With the Ebola outbreak raging out of control in Western Africa it is natural to assume that any other report of a `hemorrhagic outbreak’ carrying significant mortality in that part of the world might also be due to one of the Ebola (or Marburg) viruses.
In recent days we’ve seen media reports of an unidentified outbreak in the DRC, described as having a`hemorrhagic’ component, and that it has claimed as many as 70 lives over the past few weeks. Major symptoms included fever, vomiting, and diarrhea.
Good news, but not terribly surprising.
The reality is, there are plenty of other pathogens out there capable of producing these types of symptoms. E. Coli, Listeria monocytogenes, Salmonella typhi (Typhoid Fever) and Campylobacter jejuni for instance, all have a long (and bloody) history of causing severe gastroenteritis.
The infamous 2011 EHEC Outbreak in Germany – traced to E. Coli contaminated sprouts – infected over 4,000 people, produced hundreds of cases of kidney failure, and killed 50 people.
In Canada, 14 years ago , there was an outbreak in Walkerton, a small community northwest of Toronto, where nearly half of the residents (2,300) developed gastroenteritis. Of these, 65 were hospitalized, 27 developed hemolytic uremic syndrome (HUS) and seven died (cite A fatal waterborne disease epidemic in Walkerton, Ontario).
The bottom line from that report:
The pathogens identified as being primarily responsible were Escherichia coli 0157:H7 and Campylobacter jejuni although other pathogens were likely to have been present
A little bit of research also turned up a gastroenteritis outbreak Kinshasa, DRC a decade ago that claimed 77 lives and sickened more than 2500. This from Irin News in 2004.
KINSHASA, 14 July 2004 (IRIN) - Some 77 children have died and 2,599 others are infected following an outbreak of gastroenteritis in Kinshasa, the capital of the Democratic Republic of the Congo, according to a health ministry official.
The associate director of epidemiology at the health ministry, Dr Vital Mondonge Makuma, told IRIN on Wednesday that the disease, caused by a strain of the Escherichia coli bacterium, broke out six weeks ago. It was particularly dangerous to children aged below five years, he added.
There are also viral causes of gastroenteritis (caused by noroviruses, other caliciviruses, astroviruses and adenoviruses for the most part) – and while they are seldom fatal in healthy individuals – they can produce significant mortality in people with comorbidities.
And there’s no lack of parasites capable of inducing serious gastroenteritis as well (Giardia, Cryptosporidium, etc.)
The point here isn’t to try to pin down what the outbreak in the Congo is.
There are a number of plausible options, including many I haven’t mentioned. The doctors and epidemiologists on the ground will figure it out, and I’m certain they will let us know when they do.
But it does remind us that while we obsess over the horrors of Ebola - a thousand times more people will be killed this year by far more mundane causes - like waterborne diseases, malaria, and childhood pneumonia.
But since they don’t provoke the kind of visceral response that Ebola does, we somehow find the intestinal fortitude to tolerate them.