The following is excerpted from the CDC recommendations below.

"Studies investigating other pox viruses such as vaccinia indicate that iodine, an Environmental Protection Agency-registered surface agent, is effective...[against these viruses]". (emphasis supplied)

Ed. note: Plain iodine does not penetrate the barrier of the skin well. The formulation of iodine in ZymaDerm, combined with tea tree oil, multiplies the activity against the molluscum virus and helps the iodine to penetrate through the top layers of skin to where the virus lives and multiplies (replicates). Plain iodine applied to the skin does little for molluscum since it can not get to the virus.

CDC Recommendations: Patients with Molluscum Contagiosum and Swimming Pool Safety

Background

Concern for potential transmission of molluscum contagiosum virus via swimming pools and/or swimming pool-related paraphernalia (e.g., towels, kick boards) is a recurring issue for parents, teachers, and coaches and for health care and public health professionals.

Several investigations have centered around increased cases of molluscum contagiosum among children in the context of recreational swimming. Although biologically plausible, epidemiologic studies (studies looking at populations instead of individuals, Ed). have failed to demonstrate conclusively how, or under what circumstances, recreational swimming might facilitate molluscum contagiosum virus transmission. In fact, some studies failed to find an association between swimming pool use and virus transmission altogether. (1) Several studies that did implicate swimming pool use with molluscum neglected to adequately account for other factors that could introduce bias (unaccounted influence, Ed) or influence virus transmission, such as the age of the subjects, their participation in other forms of physical activity (i.e., contact sports), and their shared use of potential fomites (a physical object that serves as a means of transmission of infection such as towels, kick boards, Ed.). (2-4)

An additional issue complicating the interpretation of molluscum transmission studies is the widely variable incubation time (time for the infection to grow, like incubating an egg to hatch, ED) from infection to development of molluscum lesions (range, 2 weeks to 6 months), making the association between the event and lesion difficult to confirm.

It remains unclear whether contact with contaminated fomites is important (i.e., kick boards, towels) or whether swimming in potentially contaminated water alone is sufficient for virus transmission. It is conceivable that maceration (rubbing, scraping, rough distrubance of the skin bumps, Ed.) of the molluscum contagiosum lesions following water submersion facilitates person-to-person contact or fomite transmission. Current culture techniques do not support the growth of molluscum contagiosum virus, therefore, many of these questions can not be directly answered. Further research is necessary to better characterize molluscum contagiosum virus viability in pool environments. (6)

Recommendations

Since molluscum contagiosum may be found in up to 10% of the pediatric population at any given time (7), the decision to prohibit children with molluscum contagiosum from swimming in public pools should be given careful consideration. Exclusion may interfere with much needed physical and social outlets as well as create social stigma.

If such a policy were instituted, the diagnosis of molluscum contagiosum should be made by a health care provider and all participating children should be subject to the same screening physical exam. Such screening could be incorporated into annual sports/camp physicals. A thorough skin examination should already be performed during these physicals for other conditions such as atopic dermatitis. Thus, identification of molluscum lesions should not pose an undue burden during this process.

Covering visible lesions with a watertight bandage, disposing of all bandages at home or in a health care setting, using good hand hygiene, ensuring that towels are not shared, and providing individual kick boards are all reasonable interventions to help prevent the spread of molluscum contagiosum and other infections acquired through contact exposures (e.g., methicillin-resistant Staphylococcus aureus). Additionally, thorough disinfection and drying of kickboards should reduce the likelihood of molluscum contagiosum transmission.

Studies investigating other pox viruses such as vaccinia indicate that iodine, an Environmental Protection Agency-registered surface agent, is effective (emphasis supplied; ZymaDerm contains iodine in amounts well established for safety and effectiveness)... [against these viruses]. (emphasis supplied)

Children with open sores or skin breaks should avoid pool use because of other infectious risks (bacterial and mycobacterial infections). This general recommendation should remain unchanged for children with molluscum contagiosum.

Editorial Comment: Small pools of water often collect along the edges of swimming pools and children love to sit and dangle their legs in the water, exposing them to contact with these small pools of water. It is possible that virus transmission can occur from such area, since the virus would be present in much higher concentration in such smaller puddles than in the swimming pool itself.

Dr. B. Burke, MD
CBR, Inc.

References

1. Oren B, Wende SO. An outbreak of molluscum contagiosum in a kibbutz. Infection. 1991;19(3):159-161.
2. Niizeki K, Kano O, Kondo Y. An epidemic study of molluscum contagiosum: relationship to swimming. Dermatologica. 1984;169:197-198.
3. Castilla M. Molluscum contagiosum in children and its relationship to attendance at swimming-pools: an epidemiological study. Dermatol. 1995;191:165.
4. Choong KY, Roberts LJ. Molluscum contagiosum, swimming and bathing: a clinical analysis. Australas J Dermatol. 1999;40:89-92.
5. Dai NT, Yeh MK, Liu DD, et al. A co-cultured skin model based on cell support membranes. Biochem Biophys Res Commun. 2005;329(3):905-908.
6. Howell MD, Jones JF, Kisich KO, Streib JE, Gallo RL, Leung DY. Selective killing of vaccinia virus by LL-37: implications for eczema vaccinatum. J Immunol. 2004;172(3):1763-1767.
7. Gottlieb SL, Myskowsi PL. Molluscum contagiosum. Int J Dermatol. 1994;33:453-461.

CDC Page Last Modified: April 18, 2006
( http://www.cdc.gov/ncidod/dvrd/molluscum/swimming/swimming_recommendations.htm)

Web Page Last Modified Nov 5, 2006

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