"Picking your nose in public should be encouraged." by Britt Selvitelle is licensed under CC BY 2.0

Nose-Picking Can Spread Pneumonia

MedicalResearch.com Interview with:
"still picking her nose" by quinn norton is licensed under CC BY 2.0Dr Victoria Connor 

Clinical Research Fellow
Liverpool School of Tropical Medicine and Royal Liverpool Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pneumococcus is a bacteria which is very common and causes lots of different infections (pneumococcal disease). Infections can be non-invasive or invasive. Non-invasive diseases include middle ear infections, sinusitis and bronchitis. Invasive infections including chest infection (pneumonia), infections of brain and spinal cord (meningitis) and blood infections (sepsis).

Invasive pneumococcal infections is a major cause of death around the world and in the UK, is estimated that is responsible for 1.3 million deaths in children under 5 annually. Pneumococcal disease causes more deaths in low and middle income countries where approximately 90% of pneumonia deaths occur.

Pneumococcus also is commonly carried (colonises) the nose/throat of children and adults. This colonisation is important to understand as it is the main source of the bacterial transmission and is also the first step in pneumococcal infections.

The understanding of transmission of pneumococcus is currently poor. It is generally thought that transmission occurs through breathing in the respiratory sections of someone carrying pneumococcus in their nose which are infected with pneumococcus.

However more recently studies especially in mice have shown that there may be a role of hands or other objects as vehicles for the transmission of pneumococcus.

MedicalResearch.com: What should readers take away from your report?

Response: Clinicians can use this information to educate and inform their patients that good hand hygiene practices, already known to reduce enteric bacterial and viral disease, may also prevent the spread of bacteria thought to be primarily spread through aerosolisation.

It supports previous advice for clinicians that for our high-risk patients we should promote rigorous hand hygiene, avoidance shaking of hands and to ensure basic infection control measures such as avoidance of sharing food, drink, mobile phones may reduce the transmission of respiratory bacterial pathogens such as pneumococcus.

This research shows to parents that like respiratory viral infections some bacteria can also be spread by the hands. It is unclear at present if completely reducing transmission and carriage of pneumococcus in children is the best thing because carriage has been show to boost the immune system of children and reduce them carrying it again later in life. But for parents this research shows that hands are likely to spread pneumococcus which would be important when children are in contact with elderly relatives or relatives with reduced immune systems. In these situations ensuring good hand hygiene and cleaning of toys/surfaces would like reduce transmission and likely to reduce the risk of disease in these people.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: We have already conducted a RCT to investigate if hand washing could reduce this transmission from hand to nose and plan to do further studies similar to this to investigate methods of reducing tranmission.

Another next  step is to look at shedding of pneumococcus from the nose during a colonisation episode and how it is shed- via nose via saliva, cough etc as this is a crucial first step needed before any transmission to another person.

MedicalResearch.com: Is there anything else you would like to add?

Response: This pilot study showed that a human challenge models can improve our understanding of transmission and that these types of models can be used in the future to investigate how pneumococcus is spread.

The study was part funded by Unilever who had some input into the study design but no influence in running of the study or analysis of the results.


Victoria Connor, Esther German, Sherin Pojar, Elena Mitsi, Caroline Hales, Elissavet Nikolaou, Angela Hyder-Wright, Hugh Adler, Seher Zaidi, Helen Hill, Simon P. Jochems, Hassan Burhan, Neil French, Timothy Tobery, Jamie Rylance, Daniela M. Ferreira. Hands are vehicles for transmission of Streptococcus pneumoniae in novel controlled human infection study. European Respiratory Journal, 2018; 52 (4): 1800599 DOI: 10.1183/13993003.00599-2018 

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Last Updated on October 16, 2018 by Marie Benz MD FAAD