H5N1

Floodwater in New Orleans like 'toxic' stew, experts warn. Swimming in it? That's 'crazy'

Via nola.com: Floodwater in New Orleans like 'toxic' stew, experts warn. Swimming in it? That's 'crazy'. Excerpt:

On a day like Wednesday, when the New Orleans area was pounded with as much as seven inches of rain in less than three hours, it may seem like the only way past floodwater is through it. However, experts warn that wading — and especially swimming — through a flood could expose people to a stew of toxic waste and chemicals. 

One video making the rounds on social media showed someone swimming through several feet of water near Canal Street. 

 "That is crazy," said Tiong Aw, a public health microbiologist at Tulane University. "It can be dangerous and can make humans susceptible to infectious diseases and injuries."  

Other experts agreed, noting all manner of potential hazards. 

“If you’re neighboring a rural area, human and livestock waste can get into the floodwater, which can be toxic to humans,” said D.J. Sprenger, a member of Team Rubicon, a disaster response team that provides rescue and resources to areas all over the country. 

“If a residential area is flooded, medical supplies or cleaning agents can be in the water. Wild or stray animals like water snakes or rodents could be swimming in the water,” Sprenger said. “Floodwater can contain downed power lines, and the water current could be charged after a storm.”

After Hurricane Katrina hit in August 2005, the Louisiana Department of Health and New Orleans Public Response Team identified 869 cases of potential infectious disease in the weeks immediately afterward and 18 cases of Vibrio skin infections. Vibrio bacteria live in coastal waters and are more active from May through October. Five of those 18 patients died.  

One 60-year-old man arrived at a hospital with ankle wounds and diarrhea after wading through floodwater in New Orleans for three days. Vibrio vulnificus was found in his blood, and he died the next day. 

That particular type of bacteria is known to cause necrotizing fasciitis, a gruesome condition commonly known as flesh-eating bacteria. 

Fortunately, Wednesday's flood seemed to be freshwater, said experts, and Vibrio only grows in brackish water.

Picard: Streptococcus outbreak in Canada is part of a larger story

Via The Globe and Mail, André Picard writes: Streptococcus outbreak in Canada is part of a larger story. You'd better read the whole article, and take notes. Excerpt:

The Middlesex-London Health Unit has issued an alert about a continuing outbreak of invasive group A streptococcus (iGAS). 

There have been 132 reported cases of the bacterial infection since April, 2016. 

To date, there have been nine deaths, 20 cases of necrotizing fasciitis (flesh-eating disease), 20 cases of toxic shock and 29 others have ended up in intensive care with other grave symptoms.  

Those numbers are frightening, but they are just a small part of a much larger story.  

In recent months, there have been similar outbreaks of this particularly nasty strain of strep A in Toronto, Montreal, Vancouver, Calgary and likely elsewhere.  

In every city, there have been deaths and a number of amputations caused by flesh-eating disease, but the story has stayed under the radar because this type of infection largely affects intravenous-drug users and the precariously-housed, especially those living in shelters. 

Disease and death stalk marginalized communities quite routinely, so outbreaks of infectious diseases like iGAS don't generate much attention from public-health officials and the media. That is true in London as much as anywhere else. 

But what happened in London is that strep A started harming people in the general population as well.  

"There has also been an increase in iGAS infections among people who have no connection, and are not related, to the outbreak in people who inject drugs or who are under-housed. We need a better understanding of what's happening, which is why we've issued this alert," Dr. Gayane Hovhannisyan, the associate medical officer of health, said in a statement. 

In many ways, this is maddening. 

Why don't we care about infectious diseases until they start to affect school children, university students and the suit-and-tie wearing members of society?  

The reality is that almost every infectious-disease outbreak – from annual influenza through to pandemics like AIDS – strikes the vulnerable first. That's how it gains a foothold to wend its way into the general population. 

In other words, there is a great deal of self-interest in doing better health surveillance, and providing better health care, to members of marginalized communities such as the homeless, drug users and sex workers. 

But we do the exact opposite. 

Overcrowded shelters, for example, create the ideal conditions for the spread of disease. That's why the outbreaks of iGAS were concentrated at the Salvation Army Centre for Hope in London, Seaton House in Toronto and Old Brewery Mission in Montreal.

Canada: BC’s serious strep A infections rates soar to record highs

Via The Vancouver Sun: B.C.’s serious infections rates soar to record highs. Excerpt:

Faced with surging numbers of severe, invasive group A streptococcus infections across B.C., mystified provincial public health officials are seeking feedback from Canadian and American counterparts and preparing to publish reports to draw attention to the problem. 

A soon-to-be-released report will show that in 2016 there were 303 confirmed cases of invasive Group A Streptococcal disease (iGAS) in B.C., or 6.4 cases per 100,000 population, the highest rate since 1997 when it became a mandatory reportable disease. Illnesses like scarlet fever, strep throat and impetigo are caused by strep A bacteria. But it can also lead to potentially deadly toxic shock syndrome and flesh-eating disease (necrotizing fasciitis). That is what an 11-year old Richmond boy contracted four months ago when he was one of two boys in the same classroom who got iGAS.  

John Chen has been in hospital since March. A classmate was hospitalized a week earlier with different complications from the infection.  

It is the first time a cluster of cases has ever been reported to public health officials in Canada so B.C. experts are now reviewing policies and consulting colleagues to determine whether notifications to parents should go out earlier than they did in this situation when families got letters only after the second case. 

Dr. Monika Naus, a medical director at the B.C. Centre for Disease Control, said experts are unsure how to turn iGAS incidence trends around. In the Vancouver Coastal Health region, there were 47 cases of iGAS, according to the most recent (April) year-to-date report. That compares to 34 the year before. In 2016, there were 114 cases in VCH or 9.8 cases per 100,000 population. That is more than double the average of 47 cases for each of the preceding four years, when the rate per 100,000 population was 4.2 per 100,000. 

 The highest number of cases (84) was in Vancouver; those affected  ranged in age from five to 83.

Canada: Father calls for prompt notification of school infections after son diagnosed with flesh-eating disease

Via CBC News British Columbia: Father calls for prompt notification of school infections after son diagnosed with flesh-eating disease. Excerpt:

The father of a boy battling flesh-eating disease wants a review of parental notification procedures when there's been an infection at their child's school. 

Sam Chen says his 11-year-old son, John, was diagnosed with invasive Group A streptococcus on Sunday, March 26. 

Chen says he notified the school the next day and, later that afternoon, Vancouver Coastal Health sent a letter to parents telling them another student had also been infected.  

The letter warns parents to watch for symptoms of the infection — fever, sore throat and feeling unwell — and asks them to take their child to a doctor immediately if any of the symptoms develop.  

Chen says they should have been notified about the first infection.

"If we had [gotten] the letter [sooner] everything would be different. Because now, nothing can change my son's situation," Chen said.  

Symptoms exhibited days earlier 

John's symptoms had developed a few days prior to his diagnosis. A first visit to a doctor had him sent home with Advil.  

It wasn't until his parents took him to B.C. Children's Hospital that he was diagnosed, prompting 18 surgeries to save his life and limbs. He has remained in the hospital ever since.  

Dr. Althea Hayden, a medical health officer with the regional health authority, says the disease is extremely rare and those at most risk of transmission are close family members — but even that risk is very low. 

Hayden said there haven't been any documented cases of the infection being transmitted in a classroom setting. 

Necrotising fasciitis as atypical presentation of infection with emerging Neisseria meningtidis serogroup W (MenW) clonal complex 11, the Netherlands, March 2017

Via Eurosurveillance: Necrotising fasciitis as atypical presentation of infection with emerging Neisseria meningtidis serogroup W (MenW) clonal complex 11, the Netherlands, March 2017. The abstract:

In March 2017, a patient with necrotising fasciitis caused by Neisseria meningitidis serogroup W (MenW) clonal complex 11 was diagnosed in the Netherlands. Unusual and severe presentations of MenW infections are common in the current European epidemic. In the Netherlands, the incidence of MenW infections increased 10-fold, from an average of 0.03 per 100,000 population in 2002–2014 to 0.29 in 2016. Awareness of atypical presentations enables timely adequate treatment and public health action.

ECDC: CDTR, week 37

ECDC has published Communicable disease threats report, 11-17 September 2016, week 37. The abstract:

​The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 11-17 September 2016 and includes updates on  Zika virus, West Nile fever and MERS.

It also contains a report on two cases of Vibrio parahaemolyticus. One was contracted by a Norwegian woman after bathing in the Oslo fjord. A leg wound suffered the previous day became infected and turned quickly into sepsis and then necrotizing fasciitis; she lost her leg. 

The other case involved a Dutch man infected with Vibrio parahaemolyticus after putting an injured foot into the North Sea. His outcome isn't mentioned. Evidently this summer's hot weather in the Baltic region has been conducive to Vibrio growth in low-salinity bodies of water.

Hong Kong: Case of necrotising fasciitis under investigation

Via the Centre for Health Protection, a news release: Case of necrotising fasciitis under investigation. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (April 2) investigating a case of necrotising fasciitis involving an 84-year-old man.      

The patient, with underlying illness, developed left forearm pain, swelling and blisters since March 24. He was admitted to United Christian Hospital (UCH) on March 25.      

His clinical diagnosis was left arm necrotising fasciitis, with amputation performed on March 26. His current condition is serious. 

According to the test results by UCH, patient's pus sample yielded Vibrio vulnificus, a type of bacteria that can cause necrotising fasciitis.      

The patient had no recent travel history. His home contacts are asymptomatic. Investigations by the CHP are proceeding.

Hong Kong: A death from flesh-eating disease

Via the Centre for Health Protection: Case of Vibrio vulnificus infection under CHP investigation. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (December 2) investigating a case of Vibrio vulnificus infection affecting a woman aged 79. Vibrio vulnificus is a type of bacteria causing necrotising fasciitis, commonly known as flesh-eating disease.      

The patient, with chronic illness, presented with swelling in her right middle finger and right calf since November 26 and was admitted to Pamela Youde Nethersole Eastern Hospital (PYNEH) on November 27 for management. The clinical diagnosis was necrotising fasciitis. She passed away on November 28.      

Her blood, wound swab and right calf tissue culture yielded Vibrio vulnificus upon laboratory testing by PYNEH.      

Initial enquiries revealed that the patient had suffered from a scalding injury to her right middle finger before the onset of symptoms. Investigations by the CHP into her travel and exposure histories are ongoing.      

"Vibrio vulnificus, a kind of bacteria that normally lives in warm seawater, may cause infection in those who have an open wound exposed to seawater or eat seafood contaminated with the bacteria," a spokesman for the CHP explained.      

Wound infection with Vibrio vulnificus may result in necrotising fasciitis, a serious bacterial infection of the soft tissue and fascia (a sheath of tissue covering the muscle). It can lead to tissue destruction and can be fatal.

Branswell: Dr. Donald Low, the face of Toronto’s response to SARS, dies at 68

Via The Globe and Mail, Helen Branswell of The Canadian Press writes a moving obituary: Dr. Donald Low, the face of Toronto’s response to SARS, dies at 68. Excerpt:

Low was a global expert in flesh-eating disease – necrotizing fasciitis caused by group A Streptococcus. He was also an early and passionate champion of the need to combat antibiotic resistance by prudent use of the precious drugs. 

But it was through the 2003 SARS outbreak that he became a familiar face to Canadians. While he had no formal leadership role on the response team, his capacity to explain through the media to the public what was going on in the fast-moving outbreak made Low the face of Toronto’s SARS response. 

At one point he had to go into quarantine, because he’d been in contact with a colleague who came down with SARS. He worked from home and emerged, 14 days later, without developing the disease. He would later marvel that he never caught SARS, given the amount of exposure he had to cases throughout the outbreak. 

Putting in long hours over many weeks, he visibly dropped weight during the outbreak, prompting concerned strangers who saw him on TV news reports to write to ask after his health. 

While he was always cognizant of the fact that SARS ended 44 lives and permanently altered others, for Low, a microbiologist, being at an epicentre of the outbreak of a new infectious disease was a career highlight. 

In an interview in late February about the 10th anniversary of SARS, Low described the outbreak as “the most amazing experience ever.”

Sweden: Necrotizing fasciitis spreads to Stockholm

Via The Local.se: Flesh-eating disease spreads to Stockholm. Excerpt:

A life-threatening, flesh-eating bacteria is spreading in northern Stockholm, where hospital staff have recorded an immense spike in the number of cases in recent years. 

"The disease is one of the most dramatic conditions that we see in orthapedic surgery. It has an extremely quick onset which can make it seem truly dramatic," Olof Sköldenberg, orthopedist at the hospital, told the Dagens Medicin newspaper. 

Necrotizing fasciitis, more commonly known as flesh-eating disease, is an extremely aggressive bacteria that can kill a human in less than a day. The disease attacks the tissue and the deeper layers of skin, and can have a sudden onset. All infected tissue must be removed immediately for an infected person to survive. 

In northern Stockholm's Danderyd Hospital, 23 cases of the disease have been recorded between 2010 and 2012. During the previous two-year period, only one case had been reported by the hospital. 

"This is a huge increase. It could be because it has become easier to identify the condition, but we think it's rather due to a genuine increase," Sköldenberg added. 

A nationwide investigation has been launched to determine whether the disease is spreading further than just in Stockholm. 

As to why the disease is now showing increased signs of infection, the paper noted that it may be due to the bacteria becoming stronger, or people's immune system not reacting as strongly to it.