Youth FAQ - Can you get sick from caving?

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Youth FAQ - Can you get sick from caving?

Postby lookingaround » Jan 30, 2007 10:44 pm

Here is our next FAQ Question & Answer. Please post any updates, comments, or suggestions. Are there any medical professionals out there?...

Thanks!

--
Can you get sick from caving?
Many thousands of people enjoy caving every year and don’t get ill. The chances of your getting sick while caving are very small. However, there is a small chance of contracting certain diseases in some caves.

The likelihood of contracting a disease varies from region to region, and from cave to cave. Ask your cave guide if he is aware of diseases associated with the cave selected. Consult an appropriate health care professional about any questions you may have.

Histoplasmosis, a fungal disease that primarily affects the lungs, can be a concern in certain caves. The fungus that causes Histoplasmis is found throughout the world. It is estimated that 80% of people in some regions of the US would test positive for Histoplasmosis. However, most people never realize that they had it because it is often dismissed with flu-like symptoms. It is found in tropical and semi-tropical caves and to a lesser degree in temperate zone caves. It is usually associated with large quantities of bat or bird droppings. If your guide indicates that histoplasmosis is a concern in the cave that they plan to visit, this would not be an appropriate cave for a youth trip.

It might be possible to contract rabies while in a cave, but the chances are extremely remote. In order to catch rabies, you would need to get the saliva, brain matter, or other nervous system tissue from an infected mammal into an open wound or mucous membrane. This risk can be avoided by avoiding any bats (or other mammals) found in the cave. It is healthier for you and healthier for the bat if you stay away from them. There is limited (and somewhat debated) evidence that aerosol transmission of the rabies virus may be possible. Perhaps by breathing small droplets of aerosol fluids containing the rabies virus. This may have occurred in the 1950s in people working in a cave that containined many millions of bats (Frio Cave, Texas).

More information about histoplasmosis and rabies can be found online at the Centers for Disease Control http://www.cdc.gov/. If you have any questions or concerns, seek advise from a health care professional.
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Postby Cheryl Jones » Jan 31, 2007 10:55 am

Looks good!

One suggestion, to use "avoid" only once in this sentence.
"This risk can be avoided by avoiding any bats (or other mammals) found in the cave."
You could change it to:
"This risk can be avoided by staying away from bats (or other mammals) found in the cave."

Thanks Lookingaround -- you're doing a great job on this project!

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Postby NZcaver » Jan 31, 2007 3:03 pm

Is a caving addiction considered a sickness? :tonguecheek:
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Re: Youth FAQ - Can you get sick from caving?

Postby NZcaver » Jan 31, 2007 3:08 pm

lookingaround wrote:There is limited (and somewhat debated) evidence that aerosol transmission of the rabies virus may be possible. Perhaps by breathing small droplets of aerosol fluids containing the rabies virus. This may have occurred in the 1950s in people working in a cave that containined many millions of bats (Frio Cave, Texas).

I would suggest joining the first two sentences (add a comma between them), and deleting the last sentence (too much information).
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Re: Youth FAQ - Can you get sick from caving?

Postby lookingaround » Feb 6, 2007 3:51 pm

Cheryl Jones wrote:Looks good!

One suggestion, to use "avoid" only once in this sentence.
"This risk can be avoided by avoiding any bats (or other mammals) found in the cave."
You could change it to:
"This risk can be avoided by staying away from bats (or other mammals) found in the cave."

Thanks Lookingaround -- you're doing a great job on this project!

Cheryl


Good suggestion. Changed.

Thanks for the positive comment!

NZcaver wrote:
lookingaround wrote:There is limited (and somewhat debated) evidence that aerosol transmission of the rabies virus may be possible. Perhaps by breathing small droplets of aerosol fluids containing the rabies virus. This may have occurred in the 1950s in people working in a cave that containined many millions of bats (Frio Cave, Texas).

I would suggest joining the first two sentences (add a comma between them), and deleting the last sentence (too much information).


OK. How is this:

It might be possible to contract rabies while in a cave, but the chances are extremely remote. In order to catch rabies, you would need to get the saliva, brain matter, or other nervous system tissue from an infected mammal into an open wound or mucous membrane. This risk can be avoided by staying away from bats (or other mammals) found in the cave. It is healthier for you and the bat if you stay away from them. There is limited (and somewhat debated) evidence that aerosol transmission of the rabies virus may be possible, perhaps by breathing small droplets of aerosol fluids containing the rabies virus
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Re: Youth FAQ - Can you get sick from caving?

Postby NZcaver » Feb 6, 2007 4:28 pm

lookingaround wrote:It might be possible to contract rabies while in a cave, but the chances are extremely remote. In order to catch rabies, you would need to get the saliva, brain matter, or other nervous system tissue from an infected mammal into an open wound or mucous membrane. This risk can be avoided by staying away from bats (or other mammals) found in the cave. It is healthier for you and the bat if you stay away from them. There is limited (and somewhat debated) evidence that aerosol transmission of the rabies virus may be possible, perhaps by breathing small droplets of aerosol fluids containing the rabies virus.

Now I'm wondering if it's even worth putting that last sentence in at all. :neutral:

The rest of the paragraph is nicely descriptive, and to-the-point. By contrast, the "somewhat debated evidence of aerosol transmission" sentence sounds a little vague and may cause more concern than it warrants. I guess it all comes down to striking a balance between providing relevant information, and going all the way towards full disclosure.

(FYI - I'm not a medical professional, or a bat specialist. Just a caver.) :grin:
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Re: Youth FAQ - Can you get sick from caving?

Postby lookingaround » Feb 10, 2007 5:54 pm

NZcaver wrote:
lookingaround wrote:It might be possible to contract rabies while in a cave, but the chances are extremely remote. In order to catch rabies, you would need to get the saliva, brain matter, or other nervous system tissue from an infected mammal into an open wound or mucous membrane. This risk can be avoided by staying away from bats (or other mammals) found in the cave. It is healthier for you and the bat if you stay away from them. There is limited (and somewhat debated) evidence that aerosol transmission of the rabies virus may be possible, perhaps by breathing small droplets of aerosol fluids containing the rabies virus.

Now I'm wondering if it's even worth putting that last sentence in at all. :neutral:

The rest of the paragraph is nicely descriptive, and to-the-point. By contrast, the "somewhat debated evidence of aerosol transmission" sentence sounds a little vague and may cause more concern than it warrants. I guess it all comes down to striking a balance between providing relevant information, and going all the way towards full disclosure.

(FYI - I'm not a medical professional, or a bat specialist. Just a caver.) :grin:


This is a tough question. Readers are presumably coming to the NSS in search of reliable information. I feel that we should include the relevant data that we have. But, how much information is too much? Will we unnecessarily scare people away? But, if we don’t include all of the information and there is a fatality or a group of fatalities, it would be a very unpleasant situation.

What does everybody else think?

There have been two fatalities in the US that may have been the result of aerosol exposure to rabies virus in a cave. Both were about 50 years ago. Of course, medical diagnostic technology 50 years ago was quite limited by today’s standards. Both cases were probably exposures to Mexican Free-tailed bats in Texas. One person was a state rabies investigator that had handled thousands of bats. The other victim had been in a cave and denied being bitten, but a friend reported that the victim had blood on his face that was presumed to be from a bat bite.

The chances of aerosol exposure while caving are extremely small, and perhaps non-existent, but I think the information should be included.

Here is another possible rewording of this section with three possible choices for the last paragraph (each with less information than the previous one). Is this too much information? Could somebody suggest an alternative? Should we just skip it? Should we use one of the options below, if so, which one?

---
It might be possible to contract rabies while in a cave, but the chances are extremely remote. In order to catch rabies, you would need to get the saliva, brain matter, or other nervous system tissue from an infected mammal into an open wound or mucous membrane. This risk can be avoided by staying away from bats (or other mammals) found in the cave. It is healthier for you and healthier for the bat if you stay away from them.

Here are three possible aerosol paragraphs (changes indicated in shades of blue):

#1
There is limited evidence that aerosol transmission of the rabies virus might be possible. Perhaps by breathing small droplets of aerosol fluids containing the rabies virus. The Centers for Disease Control states in a report: “While aerosol transmission of the rabies virus from bats to people is theoretically possible under extraordinary conditions, the risk is otherwise negligible.” (“Histoplasmosis — Protecting Workers at Risk” http://www.cdc.gov/niosh/docs/2005-109/2005-109c.html).

#2
There is limited evidence that aerosol transmission of the rabies virus might be possible. Perhaps by breathing small droplets of aerosol fluids containing the rabies virus. The chances of getting rabies this way are unconfirmed and somewhat debated. The Centers for Disease Control states in an NIOSH report: “While aerosol transmission of the rabies virus from bats to people is theoretically possible under extraordinary conditions, the risk is otherwise negligible.” (“Histoplasmosis — Protecting Workers at Risk” http://www.cdc.gov/niosh/docs/2005-109/2005-109c.html).

#3
There is limited evidence that aerosol transmission of the rabies virus might be possible. Perhaps by breathing small droplets of aerosol fluids containing the rabies virus. This may have occurred in two people in the 1950s that were working in a cave that contained many millions of bats. However, both victims had other possible sources of infection. The chances of getting rabies this way are unconfirmed and somewhat debated. The Centers for Disease Control states in an NIOSH report: “While aerosol transmission of the rabies virus from bats to people is theoretically possible under extraordinary conditions, the risk is otherwise negligible.” (“Histoplasmosis — Protecting Workers at Risk” http://www.cdc.gov/niosh/docs/2005-109/2005-109c.html).
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Postby Cheryl Jones » Feb 11, 2007 12:31 am

The chances of aerosol exposure while caving are extremely small, and perhaps non-existent, but I think the information should be included.


I disagree. We need to should stick to facts in the info we distribute. We shouldn't disburse information that has barely a shred of evidence, if any, and which remains a theory, and a debatable one at that. Two possible cases 50 years ago does not warrant creating concern among parents and cavers around the country. "Extremely small"? That exaggerates the chance. Better chance of winning a lottery jackpot, given the number of caver-hours underground in the last 50 years.

It would seem to me a caver has a significantly higher risk of requiring medical attention from any number of incidents in a cave, and even other disease-causing microbes carried in by fauna and water.

All these statements tell me that there is no point in including the warning in our information sheets:
The chances of getting rabies this way are unconfirmed and somewhat debated
theoretically possible under extraordinary conditions, the risk is otherwise negligible
This may have occurred in two people in the 1950s that were working in a cave that contained many millions of bats. However, both victims had other possible sources of infection.


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Postby bill fish » Feb 11, 2007 4:12 pm

Regarding histo...if you are going to bring it up...


I think there should be some mention of the following "things"...I leave it to others on how to word it...

Folks with immune system problems or taking meds that suppress the immune system should not enter caves suspected of harboring histo.....I'll leave it up to others to draw the line somewhere between sligthly dusty cave #4 and giant bat guano cave #7

Neither should people with respiratory "problems"...

And if they still decide to enter...that while this isnt a guaranteed death sentence...it certainly COULD be an addition risk....

Also, any mention of histo should note that it is a FUNGAL infection and MUST be treated differently from what your typical doctor will probably suspect it is...and if the doctor wont listen.....find one that will...

Also if you are gonna mention histo....how about this....dirty "cave clothes" should not be allowed to dry out...and if dry or allowed to dry all reasonable precautions should be taken not to inhale any resulting dust....and when washed...some bleach in the washer might not be a bad idea either....

my 2 peso's

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Postby lookingaround » Mar 17, 2007 6:20 pm

Cheryl Jones wrote:
The chances of aerosol exposure while caving are extremely small, and perhaps non-existent, but I think the information should be included.


I disagree. We need to should stick to facts in the info we distribute. We shouldn't disburse information that has barely a shred of evidence, if any, and which remains a theory, and a debatable one at that. Two possible cases 50 years ago does not warrant creating concern among parents and cavers around the country.


We've finally had enough time to do some more research on this topic.

Here are several articles documenting airborne transmission of rabies:
The Journal of Infectious Diseases - Effects of Aerosolized Rabies Virus Exposureon Bats and Mice (Publication Date April 15, 2007)
Journal of Wildlife Diseases - Airborne Rabies Virus Isolation
American Journal of Epidemiology - An Outbreak Of Non-Bite Transmitted Rabies In A Laboratory Animal Colony
A Journal for the Society for General Microbiology - Airborne transmission of lyssaviruses

"Extremely small"? That exaggerates the chance.

Agreed. Perhaps 'extremely minute' would even be a stretch.

Better chance of winning a lottery jackpot, given the number of caver-hours underground in the last 50 years.

After reading the above articles would anyone be willing to buy a Power Ball ticket and then head into the nursery chamber in Frio Cave for a several hour trip? I'd bet that anybody who is unvaccinated and remains that way is more likely to end up dead from rabies than spending lotto winnings.

It would seem to me a caver has a significantly higher risk of requiring medical attention from any number of incidents in a cave, and even other disease-causing microbes carried in by fauna and water.

Agreed.

How do we proceed? What do other people think? Are there any medical professionals that could provide some guidance?
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Postby Teresa » Mar 28, 2007 2:56 pm

lookingaround wrote:
Cheryl Jones wrote:
It would seem to me a caver has a significantly higher risk of requiring medical attention from any number of incidents in a cave, and even other disease-causing microbes carried in by fauna and water.

Agreed.

How do we proceed? What do other people think? Are there any medical professionals that could provide some guidance?


I'm not a medical professional. With all due respect to Cheryl, a significantly higher risk than what?

Walking in an indoor mall?
Hiking outdoors (remember ticks and mosquitos)?
Playing with wild animals?
Walking barefoot with cut feet through a feedlot?
Shooting and gutting rabbits?
Swimming in a river, versus wading/swimming in a cave?

I would suggest, instead of going into minute detail, a statement like this:

Caving is like any other outdoor activity in that a participant is likely to encounter potentially harmful insects and pests, animal guano or feces, bad air, untreated water, bacteria, fungi, microbes and viruses unlike those in a participant's daily life.

Many caves have bats, and a small percentage of bats (just like deer, squirrels and other mammals) carry rabies. The risk exposure to bat rabies on a particular trip is highly minimized by instructing partipants they are not to touch and refrain from disturbing wild animals as much as possible. This possibility exists on every cave trip, but the probability that one's child would contract rabies as long as they avoid direct animal contact is much lower than the probability of them being involved in a traffic accident on the way to the cave.

To further minimize risk of illness, we suggest that children with open cuts, sores, stitches or abrasions not participate on a cave trip. Many infections, both in and out of the cave, are transferred via the hands. Gloves should be required, as much to keep one's hands free of contamination as dirt. No matter how clean-looking, cave water should be assumed to be contaminated with something, however the risk is rarely higher than swimming in a river or pond.

For children with chronic conditions, compromised immune systems, or pre-existing respiratory illnesses, follow your doctor's advice. A cave is not a fun place to be ill, and you will do your child a favor by deferring to a future trip when they have recovered.

After the cave trip, participants usually get cleaned up and change clothes. Sending anti-bacterial towelettes for use on the face and hands may help with your peace of mind, as well as instructing your child to wash their face and hands with soap and water (quite thoroughly!) before eating after the trip. Many cave trips are so grimy, even the most bath-averse child will crave one on their return home. Make sure they get one!

If any symptoms of illness develop within a few days of a cave trip, be sure to inform the doctor of the child's activity. Nearly all cavers cave for many, many years with few cave related illnesses because they check for and monitor insect bites, don't drink or enter visibly unsafe water, keep their hands and face clean, and take basic hygiene precautions after emerging from the cave.
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Postby Phil Winkler » Mar 28, 2007 3:18 pm

Caving, like living, may be hazardous to your health.
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Postby Cheryl Jones » Apr 16, 2007 6:26 pm

I'm not a medical professional. With all due respect to Cheryl, a significantly higher risk than what?

Than catching rabies by breathing cave air. (The stated risk I was challenging)

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Don't Drink The Water !!!!!

Postby Larry E. Matthews » Apr 23, 2007 12:39 pm

I don't think I saw this in anybody else's post, but don't drink untreated cave water or spring water.

This seems to be such simple advice, that nobody else thought to mention it.

Due to the nature of karst, containation from animal feces (on the surface) and from septic tanks may contaminate ground water. As a Health Professional (and a Geologist), I would recommend that nobody drink untreated spring water or cave water, no matter how clean it looks.

We had a case here in Tennessee, many years ago, where the trip leader (Boy Scouts) told his group: "Boys, empty your canteens and fill them up with this delicious, pure Spring Water." They ALL got sick. Later dye traces showed that poorly-treated sewage from Monteagle, Tennessee was dumped into a sinkhole and the water re-appeared at this spring at the back of Buggy Top Cave.

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Postby Phil Winkler » Apr 23, 2007 12:50 pm

Larry,

I always wondered about the Jack Daniels distillery and them bragging about the cave source of their water and its purity. Most folks in Missouri are well aware that water can travel miles in underground rivers where it gets absolutely no filtration.
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