The elbow bump is an informal greeting where two people touch elbows. Interest in this greeting was renewed during the avian flu

Avian flu

Avian influenza, sometimes avian flu, and commonly bird flu, refers to "influenza caused by viruses adapted to birds." Of the greatest concern is highly pathogenic avian influenza ....

 scare of 2006 and the 2009 swine flu outbreak, when health officials supported its use to reduce the spread of germs.

Kalaupapa Leprosy Settlement

An early popularization of the elbow bump began outside the Kalaupapa Leprosy Settlement in 1969 with the lifting of the quarantine policy, which forced leprosy

Leprosy

Leprosy or Hansen's disease is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Named after physician Gerhard Armauer Hansen, leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions...

 patients to live in an isolated peninsula on Molokai

Molokai

Molokai or Molokai is an island in the Hawaiian archipelago. It is 38 by 10 miles in size with a land area of , making it the fifth largest of the main Hawaiian Islands and the 27th largest island in the United States. It lies east of Oahu across the 25-mile wide Kaiwi Channel and north of...

. Many of the settlement's residents were devout Christians; when they began attending church services outside of the settlement, the members of the church congregation were fearful of making physical contact with them. Priests, too, were wary of such contact with the former Kalaupapa Settlement residents, but as a sign of good faith they would touch elbows. This greeting became popular among churchgoers of Hawaii

Hawaii

Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...

 in the early 1970s. Because leprosy is transmitted primarily through mucus, there is some evidence that the elbow bump constrained infections.

Urban youth

The elbow bump as a greeting is also attributed to be a derivative of the more well known fist bump, beginning in the 1980s. The earliest written record of the elbow bump by David Grimes supports this hypothesis. More recently, Shaquille O'Neal

Shaquille O'Neal

Shaquille Rashaun O'Neal , nicknamed "Shaq" , is a former American professional basketball player. Standing tall and weighing , he was one of the heaviest players ever to play in the NBA...

 demonstrated the derivative nature of the elbow bump in relation to the fist bump in 2004, when he dismissed Kobe Bryant's greeting with a half-hearted elbow bump.

2006 Avian flu outbreak

A recent advocate of the fist bump is the World Health Organization

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

. In 2006, due to fears of a possible avian flu pandemic, the WHO proposed using the elbow bump as a means of "keeping other people's cooties at arms length." Dr. Michael Bell has been a principal advocate for using the elbow bump, noting that it can also help constrain the spread of diseases such as Ebola, by modeling social behavior that limits physical contact.

2009 Swine flu outbreak

The elbow bump got renewed interest when the 2009 swine flu outbreak in Mexico began growing into a worldwide pandemic. By 2009 the elbow bump had grown so large in popularity that people in Mexico had taken it upon themselves to utilize the elbow bump to reduce the spread of disease. As in 2006, the elbow bump was supported by a number of health officials, such as Dr. Sanjay Gupta

Sanjay Gupta

Sanjay Gupta is an American neurosurgeon and an assistant professor of neurosurgery at Emory University School of Medicine and associate chief of the neurosurgery service at Grady Memorial Hospital in Atlanta, Georgia....

, CNN's chief medical correspondent.

In culture

By 2009, the elbow bump was endorsed by university officials and Nobel laureate Peter Agre

Peter Agre

Peter Agre is an American medical doctor, professor, and molecular biologist who was awarded the 2003 Nobel Prize in Chemistry for his discovery of aquaporins. Aquaporins are water-channel proteins that move water molecules through the cell membrane...

. The American Association for the Advancement of Science

American Association for the Advancement of Science

The American Association for the Advancement of Science is an international non-profit organization with the stated goals of promoting cooperation among scientists, defending scientific freedom, encouraging scientific responsibility, and supporting scientific education and science outreach for the...

 joined the World Health Organization

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 in endorsing the elbow bump. However, some of these endorsements were meant as much to elicit good humor as for purposes of good hygiene.

At the open-air service of the Greenbelt festival

Greenbelt festival

Greenbelt Festival is a festival of arts, faith and justice held annually in England since 1974. Greenbelt has grown from a Christian music festival with an audience of 1,500 young Christians to its current more secular festival attended by around 20,000 - Christians and non-Christians.The festival...

 of 2009, worshipers were encouraged to greet each other with the 'elbow bump of peace' instead of the more usual 'holy kiss

Holy kiss

The kiss of peace is a traditional Christian greeting dating to early Christianity.The practice still remains a part of the worship in traditional churches, including the Roman Catholic Church, Eastern Catholic Churches, Eastern Orthodox churches, Oriental Orthodox churches and some liturgical...

' during the Christian rite of peace, because of concerns over swine flu.