warning: Echinococcus granulosus / hydatid tapeworm eggs are NOT killed by hand sanitizer [very long post]

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CaptainDeadpool
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warning: Echinococcus granulosus / hydatid tapeworm eggs are NOT killed by hand sanitizer [very long post]

Post by CaptainDeadpool » Fri Jul 27, 2018 3:51 pm

Hi all -

I was planning a backpacking trip to IR and encountered this forum, which is a truly wonderful resource; thanks to everyone for sharing all of your insights.

One of the items that concerned me was the endemic nature of Echinococcus granulosus (the "hydatid tapeworm") in all inland lakes (and possibly surrounding Lake Superior water) on Isle Royale. For those who aren't aware, worms aren't the risk for humans - the risk is that we would stand in for moose, and have (potentially lethal) cysts form in our organs (particularly the liver, but also potentially elsewhere) if we ingest the eggs (which are found in wolf feces and, via rain runoff, are known to contaminate all inland water on Isle Royale, and quite possibly surrounding Lake Superior water, though probably at a much lower rate. It's worth noting that although the wolf population on IR has greatly diminished, foxes are known carrion feeders and while they may or may not be immune to E. granulosus - it's debated - it's probably safer to assume that they can, and that E. granulosus prevalence on the island has not diminished despite the recent decline in the wolf population.)

Although these tapeworms exist elsewhere in the United States, their concentration appears to be many orders of magnitude higher on Isle Royale vis-a-vis the Boundary Waters and other areas with the same fauna (at least to the extent I've been able to tell from a review of online sources - it doesn't seem anyone is all that concerned about echinococcosis elsewhere in the lower 48, at least from a backpacking / backcountry standpoint. Please correct me if I'm wrong; I may just have not looked far enough! I did see a few mentions of certain parts of Idaho / Montana / Utah / California / New Mexico / Arizona, but they didn't seem to be as extensive as Isle Royale and seemed to be more of a threat for sheep farmers and their dogs.)

As such, there have been several threads in the past regarding the need to use water filters (and not just UV sterilization or chemical treatment) to make water on Isle Royale safe to drink.

In the process of researching, I came across a very extensive (286-page) document on echinococcosis from the World Health Organization (WHO) that I hadn't seen cited on any of the tapeworm-related threads here. (https://www.medbox.org/preview/5255e18b ... cc/doc.pdf) It contained a lot of information on disinfection protocols that I thought was important. One of the most important aspects that I haven't seen anyone mention:
Echinococcus and Taenia eggs are highly resistant to numerous chemicals (22). For example, eggs of T. pisiformis survived for 3 weeks in 10% formalin, eggs of E. granulosus retained viability in ethanol (50%, 70%, 95%) after 5 min to 60 min exposure (19, 24, 26), but only a few survived in glutaraldehyde (5% and 10%) (27). Most of the commercial disinfectants with activity against viruses and bacteria are ineffective against Echinococcus eggs (see below).
The document goes on to recommend wearing gloves/protective equipment in the first place, and subsequent thorough hand-washing with soap and water (among other measures for decontamination of clothing, surfaces, etc.) I don't know about y'all, but when I'm backpacking, I typically use hand sanitizer (i.e. a concentrated solution of ethanol, isopropyl alcohol, or similar) to clean my hands, since it's more convenient than carrying soap and treating water to wash hands as well as drink. If "5 to 60 minutes" of exposure to ethanol concentrations similar to those in Purell didn't kill the eggs, then simply dabbing a little on your hands is the biowarfare equivalent of a band-aid on a sucking chest wound - it's not going to do any good.

So it appears that hand sanitizer would be completely ineffective against tapeworm eggs that have come to reside on your hands. In other words, even if you properly treat water that you drink, you could still contract echinococcosis if you have eggs on your hands (from contaminated soil, water, or elsewhere). This is not a theoretical concern; the document notes that in addition to transmission through drinking water, other transmission mechanisms include:
"Handling infected definitive hosts, egg-containing faeces or egg-contaminated plants or soil followed by direct hand to mouth transfer."
Another research study, "Hydatid disease in children," noted risks associated with swimming or other exposure to contaminated bodies of water: (https://www.sciencedirect.com/science/a ... 6X14001169):
The diagnostic armamentarium has to be supplemented by clinical examination and a meticulously taken history. History of bathing and swimming in pond water, which is usually contaminated with animal excreta, should be noted. Male children tend to participate in more outdoor activities and games compared to girls in villages and thus have a greater chance of coming into contact with water, soil and feces contaminated with Taenia eggs. Male preponderance has been reported in other studies...
Anyway, I just thought this is something people should be aware of - I know that previous posts have mentioned not eating unwashed wild blueberries (the document recommends preferably boiling them), but it was news to me (after several days of reading/researching) that hand sanitizer wouldn't kill any residual baddies that might be left on my hands after swimming, tripping and hand-planting on the trail (I'm particularly good at this), attempting to domesticate a wolf and bring it back on the seaplane... etc.

(That last one, to be clear, was a joke. Wolf domestication is not recommended and there are probably more severe risks involved than echinococcosis. As a separate note, and more to the point, these eggs can survive for a very long time on surfaces (including canid hair and, I would speculate, human skin) at normal humidity levels, so there's also the potential for transmission via your clothes, boots, backpack/other gear, and so on after you leave the island, unless they're all properly sanitized via desiccation with dry heat and/or high temperature washing / autoclaving.)

Obviously, it's an individual choice of how much risk you're comfortable taking, and I don't mean to be an alarmist - as Laurence Gonzales puts it in his book Deep Survival (https://amzn.to/2AcsEcs), if you never take any risks, you'll never do anything fun or worthwhile. I am aware that tens of thousands of people visit Isle Royale each year, a number which vastly exceeds the cumulative known echinococcosis cases in the lower 48 over the past several decades (it is in fact extraordinarily rare for non-indigenous, i.e. not Native American, U.S. residents to contract it domestically). I haven't done any math, but back of the envelope, one is probably far more likely to die or suffer severe disability traveling to Isle Royale than from contracting echinococcosis from Isle Royale, assuming you aren't intentionally stupid (i.e. you don't start munching on wolf feces).

But given the long-term incubation period (often asymptomatic for decades until you wake up one day and it's suddenly a big problem - potentially anaphylactic shock), invasive treatment required (excision surgery on the liver, brain, or wherever else cysts form, and/or chemotherapy), and potentially severe consequences vis-a-vis more well-known backcountry waterborne threats like Giardia or Cryptosporidium, or even vector-borne threats like Lyme disease from black-legged deer ticks, I felt like this was important information to share - clearly the base rate of contracting it on IR is substantially higher than it would be anywhere else in the wilderness, and as such there are unique considerations that must be taken into account for trips to Isle Royale compared to other backcountry adventures.

I hope this is helpful background. It took quite a while for me to type this (and, probably, for you to read it) but everyone has been so generous sharing their insights here that I wanted to do the same... maximum effort. I have never visited Isle Royale, nor talked to anyone who has, nor am I a microbiology expert nor a professional scientist, but I do have a brief background in scientific lab research and work as a research analyst in the finance/investing world - so interpreting and synthesizing information is what I do for a living. I think my conclusions here are directionally accurate for our purposes although there are undoubtedly some aspects I've misunderstood or not completely captured. Regardless, I recommend you review the appropriate portions of the linked documents yourself for further important information and context.

Best wishes from Texas!
Last edited by CaptainDeadpool on Fri Jul 27, 2018 10:28 pm, edited 1 time in total.

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JavaHiker
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Re: warning: Echinococcus granulosus / hydatid tapeworm eggs are NOT killed by hand sanitizer [very long post]

Post by JavaHiker » Fri Jul 27, 2018 10:15 pm

The CDC information on Echinococcus granulosus:

https://www.cdc.gov/parasites/echinococ ... -faqs.html.

In short, it is a most commonly a domestic canine related issue related to the sheep industry. To quote: "Risk factors for human infection include uncontrolled dogs living closely with people, uncontrolled slaughter of livestock, and unsanitary living conditions."

Wolves have never lived close to people on Isle Royale, and there are no sheep.

Please state your source(s) for your following claims:

(1) "...their concentration appears to be many orders of magnitude higher on Isle Royale vis-a-vis the Boundary Waters and other areas with the same fauna (at least to the extent I've been able to tell from a review of online sources - it doesn't seem anyone is all that concerned about echinococcosis elsewhere in the lower 48, at least from a backpacking / backcountry standpoint."

(2) "...clearly the base rate of contracting it on IR is substantially higher than it would be anywhere else in the wilderness, and as such there are unique considerations that must be taken into account for trips to Isle Royale compared to other backcountry adventures."

I am unaware of any such reported high "concentration" of "infections" on record. Rolf Peterson has reported it in moose as part of his ongoing studies, but he has always been thorough in his research so that is to be expected. I am unaware of any human contracted cases on Isle Royale.

For the general forum reader, note that I have used a First Need water purifier for water filtration since the 80's when I worked as a wilderness ranger in Wyoming and Colorado, and have never had a concern about drinking water due to the tested effectiveness of its design. As long as you maintain the canisters and replace as needed, it is effective.

Sanitary concerns in the backcountry are a reality due to the lack of "modern" amenities, but I am more concerned with human fecal contamination (sorry: reality check) and the increasing number and variety of tick and mosquito related illness diagnoses in North America than I am of the minute possibility of a rare and specifically transmittable disease which is not an endemic threat to humans that visit Isle Royale.
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Re: warning: Echinococcus granulosus / hydatid tapeworm eggs are NOT killed by hand sanitizer [very long post]

Post by Ingo » Sat Jul 28, 2018 7:12 am

The relevant question for folks is should I be concerned and what should I do? Yes, tapeworm is known to exist on the island, therefore you should filter or boil all water you consume and avoid potential contamination of eating/drinking utensils with untreated water (e.g. don’t rinse your dishes in untreated water). Chemical and UV treatments are not sufficient. That’s about it.
clearly the base rate of contracting it on IR is substantially higher than it would be anywhere else in the wilderness, and as such there are unique considerations that must be taken into account for trips to Isle Royale compared to other backcountry adventures.
This, however, is not a valid conclusion, since there’s no data comparing base rates of contraction. Without any evidence of documented cases, the contraction rate is zero, regardless of any theoretical risk. In some other places that are not known to have tapeworm it is considered sufficient to treat with chemicals or UV, but that’s the only difference.

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Re: warning: Echinococcus granulosus / hydatid tapeworm eggs are NOT killed by hand sanitizer [very long post]

Post by JavaHiker » Sat Jul 28, 2018 8:38 am

Just an added note: UV light kills bacteria, viruses and some cysts. It does not kill Giardia lamblia cysts or Cryptosporidium parvum oocysts, which must be removed by filtration or distillation. A minimum 0.4 micron water filter is recommended, and a 0.1 micron filter can handle almost any contaminated water source.
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hooky
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Re: warning: Echinococcus granulosus / hydatid tapeworm eggs are NOT killed by hand sanitizer [very long post]

Post by hooky » Sun Jul 29, 2018 8:18 pm

I filter water for drinking, so I always have clean water with me.. I rinse my hands with the filtered water to get as much dirt and grime off as i can and wash them using a small dab of Dawn, rinse with the clean water and then use sanitizer. You can't sanitize something that's dirty. It has to be clean to be sanitized. I figure that's about the best that I can do.

A contact case will easily hold enough Dawn for 1 person over 8-10 days.

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