If hand sanitisers kill 99.99% of germs, then who are those 0.01% who survive? There are three major kinds of germs which remain active even when you have used your sanitiser.

Norovirus

Among them, is the norovirus that causes diarrhoea and vomiting outbreaks in places like cruise ships and schools. It is superior to many other viruses because it has a protein capsid, which is resistant to the effects of alcohol.

Norovirus is a group of viruses that causes common illnesses and is also very contagious. It is especially active in the colder month and comes back seasonally. The first norovirus outbreak occurred in Norwalk, Ohio, USA, in a school in 1968, this is where it gets it name from.

Enterococcus faecium

The next on the list is enterococcus faecium, and it lives in the gut. As per a 2024 study titled Enterococcus faecium: evolution, adaptation, pathogenesis and emerging therapeutics, published in Nature journal, it is a Gram-positive bacterium that is a core member of the intestinal microbiota of humans and animals and an opportunistic pathogen that causes life-threatening infections, particularly among hospitalized patients. It mutates in a way that it absorbs carbohydrates and forms a gooey, slime-like substance called the biofilm, which makes it resistant to alcohol.

Clostridium Difficile

Another one is clostridium difficile. This is responsible for causing horrendous diarrhoea and vomiting in hospitalised patients. It also has a remarkable ability to respond to environmental stressors including alcohol gel by going to sleep. It produces spores and allows all metabolic activity.

Clostridium difficile (C. diff) is a type of bacteria that can cause colitis, a serious inflammation of the colon. Infections from C. diff often start after you've been taking antibiotics. It can sometimes be life-threatening.

Why Do You Label Read 99.99%?

Apart from the germs and pathogens, another reason why your label reads that it kills 99.99% is to avoid any legal hassles. If someone uses a specific product and falls sick, then the person cannot sue the company as the company did not give a 100% safety guarantee against the germs.

A better way to be healthy is always to clean your hands with soap and water and wear gloves wherever is possible.

Not every medicine carries the same level of risk. Some drugs can trigger reactions that are severe or even life-threatening. When that possibility exists, the manufacturer is required to place a special notice inside the prescribing information. This highlighted section is known as a black box warning.

A black box warning is meant to draw clear attention to the most serious dangers linked to a drug. Many medicines fall under this category. Still, having the warning in place does not automatically make the treatment unsafe. When a drug is used correctly and monitored by a trained professional, the benefits may outweigh the risks.

The sections below outline what an FDA black box warning means, why a medicine might receive one, and how it may influence your treatment plan.

What Is An FDA Black Box Warning And What Does It Signify?

A black box warning is the strongest caution that the FDA can attach to a prescription drug. You might also see it described as a boxed warning.

The presence of this warning does not mean a person should never take the medication. Instead, it alerts doctors and patients to serious potential harm. This information helps clinicians decide who is an appropriate candidate and under what circumstances the drug should be used.

Many medicines with boxed warnings remain the best or only option for certain conditions.

How Serious Is A Black Box Warning?

A drug receives this type of label when it has been linked to outcomes such as permanent injury, hospitalisation, or death. These warnings should be read carefully, and patients should discuss them openly with their healthcare provider.

Doctors follow specific precautions when prescribing drugs that carry this label to minimize unnecessary risk.

Where Can I Find A Drug’s Black Box Warning?

The warning sits at the very top of the medication’s official package insert. Its placement is deliberate so it stands out immediately. The text is printed inside a bold black border, which is how the term “black box” took hold.

You may not always receive the full package insert from the pharmacy. However, you might receive a medication guide if the drug is considered high-risk. These guides describe proper use and highlight major side effects. You can also look up medication guides online.

Information about boxed warnings is available from multiple sources. The FDA website, the drug manufacturer’s website, and medical reference sites used by clinicians all include these details.

How Does A Drug End Up With A Black Box Warning?

Every prescription drug must go through extensive testing before it reaches the market. During this process, researchers aim to uncover risks that could require a boxed warning from the start. Even so, some side effects only appear once large numbers of people begin using the drug in everyday settings.

Because of this, most black box warnings are added after a medicine has already been approved. The FDA continues to monitor safety reports through MedWatch, a program where patients, physicians, and companies can report problems.

These reports are gathered in a database called the FDA Adverse Event Reporting System. When the agency notices a pattern of serious reactions, they investigate. If needed, they update the prescribing information and add a boxed warning so that future users are clearly informed.

People assigned female at birth live with hormone shifts throughout their lives. These chemical messengers guide nearly every system in the body. The swings linked to periods, pregnancy or menopause are easy to recognise, but many other factors can unsettle hormone levels.

The body produces more than fifty hormones through the endocrine system, and changes in any of them can signal a deeper health concern. Low insulin may point toward diabetes. Excess cortisol can influence weight gain. Other hormones, like melatonin, rise and fall through the day as part of normal rhythm. And the gradual drop in estrogen and progesterone as women approach menopause is also expected.

What Causes Hormonal Imbalance?

Puberty, pregnancy and menopause naturally reshape hormone activity. Beyond these, several conditions can disrupt normal patterns. Problems with the adrenal gland, thyroid disorders, eating disorders, congenital adrenal hyperplasia, Cushing’s syndrome, diabetes or PCOS can all change your hormone levels. Changes may also stem from stress, certain medicines, tumours, cysts or environmental chemicals.

Interest in hormones has grown recently. Earlier this month, the Food and Drug Administration agreed to remove the boxed warning on menopause hormone therapy after reviewing the evidence. The decision prompted fresh discussion among women considering treatment. Clinicians say many patients are reaching out with new questions, especially in an era filled with quick tests and supplements marketed as hormone balancers. It can be difficult to tell when testing is truly needed.

Warning Signs Of Hormonal Imbalance

As each hormone plays a different role, symptoms vary widely. These are some of the more frequent changes seen in people, as per UCLA Health.

1. Menstrual changes: Shifts in estrogen and related hormones can alter the monthly cycle. Periods may become heavier, lighter, irregular or go missing. Stress, diet and exercise can contribute as well, but hormonal swings remain a leading cause.

2. Hair changes: Hair often reacts quickly to hormonal shifts. Pregnancy can bring thicker strands, while imbalances may trigger hair thinning or hair growth in unexpected places. Excessive facial hair may suggest elevated androgens. Hair loss can point toward a thyroid concern.

3. Skin Changes: Hormonal shifts can influence skin colour, texture and oil production. Acne may flare during pregnancy due to rising progesterone. Darkened patches of skin may appear on areas like the neck, groin or beneath the breasts when estrogen or progesterone levels change.

4. Sexual and vaginal symptoms: Lower estrogen levels, especially with age, can reduce libido and cause vaginal dryness or pain during intercourse. Some women may experience vaginal atrophy when estrogen remains low for long periods.

5. Weight changes: Sudden weight gain or weight loss can reflect a hormonal issue. Many women notice weight gain after menopause. Thyroid disorders, PCOS and Cushing’s syndrome are also linked to changes in body weight.

6. Mood and sleep difficulties: Falling estrogen levels influence serotonin, a chemical important for stable mood. Low serotonin can contribute to anxiety, irritability or low mood. These disruptions often spill into sleep. Some women also report night sweats or trouble staying asleep.

7. Digestive issues: Estrogen and progesterone affect digestion. When these hormones shift, the gut may respond with bloating, constipation or diarrhoea. Some research has linked hormonal changes in people AFAB to irritable bowel syndrome. Many notice digestive changes around their menstrual cycle.

What To Do If You Suspect A Hormonal Imbalance

There is no single test that measures every hormone, and at-home kits only cover a few markers. The safest first step is to speak with your primary care doctor. They can look at your overall health and decide what evaluations are appropriate.

Diagnosis may include:

• A physical exam and review of your medical history
• Checking prescriptions or supplements that may influence hormones
• Blood, urine or saliva tests to measure specific hormone levels
• A pelvic exam to check for cysts or growths
• An ultrasound to look at the ovaries, uterus, thyroid or pituitary gland

As bird flu continues to trouble several countries, health officials in the United States have reported the first known human case of the H5N5 subtype of avian influenza. The Washington State Department of Health announced on November 14, 2025, that the virus was found in a resident of Grays Harbor County.

The patient, an older adult with existing medical issues, is currently in the hospital. Authorities noted that the individual kept poultry at home that had contact with wild birds, which is believed to be the likely source of the infection, though the investigation is still underway. Since H5N5 is newly identified in humans, many are asking whether it differs from the earlier H5N1 strain.

What Is the H5N1 Strain?

H5N1 is a highly pathogenic form of avian influenza that mainly affects birds but can also infect mammals, including humans. It can lead to severe illness in people and has a high fatality rate, though it rarely spreads from one person to another, as per the World Health Organization. The virus has moved across continents in wild and farmed birds and has recently been found in dairy cattle and several other mammals.

What Is The New H5N5 Strain?

The “new” H5N1 strain refers to the 2.3.4.4b clade of highly pathogenic avian influenza (HPAI), which has caused a widespread animal outbreak since appearing in 2020. This version is a newer genetic branch of H5N1 and has swept through wild birds, poultry farms and an increasing range of mammals, including dairy herds in the United States. At present, the patient infected in the U.S. has been diagnosed with the newer H5N5 subtype.

How Is H5N5 Different From H5N1?

According to the CDC, both H5N5 and H5N1 fall under the avian influenza family, with the main distinction being the type of neuraminidase (N) protein on the virus surface. H5N5 contains the N5 protein, while H5N1 carries the N1 protein. Although this genetic change can influence viral features, their overall pattern of illness and symptoms is expected to be much the same, particularly in birds and livestock.

The genetic structure is the only difference, with H5N1 strain containing a subtype of influenza A with a segmented genome while the other has a new reassortant virus formed from several subtypes, possibly including H5N1, as per National Institute of Health.

Is A Vaccine Available For The H5N1 Bird Flu Strain?

Vaccines for bird flu do exist, but they are not intended for general public use and are not easily available for everyday protection. Some vaccines have been created and stored for possible deployment in people at higher risk, such as poultry workers and farm staff, and they are also used in animals like chickens to help manage outbreaks. The United States and several other countries have stockpiled H5N1-specific vaccines that could be rolled out if the threat to humans grows. A few nations, including Finland, are already offering them to certain high-risk groups. At the moment, there is no advice for the wider public to take a bird flu vaccine, as there is no sustained human-to-human spread and no mass-market human vaccine in use.