Rare yet dramatic diseases inspire great fear among patients [5]. These diseases usually involve terrifying symptoms, high rates of death, or both [1]. People become concerned that these frightening diseases will spread far and wide [1]. The paradox of infectious diseases is that the likelihood of spreading decreases as symptom severity increases, because victims of diseases that cause rapid and severe symptoms, such as Ebola, are quickly relegated to care and quarantine [1]. Diseases that lie dormant or do not present symptoms serious enough to warrant immediate medical attention are more likely to spread, as is the case with the common cold [1]. This inverse association between symptom severity and ability to propagate holds even within one disease type. The most dangerous strains of a disease such as influenza eventually winnow out and leave only the more mild versions affecting humans [1]. At this stage, those who are immunologically vulnerable (e.g., the elderly) are most susceptible to the remaining strains [1].

Medical practitioners are tasked with the balance of dispersing sufficient information for people to take precautionary measures without unnecessarily frightening them. Patients often view infectious disease agents as having all powerful capabilities, but the organisms that cause infectious diseases have biological constraints, just as humans do [1]. To counter the fear of vulnerability, physicians can explain the organisms’ weaknesses and the preventative measures that can be taken to exploit them [1]. Without knowledge of effective measures and the rationale for them, people will often engage in ineffectual preventative measures out of a need to feel in control in the midst of a frightening situation.

One infectious disease that presents a risk to older adolescents, particularly college students, is meningitis. Meningitis causes a swelling of the brain and spinal cord [8]. Meningitis is relatively rare; approximately between 600 and 1,000 people contract meningococcal disease in the United States each year, 21% of whom are preteenagers, teenagers, and young adults [9]. Different types of organisms cause meningitis, but the 2 most common agents are viruses and bacteria [8]. The viral form is typically less severe and can remit without medical intervention [8]. The bacterial form is highly contagious among people who come in close personal contact [10]. Invasive meningococcal disease progresses rapidly from initial symptom onset to extremely severe outcomes, including brain damage or death [11–13]. The initial symptoms are nonspecific and often described as “flu-like” [11]. This lack of clarity can cause individuals suffering from a common cold or flu to believe their symptoms indicate the onset of meningitis. Because the symptoms can progress in a matter of hours, there is little opportunity for testing when an individual develops the more general symptoms [10]. The initial symptoms progress to specific indicators: vomiting or nausea, stiff neck, confusion, and a purple/reddish pink rash that appears on the lower extremities or lower arms or hands [10].

Meningitis incidence peaks in adolescents and young adults [14, 15]. College students in particular engage in activities that promote meningococcal transmission, such as close personal contact, drinking from the same beverage glasses, and sharing cigarettes [10]. Many colleges require that their students receive the meningitis vaccine prior to enrolling in classes. In these cases, the pediatrician’s role in explaining the benefits of the vaccine is relatively straightforward. Adolescents who are not planning on attending college may still engage in behaviors that increase transmission. Without an educational institution requiring their vaccination, these patients may need to be told more explicitly that the vaccine is crucial in preventing many types of meningitis.

While vaccines are available for most serogroups of the bacterial form, not all serogroups have vaccines approved for use in the United States [10]. Therefore, even vaccinated students should understand what preventative measures are worthwhile to take if their campus experiences an outbreak [10]. Most cases of meningitis on campuses are isolated and do not transmit to other students [16]. The disease cannot spread through casual contact, such as handshakes [10]. Nor can someone contract meningitis by breathing the air where an infected individual has been [10]. Still, the activities that promote transmission are common among college students, and an outbreak of meningitis itself is likely to be the inducement students need to reduce these behaviors [10]. Before patients leave for college, pediatricians should inform them to immediately reduce forms of close personal contact if the school announces an outbreak. More anxious adolescents can be shown images of the meningitis rash so that common rashes that occur in the absence of a meningitis outbreak do not unduly alarm them.

Many infectious diseases that inspire public panic require no such preventative measures, as they are extremely rare. Panic arises when individuals believe there is some risk that they will become infected, whether that risk assessment is accurate or not. For example, the Ebola Virus Disease (referred to colloquially as “Ebola”) had claimed hundreds of lives in Africa without garnering an international response [17]. Only after health officials determined it was possible for Ebola to infect individuals outside of Africa did international bodies declare Ebola a public health emergency [17]. Once the chance of contraction entered the consciousness of the Western public, details of the virus emerged to fan the flames of panic. Panic produces “irrational” fears and “overreactions” in preventative measures [17]. One such overreaction occurred when school administrators in New Jersey banned students from Rwanda, even though this country is 1,700 miles from the outbreak region, a distance roughly equivalent to that from New York City to New Orleans [17]. Ebola panic spread more quickly and widely than the disease itself [17].

During an outbreak of a relatively new infectious disease, the lack of available research compounds public panic. Without studies to clarify the causes, treatment, and effective prevention of the disease, physicians have less information to relay to worried parents. Searching for answers and reassurance, the public relies on the media to deliver breaking news as groups such as the Centers for Disease Control and Prevention publish information as soon as it becomes available. Yet as is always the case with scientific research, new findings can contradict older information. The iterative nature of research always unfolds in this manner, but it usually does so largely outside of the public’s awareness. When placed within the context of panic, the public is even less tolerant of the imperfections that characterize research investigations. Without understanding the nature of the scientific process, parents may erroneously believe that the organizations producing these new, more accurate findings were “wrong” before, reducing their overall confidence in the organizations.

Generally, children are more susceptible than adults to contracting infectious diseases. First, young children have poor personal hygiene [18]. They tend to put their hands and other objects into their mouths [18]. Second, children’s emerging immune systems are not yet as effective as those of adults [18]. As a result of these factors, parents views that their children are more vulnerable to contracting illnesses than adults is, on average, accurate.

While parents may be concerned about the striking diseases highlighted in the media, children are significantly more likely to contract gastrointestinal diseases (such as diarrhea), upper respiratory tract infections (when caused by a strain of the rhinovirus, called the “common cold”), and acute otitis media (referred to as “ear infections”). These common ailments result in high usage of medical services. Upper respiratory infections confer heavy health care usage and economic burdens [19]. Because they are so prevalent, focusing efforts on preventing the spread of these diseases can reduce suffering and costs to families.

Parents want to know which environments may increase their children’s chances of contracting an illness. Day care centers have been of particular interest, especially as an increasing number of children are cared for in these settings. There is evidence that children who attend day care centers are at higher risk of contracting infectious diseases, although the risk has not been proven across all common ailments [18]. The most common syndrome that affects children who attend day care is the upper respiratory infection [18]. The incidence of this common cold is 1.6 times higher in children who are in day care than in children who do not attend day care [20–25]. In real numbers, this translates to an average of 7 or 8 colds per year for children under the age of 2 years who attend day care centers [20, 21]. Children who attend day care centers are also at higher risk of contracting acute otitis media [26]. On average, as the number of children present at the center increases, so does the risk of contraction [26].

The centers themselves are not considered to blame for disease transmission. Day care centers are specifically designed for children, who are already, as highlighted above, more susceptible to contracting illnesses. Two additional factors that generally contribute to the spread of illness are also present in this type of environment [18]. The day care environment provides ample opportunities for direct physical contact between children, easily aiding host-to-host transmission [18]. Also, children can be contagious while asymptomatic, permitting a disease to transmit before the day care center staff has time to implement any response to reduce the spread [18]. These same factors impact other environments where young children congregate, such as parks, camps, and preschools. In large part, the more time children spend with other children in close settings, the higher their risk for contracting an infectious disease [18].

The most important factor in the reduction of common infectious diseases is proper hand washing, including the method, frequency, and timing [18, 27]. A meta-analysis of various hand hygiene methods found that education about proper hand washing technique and the use of regular soap was efficacious in the prevention of gastrointestinal and respiratory illness [27]. Day care centers that initiated hand washing training programs saw a 50% reduction in diarrheal illness [28]. The Centers for Disease Control and Prevention recommend individuals wash their hands with soap and water for 20 seconds [29]. They should lather the soap by rubbing their hands together, rinse the soap off completely with water, and dry their hands completely [29].

This meta-analysis found no evidence supporting the use of antibacterial soap over regular, nonantibacterial soap [27]. Antibacterial soap, by definition, would not be expected to have any impact on viral illnesses, but bacterial illnesses affect a great number of children worldwide [27]. The study authors, however, found no evidence in their data supporting the hypothesis that antibacterial soaps were more effective in preventing transmission of these illnesses [27]. Not only do antibacterial soaps fail to convey extra protection against infectious diseases when used in the community, laboratory studies have found evidence that these products contribute to the development of bacteria that are resistant to antibacterial soaps and medications [30–32]. Due to the lack of evidence in favor of anti-bacterial hand soaps and the increasing evidence that the chemicals used in many of them pose public health risks, the U.S. Food and Drug Administration (FDA) banned the sale of products containing some of the most common antibacterial agents. While consumers may, for a time, still be able to purchase products containing other permitted antibacterial agents, a clear trend away from these products is emerging. As such, pediatricians should be prepared to address parents’ questions about the removal of these products, and assure parents that use of regular hand soap is effective.

In general, hand washing has been found to be slightly more effective in the prevention of gastrointestinal diseases than respiratory diseases, suggesting that other preventative measures are needed to supplement proper hand washing [27]. For example, hand washing is not particularly effective in reducing the transmission of influenza. While influenza can spread via direct physical contact and touching objects the infected individual has handled, it also spreads through droplets in the air [33]. Hand washing would influence the first modes of transmission, but not the aerosol mode of transmission. Recommendations to supplement hand washing include promoting higher uptakes of the influenza vaccine for young children [33]. Other preventative measures include increasing ventilation and separating infected individuals from other children while they remain contagious [34, 35].

Despite the popularity of alcohol-based hand sanitizers for personal use (i.e., not in hospitals), the meta-analysis did not return strong associations between such products and reductions in gastrointestinal or respiratory illness [27]. Within health care settings, alcohol sanitizers have been shown to prevent infections [29]. The difference between these findings is hypothesized to be a result of the differences between the practices and habits of people in the general population and those trained in health care fields [27]. As such, suggesting that people in the community use hand sanitizers is not a particularly helpful recommendation. The FDA is examining hand sanitizers and is expected to then rule as to whether they will permit the continued sale of these products.

In addition to antibacterial soaps, parents buy other antibacterial products aimed at disinfecting the common household [36]. These products are typically applied to surfaces within the household with the aim of inhibiting bacterial growth [36]. While these products are not directly designed to reduce illness, people who buy them may believe they are promoting healthy living among their family members [36]. While antibacterial products can protect vulnerable patients from bacteria that cause infectious disease, these products are limited in their influence on lives of typical, healthy individuals [36]. As with antibiotic medications, antibacterial products can only inhibit the growth of bacteria; they play no role in viral illness transmission [36]. These products also are static—developers select a few bacteria to target [36]. Meanwhile, bacteria are constantly growing and adapting, rendering these products effective among some bacteria for only a limited time [36]. Finally, not all bacteria cause illness in a human host [36], and humans should not attempt to kill all bacteria they come into contact with. This would be impossible in any case, but it is important for people to remember that bacteria are a crucial part of the human biosphere. Bacteria support the development of the human immune system and aid other crucial functions, such as digestion [37]. While the relationship between bacteria and health is still being studied extensively, some researchers have found a connection between higher rates of allergies in individuals who practice excessive hygienic practices [37–40]. The physician’s role is to promote effective and reasonable prevention methods for common diseases while discouraging parents from engaging in any unnecessary or overly cautious practices.

The “common cold” is indeed common, with children suffering an average of 6 to 10 colds per year [41]. A group of viruses called rhinoviruses infiltrates the upper respiratory system and causes this contagious infectious disease [42]. Most parents identify a common cold by a mixture of symptoms that may include runny nose, sore throat, congestion, coughing, fever, and fatigue. Colds present varying symptoms and severity. These differences in presentation are a result of the approximately 200 different strains of virus that can cause the illness [41]. Differences in the child’s immunity also contribute to the diversity of experiences with the common cold [41]. Parents may be surprised to learn that their child may be infected with a rhinovirus and show no symptoms at all [41].

Understanding the scientific causes of the common cold is thought to be an important step in increasing the use of preventative measures [42]. If parents hold inaccurate views about causes, they may avoid certain situations or engage in other behaviors that are ineffective in helping them achieve their goal of preventing colds. So-called folk beliefs—commonly accepted wisdom with no scientific basis—about the causes of the common cold have persisted for generations. Some of these are erroneous beliefs about what causes colds, such as changes in the weather, cold weather itself, not wearing enough clothing in cold weather, going outside in cold weather with wet hair, sleeping with wet hair, teething, and walking outside barefoot [42, 43]. Some may also believe that sharing food or utensils with a sick individual can transmit the rhinovirus. However, the virus does not thrive in saliva or normal human body temperatures [44]. Folk beliefs regarding the causes of the common cold remain common in the twenty-first century [43]. Among a sample of nearly 200 parents of children younger than 5 years, 25% believed in five or more of these erroneous notions about colds [43]. Parents who follow these folk beliefs sometimes engage in practices that are ineffective at reducing transmission of the common cold.

Once a child is already sick, misconceptions also prompt parents to make ineffective and sometimes dangerous treatment choices. On the less dangerous end, parents may be under the impression that dietary supplements such as Vitamin C, Emergen-C, and Airborne reduce the severity of cold symptoms [42]. However, there is no evidence to support these claims [44]. Many of these products are taken with water or dissolved in water. As adequate hydration is crucial for immune support during an illness, parents can save their money on these products and instead ensure that their children drink enough water when ill. More dangerously, many parents purchase and administer over-the-counter (OTC) products containing antihistamines and decongestants to their young children [45]. Many parents are familiar with OTC antihistamine and decongestant products because they take them themselves. The U.S. Food and Drug Administration (FDA) approves these OTC medications for use in adults [45]. Parents may assume that the products are safe for children [45]. The labels of the products often seem to confirm this misconception. One study found that the labels of many OTC cough and cold products include wording and images that imply safe use among children [45]. The 3 label attributes that most commonly influenced parents in this study to believe the product was safe for children were the word “infant” on the label, infant-related images (such as teddy bears or infants themselves), or other wording implying that the product is appropriate for children (such as “pediatrician recommended”) [45]. In addition to the labels, studies have found that up to half of pediatricians have endorsed these products to parents for use among children [46, 47].