H5N1

EHEC: Former WHO food safety head on the outbreak

Via Food Safety News: Q&A: Former WHO Food Safety Head on the Outbreak. Excerpt from an informative interview:

As part of our ongoing expert Q&A series, a conversation with Jorgen Schlundt, former head of Food Safety, Zoonoses, and Foodborne Diseases at the World Health Organization, now the deputy director of the National Food Institute in Denmark, on the unfolding E. coli catastrophe centered in Germany and what it means for EU food safety coordination. 

Q: I can imagine you are very busy right now. What's the latest on the outbreak? 

A: We're following this from the side, the main event is really in Germany. It seems to be clear that it is cucumbers and/or tomato salad ... we have 14 Danes [sickened in the outbreak.] We're trying to manage this in Germany and in Denmark. 

Q: Do you think the outbreak will continue to grow, or have we seen the worst? 

A: We really cannot know. I personally don't think it will get that much bigger, but it has grown pretty fast. It might be that we haven't reached the peak yet, but the numbers seem to be stabilizing.

Haiti: Spike in cholera deaths in Haiti seen as hurricane season begins

Via Google News, a typical "Oh dear, poor Haiti" report from The Canadian Press: Doctor: Spike in cholera deaths in Haiti seen as hurricane season begins. Excerpt:

A Haitian doctor says he is seeing more cholera deaths as the rainy season shifts into the hurricane season. 

Dr. Gabriel Thimothee is the executive director of Haiti's health ministry. He said 10 people have died of cholera since May 26. They all died in Carrefour, a seaside city just outside Port-au-Prince. 

It had been two weeks since somebody died of the diarrheal disease. 

Rain has soaked the Haitian capital almost every night in recent weeks. Thimothee said Tuesday that rain water contaminated with the cholera bacteria may be infecting people.

This report arrived just as I was about to post on a remarkable change in the cholera reports of the Ministry of Public Health and Population (MSPP in French). If you click through, you'll see two links on "Rapport par commune sur le cholera" for the 19th and 20th epidemiological weeks, which I presume mean May 8-14 and May 15-21.

The Canadian Press report says no one had died of cholera in the two weeks before May 26. But for week 20, the new reports break down cases, hospitalizations, and deaths by community—far more precise than the reports we've getting since last October.

And in week 20, the report lists 19 cholera deaths, whether in the community or in hospitals. It doesn't provide totals (I had to count them one by one), and the tally includes huge gaps. Most of the communities in Sud department, for example, are blank. The incidence map at the top of the PDF shows blanks all over the country.

The report also shows 359 cholera cases in Port-au-Prince in that week, 148 of them serious enough to warrant hospitalization. If 10 people have died of cholera in Carrefour since May 26, none died in week 20. But 416 people in Carrefour had cholera in week 20, and 136 went into hospital with it.

So what is going on here? I don't have the time or the expertise to draw meaningful conclusions from these new data. You might almost call it "infogmation"--information that only conceals the reality in the treatment centres and hospitals.

I would really like to see Dr. Timothee hold a press conference with a PowerPoint slide show, explaining the current state of cholera in Haiti as of June 1, in detail. 

It would be nice if the minister of MSPP, Dr. Alex Larsen, would show up at the conference also. The only thing on the MSPP website with his name on it is an article posted on April 7, 2010, about the earthquake. Since then, he has been an invisible and inaudible man.

Thinking about EHEC

It's a bright but cloudy Tuesday afternoon in Vancouver, and about 3:00 Wednesday morning in Germany. For the past week, I feel I've been living on Berlin time.

Traffic has risen by four or five times since a German reader emailed me a week ago about something strange going on in Germany. Much of that traffic is European; my visitors are 8 or 9 hours ahead of me. So I wake up every morning with hundreds of people having already arrived. Then, at 6:00 in the morning, I try to catch up by posting news from Europe's afternoon. By mid-afternoon, Europe has gone back to bed.

As with outbreaks I've covered earlier, like H1N1 in 2009, the doctors seem to be handling this one better than the politicians. The doctors want to know the source, and how this strain of E. coli has learned to be so nasty, and then devise countermeasures. The politicians want to know whom to blame, and that has led to a lot of anger and resentment.

I don't really blame the politicians; they don't want to see their voters going broke in Málaga or dying in Hamburg. But one lesson of EHEC is not to respond too quickly or emotionally. This strain of E. coli has exploited our ignorance, and the doctors will crush it only when they know more about it. They won't crush it with a pointed finger.

This blog has taught me a lot, over the years, about how information spreads on the web, or fails to. In this case, I've seen EHEC news bottled up in the German-language media for most of the past week. Only today do I see a lot of reports in North America and other parts of the world. Even so, the vast majority of reports are in German, whether from Germany, Austria, or Switzerland.

This has posed technical problems for me. I translate dengue reports from Brazil and cholera reports from the Dominican Republic because I can read Portuguese and Spanish, but I can't read German. So I resort to Chrome's translation function, which is really quite good—but it's far too literal. Editing a computer-translated report is possible, but it takes time—and the reports keep flooding in. If you know of a German-English blog or news source that's covering EHEC, please let me know.

This week has also taught me (again) about how such outbreaks are a function of our easy travel around the world. H1N1 swept out of Mexico and southern California in the lungs of European and Asian tourists. SARS leaped in hours from a Hong Kong hotel corridor to Toronto hospitals. Even if Spanish cucumbers weren't the precise source of EHEC, it doesn't seem to have sprung straight out of German soil. Something travelled cheaply some distance to Hamburg, where enough people consumed it to overwhelm the north German hospitals and scare everyone in the European Union.

Of course I'll continue to cover this outbreak as well as I can; if you can direct me to useful websites with reliable information on EHEC, in whatever language, I'll be grateful.

Camps cleared in Haiti as hurricane season starts

Via Google News, a report by The Associated Press: Camps cleared in Haiti as hurricane season starts. Excerpt:

The mayor of a large city in the Haitian capital region has begun clearing out camps set up after last year's earthquake, evicting hundreds of people amid heavy rains and the start of the hurricane season on Wednesday. 

Mayor Wilson Jeudy of Delmar city says the settlements — densely packed clusters of wooden shanties and tarps — have become staging areas for robberies, rapes and other crimes. But panicked residents say they have nowhere else to live or seek shelter. The area has seen weeks of punishing rain. 

"We don't know where we're going to go," said Elise Antoine, a 27-year-old who has been living on the grounds of Ecole Foyer Saint Famille since shortly after the January 2010 earthquake. 

Jeudy ordered police and security guards to clear at least three camps last week in this city at the edge of downtown Port-au-Prince. "We can't give people a public square as a gift to set up tents favorable to gang activity," he said in a radio interview. 

The encampments cleared last week were in two public plazas and on the grounds of a Catholic school with several hundred families in each. Guards sliced up tents and tarps and tossed people's belongings aside in early-morning raids, several witnesses told The Associated Press. A dozen people returned hours later to the school, saying they were simply hoping that the mayor wouldn't force them out again. 

More evictions are expected.

CIDRAP: News scan for May 31, and thoughts about plague

Via CIDRAP: NEWS SCAN: Plague in New Mexico, cholera in 3 countries, measles update. Excerpt:

A 78-year-old man from Santa Fe County has contracted New Mexico's second case of bubonic plague in less than a month, according to the New Mexico Department of Health (NMDH). 

The man is recovering in a hospital, according to a department news release. The first case was confirmed May 6 in a 58-year-old man from the same county who also was hospitalized but is now recovering at home. 

"We are seeing plague activity in both humans and animals from many different locations of north-central New Mexico," said NMDH Secretary Dr. Catherine Torres. "Everyone needs to be aware of the situation and take precautions to avoid rodents and their fleas." 

Plague, a bacterial disease, is generally transmitted to humans through the bites of infected fleas but can also be transmitted by direct contact with infected animals, including rodents, other wildlife, and pets, according to the NMDH. 

"Preventing your pets from roaming and hunting rodents, using a flea control product on all your pets, and not allowing them to sleep in bed with you are three things you can do to decrease your risk of being bitten by an infected flea," said NMDH public health veterinarian Dr. Paul Ettestad. 

Last month the department announced it had detected the disease in pets in two counties, including Santa Fe. In 2010 the US Centers for Disease Control and Prevention (CDC) confirmed only two human cases of plague in the United States, both in Oregon.

Most people in the US Southwest know plague is endemic in their region. Few know that it's a direct result of the racist stupidity of San Francisco officials in 1900, when plague came ashore and found a home in the slums where Chinese labourers were ghettoized.

Terrified of most American doctors, the Chinese smuggled their plague patients (living and dead) out of the city. Plague went with them, and soon migrated to local squirrels and other rodents. Eventually, plague arrived in the Southwest and there it has stayed.

 

One mixed consolation: Dr. Rupert Blue led the fight against rats in 1900 and again in 1906-1910, after the San Francisco earthquake led to a resurgence in plague from displaced rats. He treated the Chinese like human beings, and won their trust. Then he stamped out plague, and went on to become, simultaneously, the head of the American Medical Association and the US Surgeon General. If you're an American, you probably owe Dr. Blue your life.

As well as founding the US Public Health Service, he was an early advocate of a national health-insurance system. If he hadn't been fought so bitterly by American physicians, millions of other Americans might have lived longer, healthier lives over the past century. 

I learned all this from a wonderful book by Marilyn Chase, The Barbary Plague: The Black Death in Victorian San Francisco, which I reviewed in The Tyee way back in early 2006.

EHEC outbreak in Germany: Women more affected

Via BBC News: E. coli outbreak in Germany: Women more affected. Excerpt:

One of the mysteries about the outbreak of the particularly vicious strain of E. coli is that most of the victims have been women. 

In most outbreaks, the victims are children because they have not developed the immune system to fight off the food poisoning - but in the German case, it is adults and female adults, in particular. 

Scientists simply do not know why. 

One theory was that the victims were often people who liked eating what they thought was healthy food, say because it was low calorie (like cucumbers) or because it was organic. 

But the scientists are now cautioning against that view. It may be too pat. 

Dr Ulf Goebel of the Charite university hospital in Berlin said it might just be that this specific strain had something in it which found women's bodies suitable and not men's (just as some strains work on some ethnic groups and not others). 

Intriguingly, a previous outbreak of this rare type of E. coli happened in the United States in 1994 - and again the victims were predominantly women, with the average victim being 36 years of age.

EHEC: Now US checking Spanish cukes

Via Reuters: U.S. eyes Spanish produce in deadly E. coli outbreak. Excerpt:

Shipments of cucumbers and other food grown in Spain are being inspected by U.S. health officials because of a deadly E. coli outbreak that has killed 16 people in Europe and sickened more than 1,000. 

European governments scrambled to find the source of the E. coli outbreak that originated in Germany and that was first linked to contaminated Spanish cucumbers. 

While the exact source is still undetermined, vegetables have been known to harbor the killer bacteria as they are grown with fertilizer using cattle manure. 

"Due to the information received about the outbreak in Germany, FDA is flagging shipments of cucumbers, tomatoes and lettuce from Spain for further inspection," said Doug Karas, a spokesman for the U.S. Food and Drug Administration. 

He said the heightened calls for inspection began last week, and the FDA will continue to inspect Spanish produce until more information emerges about the cause of the outbreak. 

He added that cucumbers from Spain are not imported to the United States on a large scale at this time of year.

EHEC: One-quarter of HUS patients suffer consequences

Via Austria's derStandard.at: A quarter of all patients suffering from HUS -suffer consequences. Excerpt from a computer translation, with my editing:

Those who survive HUS are not automatically healthy again: "It's not like a flu that is easily got over," says Reinhard Würzner of the University Hospital of Innsbruck. 

The hemolytic-uremic syndrome, HUS for short, is the worst complication that can occur during infection with EHEC bacteria. About a quarter of all patients suffer this long-term sequelae. 

Normally up to three quarters of all HUS patients are children and only a quarter adults; but in the current outbreak the proportions are just the opposite. But because children have better recovery ability than adults, this time more HUS cases could suffer permanent damage, Würzner fears. 

The most common long-term consequences for HUS patients are renal damage. Although patients do not always need dialysis, kidney function can be reduced permanently. 

Another outcome can be brain damage that can lead to symptoms similar symptoms to a stroke: stuttering, trembling, and epileptic seizures.

EHEC: Cases increasing in northern Germany

Via Welt Online, a DPA report: Number of EHEC disease increased in the North. Excerpt from a computer translation, with my editing:

The number of EHEC disease in Schleswig-Holstein has risen again. As of 2:00 pm Tuesday, 360 persons had confirmed EHEC infections and 120 had confirmed cases of HUS, said the Health Ministry in Kiel. 

The EHEC cases are 49 patients more than reported on Monday afternoon, and 5 more who suffer from HUS. Overall, in Schleswig-Holstein far five people have died from the effects of diarrheal disease. 

Health Minister Heiner Garg (FDP) said that "the situation in hospitals is still very tight, but manageable." From this week the medical professions in Schleswig-Holstein are reported to also be supported by specialists from other states.

EHEC: Severity of Europe E. coli outbreak stuns experts

This Associated Press report has been picked up by many news outlets. Here it is via Forbes.com: Severity of Europe E. coli outbreak stuns experts. Excerpt:

In its most severe form, the infection can attack the kidneys, sometimes causing seizures, strokes and comas. 

It's "extraordinary" to see so many cases of the kidney complication from a foodborne illness, said Dr. Robert Tauxe, a foodborne disease expert at the U.S. Centers for Disease Control and Prevention. 

"There has not been such an outbreak before that we know of in the history of public health," Tauxe said. He added that the strain of E. coli in the European outbreak has not been seen in the United States, where there have been several high-profile foodborne outbreaks in recent years, but none with such a high death toll. 

There's little precedent in Europe, either. In 1996, an E. coli outbreak in the United Kingdom caused 216 cases and 11 deaths. The World Health Organization said 86 percent of those sickened were adults, and two-thirds were women. It said it was unusual that more children weren't affected.