tag:theconversation.com,2011:/africa/topics/tetanus-10514/articlesTetanus – The Conversation2023-05-30T13:56:08Ztag:theconversation.com,2011:article/2062202023-05-30T13:56:08Z2023-05-30T13:56:08ZFour dangers lurking in your garden – and how to protect yourself<figure><img src="https://images.theconversation.com/files/529077/original/file-20230530-29-d5un5v.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5487%2C3638&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The soil you use for your roses may contain something sinister.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-gardener-transplanting-red-roses-flowers-1675428565">Mariia Boiko/ Shutterstock</a></span></figcaption></figure><p>Many people see gardening as a relaxing pastime – an easygoing way to spend hours outdoors when the weather’s nice. But as a consultant in emergency medicine, I deal with all manner of medical emergencies and injuries arising from what may appear to be a harmless hobby.</p>
<p>Over the years, I have seen hand wounds from cutting implements and foot wounds from lawn mowers and garden forks. In recent weeks, I have seen falls from ladders, head wounds from falls on concrete – and, sadly, confirmed the death of a person in their later years whose enthusiastic shovelling proved too much. </p>
<p>Even in times past, the garden could be quite the health hazard. One of the <a href="https://www.ox.ac.uk/news/science-blog/penicillin-oxford-story">first patients</a> to be treated with penicillin was a police officer who had apparently contracted sepsis after a scratch from a rose thorn. In those days, the most minor of wounds could have the deadliest of consequences – and it turns out this can still happen, with a UK woman recently dying from sepsis after <a href="https://www.telegraph.co.uk/news/2016/10/03/solicitor-dies-from-sepsis-five-days-after-injuring-her-hand-gar/">scratching her hand while gardening</a>. </p>
<p>But these aren’t the only dangers lurking in your garden. Here are just a few things to look out for before you next head out to tend your plants:</p>
<h2>1. Tetanus</h2>
<p>Tetanus is a particularly nasty disease. The muscles go into spasm due to the effects of the toxin from the bacteria, <em>Clostridium tetani</em>. The <a href="https://www.ncbi.nlm.nih.gov/books/NBK459217/#:%7E:text=The%20clinical%20features%20of%20tetanus,that%20may%20cause%20respiratory%20distress">suffering</a> is almost indescribable, causing painful muscle spasms and a locked jaw. </p>
<p>Many associate tetanus with objects such as rusty nails. But this surprisingly common organism is also <a href="https://www.cdc.gov/tetanus/about/causes-transmission.html#:%7E:text=Tetanus%20is%20an%20infection%20caused,spread%20from%20person%20to%20person.">found in the soil</a>, particularly if manured, because <em>clostidia</em> are found in the gut. Roses like soil with manure, so this could turn these beloved flowers deadly if you get cut by contaminated thorns or if the soil gets into a cut. </p>
<p>Luckily, I have yet to see any cases in the emergency room because the UK immunises against tetanus. And I never want to see a case, because of how nasty it is. The case fatality rate can exceed 50% in people who aren’t immunised. This is why it’s important to check that your tetanus jab is up to date.</p>
<h2>2. Bacteria and fungi</h2>
<p>Lurking in a humble bag of compost is an ingredient many of us wouldn’t expect: <em>Legionella</em>.</p>
<p>This bacteria can cause an infection called <a href="https://www.gov.uk/government/collections/legionnaires-disease-guidance-data-and-analysis">Legionnaires’ disease</a> which is particularly harmful for the elderly and people with a compromised immune system. It can lead to a nasty and often fatal pneumonia when inhaled. Warm, stagnant water involved in the composting process may account for its presence. </p>
<p>It isn’t only pre-packaged compost that’s hazardous. Your own compost heap is also be filled with various bacteria and fungi, which, if properly maintained, should cause you no trouble. But often the mould <em><a href="https://www.nature.com/articles/s41564-022-01091-2?utm_medium=affiliate&utm_source=commission_junction&utm_campaign=CONR_PF018_ECOM_GL_PHSS_ALWYS_DEEPLINK&utm_content=textlink&utm_term=PID100060515&CJEVENT=2b6b1daafeca11ed826d8a170a18b8fb#change-history">Aspergillus</a></em> can grow when it’s hot outside. This can give rise to some <a href="https://thorax.bmj.com/content/70/3/270">nasty lung lesions</a> and may even become more widespread in the body – especially in the elderly and immunosuppressed and can be fatal.</p>
<p>Mould spores can also <a href="https://pubmed.ncbi.nlm.nih.gov/7719883/">trigger allergies</a> in some people, a condition known as extrinsic allergic alveolitis or “<a href="https://www.ncbi.nlm.nih.gov/books/NBK557580/">farmer’s lung</a>”. This condition was classically due to exposure to mouldy hay, but compost heaps can also do the same because of the presence of organisms such as <em>Aspergillus</em> and the bacteria <em>Actinomycetes</em>.</p>
<h2>3. Leptospirosis</h2>
<p><em>Leptospira</em> is a bacterium that may be found in water contaminated with rat urine. With rats often building habitats near humans, it might be best to take care near the pond or rainwater barrels when gardening. </p>
<figure class="align-center ">
<img alt="A rat in a garden looking at a wooden fence." src="https://images.theconversation.com/files/529078/original/file-20230530-23-iaic5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529078/original/file-20230530-23-iaic5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529078/original/file-20230530-23-iaic5a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529078/original/file-20230530-23-iaic5a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529078/original/file-20230530-23-iaic5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529078/original/file-20230530-23-iaic5a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529078/original/file-20230530-23-iaic5a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Beware if you have rats in your garden.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rat-garden-1842737110">battybattrick/ Shutterstock</a></span>
</figcaption>
</figure>
<p><em>Leptospira</em> can cause leptospirosis, a <a href="https://www.cdc.gov/leptospirosis/symptoms/index.html">rather unpleasant infection</a> that causes headaches, fevers, chills, vomiting, jaundice and then later, liver failure, kidney failure and meninigitis. </p>
<h2>4. Power tools</h2>
<p>While power tools can make our work easier in the garden, they can also make it much easier to injure ourselves, too. Hedge trimmers may be a great way to tame trees and bushes, but they can also amputate digits and <a href="https://www.dailymail.co.uk/news/article-9441081/Tragedy-man-dies-injuring-hedge-trimmer-Sydneys-leafy-northern-suburbs.html">inflict wounds</a> very efficiently. Be sure to wait until the hedge trimmer is fully turned off before clearing any branches you’ve removed. </p>
<p>Hedge trimmers and lawn mowers can also easily cut through electric cables, which can lead to electrocution. Power tools can also be <a href="https://www.standard.co.uk/hp/front/wife-killed-in-chainsaw-accident-7081566.html">disastrous</a> if you fall while up a ladder and if you have <a href="https://news.stv.tv/east-central/death-of-man-electrocuted-by-hedge-trimmer-could-have-been-prevented">power lines crossing your garden</a>, then please avoid them.</p>
<h2>Stay safe</h2>
<p>While these hidden dangers are certainly a risk, luckily there are many simple things you can do to avoid harm from them, including: </p>
<ol>
<li><p>Cleaning and covering wounds while gardening.</p></li>
<li><p>Make sure your <a href="https://www.rose.org/single-post/2018/04/27/tetanus-some-things-you-should-know">immunisations</a> are up to date (especially for tetanus). </p></li>
<li><p>Keeping <a href="https://www.rhs.org.uk/advice/health-and-wellbeing/minimising-health-risks-in-the-garden">compost bags</a> away from your face when you open them.</p></li>
<li><p>Deter rats by not putting cooked food on <a href="https://www.growveg.com/guides/how-to-keep-rats-out-of-your-compost/#:%7E:text=Rats%20don't%20like%20disturbance,and%20fats%20to%20the%20bin.">compost heaps</a>, <a href="https://www.ciphe.org.uk/public/plumbing-health-hazards/gardens/">covering water butts</a> and setting up traps if you have an infestation.</p></li>
<li><p>Set up ladders firmly on even ground away from power lines.</p></li>
<li><p>Enjoy having wildlife but <a href="https://www.theguardian.com/environment/2014/aug/07/man-bitten-three-times-adder">leave it alone</a> (snakes can be just as much a danger as rats).</p></li>
</ol>
<p>And one last piece of advice from me. Every year the burns unit at my hospital sees a number of people who have tried to speed up the process of lighting their barbecue or bonfire by <a href="https://www.mirror.co.uk/news/us-news/dad-suffers-horrific-burns-after-21844521">using petrol</a>. Not all survive. So if you are planning to cook the fruits of your labours on a barbecue in your garden, make sure you don’t use inflammable liquids to get the flame started, and have a fire extinguisher on hand just in case.</p>
<p>Gardening is a rewarding hobby that has many health benefits. Just be sure to take sensible precautions.</p><img src="https://counter.theconversation.com/content/206220/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Hughes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Gardening is often seen as a relaxing, harmless pasttime – but that isn’t always the case.Stephen Hughes, Senior Lecturer in Medicine, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2037632023-04-18T03:28:33Z2023-04-18T03:28:33ZWhen did you have your last tetanus vaccine? A booster dose may save your life<figure><img src="https://images.theconversation.com/files/521445/original/file-20230418-18-3hqftn.jpg?ixlib=rb-1.1.0&rect=327%2C35%2C7482%2C5199&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/covid-vaccine-plaster-doctor-patient-consulting-2211549193">Shutterstock</a></span></figcaption></figure><p>NSW Health <a href="https://twitter.com/NSWHealth/status/1646283387496443906">recently reported</a> three cases of tetanus and the tragic death of a woman in her 80s – the first tetanus fatality in the state in 30 years. </p>
<p>Tetanus is a rare but potentially fatal disease. Thankfully, it’s preventable – being up to date with tetanus vaccination is your best protection.</p>
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<h2>What is tetanus and how do you get it?</h2>
<p>The bacteria that causes tetanus is called <em>Clostridium tetani</em>. Spores can enter your body usually following a skin wound, puncture or injury. </p>
<p>Tetanus cannot be transmitted from person to person. </p>
<p>The spores are ubiquitous, found in soil, dust and animal waste. They can <a href="https://www.elsevierhealth.com.au/plotkins-vaccines-9780323357616.html">persist</a> in the environment for months to years, and are remarkably hardy – they’re even resistant to boiling and a number of disinfectants. </p>
<figure class="align-center ">
<img alt="Person gardens in soil with their bare hands" src="https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521442/original/file-20230418-28-vlw6xx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The bacteria that causes tetanus can remain in soil for years.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/q13Zq1Jufks">Sandie Clarke/Unsplash</a></span>
</figcaption>
</figure>
<p>Once in a wound, the bacteria can grow and produce a toxin. It is the toxin that acts on your nervous system to cause muscle rigidity and painful spasms. </p>
<h2>What are the symptoms?</h2>
<p>One <a href="https://www.uptodate.com/contents/tetanus">classic symptom</a> of tetanus is “lockjaw”, where the muscles around your mouth go into spasms. This makes it difficult to eat and speak but patients maintain full consciousness or awareness. The muscle contractions and spasms are intensely painful and can be triggered by loud noises, physical contact or even light.</p>
<p>Patents with tetanus are commonly treated in an intensive care unit and require cleaning of the wound, antibiotics and injections of anti-toxin, known as human tetanus immunoglobulin, as well as a vaccine. </p>
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Read more:
<a href="https://theconversation.com/at-least-five-reasons-you-should-wear-gardening-gloves-89451">(At least) five reasons you should wear gardening gloves</a>
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<p>In severe cases, spasms of muscles surrounding your airways and lungs, alongside high and low blood pressure and heart rhythm abnormalities can lead to death. </p>
<p>Despite the best treatment, about <a href="https://link.springer.com/article/10.17269/s41997-022-00732-7#:%7E:text=From%201995%20to%202019%2C%20a,range%3A%2043%E2%80%9393">2</a>-<a href="https://www.gov.uk/government/publications/tetanus-in-england-annual-reports/tetanus-in-england-2021#:%7E:text=tetanus%20is%20a%20severe%2C%20potentially,per%20year%20over%20previous%20years">10</a>% of patients die. </p>
<h2>How does the vaccine work?</h2>
<p>In Australia, tetanus is rare because of high vaccination coverage, with around <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/2A15CD097063EF40CA2587CE008354F1/$File/summary_of_national_surveillance_data_on_vaccine_preventable_diseases_in_australia_2016_2018_final_report.pdf">14 cases</a> reported to health authorities a year.</p>
<p>Tetanus can occur at any age, but is more common in older adults who have never been vaccinated or were vaccinated more than ten years ago. </p>
<p>The vaccine is very effective in preventing tetanus. Tetanus vaccination stimulates the production of antibodies, also known as antitoxin. This means vaccination doesn’t stop <em>Clostridium tetani</em> growing in contaminated wounds. Rather, it protects against the effects of the toxin.</p>
<figure class="align-center ">
<img alt="Nurse vaccinates child" src="https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521447/original/file-20230418-18-jwzs1z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccination protects you from the effects of the toxin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-doctor-putting-medical-plaster-girl-1921268393">Shutterstock</a></span>
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</figure>
<h2>When do we need a tetanus shot?</h2>
<p>Tetanus vaccination has been available in Australia since <a href="https://www.health.vic.gov.au/immunisation/vaccine-history-timeline">1925</a>. It’s currently on the National Immunisation Program (NIP) as an initial five-dose schedule for infants and children until five years of age, administered as a combined diphtheria-tetanus-acellular pertussis (DTPa) vaccine. </p>
<p><a href="https://doi.org/10.33321/cdi.2022.46.60">Most children</a> (97%) in Australia complete this primary immunisation schedule. </p>
<p>The <a href="https://www.who.int/publications/i/item/WHO-WER9206">level of antitoxin needed</a> for protection from tetanus is 0.1-0.2 international units (IU) per millilitre (mL). This level is <a href="https://pubmed.ncbi.nlm.nih.gov/16822597/">reached</a> following a fifth dose, at age four to six years. </p>
<p>But by middle age, <a href="https://pubmed.ncbi.nlm.nih.gov/30318003/">about 20%</a> of Australians have low or undetectable levels of antitoxin. This places them at risk of contracting tetanus after a wound or injury. </p>
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Read more:
<a href="https://theconversation.com/health-check-are-you-up-to-date-with-your-vaccinations-116510">Health Check: are you up to date with your vaccinations?</a>
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<p>A single dose of tetanus vaccine produces protective levels of antitoxin in these people. This is why a booster dose of tetanus vaccine is <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/tetanus">recommended</a> for the following people if their last dose was more than ten years ago: </p>
<ul>
<li><p>adults at 50 years of age</p></li>
<li><p>adults aged 65 years or over</p></li>
<li><p>travellers, of any age, to countries where it may be difficult to access timely health services if you sustain a tetanus-prone wound (any wound other than a clean, minor cut).</p></li>
</ul>
<p>If you have a tetanus-prone wound and there is any doubt about your tetanus immunisation status, you should receive tetanus immunoglobulin as soon as possible. You should also receive a tetanus vaccine. </p>
<p>If you’re overseas, it could be hard and expensive to get access to both tetanus immunoglobulin and tetanus vaccine.</p>
<h2>How do I check my vaccination status?</h2>
<p>If you’re over 14 years of age, you can check your vaccine history:</p>
<ul>
<li><p>online, by setting up a myGov account and accessing your Medicare online account through the Express Plus Medicare mobile app</p></li>
<li><p>by calling the <a href="https://www.servicesaustralia.gov.au/australian-immunisation-register">Australian Immunisation Register</a> on 1800 653 809</p></li>
<li><p>by asking your doctor or immunisation provider to <a href="https://www.health.gov.au/topics/immunisation/getting-vaccinated/check-immunisation-history">print a copy</a> of your immunisation records. </p></li>
</ul>
<p>If it has been more than ten years since your last dose, ask your GP about getting a booster. It could save your life.</p><img src="https://counter.theconversation.com/content/203763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood has previously received funding from the NHMRC for a Career Development Fellowship.</span></em></p><p class="fine-print"><em><span>Helen Quinn does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tetanus is a rare but potentially fatal disease. Being up to date with tetanus vaccination is your best protection.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyHelen Quinn, Senior Research Fellow, National Centre for Immunisation Research and Surveillance & Senior Lecturer, Children’s Hospital Westmead Clinical School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1221912019-10-06T18:52:10Z2019-10-06T18:52:10ZPharmacists can vaccinate adults against whooping cough, measles and the flu, but it might cost you more<figure><img src="https://images.theconversation.com/files/293703/original/file-20190924-54782-1fazeoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pharmacist immunisers are gradually being allowed to give more types of vaccines.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1385453168?src=jkf9PEdb4d2ziEPJcyShBw-1-85&size=huge_jpg">FotoDuets/Shutterstock</a></span></figcaption></figure><p>Vaccines have long been available from GPs and nurses. But in recent years, laws have changed to add pharmacists to the list of health professionals who can give select vaccines without a prescription. </p>
<p>This may improve vaccination coverage against the flu, whooping cough and measles. But there’s a chance it could cost you more than if your saw your GP for the same shot.</p>
<h2>Overcoming resistance</h2>
<p>Before 2014, pharmacists couldn’t give vaccinations in Australia. Then <a href="https://eprints.qut.edu.au/91903/1/QPIP%20Final%20Report%202015%20.pdf">a pilot study</a> allowed a select group of Queensland pharmacies to offer the flu vaccine. </p>
<p>By this time, pharmacists had been giving certain vaccines in <a href="https://www.opatoday.com/professional/advocacy/scope-of-practice">Canada</a>, <a href="https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-programme-decisions/pharmacist-vaccinators">New Zealand</a>, the <a href="https://www.ashp.org/-/media/assets/policy-guidelines/docs/guidelines/pharmacists-role-immunization.ashx">United States</a> and the <a href="https://psnc.org.uk/services-commissioning/advanced-services/flu-vaccination-service/flu-vaccination-training/">United Kingdom</a> for some years. </p>
<p>But in Australia, pharmacists didn’t have the skills and the law didn’t allow it. Another barrier was <a href="https://theconversation.com/how-rivalries-between-doctors-and-pharmacists-turned-into-the-turf-war-we-see-today-122534">the attitudes of other health professionals</a>, such as doctors, that pharmacists couldn’t or shouldn’t give vaccinations. </p>
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Read more:
<a href="https://theconversation.com/how-rivalries-between-doctors-and-pharmacists-turned-into-the-turf-war-we-see-today-122534">How rivalries between doctors and pharmacists turned into the 'turf war' we see today</a>
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</p>
<hr>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/28894312">Queensland pilot study</a> concluded pharmacists could safely and effectively administer certain vaccines to adults, once they were trained. This training included how to administer injections and what to do if something went wrong, such as managing <a href="https://immunisationhandbook.health.gov.au/resources/publications/managing-anaphylaxis">anaphylaxis</a> and performing CPR. </p>
<p>State and territory regulations have changed since 2014 and <a href="http://www.ncirs.org.au/new-resource-getting-vaccines-your-local-pharmacy">pharmacist vaccination services</a> have quickly grown. <a href="http://www.healthconsult.com.au/wp-content/uploads/pharmacist-administered-vaccination-program-evaluation.pdf">In Victoria</a>, for example, the number of pharmacies registered to give vaccines grew, from 36 in 2017 to 489 in July 2019. </p>
<h2>What vaccines can you get at the pharmacy?</h2>
<p>The rules <a href="http://ncirs.org.au/sites/default/files/2019-08/NCIRS%20Information%20Sheet-%20Vaccines%20from%20community%20pharmacy_August%202019_Final_0.pdf">vary in each state and territory</a>. Generally, if you’re 16 and over, pharmacist immunisers can give you the following three vaccines:</p>
<ul>
<li>influenza (flu)</li>
<li>diphtheria, tetanus and pertussis (whooping cough) – except Tasmania</li>
<li>measles, mumps and rubella (MMR) – except Tasmania and the ACT.</li>
</ul>
<p>These are important vaccines that are sometimes needed if adults missed doses earlier in life or have waning immunity. The influenza vaccine needs to be given every year in a short time frame.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-you-up-to-date-with-your-vaccinations-116510">Health Check: are you up to date with your vaccinations?</a>
</strong>
</em>
</p>
<hr>
<p>There are some further exceptions. </p>
<p>In the <a href="https://www.health.act.gov.au/sites/default/files/2019-04/Pharmacist%20vaccinations.pdf">Australian Capital Territory</a>, pregnant women can’t be vaccinated by a pharmacist. </p>
<p>In <a href="https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0003/340860/Tasmanian_Vaccination_Program_Guidelines_-_September_2019_.pdf">Tasmania</a> and <a href="http://www.healthywa.wa.gov.au/%7E/media/Files/Corporate/general%20documents/medicines%20and%20poisons/Word/Pharmacist_vaccination_code.ashx">Western Australia</a>, the flu vaccine can be given by a pharmacist to those aged ten and over. </p>
<p>Pharmacist immunisers are gradually being allowed to give more types of vaccines. In Western Australia, for example, pharmacists can now deliver the <a href="https://www.mediastatements.wa.gov.au/Pages/McGowan/2019/08/WA-pharmacists-able-to-administer-greater-range-of-vaccines.aspx">meningococcal ACWY</a> vaccine to those aged 16 and over. This vaccine protects against <a href="https://theconversation.com/what-is-meningococcal-disease-and-what-are-the-options-for-vaccination-88769">around half of the strains that cause meningococcal disease</a> in Australia. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-meningococcal-disease-and-what-are-the-options-for-vaccination-88769">What is meningococcal disease and what are the options for vaccination?</a>
</strong>
</em>
</p>
<hr>
<h2>It might cost you more</h2>
<p>Some vaccines that would be free from your GP, practice nurse or immunisation clinic will need to be paid for if given at a community pharmacy. That’s because pharmacist immunisers <a href="https://www.psa.org.au/pharmacist_administered_vaccinations/">aren’t able to access</a> the government-funded vaccines that your clinic can. </p>
<p>Victoria is an <a href="http://www.ncirs.org.au/new-resource-getting-vaccines-your-local-pharmacy">exception</a> – pharmacists can give select government-funded vaccines. And in the ACT and WA, the over-65s can access government-funded flu vaccines at pharmacies. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295127/original/file-20191001-173358-1gnevx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295127/original/file-20191001-173358-1gnevx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295127/original/file-20191001-173358-1gnevx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295127/original/file-20191001-173358-1gnevx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295127/original/file-20191001-173358-1gnevx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295127/original/file-20191001-173358-1gnevx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295127/original/file-20191001-173358-1gnevx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pharmacists can’t usually access government-funded vaccines, aside from in Victoria.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1385081492?size=huge_jpg">Dragana Gordic/Shutterstock</a></span>
</figcaption>
</figure>
<p>The cost of vaccines at pharmacies varies. In <a href="http://www.healthconsult.com.au/wp-content/uploads/pharmacist-administered-vaccination-program-evaluation.pdf">Victoria</a>, for example, the total fee charged for people not eligible for a government-funded vaccination is around A$20 for influenza and A$43 for pertussis (whooping cough). </p>
<p>Even if the vaccine is free, the pharmacy may still charge <a href="https://ajp.com.au/news/flu-vax-charges-under-scrutiny/">a consultation fee</a>. </p>
<p>If you see your GP, they may either bulk bill you for the appointment or charge a consultation fee. </p>
<p>The best thing is to check ahead about any out-of-pocket expenses for vaccination when you make your booking.</p>
<h2>Do you need to see a GP?</h2>
<p>Pharmacy vaccination <a href="https://bmjopen.bmj.com/content/6/9/e011948">increases access</a> to preventative health care, especially for those living in rural and remote areas, where it’s <a href="https://grattan.edu.au/wp-content/uploads/2014/04/196-Access-All-Areas.pdf">difficult to visit a doctor or clinics are infrequent</a>.</p>
<p>Having pharmacists as immunisers also increases the immunisation workforce capacity for public health responses. To help address an outbreak of meningococcal disease last year in Tasmania, <a href="http://www.premier.tas.gov.au/releases/supporting_pharmacies_to_deliver_meningococcal_vaccines">pharmacist immunisers administered the meningococcal ACWY vaccine</a> to people aged 10 to 21. </p>
<p>Going to the pharmacist for some vaccines may take some <a href="https://grattan.edu.au/wp-content/uploads/2014/04/196-Access-All-Areas.pdf">pressure off family doctors</a> and free GPs to <a href="https://grattan.edu.au/wp-content/uploads/2017/03/886-Cutting-a-better-drug-deal.pdf">deliver more complex care</a> that only they can perform. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-role-of-pharmacists-should-be-overhauled-taking-the-heat-off-gps-73905">The role of pharmacists should be overhauled, taking the heat off GPs</a>
</strong>
</em>
</p>
<hr>
<p>But there may be instances when it’s better to go to your GP for a vaccination, for example, if you’re pregnant, have a chronic health condition or need some blood tests related to vaccination. Or you might have other things to discuss with your doctor other than vaccines.</p><img src="https://counter.theconversation.com/content/122191/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Tran is an employee at the National Centre for Immunisation Research and Surveillance (NCIRS). NCIRS receives service contract funding from the Australian Government Departments of Health, NSW and other state government Departments of Health. Catherine Tran has not personally received any relevant external funding, including from any governments, foundations, or research council grants.</span></em></p><p class="fine-print"><em><span>Clayton Chiu is a public health physician and employee at the National Centre for Immunisation Research and Surveillance (NCIRS). NCIRS receives service contract funding from the Australian Government Departments of Health, NSW and other state government Departments of Health. Clayton Chiu has not personally received any relevant external funding, including from any governments, foundations, or research council grants.</span></em></p><p class="fine-print"><em><span>Kristine Macartney is the Director of the National Centre for Immunisation Research and Surveillance (NCIRS). NCIRS receives funding from the Australian Government, NSW and other state government Departments of Health. She also receives funding from the National Health and Medical Research Council (NHMRC).</span></em></p>You no longer have to go to your GP to get your flu shot or catch up on vaccinations you missed earlier in life or have waning immunity to. But they’re unlikely to be free.Catherine Tran, Senior Research Officer and Pharmacist, National Centre for Immunisation Research and Surveillance, University of SydneyClayton Chiu, Public Health PhysicianKristine Macartney, Professor, Discipline of Paediatrics and Child Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/885692018-01-24T19:17:01Z2018-01-24T19:17:01ZDon’t worry, the chance of dying from potting mix is very slim<figure><img src="https://images.theconversation.com/files/202982/original/file-20180123-182951-17fu2wn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Potting mix is known to carry harmful bacteria and fungi.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/7LsyosoO0GQ">Photo by Markus Spiske on Unsplash</a></span></figcaption></figure><p>Gardening is generally a healthy and pleasurable hobby or occupation. However, any activity carries some risk – and gardening is no exception. </p>
<p>Potting mix is known to carry harmful bacteria and fungi. And there have been <a href="http://www.dailymail.co.uk/news/article-2762227/Family-mourns-mother-two-killed-bacteria-potting-mix.html">reports of deaths</a> from diseases, such as the <a href="http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11144971">Legionnaires’ disease</a> (a lung infection), that have been attributed to bacteria in potting mix.</p>
<p>Many bacteria and fungi that can cause infections in people live in soil and water. So it’s not surprising that potting mix can also have in it bacteria and fungi that may on occasion cause harm to people, and in rare cases even kill them. But it’s important to note that, overall, the risk is very low. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-science-is-in-gardening-is-good-for-you-65251">The science is in: gardening is good for you</a>
</strong>
</em>
</p>
<hr>
<h2>Fertilising more than plants</h2>
<p>Potting mix is usually a mixture of inorganic and organic material. It’s also often at a higher temperature compared to soil because of where and how it’s stored, so it retains heat for longer. Bacteria and fungi generally grow better and reach higher numbers when they are in moist and warm environments.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/202994/original/file-20180123-182973-3e1b6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/202994/original/file-20180123-182973-3e1b6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/202994/original/file-20180123-182973-3e1b6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=467&fit=crop&dpr=1 600w, https://images.theconversation.com/files/202994/original/file-20180123-182973-3e1b6d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=467&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/202994/original/file-20180123-182973-3e1b6d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=467&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/202994/original/file-20180123-182973-3e1b6d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=587&fit=crop&dpr=1 754w, https://images.theconversation.com/files/202994/original/file-20180123-182973-3e1b6d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=587&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/202994/original/file-20180123-182973-3e1b6d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=587&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Potting mix is usually warmer than soil, which makes it a better environment for bacteria and fungi to grow.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>If bacteria or fungi are already present in low numbers, they can quickly grow to very high numbers in optimal conditions. This includes many bacteria in soil that can cause problems in people – such as strains of <em>nocardia</em> (causes nocardiosis, an infection of the lungs or whole body), <em>legionella</em> (causes Legionnaires’ disease), and <em>clostridium</em> (causes tetanus).</p>
<p>Numerous fungi can also be present in soil and potting mix. In certain areas of the world, soil contains fungi that can invade if inhaled and cause disease. These include the <a href="https://www.cdc.gov/fungal/diseases/histoplasmosis/index.html">lung infection histoplasmosis</a>, which is caused by a fungus that lives mainly in parts of the United States, but also in some parts of Central and South America, Africa, Asia, and Australia.</p>
<h2>Protecting ourselves</h2>
<p>The risk to most people of becoming infected with any of these bacterial or fungal diseases is very low. Disease is more likely to be a risk when the micro-organisms are present in very high numbers.</p>
<p>Bacteria or fungi also need to be introduced into our bodies to cause disease. This usually happens through inhalation, where the organisms go into the lungs. It can also occur through the skin, such as with the chronic fungal infection <em>sporotrichosis</em>, also known as “rose gardener’s disease”. If, for any reason, micro-organisms are present in high numbers, then the exposure and risk will be higher. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/203130/original/file-20180124-33538-1a0l3x6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/203130/original/file-20180124-33538-1a0l3x6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/203130/original/file-20180124-33538-1a0l3x6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/203130/original/file-20180124-33538-1a0l3x6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/203130/original/file-20180124-33538-1a0l3x6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/203130/original/file-20180124-33538-1a0l3x6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/203130/original/file-20180124-33538-1a0l3x6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/203130/original/file-20180124-33538-1a0l3x6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A fungal infection known as rose gardener’s disease can happen with the organism entering the skin directly through an injury.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>There are many things we can do to protect ourselves from introducing bacteria or fungi into our bodies. The most essential is basic hygiene.</p>
<p>If people smoke, eat or drink without first washing their hands, they are at an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870547/">increased risk of legionella infection</a> from potting mix. This implies direct inhalation isn’t the only way for the bacteria to enter the body, but that oral intake of micro-organisms via contaminated hands is also a risk.</p>
<p>Another added <a href="https://assist.asta.edu.au/sites/assist.asta.edu.au/files/AIS%20Safe%20handling%20and%20use%20of%20potting%20mix_2.pdf">protection measure</a> is wearing gloves. This doesn’t mean you should then not wash your hands before eating. A physical barrier in addition to washing hands obviously provides better protection.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/at-least-five-reasons-you-should-wear-gardening-gloves-89451">(At least) five reasons you should wear gardening gloves</a>
</strong>
</em>
</p>
<hr>
<p>Masks can be worn in high-risk situations, such as when opening a bag of potting mix. Directing the bag away from the gardener when opened, and being in a well-ventilated area, will decrease any inhalation risk. </p>
<h2>Signs of infection</h2>
<p>People who have a lower immunity, such as those with diseases such as HIV or lymphoma, are more at risk of catching something from potting mix. So it’s even more important they use extra appropriate precautions, including wearing masks when in higher-risk situations. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/199830/original/file-20171219-27568-1inhzrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/199830/original/file-20171219-27568-1inhzrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/199830/original/file-20171219-27568-1inhzrd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/199830/original/file-20171219-27568-1inhzrd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/199830/original/file-20171219-27568-1inhzrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/199830/original/file-20171219-27568-1inhzrd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/199830/original/file-20171219-27568-1inhzrd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Simple safety provisions can protect us from harmful bacteria and fungi.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The symptoms or signs of infection acquired from soil or potting mix depend on where the infection is and what micro-organism is causing it. With potting mix, the main worry is <em>legionella longbeachae</em>. This generally causes a lung infection such as pneumonia. </p>
<p>Symptoms can initially be fever, aches and pains, which are fairly general of illness. But as the infection involves more of the respiratory tract, cough, shortness of breath and/or pain on breathing may develop.</p>
<h2>Treatment</h2>
<p>While <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4934a1.htm">potting-mix-linked legionella infections</a> are uncommon, cases have occurred in countries including Australia, Japan and the US. </p>
<p>So, if people develop symptoms that are ongoing and have had recent exposure to potting mix within the incubation period (two to ten days after exposure), they need to <a href="http://www.masulacompliance.com.au/news/what-you-should-know-if-you-work-with-soils-compost-and-potting-mix">seek medical help</a> and make it clear to that person that they were worried about potting mix being involved. </p>
<p>It’s important to note the potting mix connection because antibiotics needed to kill <em>legionella</em> are different to standard penicillin-like antibiotics often used to treat pneumonia acquired in the community.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-common-garden-chemicals-a-health-risk-65643">Are common garden chemicals a health risk?</a>
</strong>
</em>
</p>
<hr>
<p>Overall, though, we need to keep these risks in perspective. Millions of people garden and all will be exposed to soil and/or potting mix. Very few of these infections occur in Australia and elsewhere. Fairly simple provisions such as washing hands, wearing gloves and – where necessary – wearing a mask will ensure rates of infection remain low.</p><img src="https://counter.theconversation.com/content/88569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Collignon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The risk of bacterial or fungal infection from potting mix is very low. Wearing gloves and washing your hands will keep it even lower.Peter Collignon, Professor, infectious diseases and microbiology, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/894512018-01-08T19:35:40Z2018-01-08T19:35:40Z(At least) five reasons you should wear gardening gloves<figure><img src="https://images.theconversation.com/files/200116/original/file-20171220-4995-60vm3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not just to avoid creepy crawlies. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Gardening is a great way to relax, be one with nature and get your hands dirty. But lurking in that pleasant environment are some nasty bacteria and fungi, with the potential to cause you serious harm. So we need to be vigilant with gardening gloves and other protective wear.</p>
<p>Soils contain all sorts of bacteria and fungi, most of which are beneficial and do helpful things like breaking down organic matter. But just as there are pathogenic bacteria that live on your body amid the useful ones, some microorganisms in soil can cause serious damage when given the opportunity to enter the body. This commonly happens through cuts, scrapes or splinters. </p>
<p>Plants, animal manure, and compost are also sources of bacteria and fungi that can cause infections.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-science-is-in-gardening-is-good-for-you-65251">The science is in: gardening is good for you</a>
</strong>
</em>
</p>
<hr>
<h2>1. Tetanus</h2>
<p>Traditionally, the most common and well-known infection is tetanus, caused by <em>Clostridium tetani</em>, which lives in soil and manure. Infections occur through contamination of cuts and scrapes caused by things in contact with the soil, such as garden tools or rose thorns. </p>
<p>Fortunately, most people have been vaccinated against tetanus, which means even if you are infected, your body is able to fight back against the bacteria to prevent it becoming serious. Symptoms include weakness, stiffness and cramps, with the toxins released leading to muscular paralysis and difficulty chewing and swallowing – hence the common term for tetanus of lockjaw.</p>
<h2>2. Sepsis</h2>
<p>Bacteria such as <em>Escherichia coli</em>, <em>Salmonella</em>, <em>Campylobacter jejuni</em>, and <em>Listeria monocytogenes</em> are often present in gardens as a result of using cow, horse, chicken <a href="http://miami-dade.ifas.ufl.edu/pdfs/urban_hort/Gardening-Infectious-Disease.PDF">or other animal manure</a>. Bacterial infections can lead to sepsis, where the bacteria enter the blood and rapidly grow, causing the body to respond with an inflammatory response that causes septic shock, organ failure, and, if not treated quickly enough, death. </p>
<p>A <a href="http://www.telegraph.co.uk/news/2016/10/03/solicitor-dies-from-sepsis-five-days-after-injuring-her-hand-gar/">high-profile case recently occurred</a> in England, where a 43-year-old solicitor and mother of two died five days after scratching her hand while gardening. This hits close to home, as a number of years ago my mother spent ten days in intensive care recovering from severe sepsis, believed to be caused by a splinter from the garden.</p>
<h2>3. Legionellosis</h2>
<p>Standing pools of water may hold <em>Legionella pneumophila</em>, the bacteria causing Legionnaires’ disease, more commonly known to be associated with outbreaks from contaminated air conditioning systems in buildings. </p>
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Read more:
<a href="https://theconversation.com/are-common-garden-chemicals-a-health-risk-65643">Are common garden chemicals a health risk?</a>
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<p>Related bacteria, <em>Legionella longbeachae</em>, are found in soil and compost. In 2016 there were <a href="http://www.stuff.co.nz/life-style/home-property/77013947/8-dangers-lurking-in-your-garden-that-you-might-not-know-about">29 confirmed cases of legionellosis in New Zealand</a>, including a Wellington man who picked up the bug <a href="https://www.stuff.co.nz/national/health/76915471/potting-mix-nearly-kills-wellington-man">from handling potting mix</a>. </p>
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<a href="https://images.theconversation.com/files/200117/original/file-20171220-4997-1auvpi5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/200117/original/file-20171220-4997-1auvpi5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/200117/original/file-20171220-4997-1auvpi5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/200117/original/file-20171220-4997-1auvpi5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/200117/original/file-20171220-4997-1auvpi5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/200117/original/file-20171220-4997-1auvpi5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/200117/original/file-20171220-4997-1auvpi5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/200117/original/file-20171220-4997-1auvpi5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Potting mix should be handled with gloves, while wearing a dust mask.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>Another ten cases were reported in Wellington in 2017, again associated with potting soil. In New Zealand and Australia, <em>Legionella longbeachae</em> from potting mix accounts for approximately <a href="http://hcinfo.com/about/outbreaks/recent/">half of reported cases of Legionnaires’ disease</a>. There were <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi4001e8.htm">around 400 total cases</a> of Legionellosis in Australia in 2014. </p>
<p>The bacteria is usually inhaled, so wearing a dust mask when handling potting soil and dampening the soil to prevent dust are recommended.</p>
<h2>4. Melioidosis</h2>
<p>An additional concern for residents of northern Australia is an infection called melioidosis. These bacteria (<em>Burkholderia pseudomallei</em>) live in the soil but end up on the surface and in puddles after rain, entering the body through cuts or grazes, and sometimes through inhalation or drinking groundwater. </p>
<p>Infection causes a range of symptoms, such as cough and difficulty breathing, fever or sporadic fever, confusion, headache, and weight loss, with up to 21 days before these develop. </p>
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Read more:
<a href="https://theconversation.com/five-reasons-not-to-spray-the-bugs-in-your-garden-this-summer-85673">Five reasons not to spray the bugs in your garden this summer</a>
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<p>In 2012, there were <a href="http://www.theaustralian.com.au/news/health-science/warning-as-three-die-from-soil-disease/news-story/293f88df25be1ed673d8eea5c443e4dc?sv=d2b413f169f14cdab32b7c5257c75ced">over 50 cases in the Northern Territory</a> leading to three deaths, with <a href="http://www.abc.net.au/news/2015-10-12/melioidosis-season-darwin-man-flees-deadly-dirt-disease/6846404">another case receiving publicity in 2015</a>. Preventative measures include wearing waterproof boots when walking in mud or puddles, gloves when handling muddy items, and, if you have a weakened immune system, avoiding being outdoors during heavy rain.</p>
<h2>5. Rose gardener’s disease</h2>
<p>A relatively rare infection is sporotrichosis, “rose gardener’s disease”, caused by a fungus (<em>Sporothrix</em>) that lives in soil and plant matter such as rose bushes and hay. Again, infections through skin cuts are most common, but inhalation can also occur. </p>
<p>Skin infection leads to a small bump up to 12 weeks later, which grows bigger and <a href="https://www.cdc.gov/fungal/diseases/sporotrichosis/index.html">may develop into an open sore</a>. An outbreak of ten cases was <a href="http://outbreaknewstoday.com/australia-sporotrichosis-outbreak-reported-in-the-northern-territory-41184/">reported in the Northern Territory in 2014</a>. </p>
<p>Aspergillus, usually <em>Aspergillus fumigatus</em>, and <em>Cryptococcus neoformans</em> are other fungi that can cause lung infections when inhaled, usually in people with <a href="http://www.livingthecountrylife.com/gardening/fungal-infection-garden-work/">weakened immune systems</a>. Gardening activities such as turning over moist compost can release spores into the air.</p>
<p>Of course, there are plenty of other dangers in the garden that shouldn’t be ignored, ranging from poisonous spiders, snakes and stinging insects, to hazardous pesticides and fungicides, poisonous plants, and physical injuries from strains, over-exertion, sunburn, allergies, or sharp gardening tools.</p>
<p>So enjoy your time in the garden, but wear gloves and shoes, and a dust mask if handling potting soil or compost. And be aware if you do get a cut or scrape then end up with signs of infection, don’t delay seeing your doctor, and make sure you let them know what you’ve been doing.</p><img src="https://counter.theconversation.com/content/89451/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Blaskovich receives funding from the National Health and Medical Research Council (NHMRC), the Wellcome Trust (UK), the Innovations Connections Fund (Australian Government), and the Global Connections Fund (Australian Academy of Technology and Engineering), all associated with antibiotic research. He collaborates with a number of private companies involved in commercialising new antibiotics.</span></em></p>Lurking in the garden are some nasty bacteria with the potential to cause you serious harm.Mark Blaskovich, Senior Research Officer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/582372016-04-24T07:08:13Z2016-04-24T07:08:13ZAfrican leaders step up to the plate to narrow immunisation gaps<figure><img src="https://images.theconversation.com/files/119926/original/image-20160423-22390-14qs5q6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An Ethiopian boy receives a polio vaccination. Africa has done well with polio eradication but lags behind other vaccination efforts. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/unicefethiopia/13102269545/in/photolist-kXNyg4-gkYLcp-bwUa4-gkYtis-gkYtwd-kXNvVc-gkYfVk-gkYsFq-o3iFki-gkY6NG-ojK32N-dv6HeW-ohJYKd-dv17Ca-dzX4Kc-eeey42-n68C7H-dv7fCj-gkYLyX-n6aspG-kXNGwv-gkYfAH-dALrWj-dAEYE4-vXGh3C-kXQ1T9-n68FDc-dv6N1d-gkYL6x-n6aryJ-dNHJFa-n68ET4-gkYeTv-dCUHhs-ojK3xY-dv1ar2-dv19iX-dv6Kxm-dv19xR-dv196V-kXP7Ek-n68AJT-n68NTa-kiSKzz-kXNFgV-mLdz9x-n6awZd-n6cAgD-9RRXyx-n68GiX">Unicef Ethiopia/2013/Sewunet</a></span></figcaption></figure><p><em>Six of the ten countries that are home to 60% of unvaccinated children in the world are in Africa. There have been fresh steps to narrow this gap: African ministers have <a href="http://immunizationinafrica2016.org/">committed</a> to increase resources to improve coverage as well as to target missed opportunities for vaccinations. The Conversation Africa health and medicine editor Candice Bailey spoke to Professor Charles Shey Wiysonge about gaps in vaccination coverage on the continent and efforts to narrow them.</em></p>
<p><strong>Where has Africa done well, where has it done badly in vaccines?</strong></p>
<p>Vaccination is one of the most successful and cost-effective ways to save children’s lives and help them grow into healthy adults.</p>
<p>Africa has done particularly well with polio eradication and introducing new and underutilised vaccines. Nigeria, the last polio endemic country in Africa, has been polio free since <a href="https://theconversation.com/africa-is-within-reach-of-being-declared-a-polio-free-region-44786">July 2014</a>, which is an enormous achievement. </p>
<p>The original target was to stop global polio transmission by 2000. This target and several others were missed because of lack of progress in Nigeria, Afghanistan and Pakistan. The Nigerian government and its technical partners established and enforced clear accountability systems that helped them achieve their goals. </p>
<p>But Africa is still lagging behind with vaccinations. The countries with the largest numbers of unvaccinated children are Nigeria, Ethiopia, the Democratic Republic of Congo, Uganda and <a href="http://www.who.int/wer/2015/wer9046.pdf?ua=1">South Africa</a>. And many other countries have large geographic areas with thousands of unvaccinated children. This is measured by the number of children who have not yet received the required three doses of the diphtheria, tetanus and pertussis vaccines.</p>
<p>Overall immunisation coverage in Africa is only 77%. </p>
<p>Measles and rubella have not yet been eliminated on the continent. And 14 African countries have not been able to eliminate maternal and neonatal tetanus. </p>
<p>Tetanus is a stark reminder of the shocking inequality in health-care provision in Africa. Of the 14 countries, Angola, the Democratic Republic of Congo, Equatorial Guinea, Ethiopia and Guinea are close to elimination. Chad, Kenya, Niger, Nigeria and Sudan are drastically behind. The Central African Republic, Mali, Somali and South Sudan are held back by conflict. </p>
<p>In these countries, thousands of pregnant women still become infected with tetanus during delivery and too many babies become sick with tetanus and die because their mothers were not vaccinated. It is of utmost importance to reach all girls and women with tetanus vaccination. </p>
<p><strong>African ministers are <a href="http://immunizationinafrica2016.org/ministerial-declaration-english/">committing more resources</a> to improve vaccination coverage. Where will this get us?</strong></p>
<p>The commitment is landmark and could allow for equal access to existing vaccines for all Africans. For many years immunisation programmes in Africa were plagued by insufficient national <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001405">leadership</a>. </p>
<p>The ministerial commitment is a positive sign of that leadership. National leadership can make a big difference. For example, national leadership led to the polio success story in Nigeria. In the same way, a lack of national leadership in Somalia affected immunisation service financing, staffing and delivery. Even if vaccines are provided and delivered by external aid agencies and nongovernmental organisations, underlying health-care system challenges imply that positive change will not be sustained. </p>
<p>To maintain current accomplishments and make further progress on immunisation in Africa, it is essential that African governments make the needed investments and efforts to achieve immunisation goals. The joint ministerial commitment is a step in the right direction, as there is power in joint action. </p>
<p><strong>Aside from money, what else is needed?</strong></p>
<p>Accountability is also needed. The ministerial commitment can only bring about sustainable positive change if the ministers walk the talk. They need to live up to that commitment by ensuring accountability and that there is implementation at country level. </p>
<p>As part of this accountability system, every country should have a national vaccine action plan. These systems should be able to review sub-national (district) progress towards national goals. The country plans should give proper attention to the quality of data, community ownership and uninterrupted availability of vaccines in all <a href="http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-578">vaccinating facilities</a>. </p>
<p>Without knowing who has been vaccinated for which diseases at local and country level, it is impossible to allocate resources where they will provide the most return or to understand how to improve programme efficiency. Data need to be useful and inform immunisation strategy at every level. </p>
<p>But to increase vaccination coverage, vaccines must be available and the community must be <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0037905">engaged</a>. Vaccine stock-outs are commonly reported in many African countries and these interrupt immunisation services. </p>
<p><strong>You identify missing gaps as being a big deal. Why?</strong></p>
<p>Missed opportunities occur when children or adults (who are eligible for vaccination) come in contact with health-care services but for some reason they don’t receive the vaccinations they need.</p>
<p>At least one in every four children in Africa is still not receiving the vaccinations they need. As a consequence, a substantial proportion of over 1.5 million children who die from vaccine-preventable diseases globally live on the African continent.</p>
<p>Many of the children who have not yet received the vaccinations they need have access to and actually visit health facilities. </p>
<p><a href="http://www.who.int/immunization/sage/meetings/2016/april/1_C_Wiysong_Missed_Opportunities_SAGE-April-2016.pdf?ua=1">Studies</a> have shown that the problem of missed opportunities is huge in many developing countries. About 32% of children who visit health facilities need vaccines, but do not receive them. </p>
<p>The problem is even bigger in Africa, where <a href="http://www.who.int/immunization/sage/meetings/2016/april/2_R_Mihigo_Missed_Opportunities_SAGE-April-2016.pdf?ua=1">studies</a> show that up to 96% of children in some areas visit clinics but do not get vaccines.</p>
<p><strong>How do countries fix this?</strong></p>
<p>Missed opportunities have to do with policies, training, organisation and management of health-care services. These are things that can be corrected quickly and with relatively little investment, and can have an impact on increasing immunisation coverage. They can also help Africa to achieve the goals of the <a href="http://www.who.int/immunization/global_vaccine_action_plan/en/">Global Vaccine Action Plan</a>. </p>
<p>African countries should regularly conduct field assessments to understand how opportunities to vaccinate people are being missed by health-care workers and their systems, and act to reduce their occurrence.</p>
<p>In countries where child vaccination was missed, there are now adolescent and adult unvaccinated populations. In addition, a new phenomenon is emerging in some African countries known as “<a href="http://www.sciencedirect.com/science/article/pii/S0264410X15005009">vaccine hesitancy</a>”. Vaccine-hesitant people may accept all vaccines but with concerns. Some may accept only some vaccines, or delay in taking up vaccines. Others may totally reject all vaccines.</p>
<p>It is very important to get the right <a href="http://www.scielo.org.za/pdf/samj/v105n11/10.pdf">information</a> about vaccinations to both the people who need vaccinations and those who provide the vaccinations.</p>
<p>Parents, guardians, adolescents, adults and health workers need to understand the vital importance of keeping immunisations up to date.</p><img src="https://counter.theconversation.com/content/58237/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles Shey Wiysonge does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Every year hundreds of thousands of children die from vaccine-preventable diseases. Africa leaders could change this if they improved vaccination efforts.Charles Shey Wiysonge, Professor of Clinical Epidemiology at the Faculty of Medicine and Health Sciences, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.