H5N1

Mongolia: Two dead of bubonic plague

Via Web24 News, an Infobae report: Mongolia ordered quarantine and closure of part of the border with Russia after reported deaths from bubonic plague. A lightly edited excerpt and then a comment:

Mongolia ordered entry into quarantine from the city of Tsetseg, in the western province of Khov, after two deaths were detected by bubonic plague, as reported by local health authorities. A partial closure of the border with Russia was also ordered, to avoid an outbreak that could spread beyond the country’s limits. 

The victims, whose identity was not disclosed so far, had consumed marmot meat. The disease is also known in the region as “marmot plague” 

“Specialists from the National Center for Disease Control and Prevention (NCDC) and the National Center for Disease Control and Prevention (NCDC) in Khovd and Bayan-Ulgii are working to establish a quarantine in Jargalant and Tsetseg soums," the local government said. 

“In the two confirmed cases, 146 first contact and 504 second contact individuals were identified, and 146 first contact samples were collected and analyzed," health workers said in the statement. 

The affected place is about 500 kilometers south of Siberia. The Russian state news service, Tass, confirmed the immigration closure to prevent the passage of private vehicles and the transport of merchandise.  

It is not the first time that Mongolia has resorted to a similar measure on that edge.. A key border crossing with Russia with closed in May 2019 on suspicion that it may have played a role in an outbreak of the plague, leaving several Russian tourists stranded. A couple had died after eating marmot meat in that incident.

The May 2019 incident was reported here. In November 2019, three more cases were reported, one resulting from eating a plague-infected rabbit.

A message from one of our local supermarkets on COVID-19

An email from Stong's, a supermarket where we do a lot of shopping: Working Together To Keep Our Community Safe. Excerpt and then a comment:

To our Valued Guests,   

As the coronavirus COVID-19 affects communities across Canada, we want to update you on what we are doing at Stong’s.  Our entire team of almost 300 strong have been working diligently to keep our stores running.  Our supply chain remains robust and we are working around the clock to replenish our shelves.  The number of people looking to use our on line shopping service has been overwhelming and we continue to add resources to try and address this challenge.  

As your local community grocery store, our number one priority is to keep our customers and our team members safe. In addition to the steps I outlined in my communication last week, we continue to make changes as the situation evolves.  Some of the changes we are making include, but are not limited to:   

Store Hours – effective immediately our store hours have changed to 8am – 9pm daily 

Special shopping hours – On Wednesdays and Fridays, we will open our doors one hour early as a special shopping hour for seniors and those at risk 

New Signage – installation of visual reminders for all visitors to practice social distancing 

Reusable Grocery bags –for customers that choose to bring their own shopping bags, we will ask for your help to please bag your own groceries. 

Online shopping – we are actively hiring and putting out a call for volunteers in the community to assist those that are unable to get out and shop.  

For everyone that has visited our stores, you would have noticed some of the actions we have already taken:  

• We have suspended the sale of any self serve ready to eat foods including our salad bars, bulk foods, hot soup and bulk bakery products 

• We have removed all indoor seating to encourage social distancing 

• We have added janitorial staff devoted strictly to the increased cleaning and sanitizing of all high touch areas throughout the store 

• We have reduced the hours in our café, which will allow us to redeploy our resources to more essential services within the store   

How you can help us: 

• Practice proper social distancing.  Keep your distance from other customers whenever and wherever possible 

• Please shop in store if you are able, and leave our on line shopping service for those that are unable to leave their homes at this time. 

• Recognize the efforts of our team in store.  Please show kindness to all, as a community, we will all get through this if we all support one another.   

At Stong’s we are committed to doing our best to ensure our stores offer a safe shopping and working environment and help keep our communities safe. We will continue to monitor all public health departments advisories and, when appropriate and available, update you on how we are adapting our store practices with everyone’s safety in mind.   

Thank you for your continued support. Stay safe!

Meanwhile, just a block away from Stong's on Dollarton Highway, Deep Cove Brewers and Distillers have dropped their excellent lunches; they are now off-sales only. As a loyal fan of their Tin Can ale, I hope that they too stay safe, but they really need to update their website right away.

US: CDC investigation update of E. coli 0157 H7 infections now linked to romaine lettuce

CDC has published CDC Investigation Update of E. coli 0157 H7 Infections Now Linked to Romaine Lettuce. Excerpt:

A CDC investigation notice of a multistate outbreak of E. coli 0157:H7 infections has been posted: https://www.cdc.gov/ecoli/2019/o157h7-11-19/index.html  

What is new: 

• Consumers should not eat and retailers and restaurants should not sell or serve any romaine lettuce harvested from the Salinas, Calif. growing region. 

• This advice includes all types of romaine lettuce harvested from Salinas, such as whole heads of romaine, hearts of romaine, and packages of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, Caesar salad, and organic romaine. 

• If you have romaine lettuce at your home or restaurant and the label says “Salinas” (whether alone or with the name of another location). don’t eat it. Throw it away. If you don’t know if the lettuce is romaine or whether a salad mix contains romaine, don’t eat it or serve it. Throw it away. 

• Most romaine lettuce products are labeled with a harvest location showing where they were grown. Do not eat, serve, or sell any lettuce labeled as grown in Salinas, regardless of any other location on the label. 

• Restaurants and retailers should check the label on bags or boxes of romaine lettuce or ask their suppliers about the source of their romaine lettuce. 

Latest outbreak information:  

• A total of 40 people infected with the outbreak strain of coli 0157:H7 have been reported from 16 states. 

• A total of 27 hospitalizations have been reported. Five people have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported. 

• Epidemiologic and laboratory evidence and interviews with ill people indicate that romaine lettuce from the Salinas, Calif., growing region may be contaminated with coli O157:H7 and is making people sick. 

• FDA is tracing the romaine lettuce eaten by ill people in this outbreak. Preliminary information collected indicates that the lettuce eaten by some of the ill people was grown in Salinas, Calif. No common grower, supplier, distributor, or brand of romaine lettuce has been identified. 

• The USDA has recalled several products containing romaine lettuce due to possible coli contamination. 

• Laboratory data confirmed this outbreak is caused by the same strain of coli O157:H7 that caused previous outbreaks linked to leafy greens in 2017 and romaine lettuce in 2018. 

• This investigation is ongoing and CDC will provide updates when more information becomes available. 

About Shiga toxin-producing E. coli:  

• People get sick from Shiga toxin-producing E. coli an average of 3 to 4 days after swallowing the germ. 

• Most people get diarrhea (often bloody), severe stomach cramps, and vomiting. 

• Most people recover within a week, but some illnesses can last longer and be more severe. 

• Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out.

See also this Washington Post report.

US: Tainted pork, ill consumers and an investigation thwarted

Via The New York Times: Tainted Pork, Ill Consumers and an Investigation Thwarted. Excerpt:

It was 7 a.m. on Independence Day when a doctor told Rose and Roger Porter Jr. that their daughter could die within hours. For nearly a week, Mikayla, 10, had suffered intensifying bouts of fever, diarrhea and stabbing stomach pains. 

That morning, the Porters rushed her to a clinic where a doctor called for a helicopter to airlift her to a major medical center.  

The gravity of the girl’s illness was remarkable given its commonplace source. She had gotten food poisoning at a pig roast from meat her parents had bought at a local butcher in McKenna, Wash., and spit-roasted, as recommended, for 13 hours. 

Mikayla was one of nearly 200 people reported ill in the summer of 2015 in Washington State from tainted pork — victims of the fastest-growing salmonella variant in the United States, a strain that is particularly dangerous because it is resistant to antibiotics.

 What followed was an exhaustive detective hunt by public health authorities that was crippled by weak, loophole-ridden laws and regulations — and ultimately blocked by farm owners who would not let investigators onto their property and by their politically powerful allies in the pork industry. 

The surge in drug-resistant infections is one of the word’s most ominous health threats, and public health authorities say one of the biggest causes is farmers who dose millions of pigs, cows and chickens with antibiotics to keep them healthy — sometimes in crowded conditions before slaughter.

Overuse of the drugs has allowed germs to develop defenses to survive. Drug-resistant infections in animals are spreading to people, jeopardizing the effectiveness of drugs that have provided quick cures for a vast range of ailments and helped lengthen human lives over much of the past century.

But public health investigators at times have been unable to obtain even the most basic information about practices on farms. Livestock industry executives sit on federal Agriculture Department advisory committees, pour money into political campaigns and have had a seat at the table in drafting regulations for the industry, helping to ensure that access to farms is generally at the owners’ discretion. 

Dr. Parthapratim Basu, a former chief veterinarian of the Agriculture Department’s Food Safety and Inspection Service, said the pork industry regularly thwarted access to information on antibiotic use. 

“When it comes to power, no one dares to stand up to the pork industry,” he said, “not even the U.S. government.”

DRC: 12 Kwango province health zones affected by Konzo disease

As if the DR Congo didn't have enough to deal with, province26.drc.net reports: DRC: 12 health zones affected by Konzo disease (Kwango). The Google translation, with a link to a definition of the disease:

Kwango Provincial Health Division Chief Pierre Mwela says 12 of the 14 health zones in the province are affected by Konzo disease. 

He said it Saturday, July 20 at Okapi Radio. 

The patients show signs of malnutrition and weaknesses in the upper and lower limbs. This disease affects the nerves of the individual and mainly causes paralysis of the lower limbs. The affected subject has deformed limbs and especially has difficulty walking because he has no balance, notes Mr. Mwela.  

The cause of this disease is mainly related to the consumption of cassava which has not experienced retting, a technique that eliminates the toxic substances of certain food plants. 

Pierre Mwela adds that several households are attacked. But to date, there is only preventive treatment. 

The Italian rights NGO ISCO sensitizes the population of Kwango on this disease which mainly affects children.  

According to Rachel Muwawa, ISCO's Communications Officer, this awareness concerns six sites already identified with 4,800 households. Targeted households will receive information needed to prevent this disease, the source said. 

Rachel Muwawa calls on the country's authorities to increase awareness and care for children and women with the disease.  

Konzo is a disease that dates back decades. It is experiencing a recrudescence, to date, following chronic malnutrition in this province, say the health authorities.

ECDC rapid risk assessment: Public health risks related to communicable diseases during the hajj 2019, Saudi Arabia, 9–14 August

ECDC has published Rapid risk assessment: Public health risks related to communicable diseases during the hajj 2019, Saudi Arabia, 9–14 August 2019. The executive summary: 

Main conclusions and options for response 

In 2019, the hajj will take place between 9 and 14 August. 

The risk for EU/EEA citizens to become infected with communicable diseases during the 2019 hajj is considered low, thanks to the vaccination requirements for travelling to Makkah (Mecca) and the Saudi Arabian preparedness plans that address the management of health hazards during and after hajj.   

As with other mass gathering events, the risk of communicable disease outbreaks is greatest for food- and waterborne diseases and respiratory diseases. Outbreaks of MERS-CoV continue to be reported from the Arabian Peninsula, specifically from Saudi Arabia, which implies that there is a risk of importation of cases to Europe after the hajj.  

The risk of vaccine-preventable and vector-borne diseases is considered low if preventive measures are applied.   

Advice for those making the hajj 

Prior to travelling 

It is important that travellers seek advice from healthcare providers on the health requirements and recommendations for Saudi Arabia. Travellers should be advised to follow recommendations issued by the Saudi Arabian Ministry of Health and WHO. Advice issued by ECDC should also be taken into account.  

According to the Saudi authorities, pilgrims are required to provide proof of vaccination with the conjugated meningococcal ACW135Y vaccine administered no less than ten days prior to arrival in Saudi Arabia in order to obtain an entry visa. Travellers making the hajj should be up to date with immunisations routinely administered in their EU country of residence, including vaccinations for measles, mumps and rubella (MMR) and diphtheria-tetanus-polio. Additional vaccinations such as hepatitis A, hepatitis B, influenza, and rabies may be indicated.  

During the hajj 

Travellers making the hajj should take the following into account:  

• Pay attention to personal hygiene and adhere to food and water hygiene regulations in order to decrease the risk of gastrointestinal illnesses. 

• Practise respiratory hygiene and cough etiquette to reduce the risk of respiratory infections. 

• Practise insect and tick bite avoidance measures day and night. 

• Visit only licensed barbers for shaving. 

• Due to the expected high temperatures, avoid direct sun exposure and drink sufficient amounts of liquid. 

After the hajj 

Travellers returning from the hajj should seek medical attention immediately if they experience symptoms suggestive of any type of infection, e.g. gastrointestinal or respiratory. They should also mention their travel history to their healthcare provider. 

Due to continuing reports of MERS-CoV disease in Saudi Arabia, people returning from the hajj should be made aware of the need to seek immediate medical advice if they have a fever (38 ºC and over), cough or difficulties breathing within 14 days of their return. 

Travel history and previous hospitalisation should be reported to the healthcare provider if a person returning from the hajj requires hospitalisation within one year after returning from the hajj. This is to ensure that the possible acquisition of antimicrobial-resistant (AMR) bacteria will be considered and that appropriate measures can be implemented in accordance with national guidelines for the prevention of AMR. 

Death toll from acute encephalitis in east Indian town rises to 129 children

Via Thompson Reuters: Death toll from acute encephalitis in east Indian town rises to 129 children. 

NEW DELHI, June 23 (Reuters) - At least 129 children have now died of Acute Encephalitis Syndrome (AES) in the town of Muzaffarpur in the eastern Indian state of Bihar since an outbreak earlier this month, a medical official said on Sunday. 

The death toll from AES, a fever that affects the central nervous system, has risen from 97 reported last Monday and medical and government officials are facing mounting criticism for struggling to contain the crisis in the town of nearly 350,000 people. 

AES, known as 'brain fever' is caused by any one of a number of viruses. Symptoms include high fever, vomiting and, in severe cases, seizures, paralysis and coma. Infants and elderly people are particularly vulnerable.  

"I received my last update in the afternoon and according to the latest report that I have, 129 children have died so far," Shailesh Prasad Singh, the top state medical official in Muzaffarpur told Reuters by phone. The town lies about 80 km (50 miles) from Patna, the state capital. 

The precise causes of AES are not known, though a majority of medical professionals say it is linked to a ferocious heat-wave. 

Some studies have blamed toxins in lychees, a fruit grown in abundance in orchards around Muzaffarpur. But many families told Reuters last week that their children had not eaten them in recent weeks. 

Singh said a team of experts, including doctors, paramedics and other government officials were working "round the clock" to contain the spread of AES, which killed more than 350 children in a previous outbreak in Bihar in 2014.  

Doctors from other parts of the country had been dispatched to Muzaffarpur to help staff at the Sri Krishna Medical College Hospital which had to evict a group of sick inmates from a ward to accommodate the surge in AES patients. Most of the children who died were being treated at the hospital.  

Nearly half of all children in Muzaffarpur are underweight, and a similar number are stunted, making them vulnerable to AES, which grips the town almost every year when summer temperatures surge. 

As the death toll mounts, both the Bihar and the federal governments have come under criticism for their inability to save children, and doctors and government officials have faced angry protests. 

On Sunday, the Bihar government suspended a doctor in Muzaffarpur for dereliction of duties, news agency ANI, a Reuters affiliate, said. 

India's Federal Health and Family Welfare Minister Harsh Vardhan, who is himself a doctor, said last week that health officials have finalised plans for construction of a 100-bed paediatric intensive care unit in Muzaffarpur, but gave no timeframe for when it would be built.

UK: Hancock pledges hospital food overhaul after listeria deaths

Via The Guardian: Hancock pledges hospital food overhaul after listeria deaths. Excerpt:

Health secretary Matt Hancock has ordered a “root and branch” review of NHS food after two more patient deaths were linked last week to a listeria outbreak. The new deaths bring the number of suspected fatalities to five and doctors have warned that further cases could occur.  

Hancock said he was “incredibly concerned” after it emerged the patients were suspected of dying as a result of eating pre-packaged sandwiches and salads linked by the same supplier, The Good Food Chain. 

The affected products have since been withdrawn from hospitals and Public Health England said evidence suggested all the deaths had occurred before the items were removed from circulation on 25 May. 

“We need a radical new approach to the food that is served in our NHS,” added Hancock. “Our NHS should be at the forefront of supporting people to make healthy choices.”  

A Public Health England official said investigations into the outbreak were taking place and were being conducted in partnership with the Food Standards Agency. Listeria is caused by the bacterium Listeria monocytogenes and can trigger very severe disease in humans. It usually affects people whose immune systems have been weakened – such as the elderly, pregnant women or patients taking immuno-suppressant drugs. The disease is caught by eating contaminated food.  

The first three deaths were at Manchester University NHS foundation trust and Aintree University Hospital NHS foundation trust in Liverpool. One of the two new cases is understood to have died after these three cases. However, the other patient died before the three succumbed. Doctors have only just discovered the death was linked to the same strain of the bacterium. 

“These two cases had already been reported to Public Health England but were re-analysed using whole genome sequence data,” said Dr Catherine Rees, associate professor in microbiology at Nottingham University. “This showed that the listeria isolated from these patients were highly likely to have come from the same source.”

The trusts where the latest two victims were receiving treatment have not yet been named, although PHE said there are now seven trusts across the country dealing with listeria cases. The first case showed symptoms on 25 April and sandwiches and salads were withdrawn on 25 May. It is understood that some of the products were sold at hospitals, while others were given to patients.

“Pre-packed sandwiches are recurrently incriminated in the UK in listeriosis episodes,” added Professor Jose Vazquez-Boland of Edinburgh University. “For example, in 2017 there was an outbreak in Yorkshire and the Humber that also involved sandwiches supplied to hospitals. There is clearly a warning here that microbiological controls for listeria need to be stepped up with pre-packed sandwiches. 

“In general, foods involved in listeria infections are industrially processed foods that are kept at refrigeration temperatures and are consumed without previous cooking.”  

The Good Food Chain, which supplied 43 NHS trusts across the UK, voluntarily ceased production. The company was supplied with meats from North Country Cooked Meat. Some of these have since tested positive for the outbreak strain of Listeria monocytogenes and the company has also stopped production. 

“Since the source has been traced, there should be no more exposure, but the bacterium’s long incubation period means that the risk of new cases coming to light cannot be ruled out yet,” added Rees.

At least 31 children in India killed by toxin in lychees

Via The Guardian: At least 31 children in India killed by toxin in lychees. Excerpt:

At least 31 children have died in northern India in the past 10 days from a brain disease believed to be linked to a toxic substance found in lychee fruit, health officials have said. 

The deaths were reported by two hospitals in Muzaffarpur in Bihar state, famed for it lush lychee orchards, officials said. 

The children all showed symptoms of acute encephalitis syndrome (AES), senior health official Ashok Kumar Singh said, adding most had suffered a sudden loss of glucose in their blood. 

At least 40 other children complaining of similar symptoms were being treated at intensive care units. 

“We are trying our best to save them,” said S P Singh, the chief medical officer of Sri Krishna medical college and hospital.

The outbreaks of the disease have happened annually during summer months in Muzaffarpur and neighbouring districts since 1995, typically coinciding with the lychee season. 

“The health department has already issued an advisory for people to take care of their children during the hot summer when day temperature is above 40 degrees,” Ashok Kumar Singh said.

Canada: Norovirus closes down two Richmond restaurants on Mother's Day

Via the Richmond News here in Metro Vancouver: Norovirus closes down two Richmond restaurants on Mother's Day. Excerpt:

Hundreds of Mother’s Day diners were scrambling to find last-minute places to eat – after a Norovirus outbreak closed restaurants in two neighbouring Richmond hotels.  

Harold’s Bistro in the Sheraton on Westminster Highway and Cavu Kitchen in the Hilton, around the corner on Minoru Boulevard, both closed their kitchens on the weekend.

According to Vancouver Coastal Health (VCH), a number of the Sheraton’s food handling and cleaning staff, as well as hotel guests, did appear to be suffering on Saturday and Sunday from a Norovirus outbreak.  

Whereas Sanjeet Sadana, general manager at the Hilton, said there was “no reported guest sickness.” 

“They closed down all food and beverage facilities in the hotel. A VCH environmental health officer inspected Saturday,” added the VCH spokesperson. 

“Also, on Saturday a kitchen staffer at the Hilton hotel went home ill. The staffer had assisted at the Sheraton on Friday. They also closed down their kitchen as a precaution.”  

Both hotels, said the spokesperson, are deep-cleaning the food and beverage areas today (Monday), so those areas of the hotel are still closed.  

VCH was sending health inspectors to both hotels today and Wednesday to follow up on what has been done.