We all look for ways in which we can stay healthy and avoid illness. Not only can illnesses be inconveniencing and annoying, but also they can be serious and life-threatening. Below are 10 considerations for anyone that would like to stay infection-free this year (in no particular order):

1. Get vaccinated.

Vaccinations are an excellent protection from infection, though some better than others. In the pre-antibiotic era, the hope of eradicating illness was on vaccine discovery. It is still important as ever. Viral illnesses for which we have vaccinations, such as polio and measles, are still breaking out in various undervaccinated areas.

They are an attempt to equip the immune system with active soldiers ready for battle, by putting an “unequipped virus” or “weapon knowledge” into the body to allow it to form antibodies against them. With the most likely side effect being a sore arm for a few days, it seems like a pretty good trade-off. Generally, a viral vaccine may be 1) live,attenuated (weakened), or 2) killed or component vaccines; Bacterial vaccinations are usually wall or toxin components and are formulated as polysaccharide (sugar) or conjugate (mixture).

Live vaccinations generally induce a more robust immune response. Some examples of live vaccinations include measles,mumps and rubella (MMR), oral polio vaccine (not routinely used in the US currently), Varicella, live influenza vaccine, yellow fever vaccine and oral typhoid (Salmonella typhi) vaccination. Killed or component vaccinations include injectable polio vaccine (IPV), tetanus, diphtheria and pertussis toxoid (Tdap), pneumococcal vaccine (Pneumovac), and quadrivalent meningitis (A,C,Y, W-135), influenza trivalent vaccine.

Anytime there have been disruptions in vaccine administration, ie a misconception that vaccinations are linked to autism (Wakefield debacle) {As an aside, the rate of a severe reaction to MMR vaccine is 1 to 100,000 – including encephalitis in a smaller fraction compared to severe complication or death to wild type measles 1 to 1,000}, religious or other beliefs,etc, there have been clusters of illnesses that would not regularly be seen with vaccination; thus, non-vaccination may cripple “herd immunity” and increase the emergence of an infection. Measles (rubeola) continues to erupt in areas of low vaccine penetration, sometimes imported from higher prevalent countries with less rigorus vaccine systems in place. For instance, Ukraine saw more than 30,000 cases of confirmed measles in 2018. The country has a. estimated vaccination coverage of 46%

As of February 3rd, in Clark county WA there have been 47 confirmed cases and 7 suspected cases of measles, the majority in those unvaccinated (41/47).

Vaccinations are a great option for patients to avoid becoming ill. Get vaccinated! Keep your children on a vaccine schedule ideally without slowing it down.

2. Get plenty of sleep

Sleep deprivation can lead to impairment of immune activation, both natural immunity (NK cell population) and T cell function. Pro-inflammatory cytokines IL-6 and TNF-alpha Receptor 1 were increased after four days of sleep deprivation. There is likely impaired activation of the immune system and inflammation after periods of decreased sleep.

Sleep disorders such as sleep apnea or primary insomnia can decrease efficiency of sleep and lead to health risks. It is important to discuss with your doctor if you have frequent sleeping problems, whether it is getting to sleep or staying asleep. Other signs can include decreased restful sleep, feeling tired early in the day, “caffeinating” possibly more than 2-3 cups reaching for alcohol or sleeping pills at night. Other signs include lower extremity swelling, frequent nighttime urination, dry mouth in the night, night sweats and morning headaches.

3. Avoid or limit medications that can affect the immune system.

A lot of previous prescription medications are now available over the counter. Medications can have direct or indirect effects on the immune system. Medications such as prednisone, cellcept (mycophenolate), imuran (azathioprine) can have a direct effect on the immune system usually by impairing both B-cell (think antibodies) and T-cell (think killer T-cells) function.

Newer medications, known as monoclonal antibodies are directed toward T cell receptor (CD-3) and IL-2a and are associated with some immunodeficiency. There may be an increased risk of activating TB in someone who has latent TB infection as well as Staph aureus infections possibly and other fungal infections.

Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, diclofenac, etc; may lead to an increased risk of infection, such as skin and soft tissue infections – the jury is still out. Careful consideration to the risks and benefits should be discussed in using all of the above medications. On a personal experience note, I have seen much more severe skin and soft tissue infections in patients that take high doses of nonsteroidals.

Antibiotics used for long periods of time or for inappropriate diagnoses can lead to an increased risk of infections, including Clostridium difficile diarrhea, increased carriage of Methicillin-resistant Staphylococcal aureus (MRSA), and increased risk of skin and vaginal fungal infections.

4. Social distance from anyone that may be ill.

This is probably the most challenging thing of which to remain aware. It is not always clear if a contact is ill. He or she may not be aware of this in the prepatent period, the time before a patient becomes clinically aware of an illness, yet is able to spread the illness. Children have a hard time with this, and usually the whole family gets the virus after a child comes down with the illness.

It is a good practice to not shake someone’s hand if they have coughed or sneezed or picked their nose with it. But one doesn’t always know… Can I get a fist bump instead? Since it is kind of cool now to do that, the other person will never know. Maybe you can still wipe your hands with that keychain alcohol hand sanitizer – carry alcohol or wash your hands after shaking hands and before eating.

5. Keep physically active and Keep levels of Stress Low

Regular exercises strengthens the body and provide richly oxygenated blood to the body. Regular physical activity leads to a reduction of stress reaction and enhances sleep. Rapid increases in Natural Killer (NK) cells were found after exercise secondary to norepinephrine release.

Stress hormones, such as cortisol, are released in a fight or flight perceived or real situation or with sleep deprivation. These hormones can lead to T-cell dysfunction and leukocyte adhesions molecules which allow T-cell to traffic to sites of infection. Exercise and meditation will likely reduce one’s reaction to stress and lead to decreased cortisol secretions.

6. No smoking and marijuana and limit excessive alcohol intake

If you are a smoker, NOW is the best time to quit. A smoker has a three-fold higher risk of bacterial pneumonia than a non-smoker. Tobacco paralyzes respiratory cilia (tiny hairs) movement, limiting the body’s natural ability to clear bacteria and other particles away from the lower respiratory tract.

Excessive alcohol intake may lead to an increased aspiration risk. Alcohol in excess can also impair the bone marrow, leading generally to a macrocytic anemia with a low platelet count and low white blood count.

7. Good dental hygiene. See a dentist twice yearly.

Good dental hygiene is an important defense from infection. The mouth harbors billions of bacteria. In the setting of poor hygiene, the barrier of the gingiva is altered, increasing the likelihood of bacteremia. Serious infections, including a heart valve infection (endocarditis) can result from a breach in this barrier. Regular brushing and flossing cleans the teeth of any residual foods that can cause fermenting Strep bacteria to produce acid that leads to dental caries and gingivitis.

8. Healthy skin keeps the primary defense strong. Keep the skin moisturized so that there is risk for skin abrasions, cuts or fissures of the skin, such as in dry skin. Be careful with the razor, ensuring razor is not dull, it is treated with rubbing alcohol, shaving cream is used and the skin is moisturized after. Any traumatized area should be protected and avoid unroofing any scabs. I routinely see patients with recurrent Staphylococcus aureus infections and they ask me how to reduce this. Most of them happen to be body shavers – men and women!

9. Yearly physical evaluation and medical visits and screening studies as needed.

Even with the availability of medical information on the internet, there is still substantial knowledge asymmetry. Therefore, a patient relies on the expertise of a trained clinician. I use the analogy of “taking your car in for service”. It is often the case that a person is not able to fully determine the root cause of a problem on account of the subjectivity of their interaction with the symptoms and signs and limited medical knowledge base. A clinician can process the information and approach it more objectively. A clinician can approach your health with a thorough history, physical examination and screening tests that may uncover medical conditions that would increase the risk of infections, e.g. diabetes mellitus, thyroid disease, hepatitis C, HIV,etc. Another example of the value of a medical visit is to mitigate a risk that would predispose to an infection (e.g. treating asthma) or treat an infection before it worsens.

Thus, a good way to ensure that you stay clear of infectious diseases would be to have medical visits. In someone who is healthy, probably a yearly visit is a good place to start.

10. Keep a healthy weight and a nutritious diet.

An optimally functioning body will be able to neutralize an infectious particle and reduce the severity of disease process. As one becomes more overweight, the body is already taxed by its attempt to compensate. This impacts the way the immune system functions as well. There was an association with high Body mass index results (BMI>35) and increase need for being hospitalized in the ICU or even death during the swine flu outbreak in 2010. Reasons are multiple: 1) Sleep deprivation from obstructive sleep apnea lead to cortisol hypersecretion; 2) chronic hypoventilation of the lungs increases the risk of pneumonia: 3) aspiration of gastroesophageal reflux leads to an increased risk of pneumonia. 4) Long-term obesity can lead to liver and spleen disease, which impairs the immune system substantially.

In summary, protection from infectious diseases does not always require a non-rebreather mask or a biohazard suit. Practicing a common sense approach to keeping healthy is often all that is needed.