selena said she needed to educate teachers about her daughters' illnesses. "I really tried to do my homework. I did a lot of research. Obviously I talked to parents online in a support group," she said.

Schools are starting to better recognize that mental health is key to academic and social success, said Darcy Gruttadaro, director of advocacy at the National Alliance on Mental Illness, a grassroots organization headquartered outside Washington, D.C.

"Kids spend six hours a day in school, and mental health is essential to learning.

"Kids spend six hours a day in school, and mental health is essential to learning. So schools that are very data-driven understand that in order for some kids to succeed, their mental health needs must be met," she said.

Nonetheless, schools vary greatly in the degree to which they are willing and able to accommodate mental health issues. "Some are doing a lot and training teachers on how to recognize warning signs and talk to families. And others are doing very little to understand the needs of students and how to work with families," said Gruttadaro.

Sydney's and Laney's public schools were willing to make accommodations - but the girls' struggles continued. So, Selena transferred both to a smaller charter school called High Point Academy.

Principal John Hurley said he's seen a growing number of students coming in with mental health diagnoses. The school wants to help - but teachers are not well prepared to handle these issues.

"My training in mental health was one chapter in a book that we covered in one day," recalled Hurley. Many teachers have experience with attention deficit hyperactivity disorder, he said, but they don't have the tools to draw on when dealing with mood disorders.

"Because we're left in the dark, we have to fumble around to figure out what works best."

"Because we're left in the dark, we have to fumble around to figure out what works best," explained Hurley. "Sometimes you can be wildly successful, and sometimes you can fail miserably and you could have done the exact same thing for two different students."

That's a pretty good description of what happened with Laney and Sydney.

Laney started High Point in the second grade and, by October, had already begun acting out.

"A lot of the times she didn't like to write, so ... she'd get frustrated and she might tear up her paper just depending on how she was feeling," said her second grade teacher, Erica Smith. Occasionally, Laney would also tear up other students' assignments.

Selena was thrilled when Smith reached out and asked for advice. They started communicating almost daily, sharing tips about how best to reach Laney. They developed an individualized education plan, and Smith had a "safe spot" in the classroom where Laney could go to cool down until she could rejoin the class.

At the same time, Laney's doctor adjusted her medications to help balance her mood. The solutions worked - pretty soon Laney was thriving. But Selena knew from experience that what works with one kid doesn't always work with the other.

Selena helped get Sydney an individualized education plan that gave her extra time on tests, fewer assignments and two periods a day with special education teacher Pam Smith, who has a background in mental health.

"I really feel we had everything we could have had that was available to us to meet her needs," said Pam Smith. "I really feel that we went over and above sometimes."

"I started realizing it just wasn't working. I can't send my child somewhere every day and ignore the fact that it's having a negative impact on her mental health."

But nothing seemed to work. Sydney had trouble making friends and often shut down in class. She kept falling further behind.

"I started realizing it just wasn't working. I can't send my child somewhere every day and ignore the fact that it's having a negative impact on her mental health," said Selena.

So in March, she pulled Sydney out of High Point and home-schooled her for the rest of the year.

She looked for a therapeutic school for Sydney to attend this year, but she couldn't find one in her area. So this year, Sydney is attending an online school from home, while Selena works and Laney goes to the third grade at High Point. It's not an ideal solution. Selena wanted Sydney to be in a brick and mortar school with other kids, but she said she's had to learn to be flexible.

"You think as a parent you're supposed to just say, 'Get up and go back to school' the next day. And so you really have to sometimes stop and take stock of what's going on and maybe change the path," she said.

As for Sydney, she said she was looking forward to studying from home. For the first time in years, she said she hadn't been crying ahead of the first day of school.

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One out of five children have mental illness, and schools often don't help

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School has been a real challenge for them. That's not unusual for the 1 in 5 children with a mental illness. They often suffer anxiety, difficulty focusing and social challenges.

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*The Rüppell's griffon vulture is believed to be the world's highest-flying bird, with confirmed sightings at more than 35,000 feet (10,668 meters).

* Turkey vultures have such a good sense of smell that they've helped natural gas companies detect gas leaks. The gas contains the same chemical found in a dead animal, which attracts the vultures to the leak.

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Vultures may be gross, but they play an important role in the ecosystem.

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(by Betsy McKay and Gautam Naik, WSJ.com) - The swine flu epidemic crossed new borders Tuesday with the first cases confirmed in the Middle East and the Asia-Pacific region, as world health officials said they suspect American patients may have transmitted the virus to others in the U.S.

Most people confirmed with the new swine flu were infected in Mexico, where the number of deaths blamed on the virus has surpassed 150. But confirmation that people have been infecting others in locations outside Mexico would indicate that the disease was spreading beyond travelers returning from Mexico, World Health Organization spokesman Gregory Hartl told reporters on Tuesday in Geneva.

Mr. Hartl said the source of some infections in the U.S., Canada and Britain was unclear. The swine flu has already spread to at least six countries besides Mexico, prompting WHO officials to raise its alert level on Monday.

"At this time, containment is not a feasible option," said Keiji Fukuda, assistant director-general of the World Health Organization.

The United Nations public-health agency raised its global alert to phase 4 from phase 3. The change recognizes that the new A/H1N1 virus spreads from person to person, and signals that governments should prepare for outbreaks. Phase 6 is a pandemic.

Fifty cases - none fatal and most of them mild - were confirmed in the U.S. Including the New Zealand, Israeli and new Spanish reports, there were 92 confirmed cases world-wide on Tuesday. That included six in Canada, one in Spain and two in Scotland.

New Zealand confirmed that 11 people who recently returned from Mexico contracted the virus, Health Minister Tony Ryall said. Laboratory tests on samples from three of the 11 came back positive and "on that basis we are assuming" the eight others are also infected, he said.

Those infected had suffered only "mild illness" and were expected to recover, Public Health Director Mark Jacobs said.

In the Israeli city of Netanya, hospital officials said a 26-year-old patient recently returned from Mexico was the region's first confirmed case of swine flu, but didn't know whether the patient had the same strain as the one that appeared in Mexico. Avinoam Skolnik, Laniado Hospital's medical director, said Israeli Health Ministry laboratory tests confirmed the virus but the patient has fully recovered and is in "excellent condition."

Meanwhile, a second case was confirmed Tuesday in Spain, Health Minister Trinidad Jimenez said, a day after the country reported its first case. The 23-year-old student, one of 26 patients under observation, was not in serious condition, Mr. Jimenez said.

The European Union health commissioner suggested that Europeans avoid nonessential travel both to Mexico and parts of the U.S. Russia, Hong Kong and Taiwan said they would quarantine visitors showing symptoms of the virus.

Governments in Asia - with memories of previous flu outbreaks - were especially cautious. Singapore, Thailand, Japan, Indonesia and the Philippines dusted off thermal scanners used in the 2003 SARS crisis and were checking for signs of fever among passengers from North America. South Korea, India and Indonesia also announced screening.

Teams of doctors, nurses and government officials boarded flights arriving in Japan from Mexico, the U.S. and Canada to check passengers for signs of the flu, Japanese Health Ministry official Akimori Mizuguchi said.

World stock markets fell Tuesday as investors worried that any swine flu pandemic could derail a global economic recovery.

Cases Increase in the U.S.

With the virus spreading, the U.S. prepared for the worst even as President Barack Obama tried to reassure Americans. At the White House, a swine flu update was added to Mr. Obama's daily intelligence briefing. Mr. Obama said Monday the outbreak is "not a cause for alarm," even as the U.S. stepped up checks of people entering the country and warned U.S. citizens to avoid nonessential travel to Mexico.

"We are proceeding as if we are preparatory to a full pandemic," said Homeland Security Secretary Janet Napolitano.

The number of U.S. cases rose to 50, the result of further testing at a New York City school, although none was fatal. Other U.S. cases have been reported in Ohio, Kansas, Texas and California.

The Food and Drug Administration issued emergency guidance that allows certain antiviral drugs to be used in a broader range of the population in case mass dosing is needed to deal with the outbreak. The agency originally approved the use of the antiviral drug Tamiflu for the prevention and treatment of influenza in adults and children age 1 and older. Another antiviral drug, Relenza, was originally approved to treat people 7 years and older and to help prevent flu in those 5 and older.

Late Monday, the FDA said it issued emergency guidance to allow Tamiflu to treat and prevent flu in children under 1 year old and to provide doses other than originally approved in children over 1. The drugs may be distributed to larger segments of the population without complying with the approved label requirements, the FDA said. The agency also authorized a swine flu diagnostic test for testing samples from people with certain flu infections who virus subtypes cannot be identified by currently available tests.

On Monday, the Centers for Disease Control and Prevention raised its number of confirmed cases to 40 people, who ranged in age from 7 years old to 54.

The new cases tallied by the CDC were linked to the outbreak at the St. Francis Preparatory School in Queens, New York, where eight people had been identified earlier. The new cases came after further testing and weren't new outbreaks, said Richard Besser, the CDC's acting director.

The new cases in Texas include a 24-year-old, a 7-year-old and a 3-month-old in Dallas County. The Dallas County city of Richardson, where the 7-year-old is enrolled, will close an elementary school for the rest of the week, school-district spokeswoman Liz Morse said.

None of the Richardson students have required hospitalization, Ms. Morse said. She said the district made the decision to close Canyon Creek Elementary School on Monday afternoon after consulting with county health officials. She said parents of all Canyon Creek students, even those without symptoms, should keep their children out of public places to avoid spreading the disease.

"We really want the students to not be in public places, to stay maybe a little secluded so that if they've caught it they won't be spreading it around," Ms. Morse said.

The flu outbreak comes as the Obama administration seeks a new head of its Department of Health and Human Services, which oversees the CDC. The Senate on Tuesday is expected to begin debating the nomination of Kansas Gov. Kathleen Sebelius as HHS secretary. Democratic and Republican aides in the Senate said they expected Senate approval.

The U.S. government is far better prepared for an outbreak than it was when SARS awakened politicians and the public to the notion that infectious diseases continue to be deadly, even with modern vaccines.

Prodded by SARS and the avian flu scare that followed, President George W. Bush in 2005 issued a pandemic flu preparedness plan. Since 2006, $6.2 billion has been appropriated to stockpile antivirals, step up surveillance and improve vaccine-making and technology.

But state and local health departments - which are often the first to detect new infectious threats - haven't received federal funds for pandemic flu preparedness since 2006. Many of the agencies have cut staff and services in the recession.

"You can't stand up to this kind of capacity overnight if you haven't had resources to keep people on staff," said Jeffrey Levi, executive director of Trust for America's Health, a public health advocacy organization.

Investigation Intensifies

Mexico, where the number of deaths believed caused by swine flu rose by 50% on Monday to 152, is suspected to be ground zero of the outbreak. Health officials said they were stumped over why the strain has been so deadly in Mexico, where the number of suspected cases has surpassed 2,000 people.

Amid the alarm, there was a spot of good news. The number of new cases reported by Mexico's largest government hospitals has been declining the past three days, Mr. Cordova said, from 141 on Saturday to 119 on Sunday and 110 Monday.

In a bid to prevent mass contagion, Mexico canceled school nationwide until May 6, and the Mexico City government is considering a complete shutdown, including all public transportation. The Cinco de Mayo parade celebrating Mexico's defeat of a French army on May 5, 1862 and Mexico City's traditional May 1 parade were canceled. More than 100 museums nationwide were closed.

Three games involving Mexico City soccer clubs were played with no spectators over the weekend. Decio de Maria, secretary general of the Mexican soccer federation, said plans for future matches would be announced on Wednesday.

"The idea is to look for the fewest number of games that have to be played behind closed doors," he said. "If it's necessary, we'll play all the matches behind closed doors. We don't foresee canceling any games."

Many residents of Mexico City wore blue surgical masks, though the CDC said most masks offer little protection. Many victims have been in their 30s and 40s - not the very old or young who typically succumb to the flu. So far, no deaths from the new virus have been reported outside Mexico.
-Betsy McKay, Gautam Naik, Janet Adamy, Shai Oster, J.R. Wu, Ben Casselman, Jennifer Martinez, Alicia Mundy and Jonathan D. Rockoff contributed to this article. Write to Betsy McKay at betsy.mckay@wsj.com and Gautam Naik at gautam.naik@wsj.com.
Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. Reprinted here for educational purposes only. Visit the website at wsj.com.

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(by Betsy McKay and Gautam Naik, WSJ.com) - The swine flu epidemic crossed new borders Tuesday with the first cases confirmed in the Middle East and the Asia-Pacific region, as world health officials said they suspect American patients may have transmitted the virus to others in the U.S.

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Plague is best known as the killer disease that wiped out nearly half of Europe during the 1300s. But the germ infected people up to 3,000 years earlier than that, DNA from ancient teeth now show.

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Cell vs. virus: A battle for health - Shannon Stiles

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Aedes aegypti A species of mosquito that can transmit the viruses responsible for several tropical diseases, including dengue fever, yellow fever, chikungunya and West Nile disease.

Centers for Disease Control and Prevention, or CDC An agency of the U.S. Department of Health and Human Services, CDC is charged with protecting public health and safety by working to control and prevent disease, injury and disabilities. It does this by investigating disease outbreaks, tracking exposures by Americans to infections and toxic chemicals, and regularly surveying diet and other habits among a representative cross-section of all Americans.

chikungunya A tropical disease that has been crippling large numbers of people in Africa and Asia. It's caused by a virus that is spread by mosquitoes. It recently has been spreading widely throughout warm nations. More than 3 million people have suffered through its initial flu-like symptoms. A large share may also go on to develop intense pain in their muscles and joints that can last months to years. There is no cure or vaccine.

dengue fever A potentially lethal infectious disease transmitted by mosquitoes. No vaccine yet exists to prevent infection with the virus responsible for the disease, which causes high fevers, severe headache, joint pain, pain behind the eyes, rash, bone pain and sometimes mild bleeding. A more severe form of the disease, known as dengue hemorrhagic fever can cause uncontrolled bleeding if not treated right away.

extract (v.) To separate one chemical (or component of something) from a complex mix. (noun) A substance, often in concentrated form, that has been removed from its natural source. Extracts are often taken from plants (such as spearmint or lavender), flowers and buds (such as roses and cloves), fruit (such as lemons and oranges) or seeds and nuts (such as almonds and pistachios). Such extracts, sometimes used in cooking, often have very strong scents or flavors.

larva (plural: larvae) An immature life stage of an insect, which often has a distinctly different form as an adult. (Sometimes used to describe such a stage in the development of fish, frogs and other animals.)

perennial (in botany) A plant that lives for many years. Some may die back in harsh weather (extreme heat or cold), but then come back months later when conditions improve.

Society for Science and the Public (or SSP) A nonprofit organization created in 1921 and based in Washington, D.C. Since its founding, SSP has been not only promoting public engagement in scientific research but also the public understanding of science. It created and continues to run three renowned science competitions: The Intel Science Talent Search (begun in 1942), the Intel International Science and Engineering Fair (initially launched in 1950) and Broadcom MASTERS (created in 2010). SSP also publishes award-winning journalism: in Science News (launched in 1922) and Science News for Students (created in 2003). Those magazines also host a series of blogs (including Eureka! Lab).

toxic Poisonous or able to harm or kill cells, tissues or whole organisms. The measure of risk posed by such a poison is its toxicity.

tropics The region near Earth's equator. Temperatures here are generally warm to hot, year-round.

subtropics A geographic region that reaches to the beginning of the temperate climate zone (around 40° North and 40° South latitudes) from the edges of tropics, that band of hot climate spanning the outer belly of the planet. The tropics reach out to the Tropic of Cancer (around 23.5° north latitude) and Tropic of Capricorn (around 23.5° south latitude). The subtropics tend to be reliably warmer than temperate climates, but may experience brief periods of frost that would be unexpected in the true tropics.

temperate In geography, referring to areas that are cooler than the tropics but warmer than polar regions.

virus Tiny infectious particles consisting of RNA or DNA surrounded by protein. Viruses can reproduce only by injecting their genetic material into the cells of living creatures. Although scientists frequently refer to viruses as live or dead, in fact no virus is truly alive. It doesn't eat like animals do, or make its own food the way plants do. It must hijack the cellular machinery of a living cell in order to survive.

Zika virus A virus that can be transmitted to humans via mosquitoes. About 20 percent of infected people get sick. Symptoms include a slight fever, rash and pinkeye and usually fade quickly. A growing body of evidence suggests that the virus could also cause a devastating birth defect - microcephaly. Evidence suggests it may also cause neurological conditions such as Guillain-Barré syndrome.

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Common plant could help fight Zika virus

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A teen discovered that extracts from leaves of the San Francisco plant (Codiaeum variegatum) kill larvae of the mosquito that helps spread the Zika and dengue fever viruses.

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It's not like anybody believes their shopping carts are clean. Most supermarkets place a dispenser of sanitizing wipes nearby, as if to hint at the exact opposite.

But in case you were on the fence, yes, they're gross.

A study of 85 random shopping carts conducted by Dr. Charles P. Gerba found that 50 percent carried E. coli, while 72 percent contained coliform bacteria. "The exceptionally high level of coliform bacteria suggests that fecal material may be involved in cart contamination," the report further stated.

In other words, your cart most likely harbors bathroom germs.

According to Donna Duberg, an assistant professor of clinical laboratory science at Saint Louis University, these pathogens find their way into our carriages through a number of avenues. "Certainly children can be a source of the germs," she explains, as toddlers often ride in carts when accompanying their parents, but Duberg doesn't downplay the role of the consumers either. "We may bring in germs with our hands," she adds.

Depending on our immune systems, many of these pathogens have the potential to make us sick, too. "Especially the fecal coliforms," notes Elizabeth Scott, an assistant professor of biology at Simmons University in Boston. "The concern is that we can pick up pathogens from the cart that can be transmitted directly to our mouths or to other foodstuffs."

Is this really that big of a concern, though? Germs are everywhere, from to They're always going to be present, so how bad could a shopping cart be?

Duberg cites Gerba's findings for the answer: "[There are] 138,00 total bacteria per square inch of a shopping cart - an amount which exceeds the number of bacteria in the average public restroom," she says. "These are fecal bacteria capable of causing illness."

Unfortunately, fecal germs aren't the only bacteria to be wary of. "There are bacteria capable of causing food-borne illnesses such as Salmonella, Shigella, Listeria, and, of course, E. coli O157H7 that may be hiding in the food we are purchasing, especially the fruits and vegetables and raw meats," says Duberg. "You can tell by doing a quick scan of food recalls," such as these online safety alerts posted by the FDA, she adds.

Taking both fecal and food-borne pathogens into account, it's no wonder there are disinfecting wipes in almost every supermarket. But as it turns out, they may not be as effective as we think.

"In theory, it's a good idea, but rather hard to achieve," explains Scott. "Where do you apply the disinfectant? How effective is the disinfectant? It's much better to practice careful hand hygiene and use alcohol hand sanitizer and hand washing."

Duberg adds that most of the wipes are utilizing benzalkonium chloride - and not bleach or alcohol - a disinfecting agent. This means that in order to sanitize, shoppers should be thoroughly wetting the surface areas (handles, grates, coffee cup holders) with the wipes. But if a shopper wanted to disinfect, Duberg says most brands of benzalkonium chloride recommend you leave the surfaces wet for up to four minutes.

The good news, she adds, is that if you thoroughly wet the surfaces with a benzalkonium chloride wipe, "you're going to get way over 99 percent" of the germs.

Or, if you'd rather skip that step, you can just grab a hand-held basket instead. Baskets might contain the same pathogenic bacteria as a cart, but as Scott says, "If it's baskets vs. carts, at least baskets aren't used to carry kids."

But just to be safe, you should probably make time to wipe down the basket, too.

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Maybe a bit grosser than you initially thought.

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Plague is one of the deadliest diseases in human history, second only to smallpox. A bacterial infection found mainly in rodents and associated fleas, plague readily leaps to humans in close contact. Plague outbreaks are the most notorious epidemics in history, inciting fears of plague's use as a biological weapon.

Today, plague cases still pop up sporadically around the world-including in the United States or China, where a suspected case was recently reported in the Inner Mongolia region. But the disease is no longer as deadly as it can be treated with antibiotics when available.

Here's what you need to know about the plague, including how it spreads, the difference between bubonic and pneumonic plague, the most infamous plague pandemics in history, and why it's not all that unusual to see modern cases of the disease.

Stages of plague

For hundreds of years, what caused plague outbreaks remained mysterious, and shrouded in superstitions. But keen observations and advances in microscopes eventually helped unveil the true culprit. In 1894, Alexandre Yersin discovered the bacterium responsible for causing plague: Yersinia pestis.

Y. pestis is an extraordinarily virulent, rod-shaped bacterium. Y. pestis disables the immune system of its host by injecting toxins into defense cells, such as macrophages, that are tasked with detecting bacterial infections. Once these cells are knocked out, the bacteria can multiply unhindered.

Many small mammals act as hosts to the bacteria, including rats, mice, chipmunks, prairie dogs, rabbits, and squirrels. During an enzootic cycle, Y. pestis can circulate at low rates within populations of rodents, mostly undetected because it doesn't produce an outbreak. When the bacteria pass to other species, during an epizootic cycle, humans face a greater risk for becoming infected with plague bacteria.

Rats have long been thought to be the main vector of plague outbreaks, because of their intimate connection with humans in urban areas. Scientists have more recently discovered that a flea that lives on rats, Xenopsylla cheopis, primarily causes human cases of plague. When rodents die from the plague, fleas jump to a new host, biting them and transmitting Y. pestis. Transmission also occurs by handling tissue or blood from a plague-infected animal, or inhalation of infected droplets.

Bubonic plague, the disease's most common form, refers to telltale buboes-painfully swollen lymph nodes-that appear around the groin, armpit, or neck. The skin sores become black, leading to its nickname during pandemics as "Black Death." Initial symptoms of this early stage include vomiting, nausea, and fever.

Pneumonic plague, the most infectious type, is an advanced stage of plague that moves into the lungs. During this stage, the disease is passed directly, person to person, through airborne particles coughed from an infected person's lungs.

If untreated, bubonic and pneumonic plague can progress to septicemic plague, infecting the bloodstream. If left untreated, pneumonic and septicemic plague kills almost 100 percent of those it infects.

Infamous plagues

Three particularly well-known pandemics occurred before the cause of plague was discovered. The first well-documented crisis was the Plague of Justinian, which began in 542 A.D. Named after the Byzantine emperor Justinian I, the pandemic killed up to 10,000 people a day in Constantinople (modern-day Istanbul, Turkey), according to ancient historians. Modern estimates indicate half of Europe's population-almost 100 million deaths-was wiped out before the plague subsided in the 700s.

Arguably the most infamous plague outbreak was the so-called Black Death, a multi-century pandemic that swept through Asia and Europe. It was believed to start in China in 1334, spreading along trade routes and reaching Europe via Sicilian ports in the late 1340s. The plague killed an estimated 25 million people, almost a third of the continent's population. The Black Death lingered on for centuries, particularly in cities. Outbreaks included the Great Plague of London (1665-66), in which 70,000 residents died.

The cause of plague wasn't discovered until the most recent global outbreak, which started in China in 1860 and didn't officially end until 1959. The pandemic caused roughly 10 million deaths. The plague was brought to North America in the early 1900s by ships, and thereafter spread to small mammals throughout the United States.

The high rate of fatality during these pandemics meant that the dead were often buried in quickly dug mass graves. From teeth of these plague victims, scientists have pieced together a family tree of Y. pestis, discovering that the strain from the Justinian Plague was related to, but distinct from, other strains of the plague. ( Read how modern plague strains descended from a strain that arose during the Black Death pandemic.)

Plague in modern society

Plague still exists in various parts of the world, popping up sporadically and followed actively by the World Health Organization and Centers for Disease Control and Prevention. Most cases have appeared in Africa since the 1990s.

Between 2004 to 2014, the Democratic Republic of the Congo reported the majority of plague cases worldwide, with 4,630 human cases and 349 deaths. Scientists link the prevalence of plague in the Democratic Republic of Congo to the ecosystem-primarily mountain tropical climate. More recently, plague broke out in Madagascar in 2017, causing more than 2,300 cases.

The United States, China, India, Vietnam, and Mongolia are among the other countries that have had confirmed human plague cases in recent years. Within the U.S., on average seven human cases of plague appear each year, emerging primarily in California and the Southwest.

Today, most people survive plague with rapid diagnosis and antibiotic treatment. Good sanitation practices and pest control minimize contact with infected fleas and rodents to help prevent plague pandemics.

Plague is classified as a Category A pathogen, because it readily passes between people and could result in high mortality rates if untreated. This classification has helped stoke fears that Y. pestis could be used as a biological weapon if distributed in aerosol form. As a small airborne particle it would cause pneumonic plague, the most lethal and contagious form.

Of conservation concern, federally endangered black-footed ferrets contract another form of the plague, sylvatic plague, from nearby prairie dogs. Plague can decimate prairie dog populations, which are a critical food source for black-footed ferrets. Scientists have started to administer a vaccine to prevent plague outbreaks in prairie dogs and black-footed ferrets.

This story has been updated. It was originally published on August 20, 2019.

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Plague (Black Death) bacterial infection information and facts

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Known as the Black Death, the much feared disease spread quickly for centuries, killing millions. The bacterial infection still occurs but can be treated with antibiotics.

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How do cancer cells behave differently from healthy ones? - George Zaidan

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So there I was at a kid's birthday party, my 13-month-old daughter playing merrily with her brother in the sandbox, when she suddenly decided that she was hungry. Into her mouth it went-all of the sand-and though I was up with a leap and a "No," I was too late. I laughed nervously while furiously fishing sand out of her mouth (it's surprisingly hard to do, by the way) as other parents looked on with a mixture of unease and relief- Gross, but thank God it wasn't mine. My friend, the host who owned the sandbox, appeared. "Did I ever tell you," she said, "that I think my cat poops in there?"

Kids love sandboxes. Parents do not, and for good reason. When public health-testing organization NSF International sampled 26 different items in public places-toys at doctors' offices, children's library books, playground sandboxes-for a 2008 study on germs, they found that sandboxes were far and away the germiest of all, harboring nearly 2,000 times more bacteria, yeast, and mold per square inch than the door handles of public restrooms.

Of course, bacteria, yeast, and mold aren't all bad. Many are actually quite good for us. Not so for the other microbial gifts that sandboxes sometimes leave for kids: parasitic worms. Like giant litter boxes, uncovered sandboxes invite animals-raccoons, dogs, cats-to use them as bathrooms, which essentially turns them into giant parasite Petri dishes. And that's bad, because even if your kids don't eat handfuls of sand like mine do, they probably do put their fingers in their mouths an awful lot-and parasites are transmitted by what is not-so-euphemistically called the fecal-oral route, meaning they go from one animal (or kid's) butt straight to the next kid's mouth. Bon appétit!

OK, I know you're rolling your eyes, thinking: But most kids who play in sandboxes don't get sick. Fair enough. But it's also possible that kids are getting sick and we just don't know it. Doctors are not required to notify the government when they diagnose these infections-so no one is closely monitoring them or their epidemiology-and many kids who get parasites probably either never get diagnosed with them, as symptoms can be mild and spontaneously resolve, or their diagnoses are kept quiet. (Are you really going to tell your friends that your kid just got dewormed?) And when little Annie does get parasites, her parents also aren't going to tie it back to that time three weeks ago when she played in a sandbox. The fact is that a large proportion of Americans-many of them kids-are infected by parasites, and sandboxes are a known hot spot. "There is a real threat," says Laila Woc-Colburn, an infectious disease specialist at the Baylor College of Medicine in Houston.

Consider what happened when researchers at McGill University tested the surface sand from sandboxes at 10 local day care centers in 1991. Two of the sandboxes, they discovered, were contaminated with eggs of a parasite called . Once a child eats them, the eggs hatch in his or her body into larvae, which can burrow into the liver, lungs, central nervous system, or eyes. Sometimes the infection is asymptomatic, but when it's not and is not properly diagnosed and treated, it can cause liver damage, lung damage, or blindness. (An earlier 1979 study found that a whopping 39 percent of residential sandboxes in Kansas contained Toxocara eggs. Perhaps unsurprisingly, research suggests that 1 out of every 7 Americans over the age of 6 has been infected with this parasite.)

The McGill study also reported that one of the sandboxes with Toxocara eggs was co-contaminated with the eggs of , a parasitic worm that can, occasionally, cause intestinal blockage and stunted growth. Another parasite kids can get from sandboxes is Toxoplasma gondii, which is spread by cats and believed to chronically infect more than 1 out of every 6 Americans. In one study, researchers in Japan spied on three urban sandboxes at night using camcorders and found that over the course of five months, cats pooped in the boxes 961 times, and dogs pooped in them 11 times. They calculated that one of the sandboxes contained more than 1.5 million viable Toxoplasma eggs per square foot of sand, yet children need only ingest a single egg to get sick.

Although Toxoplasma infections are typically mild-some people get flu-like symptoms, while others feel fine, though most will harbor the parasite for the rest of their lives-individuals with compromised immune systems can fall very ill, and when women become infected during pregnancy, their babies can develop brain or vision damage or become sick later in life. (Some research also suggests that the parasite can affect behavior and personality. So the next time an aggressive driver cuts you off, calm yourself with the thought that he might be infested.)

Let's also not forget pinworms, the tiny little worms that live in your intestines, scurry down to your anus while you sleep, and lay their eggs there every night. Nearly half of all American kids are believed to have pinworms at any given time (and when they do, their parents usually have them too), but they're tough to diagnose: You basically have to set an alarm for a few hours after you go to sleep and then inspect your anus for crawling worms. (No, I'm not kidding.) As Austin, Texas-based pediatrician Ari Brown wrote in her best-selling book Toddler 411, sandboxes are an excellent place for kids to catch pinworms, because pinworms cause kids' butts to itch; then they scratch their butts, getting pinworm eggs on their fingers; then they build sandcastles studded with worm eggs.

I've left my favorite (as in: most absolutely terrifying) sandbox parasite for last. It's called Baylisascaris procyonis, and it is a roundworm that typically infects raccoons.

As many as 4 out of 5 raccoons carry this parasite, and infected coons typically poop out thousands, if not millions, of eggs a day-perhaps right on your lawn. In a 2009 study, researchers found raccoon poop in more than half of the suburban Chicago backyards they sampled. Once there, the parasite's eggs are virtually indestructible, except with exposure to very high heat. One scientist who has studied them recommends using an acetylene torch to incinerate the bastards.

Human infections with Baylisascaris seem to be very, very rare, although no one really knows why, considering everything I wrote above. But thank goodness, because the parasites are extremely dangerous. "If eggs are accidentally ingested by a human," a recent clinical report explained, "larval infection can lead to devastating neurological disease and death." One-third of cases are fatal. In 2009, two kids from Brooklyn caught it; one developed permanent brain damage, and the other went blind in one eye. Another child fell ill with it in Canada in 2009, presumably after-you guessed it!-playing in a sandbox. He was lucky because he was diagnosed and treated quickly, but the infection nevertheless robbed him of the ability to speak, gave him a seizure disorder, and damaged his eyesight.

So, yes, sandboxes are gross and can be dangerous. This is not to say that you should never let your kids play in them, because the danger is remote-they only rarely cause serious illness (my daughter's sandy snack seems to have done her no harm, although I haven't had her tested). If you own your own sandbox, though, consider covering it at night to keep out animals. If you have dogs or cats, make sure they are regularly checked for worms, and keep them out of the sandbox so they never wonder whether it might work well as a toilet. If you suspect that raccoons are pooping on your lawn, check out this Centers for Disease Control and Prevention guide to cleaning up their hazardous excrement.

As for public sandboxes: It kind of goes without saying, but if they smell bad, stay away. Also, (try to) keep your kids from putting their hands (or all the sand) in their mouths when they play, and make them wash their hands afterward. (Hand sanitizer won't kill worm eggs, Woc-Colburn says, so best to do it the old-fashioned way.) Would it be crazy to steer your kids away from public, always-uncovered sandboxes just in case? No, particularly if your kids have other sources for creative hands-on play. Brown, for one, has advised parents against them. And if your sandbox-frequenting kid does get really sick-symptoms of parasitic infections vary but can include fever, coughs, stomach pain, eye pain, or seizures-of course, take him to the pediatrician, and mention his sandbox use and any other relevant info, such as that you suspect your cat poops in it. Chances are high that your kid is never going to get really sick from sand play, but it's good to know about the risk just in case, even though it means-and for this I apologize-that you will never be able to look at a sandbox the same way again.
Read more of Slate's parenting coverage, including:

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Sandboxes Are Disgusting! Are You Sure You Want Your Kids Playing in Them?

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So there I was at a kid's birthday party, my 13-month-old daughter playing merrily with her brother in the sandbox, when she suddenly decided that she...

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Bacteria and other microbes can make us sick. But there's a lurking danger with some germs that's far more frightening than a bout of food poisoning or an infected wound. Today, drugs exist to fight most of these germs. They're called antibiotics. Before these medicines came along, common infections frequently killed people. And that's where the danger lies: What will happen if antibiotics no longer kill germs?

Already some antibiotics have lost their superpowers. Many others are beginning to lose theirs. Biologists describe this problem as resistance. Across the globe, germs are becoming resistant to antibiotic medicines. In a sense, these "superbugs" have begun to laugh at those former wonder drugs.

But resistance is no laughing matter. As germs toughen up against drugs that are supposed to slay them, treatable conditions such as TB - tuberculosis - can spread. And surgeries that rely on antibiotics could turn from life-saving to life-threatening.

The threat is huge

"Alarming levels" of drug-resistant bacteria already exist in many parts of the world. That's the conclusion of a 257-page report published in April. It was issued by the World Health Organization (WHO).

This United Nations agency, based in Geneva, Switzerland, recently reviewed how well these germ slayers perform in 114 countries. In some places, it found, antibiotics no longer work for half of all people being treated against common diseases. Those diseases include pneumonia and gonorrhea.

The Centers for Disease Control and Prevention (CDC), based in Atlanta, Ga., also has been investigating the problem . It estimates that in the United States alone, antibiotic-resistant infections now sicken some two million people each year. At least 23,000 of them die.

But even antibiotic-resistant germs that don't kill can be a problem. Their infections become harder to treat - and more expensive. Consider one estimate - $233 million - published May 20 in the journal Antimicrobial Resistance and Infection Control. That's how much researchers calculated that it costs the United States each year to deal with just one resistant superbug. That germ causes a lung disease known as pneumonia.

Drug-immune bugs that flourish in the human gut can enter the environment with every flush of the toilet. Researchers discovered how big this problem is when they analyzed wastewater from 11 sites in one French city. Antibiotic-resistant bacteria tainted 96 percent of their samples. A May 1 paper in Clinical Infectious Diseases describes the disturbing details.

Some scientists have scouted for such germs in the environment. They collected superbugs at hospitals. Then they probed the germs, identifying parts of their genes that appear to make them resistant to antibiotics. Next, the researchers looked in the outdoor environment for that same genetic fingerprint of superbugs. And they turned up that superbug DNA in 71 places - from the soil and sea water to human wastes. The researchers reported their findings May 8 in Current Biology.

Why it's happening

Drug designers have created antibiotics to kill bacteria, as well as some fungi and other germs. But sometimes, a few treated germs survive. They survive because they're stronger. Or they may have certain genetic mutations that allow them to break down the drug. They might even have evolved a way to keep the drugs from harming their operational machinery. Over time, all germs susceptible to a drug will die off. That will leave behind only superbugs - those microbes that medicines can't kill.

This is not surprising. In fact, it's quite natural. Part of evolution, it's known as survival of the fittest.

Scientists stumbled onto the first antibiotic, penicillin, around 1930. Since then, research has produced a medicine cabinet full of additional ones. It appeared that these would make many of the worst bacterial infections ever more manageable. So, during the 1970s, drug developers began focusing on noninfectious health problems, such as cancer and heart disease. As a result, in the past 30 years, no new types of antibiotics have been developed.

Right now, bacteria are outsmarting antibiotics faster than developers can make new ones. And there are no signs things will change, says Stewart Cole. He directs the Global Health Institute at the Ecole Polytechnique Fédérale de Lausanne in Switzerland.

Writing in the May 12 Philosophical Transactions of the Royal Society B, he argues that the "golden age" of antibiotic development "is a distant memory, and the likelihood of there being another seems slim." This lack of new types of germ killers, he says, has been allowing superbugs to morph and thrive.

One of the most famous of them is known as MRSA (pronounced MER-sah). The letters stand for methicillin-resistant Staphylococcus aureus . Methicillin is a widely used antibiotic. And Staph aureus is a germ that can cause boils, food poisoning, toxic-shock syndrome and more. These bacteria sicken (and sometimes kill) by releasing potent natural poisons - called toxins - into the body.

Despite its name, MRSA is resistant to far more antibiotics than just methicillin. That makes this superbug particularly nasty in hospitals and prisons. These are places where people often have open wounds or weak immune systems. Both increase a person's chance of picking up an infection.

Too much of a good thing

Drug resistance can develop at any time. But its likelihood climbs as the use of an antibiotic increases. And this is especially true when an antibiotic is overused. That's when a doctor prescribes it for infections it has no hope of curing.

For instance, doctors sometimes prescribe antibiotics to treat an infection before they learn if the disease is caused by bacteria. If viruses are responsible, then antibiotics will be useless. The reason: Antibiotic medicines do not kill viruses. Yet by giving an antibiotic to someone with a viral infection, that drug will reach good bacteria living in our bodies. And over time, some of these bacteria will become resistant to the drug.

Last year, the CDC reported that up to half of the antibiotics that U.S. doctors prescribed went to people who didn't actually need them.

Take, for example, someone who visits a doctor for a lingering cough. Viral infections cause most coughs. So a viral cough won't be helped by drugs and will tend to go away on its own. Yet 71 percent of the time, doctors will still prescribe antibiotics for patients coming in with a common cough, a May 21 study finds.

"I think there's this perception among both doctors and patients that coughs don't go away without antibiotic treatment," Jeffrey Linder told Science News for Students . Linder, who coauthored the new report, is a doctor at Brigham & Women's Hospital in Boston, Mass. He and Michael Barnett, also from the hospital, tracked the drugs that doctors prescribed during more than 3,000 U.S. clinic visits between 1996 and 2010. They reported their findings in the Journal of the American Medical Association .

A small number of people who visit a doctor with a cough turn out to have bacterial pneumonia. These cases do require antibiotic treatment. But Linder says doctors should easily be able to recognize these few from the hordes of people coming in with a routine, viral cough.

Perilous profit

Antibiotic overuse also has become a problem on farms. In the United States, animals - not people - receive about 80 percent of all antibiotics. Sometimes the drugs are used to save an infected animal or prevent disease from spreading through a herd. More often, though, feed suppliers put small amounts of these drugs into the food that will be given to healthy animals. These antibiotics help speed the animals' growth. And this has boosted farmers' profits.

But using antibiotics just to beef up livestock is "a direct threat to human health," argues Kellogg Schwab. He's an environmental microbiologist at Johns Hopkins University in Baltimore, Md. Earlier, he and his coworkers detected bacteria that are resistant to antibiotics in the exhaust air blowing out of farm buildings. That suggests these superbugs can spread through the air from animals to people.

SteveOehlenschlager / iStockphoto

Germs that are immune to antibiotics also can hitch a ride into your body through ground beef or the chicken breast on your cutting board. Biologists have found that much of the fresh beef, pork and poultry sold in grocery stores contains bacteria resistant to antibiotics.

Even if those germs don't sicken us or cause other immediate harm, they can offload their resistance genes into other bacteria that normally live inside our bodies. Sometimes, like with the MRSA superbug, resistance is carried on circular pieces of DNA called plasmids. These plasmids can slip easily from one bacterial cell into another.

In this way, our gut microbes can become "a reservoir of resistance," says Sharon Peacock. She's a microbiologist at the University of Cambridge in England. Later, "when we actually get sick and need an antibiotic, we may already carry a resistance gene" that may keep that drug from working, she says.

In the United States, farmers have fought against banning antibiotics as growth promoters. They say it will reduce their profits because more animals will get sick, slowing their growth. But that's not been the experience in other countries.

The U.S. Food and Drug Administration, or FDA, has proposed banning antibiotic use in healthy animals. But for more than 30 years, the livestock industry and Congress have fought such action. Recently, the FDA stepped up its efforts to end this practice.

In December 2013, FDA laid out a plan to phase out within three years the use of antibiotics on farms to boost livestock growth. Its stated reason: concern that farm use of these drugs has made more germs immune to the antibiotics needed to fight life-threatening infections in people. And that's a worry because the same germs that sicken animals often sicken people.

Antibiotic resistance is a complex and growing problem. Many microbiologists worry that the time when antibacterial medicines no longer work could be coming. Thankfully, doctors and many patients are becoming more aware of the problem. Researchers also are hard at work creating new tools to keep superbugs from taking over.
Next: How scientists are trying to tackle the problem
Power Words

antibiotic A germ-killing substance prescribed as a medicine (or sometimes as a feed additive to promote the growth of livestock). It does not work against viruses.

bacterium (plural bacteria) A single-celled organism forming one of the three domains of life. These dwell nearly everywhere on Earth, from the bottom of the sea to inside animals.

boils (in medicine) A skin infection that starts as a hard, red, painful lump. Eventually, it gets bigger, softens and fills with pus. A common source of these is a bacterium known as Staphylococcus aureus.

bioengineer A researcher who applies technology for the beneficial manipulation of living things. Bioengineers use the principles of biology and the techniques of engineering to design organisms or products that can mimic, replace or augment the chemical or physical processes present in existing organisms. This field includes researchers who genetically modify organisms, including microbes. It also includes researchers who design medical devices such as artificial hearts and artificial limbs.

Centers for Disease Control and Prevention, or CDC An agency of the U.S. Department of Health and Human Services, CDC is charged with protecting public health and safety by working to control and prevent disease, injury and disabilities. It does this by investigating disease outbreaks, tracking exposures by Americans to infections and toxic chemicals, and regularly surveying diet and other habits among a representative cross-section of all Americans.

cholera A bacterial disease that infects the small intestine, causing sever diarrhea, vomiting and dehydration. It is spread by germs from feces that contaminate water or food.

DNA (short for deoxyribonucleic acid) A long, spiral-shaped molecule inside most living cells that carries genetic instructions. In all living things, from plants and animals to microbes, these instructions tell cells which molecules to make.

evolution A process by which species undergo changes over time, usually through genetic variation and natural selection, that leave a new type of organism better suited for its environment than the earlier type. The newer type is not necessarily more "advanced," just better adapted to the conditions in which it developed.

fungus (plural: fungi) Any of a group of unicellular or multicellular, spore-producing organisms that feed on organic matter, both living and decaying. Molds, yeast and mushrooms are all types of fungi.

gene A segment of DNA that codes, or holds instructions, for producing a protein. Offspring inherit genes from their parents. Genes influence how an organism looks and behaves.

germ Any one-celled microorganism, such as a bacterium, fungal species or virus particle. Some germs cause disease. Others can promote the health of higher-order organisms, including birds and mammals. The health effects of most germs, however, remain unknown.

gonorrhea A serious disease that can infect the genitals, rectum and throat. This sexually transmitted disease is very common, especially among people between the ages of 15 and 24. Untreated, it can cause infertility or death. "Untreated gonorrhea may also increase your chances of getting or giving HIV - the virus that causes AIDS," according to the U.S. Centers for Disease Control and Prevention.

growth promoter (in livestock agriculture) A medicine, usually an antibiotic, added in small doses to the feed given to animals raised for meat. Used as a preventive medicine, it can reduce the risk that animals will become sick, which would slow their growth. And that would decrease a farmer's profits.

immune system The collection of cells and their responses that help the body fight off infection.

infection A disease that can be transmitted between organisms.

influenza (or flu) A highly contagious viral infection of the respiratory passages causing fever and severe aching. It often occurs as an epidemic.

livestock Animals raised for meat or dairy products, including cattle, sheep, goats, pigs, chickens and geese.

microbe Short formicroorganism. A living thing that is too small to see with the unaided eye, including bacteria, some fungi and many other organisms such as amoebas. Most consist of a single cell.

microbiology The study of microorganisms, principally bacteria, fungi and viruses. Scientists who study microbes and the infections they can cause or ways that they can interact with their environment are known as microbiologists.

mutation Some change that occurs to a gene in an organism's DNA. Some mutations occur naturally. Others can be triggered by outside factors, such as pollution, radiation, medicines or something in the diet. A gene with this change is referred to as a mutant.

plasmid A small circular loop of DNA that is separate from the main chromosomal DNA of bacteria.

pneumonia A lung disease in which infection by a virus or bacterium causes inflammation and tissue damage. Sometimes the lungs fill with fluid or mucus. Symptoms include fever, chills, cough and trouble breathing.

resistance (as in drug resistance) The reduction in the effectiveness of a drug to cure a disease, usually a microbial infection. (as in disease resistance) The ability of an organism to fight off disease.

superbug A popular term for a disease-causing germ that can withstand medicines.

toxic shock syndrome A rare and potentially deadly bacterial infection caused by Staphylococcus aureus. This bacterium release toxins - natural poisons - into the body of its host. Symptoms include a sudden high fever, muscle aches, vomiting, diarrhea, a rash and sometimes seizures.

toxin A poison produced by living organisms, such as germs, bees, spiders, poison ivy and snakes.

tuberculosis A bacterial disease that causes unusual growths in the lungs or other tissues. Untreated, it can kill. The infection usually spreads when a sick individual coughs (or talks, sings or sneezes), spewing germs into the air.

virus Tiny infectious particles consisting of RNA or DNA surrounded by protein. Viruses can reproduce only by injecting their genetic material into the cells of living creatures. Although scientists frequently refer to viruses as live or dead, in fact no virus is truly alive. It doesn't eat like animals do, or make its own food the way plants do. It must hijack the cellular machinery of a living cell in order to survive.

World Health Organization An agency of the United Nations, established in 1948, to promote health and to control communicable diseases. It is based in Geneva, Switzerland. The United Nations relies on the WHO for providing international leadership on global health matters. This organization also helps shape the research agenda for health issues and sets standards for pollutants and other things that could pose a risk to health. WHO also regularly reviews data to set policies for maintaining health and a healthy environment.

Citations

E. Landhuis. " The war on superbugs." Science News for Students. July 16, 2014.

B. Harder. " Joining the Resistance: Drug-immune microbes waft over hogs." Science News. Jan. 1, 2005.

A.L. Mascarelli. " Infectious animals." Science News for Students. April 17, 2013.

J. Raloff. " Antibiotics afield." Science News. Nov. 26, 2005.

J. Raloff. " Growth-promoting antibiotics: On the way out?" Science News. March 23, 2012.

J. Raloff. " Retail meats host drug-resistant bacteria." Science News. Oct. 20, 2001.

N. Seppa. " Danes keeping drugs out of livestock." Science News. April 8, 2003.

Original Journal Source: M. Barnett and J. Linder. Antibiotic prescribing for adults with acute bronchitis in the United States, 1996-2010. Journal of the American Medical Association (JAMA). Published May 21, 2014. doi: 10.1001/jama.2013.286141.

Original Journal Source: J. Nesme et al. Large-scale metagenomic-based study of antibiotic resistance in the environment. Current Biology. Published May 8, 2014. doi: 10.1016/j.cub.2014.03.036.

Original Journal Source: S. Peacock. Health care: Bring microbial sequencing to hospitals. Nature. Published May 29, 2014. doi:10.1038/509557a.

Original Journal Source: B. Spellberg, J. Bartlett and D. Gilbert. The future of antibiotics and resistance. New England Journal of Medicine. Published Jan. 24, 2013. doi: 10.1056/NEJMp1215093.

Original Journal Source: S. Cole. Who will develop new antibacterial agents? Philosophical Transactions of the Royal Society B. Published May 12, 2014. doi: 10.1098/rstb.2013.0430.

Original Journal Source: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Antibiotic-resistant threats in the United States, 2013.

Original Report Source: World Health Organization. Antimicrobial resistance global report on surveillance, 2014.

Teachers' questions: Superbugs: A silent health emergency

Esther Landhuis is a freelance journalist in the San Francisco Bay Area. She worked on her high school newspaper and spent a decade studying biology before discovering a career that combines writing and science.

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Have antibiotics become too popular? Overusing these medicines fuels resistant germs that pose a global health threat.

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Newsela | Instructional Content Platform

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Newsela is an Instructional Content Platform that supercharges reading engagement and learning in every subject.

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Kids learn about infectious diseases including pathogens such as viruses, bacteria, parasites, and fungi as well as transmission and other types of diseases.

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alien A non-native organism. (in astronomy) Life on or from a distant world.

annual Adjective for something that happens in every year.

astronaut Someone trained to travel into space for research and exploration.

constant Continuous or uninterrupted.

Enceladus The sixth largest of Saturn's more than 50 moons. Enceladus is bright white and covered with a thick shell of ice. Deep beneath that ice sits what appears to be a global ocean of salty liquid water. Enceladus is a round sphere, 500 kilometers (310 miles) across. It is a little less than one-third the width of Earth's moon.

environment The sum of all of the things that exist around some organism or some device and the condition those things create for that organism or device. Environment may refer to the weather and ecosystem in which some animal lives, or, perhaps, the temperature, humidity and placement of components in some electronics system or product.

Europa One of the moons of Jupiter and the sixth-closest satellite to the planet. Europa, 1,951 miles across, has a network of dark lines on a bright, icy surface.

extraterrestrial (ET) Anything of or from regions beyond Earth.

extremophile A microorganism that lives in conditions of extreme temperature, acidity, alkalinity or concentrations of chemicals.

germ Any one-celled microorganism, such as a bacterium, fungal species or virus particle. Some germs cause disease. Others can promote the health of higher-order organisms, including birds and mammals. The health effects of most germs, however, remain unknown.

geyser A vent (opening) in Earth's surface that intermittently sends up a tall spray of steam or hot water. The sometimes explosive discharge of water and steam is propelled by the geothermal heating of water below ground.

Jupiter (in astronomy) The solar system's largest planet, it has the shortest day length (10 hours). A gas giant, its low density indicates that this planet is composed of light elements, such as hydrogen and helium. This planet also releases more heat than it receives from the sun as gravity compresses its mass (and slowly shrinks the planet).

lander A special, small vehicle designed to ferry humans or scientific equipment between a spacecraft and the celestial body they will explore.

Mars The fourth planet from the sun, just one planet out from Earth. Like Earth, it has seasons and moisture. But its diameter is only about half as big as Earth's.

microbe Short for microorganism. A living thing that is too small to see with the unaided eye, including bacteria, some fungi and many other organisms such as amoebas. Most consist of a single cell.

NASA Short for the National Aeronautics and Space Administration. Created in 1958, this U.S. agency has become a leader in space research and in stimulating public interest in space exploration. It was through NASA that the United States sent people into orbit and ultimately to the moon. It also has sent research craft to study planets and other celestial objects in our solar system.

orbiter A spacecraft designed to go into orbit, especially one not intended to land.

organism Any living thing, from elephants and plants to bacteria and other types of single-celled life.

planet A celestial object that orbits a star, is big enough for gravity to have squashed it into a roundish ball and has cleared other objects out of the way in its orbital neighborhood. To accomplish the third feat, the object must be big enough to have pulled neighboring objects into the planet itself or to have slung them around the planet and off into outer space. Astronomers of the International Astronomical Union (IAU) created this three-part scientific definition of a planet in August 2006 to determine Pluto's status. Based on that definition, IAU ruled that Pluto did not qualify. The solar system now includes eight planets: Mercury, Venus, Earth, Mars, Jupiter, Saturn, Uranus and Neptune.

robot A machine that can sense its environment, process information and respond with specific actions. Some robots can act without any human input, while others are guided by a human.

satellite A moon orbiting a planet or a vehicle or other manufactured object that orbits some celestial body in space.

Saturn The sixth planet out from the sun in our solar system. One of the four gas giants, this planet takes 10.7 hours to rotate (completing a day) and 29 Earth years to complete one orbit of the sun. It has at least 53 known moons and 9 more candidates awaiting confirmation. But what most distinguishes this planet is the broad and flat plane of seven rings that orbit it.

science fiction A field of literary or filmed stories that take place against a backdrop of fantasy, usually based on speculations about how science and engineering will direct developments in the distant future. The plots in many of these stories focus on space travel, exaggerated changes attributed to evolution or life in (or on) alien worlds.

terrestrial Having to do with planet Earth, especially its land. Terra is Latin for Earth.

viable Able to live and survive. (in biology) Able to survive and/or live a normal lifespan.

weed (in botany) A plant growing wild in, around - and sometimes smothering over - valued plants, such as crops or landscape species (including lawn grasses, flowers and shrubs). Often a plant becomes such a botanical bully when it enters a new environment with no natural predators or controlling conditions, such as hard frosts. (in biology, generally) Any organism may be referred to as a "weed" if it enters an environment and begins to overwhelm the local ecosystem.

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Keeping space missions from infecting Earth and other worlds

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Scientists are always looking for ways to stop Earthly microbes from polluting other planets. The same goes for bringing bits of other planets back to Earth.

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Even though it isn't guaranteed to cause health problems, there are quite a few gross things that can happen when you don't wash your hands. Because, as we all know, germs are everywhere. And it often doesn't take much to pick them up throughout the day, or pass them along to others.

Thankfully, the immune system usually steps in before bacteria and viruses can do any real damage. But if you aren't washing your hands regularly, you may be unnecessarily putting yourself at risk. After all, "the number one way to prevent disease is hand washing," Dr. Elizabeth Trattner, tells Bustle. So even though it can be easy to put it off, it's much healthier to pop off to the bathroom and give your mitts a quick scrub, especially after coming in contact with dirty surfaces or if you happen to be sick.

"The best hand washing technique is to rinse hands under warm water, then lather with soap for 20 to 30 seconds, getting all areas of the hands," Brianne Bell, registered dietician and food service supervisor, tells Bustle. "Rinse under warm water and dry with a clean towel." That should help reduce the risk of all the gross things below, which may be more likely to happen if you don't wash your hands.

1. You Might Catch More Colds

According to the Centers for Disease Control and Prevention (CDC), about 80 percent of infectious disease is spread by touch. And really, all it takes is the simple act of grabbing a germ-riddled doorknob and then touching your nose, in order to get infected. So let this serve as motivation to whip out the soap on a more regular basis, not only for your own sake, but for everyone else's health as well.

Of course, that doesn't mean you need to become paranoid. Most of the time your body protect you from germs, especially if your immune system is strong. But even still, washing up whenever you've been around someone with a cold is always a good idea.

2. Fecal Matter Can End Up In Your Food

It's a gross truth, but fecal matter is lurking in more places than you might think - including your hands. And rather disgustingly, those particles can get into food and make you sick, according to the CDC.

It may not be something you want to imagine. But as long as you're washing your hands after using the bathroom, changing a diaper, walking your dog, or even using public transportation, you should be able to lower your risk.

3. You Could Get Or Spread Food Poisoning

There are many ways to come down with a case of food poisoning, including eating undercooked meats, or food that has gone bad. You can also get pretty darn sick by preparing meals with dirty hands. (See above information about fecal matter).

According to the CDC, a large percentage of food-borne disease outbreaks are spread by contaminated hands. But appropriate hand washing practices can reduce the risk of food-borne illness and other infections. So do yourself, and everyone else, a huge favor by washing before you handle food.

4. You're Infecting Everyone You Touch

Sure, it's polite to cover your sneeze with your hand than it is to let if fly. And yet, how often do you really wash up after doing so? It's easy to forget, or to touch a few surfaces first - and just like that the germs spread.

Again, hand washing is the best way to prevent the transfer of disease, which is why "this is one of the first things you learn in medical school or in any health profession," Dr. Trattner says.

In a pinch, using hand sanitizer can cut back on the transfer of germs, Bell says. But nothing beats a good ol' scrub when it comes to reducing the amount of bacteria and viruses on your hands.

5. You Can Get Pink Eye

Pink eye, also known as conjunctivitis, is an eye infection many people catch in elementary school, mostly because it's highly contagious and thus spreads like wildfire among kids. But adults can get it, too.

In fact, often all it takes is a quick moment of hand-to-eye contact when you have an infected person's secretions on your hand, according to the American Academy of Ophthalmology, before the typical symptoms of redness, itchiness, and pus in the eyes will begin.

6. Your Snacks Can Get Contaminated

Think of all the times you've plunged a dirty hand into a bag of chips, box of crackers, or bowl of popcorn. If you aren't washing your hands, it's so easy to contaminate these shared foods with germs, according to the New York State Department of Health.

This is also why you may not want to share food or utensils with someone who is sick, especially if they have the norovirus. According to the CDC, if you get the norovirus illness, you can shed billions of norovirus particles that you can't see without a microscope, and it only takes a few of these particles to make people sick.

7. You Might Pick Up Hepatitis A

Not washing your hands can also lead to hepatitis A. "This is a serious liver virus that spreads when people do not wash their hands before making food and drinks," Dr. Tania Elliott, board-certified allergist/immunologist at NYU Langone Health, tells Bustle. "It also spreads through sexual contact with people who have hepatitis A, and by eating foods contaminated with the virus."

You can, however, make it less likely to happen. As Dr. Elliott says, "Washing your hands with soap and warm water after using the bathroom, changing a diaper, or before making food and drinks can help stop the spread of hepatitis A."

8. Diarrhea May Become A Frequent Visitor

Not washing your hands regularly can increase your chances of catching an illness that leads to diarrhea. One of these might be shigellosis, a bacterial infection with symptoms that include watery diarrhea, abdominal cramps, and fever, according to the CDC.

There is good news, though, in that simply washing your hands - especially after coming in contact with germ-y surfaces - can prevent about 30 percent of diarrhea-related sicknesses, the CDC says.

9. You Might Catch The Epstein-Barr Virus

We talked about poop in your food. Now what about urine, or saliva? Turns out, these are carriers of diseases like typhoid, cytomegalovirus, and Epstein-Barr virus, which are spread by contaminated hands, according to the CDC.

Epstein-Barr is the virus that causes mononucleosis, AKA the "kissing disease," which can lead to fever, weakness, swollen neck glands, and fatigue that lasts for weeks. "This is spread through saliva, so kissing, sharing food or beverages, or touching something with saliva on it are all ways in which it can be transmitted," Dr. Elliott says. "Hand washing, especially after touching the face and mouth [...] can help prevent the spread."

10. It Could Contribute To Antibiotic Resistance

According to the CDC, reducing the number of infections people get by washing your hands can help prevent the overuse of antibiotics, which is the single most important factor leading to antibiotic resistance around the world.

"Antibiotics are often overused when someone has a viral infection (remember, antibiotics only fight bacterial infections, not viruses)," Dr. Elliott says. "So, the fewer viral infections (by proper hand washing and other sanitary measures), the less use of unnecessary antibiotics."

In fact, hand washing can also prevent people from getting sick with germs that are already resistant to antibiotics and that can be difficult to treat, according to the CDC. So help out everyone on the planet, and wash your those hands!

11. Acne Can Crop Up

Not washing your hands can also increase the chances of an acne breakout, all thanks to the way bacteria can transfer from your hands to your face.

"Touching, rubbing, and picking [at the] face are common causes for more acne," Dr. Yoram Harth, board-certified dermatologist and medical director of MDacne, tells Bustle. "When the hands are not washed, the bacteria on the skin of our hands spread to the face and can cause more acne."

Germs truly are lurking around every corner. And they can obviously cause and spread all sorts of diseases, from the common cold, to the norovirus, and even hepatitis A. But by getting into the habit of washing your hands regularly - especially before touching food - you may be able to enjoy a more germ-free life.
This post was originally published on 4/12/2016. It was updated on 6/7/2019.

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11 Gross Things That Can Happen When You Don't Wash Your Hands Enough

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Even though it isn't guaranteed to cause health problems, there are quite a few gross things that can happen when you don't wash your hands. Because, as we all know, germs are everywhere. And it often doesn't take much to pick them up throughout the...