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April 25th: The hygiene hypothesis - a misnomer which is undermining public health

In a presentation given at the Microbiology Society conference, Sally Bloomfield set out what needs to be done to achieve hygiene behaviour change whilst also addressing need for exposure to essential microbes.

The ‘hygiene hypothesis’ first cited in 1989 proposed that lack of exposure to childhood infections due to smaller family sizes, improved household amenities and higher standards of personal cleanliness were underlying causes of rising allergies. Despite agreement that this hypothesis is a misnomer and the exposures needed are largely non harmful “Old Friends” microbes, and that the underlying causes are lifestyle changes such as C-section childbirth, less time outdoors, altered diet, too many antibiotics etc, the idea that hygiene and cleanliness is the problem still persists in the minds of the public and the media and is undermining attitudes to hygiene and its importance

A survey by the IFH found that, of 25 news articles published since 1998, 20 continued to cite hygiene as a cause of reduced exposure to friendly microbes and 10 cited the “hygiene hypothesis” as explaining the link to immunological disorders. Continued promotion of this misnomer is making the public confused and distrustful about hygiene. What’s most worrying is that this is happening at a time when hygiene is becoming more important.

It is now time to stop using this simplistic misnomer to describe a highly complex issue which has profound implications for health.  We need to work to restore public confidence in hygiene. The important news is that empowering us to practice good hygiene in order to take care of our own health, including reducing the need of antibiotic prescribing is now a part or government health strategy and the new UK 5 years plan for tackling antibiotic resistance.  By contrast the hygiene hypothesis is fake news - like linking measles vaccination and autism – which is undermining public health.