Mexican MOH: Bacterial Contamination Suspected Deaths & Illness in Chiapas

 

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A couple of days ago a report surfaced from Chiapas, Mexico where tragically a large number of infants fell seriously ill, and two died,  after receiving routine vaccinations.

 

Bad Vaccines Kill 2 Babies, Sicken 29 in Chiapas, Mexico

MEXICO CITY — Mexico's public health system has suspended infant vaccines after two babies died and 29 were sickened in an impoverished community.

Six of the 29 babies are in grave condition after receiving vaccinations for tuberculosis, rotovirus and Hepatitis B, which are generally administered between 0 and 6 months, according to a national schedule. The cause of the adverse reactions is not known, the Mexican Institute for Social Security said Sunday.

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Sadly, the `anti-vaccine brigade’ have quickly turned this tragedy into a cause célèbre, using it to `prove’ the that vaccines are unsafe, just as they attempted to do  last September when U.N.: At least 15 children die from bad measles vaccinations in northern Syria.

 

That tragedy turned out to be due to human error, not the vaccine, as we learned 10 days later from this statement by the World Health Organization.

 

Statement regarding interim findings of WHO assessment of deaths of children in Idleb Governorate, Syria

Statement
27 September 2014

A WHO assessment of the cause of the death of 15 children in rural Idleb, northern Syria has concluded that the most likely cause of the event was the incorrect use of a drug called Atracurium as a diluent for Measles/Rubella vaccine.

There is no evidence that the Measles/Rubella vaccine itself or its correct diluent were the cause of this tragic event.

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Regarding this latest incident, Mexico’s IMSS has released a preliminary report that seems to exonerate the vaccines and implicates bacterial contamination instead.

 

IMSS report, Ministry of Health and COFEPRIS progress on developments in Chiapas

No. 036 /2015

Following the developments relating to girls and boys who allegedly adverse reactions associated with the use of vaccines in Pepper, Simojovel municipality, Chiapas, IMSS, community and the Ministry of Health COFEPRIS unveiled at conference Press the progress of the case.

Due to its improvement, it is being discharged to 10 more hospitalized children in the "Dr. Gilberto Gómez Maza ". As the 5 that were discharged yesterday, will remain under medical observation in the city of Tuxtla Gutierrez. Additionally, children of the 6 reported severe, 2 and are stable.

Of the 14 who remain hospitalized, 10 are stable and 4 are serious. The IMSS and the Ministry of Health of the state of Chiapas continue to work hard to keep giving them the best care.

Research on these unfortunate events continues. In order to keep the population informed promptly and provide certainty to all parents, is issued a partial conclusion: the targeted problem that occurred in the community Pepper, it was not due to a problem associated with the vaccine.

It was reported that the COFEPRIS analyzed batches of the vaccine and released in October last year, which was established that the vaccines were properly certified. Additionally, it was shown that of the 52 children who were given the vaccine in the Pepper, 21 community had no damages, in addition to the application of this vaccine in other parts of the country, which comes from the same batch, did not present negative reactions.

During the conference it was explained that one of the issues that led to the conclusion that vaccines were not chemically defective or wrong, is that culture results yielded local presence outside contamination, biological or outside the vaccine. This was reinforced by the fact that certain bacteria were found, which is consistent with the clinical pictures of children who have been hospitalized.

It announced that the investigation continues to determine the type of bacteria and the source of external contamination, so he entered a second stage of analysis.

The IMSS, the Ministry of Health, the COFEPRIS and the state government of Chiapas remain in close communication and collaboration in this case. As it has done, it will continue to report in a timely and appropriate manner.

 

 

There is obviously a lot we don’t know about this incident, including how this bacterial contamination occurred, and I obviously have no personal information on the matter.  We will hopefully learn more in the coming days. 

 

Reportedly this incident occurred in rural, low resource setting. The most likely scenario is that one or more of these vaccines required reconstitution, and that an expired or contaminated diluent was used (see PDF file Vaccines with Diluents: How to Use Them).

 

Unfortunately, no matter what the final verdict turns out to be, it will do little to `un-ring’  the anti-vaccine alarm bells that have been sounded across the internet over the the past few days.

ICAAC Video: How Quickly A Virus Can Spread In A Building

 

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The 54rd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) runs through September 9th in Washington D.C. , and this morning we’ve an absolutely fascinating video sponsored by the American Society for Microbiology showing just how quickly a single introduction of a virus into an office environment can spread to contaminate an entire building.

 

Of particular interest, this conversation explores how their results relate to this week’s Enterovirus (HEV-D68) outbreak (see Enterovirus D-68 (HEV-D68) Update).

 

First, the press release on the study, then a link to the video on  MicrobeWorld’s Youtube channel.

 

How Quickly Viruses Can Contaminate Buildings and How to Stop Them

EMBARGOED UNTIL: Monday, September 8, 2014, 9:00 a.m. EDT

(Images are courtesy Gerba Lab and are free to use. First image is Gerba and a student working on samples and second is a sampling sponge.)

WASHINGTON, DC – September 8, 2014 – Using tracer viruses, researchers found that contamination of just a single doorknob or table top results in the spread of viruses throughout office buildings, hotels, and health care facilities. Within 2 to 4 hours, the virus could be detected on 40 to 60 percent of workers and visitors in the facilities and commonly touched objects, according to research presented at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), an infectious disease meeting of the American Society for Microbiology.

There is a simple solution, though, says Charles Gerba of the University of Arizona, Tucson, who presented the study.

“Using disinfecting wipes containing quaternary ammonium compounds (QUATS) registered by EPA as effective against viruses like norovirus and flu, along with hand hygiene, reduced virus spread by 80 to 99 percent,” he says.

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The video is available on the http://www.microbeworld.org/podcasts/asm-live website right now, but should be moved to the MicrobeWorld’s Youtube channel later today.

 

Monday, September 8

9:00 a.m. -- How Quickly Viruses Can Contaminate a Building
Using tracer viruses, researchers found that contamination of just a single doorknob or table top results in the spread of viruses throughout office buildings, hotels, and health care facilities. Within 2 to 4 hours, the virus could be detected on 40 to 60 percent of workers and visitors in the facilities and commonly touched objects. Simple use of common disinfectant wipes reduced virus spread by 80 to 99 percent.

Charles Gerba, University of Arizona, Tucson

 

 

Sigh.  Based on this, and the viral threats lining up, guess I’m gonna need to lay in a bigger supply of hand sanitizer.

EID Journal: Persistence Of H5N1 In Soil

 

Photo Credit – FAO

 

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The notion that the H5N1 `bird flu’ virus can persist in the environment – for hours or days (or perhaps even weeks) - is hardly new, yet very little is really known about how, and where, the virus resides outside of a living host.

 

As H5N1 is primarily a gastrointestinal malady in birds it is believed that the virus is commonly spread in the wild via shared feces-contaminated pond and lake waters (see Bogor: H5N1 Detected In Retention Pond).

 

But there appear to be other routes of transmission as well.

 

In June of 2010, we saw a study (see Birds Of A Feather . . . .) in PLoS One, suggesting that waterfowl may be spreading avian flu viruses because their preening oils bind the virus to their feathers.

 

Another study conducted by researchers at the  National Institute of Animal Health, Tsukuba, Ibaraki, Japan was reported in the August 2010 issue of Applied and Environmental Microbiology.

 

They determined that the H5N1 virus may persist on the dropped feathers from infected ducks and may therefore spread to the environment. 

 

Applied and Environmental Microbiology, August 2010, p. 5496-5499, Vol. 76, No. 16
0099-2240/10/$12.00+0     doi:10.1128/AEM.00563-10

Persistence of Avian Influenza Virus (H5N1) in Feathers Detached from Bodies of Infected Domestic Ducks

Yu Yamamoto, Kikuyasu Nakamura, Manabu Yamada, and Masaji Mase

 

The surprising part of this study is how long these feathers retained some degree of viral contamination at various temperatures.

 

At 4°C (39F) the virus was detectable for 160 days, while at the higher temperature 20°C (68F), the virus was detected for 15 days.

 

We saw another study from 2010, which appeared in Environmental Science and Technology, titled:

 

Environmental Persistence of a Highly Pathogenic Avian Influenza (H5N1) Virus

Joseph P. Wood, Young W. Choi, Daniel J. Chappie, James V. Rogers, and Jonatha

n Z. Kaye

DOI: 10.1021/es1016153

Copyright © 2010 American Chemical Society

 

Researchers conducted tests on four inanimate materials (glass, wood, galvanized metal, and top soil) to determine how long – and under what environmental conditions – the virus could survive.

 

They adjusted factors such as  temperature, relative humidity, and simulated sunlight and checked the samples over a period of 13 days. The virus was most persistent at lower temperatures, and on surfaces such as glass and steel.

 

Their conclusion?: under the right conditions, the virus could be expected to persist beyond 13 days.

 

 

Earlier this year we looked at a study published in the journal Influenza and Other Respiratory Viruses that examined environmental samples taken in Cambodia between April 2007 and February 2010 during several bird flu outbreaks (see Environment: a potential source of animal and human infection with influenza A (H5N1) virus  Gutiérrez, Buchy et al.)

Out of 246 samples taken around farms with outbreaks, 19% of dust, mud and soil samples showed contamination from the H5N1 virus.

 

Admittedly, just because RT-PRC testing was able to detect a virus in a sample doesn’t necessarily mean that the virus is viable.  But it does give us an idea of the environment spread of the virus.

 

All of which brings us to a letter, again from  Ramona A. Gutiérrez and Philippe Buchy of the Institut Pasteur in Cambodia, that appears in September’s edition of the CDC’s EID journal.

 

Volume 18, Number 9—September 2012

Letter

Contaminated Soil and Transmission of Influenza Virus (H5N1)

To the Editor: Highly pathogenic avian influenza (HPAI) virus (H5N1) has been responsible for 603 confirmed human cases worldwide, including 356 that resulted in death, and for >7,000 epizootic outbreaks (1,2). Direct contact between hosts is the main mechanism of transmission for avian influenza viruses, but the possible role of the environment as a source of HPAI virus (H5N1) infection has been rarely studied, particularly in the context of countries where the virus is enzootic or epizootic (3–7). To determine if contaminated soil contributes to the transmission cycle of HPAI virus (H5N1), we used experimental and simulated field conditions to assess possible transmission in chickens.

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Essentially, these researchers took 3 types of soil, described as:

 

(1) sandy topsoil collected from around rice fields in Phnom Penh Province, Cambodia;

2) building sand purchased from a local building company; and

3) soil-based compost purchased from a local tree nursery

. . . and inoculated samples with low to high doses of the H5N1 virus. They then introduced these soil samples to the bottom of cages where chickens were housed, and then tested the chickens for infection over the next several days.

You can read the entire letter for more details on their methods and materials. The results are summarized in the chart below:

 

Essentially, sandy topsoil collected from rice fields proved to be a poor environment for transmitting the H5N1 virus, while soil-based compost proved highly effective. 

 

The authors believe that the highly acidic nature of the sandy topsoil may work to inactivate viral particles.

 

Since one of the methods used to control and contain an avian flu outbreak is environmental decontamination, knowing which types of soil are unlikely to harbor and transmit the virus can save time, and reduce the use of harsh (and often scarce) chemicals in the environment.

 

Interestingly, the authors also found evidence to suggest that exposure to moderately contaminated soil may help poultry to develop a protective immune response to the virus.

 

H5N1 is not the only viral contender to spark the next pandemic, but due to its apparent high lethality, it is the one we tend to concentrate on the most.  

 

Fortunately the virus remains adapted primarily to avian physiology – not human - and must mutate further if it is to become an imminent public health threat. 

 

But with 20+ clades of the virus now circulating, and numerous opportunities to expose and infect other hosts (human, swine, mammal, and avian), the concern is this virus may one day succeed.

EID Journal: Indonesian Bird Markets Tested For H5N1

 

 

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Timing, they say, is everything.

 

And so it is fitting that on a day when we learn of an H5N1 positive Hong Kong resident - who reportedly visited live bird markets on the mainland  - we get this survey of H5N1 environmental contamination at LBMs (Live Bird Markets) in Indonesia.

 

The `big news’ here is that traces of the H5N1 virus were detected (using real-time reverse transcription–PCR and virus isolation) in nearly half (47%) of the 83 markets tested.

 

You should know, however, that RT-PCR testing can detect non-viable virus particles. And so just because the virus was detected, that doesn’t necessarily mean the virus was capable of infecting a new host.

 

Virus isolation, while less well suited for testing environment samples, only detects viable viral contamination.

 

As you might expect, the percentage of positives by virus isolation was considerably lower than that returned by RT-PCR.

 

Of the 280 positive samples by RT-PCR, only  13 (4.6%) were positive by virus isolation (Probably a low-ball number, given the sensitivity of the test).

 

These numbers do give us an idea of just how prevalent H5N1 is in domestic poultry in Indonesia, and argue compellingly for better sanitation procedures in live markets.

 

I suppose the solace we can take from all this is that – despite numerous contaminated live bird markets in Indonesia - we haven’t seen a huge number of human infections. 

 

Given the amount of human contact with infected birds and contaminated environments, this strongly suggests that the virus remains poorly adapted to human physiology and difficult to contract.

 

This study is published ahead of print in today’s EID Journal.

 

 

Volume 16, Number 12–December 2010

Research

Environmental Sampling for Avian Influenza Virus A (H5N1) in Live-Bird Markets, Indonesia

Indriani R, Samaan G, Gultom A, Loth L, Indryani S, Adjid R, et al. Environmental sampling for avian influenza virus A (H5N1) in live-bird markets, Indonesia. Emerg Infect Dis [serial on the Internet]. 2010 Dec [date cited]. http://www.cdc.gov/EID/content/16/12/1889.htm

DOI: 10.3201/eid1612.100402

Abstract

To identify environmental sites commonly contaminated by avian influenza virus A (H5N1) in live-bird markets in Indonesia, we investigated 83 markets in 3 provinces in Indonesia.

 

At each market, samples were collected from up to 27 poultry-related sites to assess the extent of contamination. Samples were tested by using real-time reverse transcription–PCR and virus isolation. A questionnaire was used to ascertain types of birds in the market, general infrastructure, and work practices.

 

Thirty-nine (47%) markets showed contamination with avian influenza virus in >1 of the sites sampled. Risk factors were slaughtering birds in the market and being located in West Java province.

 

Protective factors included daily removal of waste and zoning that segregated poultry-related work flow areas. These results can aid in the design of evidence-based programs concerning environmental sanitation, food safety, and surveillance to reduce the risk for avian influenza virus A (H5N1) transmission in live-bird markets.

 

Follow the link to read details about the methods of sample collecting,testing and the results.