Outbreak News Radio Show

 

# 9908

 

Although we recorded it Thursday night (April 2nd) for Broadcast on Sunday, Robert Herriman’s latest Outbreak News This Week Radio Show is now online.  Robert’s guests included CDC researcher Dr. Ivo Foppa discussing a recent CDC Study: Lives Saved By the Flu Vaccine, along with this humble blogger.

 

Robert, a microbiologist, runs the Outbreak News Today website. 

 

The link to the show can be found below, and an archive of earlier shows is available at this link.  You can follow  Robert Herriman @bactiman63 on twitter as well.   

 

 

Avian influenza update on Outbreak News Radio

Posted by Robert Herriman on April 5, 2015

Mike Coston, Editor of Avian Flu Diary joined me on today’s, Outbreak News This Week Radio Show and I spent a huge portion of the hour-long program on the latest news, updates and analysis concerning avian influenza, both in humans and in birds, here and abroad.

(Continue . . . )

More Than One Way to `Contain An Outbreak’

Credit WHO

 

 

# 9879

 

Until the middle of January, Egypt’s Ministry of Health got good marks in reporting this winter’s surge in H5N1 cases, publishing frequent updates that included YTD numbers for cases, deaths, hospitalizations, and recoveries. 

 

That streak ended on January 22nd, when Egypt’s MOH Confirms their 21st H5N1 Case of 2015.

 

Since then, as has been noted often (see The Silence Of The Egyptian MOH &  Media: WHO H5N1 Mission To Egypt), the Egyptian MOH has ceased to report most cases on their website and the YTD numbers attributed to MOH spokesmen in the Egyptian media have been `fanciful’ at best.

As a result, we continue to see reports like the one below – published today - which cherry picks a single recent H5N1 case, while at the same dramatically downsizing the YTD impact of this year’s H5N1 outbreak.  

 

While never directly mentioning 2015’s YTD numbers, by admitting to 16 deaths and referring to a CFR of 37.4%, the reader is left with the idea that there have been perhaps 43 or 44 cases this year.  

 

A far cry from the latest World Health Organization numbers (as of March 17th) of 116 cases and 36 deaths for the year (see Avian influenza A (H5N1) in Egypt update, 21 March 2015).

 

Egypt bird flu death toll at 16 in 2015

Sun, 29/03/2015 - 11:43

A 27-year old woman who raised birds in her home in the Sohag governorate, died of bird flu on Sunday.

Tahta Fevers Hospital received the victim, who was suffering from bird flu symptoms, before she was transferred to Assiut Fevers Hospital upon the request of her family, according to a medical source at Tahta hospital.

A medical team inspected the woman's house in Tahta and conducted tests on those who were in contact with the woman as a preventive measure.

(Continue . . .)

Although local media reports are sporadic, and are unlikely to represent the true burden of this year’s outbreak,  FluTracker’s conservatively curated Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List  continues to add cases, with at least 120 cases logged for the year.

Fortunately,  Egypt continues to report cases to the World Health Organization under the IHR (International Health Regulations) - which requires countries to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO – so we are not completely in the dark regarding this H5N1 outbreak.

 

While we don’t have a recent WHO update to compare it to, China’s recent silence on H7N9 is also suspect, with no new cases reported now for 20 days (see last week’s HK CHP Avian Flu Report: 2 Weeks Without An H7N9 Case Report and  H7N9: No News Is . . . . Curious).  

 

This dramatic halt in reporting comes – perhaps coincidentally – at the same time we saw a major study appear in the Journal Nature  (see Dissemination, Divergence & Establishment of H7N9 In China) warning that the H7N9 virus was evolving rapidly, and that it posed a growing pandemic threat.

A search on Xinhua’s English language news site for the term `H7N9’ returns their last article on March 12th of this year, which (again, perhaps coincidentally) dealt with the Nature study above (see Scientists call for effective measures amid H7N9 mutation Xinhuanet 2015-03-12 14:13).

 

The Chinese language IFENG search engine does return more recent `H7N9’ articles, but they all refer to cases in February and/or steps local and national health officials are taking to prevent new cases.  

 

But if there have been any H7N9 cases detected since early March, they aren’t being reported in the media, or on provincial MOH websites.

 

It is certainly possible that fewer infections are being recorded this winter, and interventions such as the closing of live poultry markets have dramatically reduced transmission.  That all cases should halt abruptly, this early in the year, and across the entire region would be remarkable, however. 

We’ll have more to go on when the next WHO update on China is released.

 

Since China and Egypt are both dealing with high-profile infectious disease outbreaks, their `management’ of the news understandably draws a good deal of attention, but they are far from being the only nations who indulge in `creative disease reporting’.  

 

All governments have an aversion to mobs bearing pitchforks and torches, and therefore want to project the image that they are competent, in control, and (most importantly) vitally important to the people they supposedly serve. 

 

Even in this country I see a number of state and local health and agricultural department websites which seem far more concerned with extolling their services and achievements, than they are in addressing local problems.  Of course, none of them are dealing with a deadly avian flu outbreak, so direct comparisons are hard to make.

 

While it may seem an odd bit of logic, as long as governments can control the message - as we are seeing in Egypt – it is a pretty good sign that avian flu infections remain sporadic and that efficient transmission of the virus is not happening.   

 

So, in a sense, no news can be `good news’ – at least in the short run. 

 

The problem is, the less we know about the early trajectory of an outbreak, the less lead time we’ll have to prepare - if and when something does start to change.

`Mystery Diseases’ In Hard To Verify Places

 

 

# 9085

 

A day scarcely goes by where the dedicated volunteers at FluTrackers, the Flu Wiki, or ProMed Mail don’t come across a media report of an `unidentified disease’ raging in some remote part of the world.  Often initial news reports are either highly speculative, or just downright wrong, and so I approach these stories with caution.

 

Fever is, by the way, the most common presenting symptom of an infection, and FUO (Fever of Undetermined Origin) is one of the most common admitting diagnoses on the planet.  But, like with most UFO reports and magic tricks, given a little time and some investigative skills, FUOs are usually found to be far less mysterious than originally thought.

 

India seems particularly fond of reporting outbreaks of `mystery fevers’ -  to the point where it has almost become an easily recognizable meme in the papers.

 

These usually turn out to be due to vector borne diseases like Dengue, Chikungunya, or Japanese Encephalitis - but sometimes the diagnosis remains elusive for years thanks to a massive population, a plethora of pathogens, and relatively few testing facilities (see Times of India Mysterious fever grips part of Kolkata).

.

Whenever public health is being hyper vigilant over an emerging threat – like MERS,  Ebola, or Bird Flu – local media often latch onto that as a likely explanation – mostly, I suppose, because it sells papers -  even though the facts may not fit the narrative. 

 

We saw that earlier this summer with reports of `hemorrhagic’ fever in Sudan, which in turn gave rise to some highly speculative news reports  like  - Sudan: Port Sudan Hit by Unknown Virus, MERS Suspected - despite the fact that little about the reports matched MERS. 

 

After a week of confusion, we finally saw Dengue, Not MERS, In Red Sea State (Sudan).

 

We aren’t exactly immune in this country, as some headline writers are still referring to the EV-D68 virus as a `mystery virus’, despite it having been identified by the CDC two weeks ago.

 

Last December, we saw a bit of a media furor over reports of four deaths from an as-yet unidentified flu-like illness in Texas (see Texas: MCHD On Deaths From Unidentified `Flu-like’ Illness) which turned out to be seasonal H1N1 flu, and in May of 2013 Dothan, Alabama was hit by an unusual cluster of severe respiratory illness which after three days was resolved (see Dothan Respiratory Illness – No Unusual Pathogens).

 

Of course, sometimes reports of a strange disease outbreak really does indicate something new, or at least, unusual. 

 

That’s how the Ebola outbreak in West Africa (in a region not  previously known for having Ebola) was initially described; as `a mysterious hemorrhagic fever’.  

 

And it was just two years ago when the first MERS case was described in a letter to ProMed Mail by Professor Zaki (see VDU Blog Happy 2nd birthday Middle East respiratory syndrome coronavirus (MERS-CoV)...).

 

The list goes on. 

 

The first inkling of the  2009 H1N1 pandemic began with an uptick of  unidentified respiratory cases in Mexico.  H5N1 bird flu outbreaks in Indonesia, Turkey, and Egypt were often first identified by the media as a `mystery outbreak’, as were the first reports of three unknown pneumonia cases in China that turned out to be H7N9.

 

While most of these reports turn out to be due to something relatively common, every once in awhile . . . .

 

Which bring us to reports out of Venezuela over the past six days suggesting some sort of `hemorrhagic fever’ that has claimed the lives 8 or more people (reports varied).  Not surprisingly, local media and social media outlets immediately evoked the `E’ word, but there is little reason to suspect Ebola in South America.

Flutrackers has diligently collected and translated scores of newspaper articles over the past week in their thread Venezuela - Deaths in Maracay Central Hospital and elsewhere by unidentified illness(es?) - one case meningococcal disease confirmed.  

 

Between blanket government denials and attempts to censor reports, a lack of testing, and a tendency for the media to try to both sensationalize the story and lump all `suspicious’ deaths into the same outbreak, we are left with more confusion than clarity.  This `mystery outbreak’ could turn out to be anything, or perhaps nothing.

 

The usual suspects that immediately come to mind in this part of the world include Hemorrhagic Dengue, Venezuelan hemorrhagic fever (Guanarito virus (GTOV)), one of the South American Hantaviruses, or perhaps Leptospirosis. 

Other etiological agents, including toxins, or something `new’ cannot be excluded.

 

The newshounds at FluTrackers will continue to watch developments in Venezuela, and I’ll report any significant announcements.   Whatever is behind this outbreak, I suspect will eventually be known.

 

Those interested in either this outbreak – or in the process used by these dedicated newshounds – will want to check in on the FT thread for more frequent updates.

Enterovirus D-68 (HEV-D68) Update

States reporting suspected or confirmed HEV-D68

 

 

# 9045

 

Although lab confirmation is still awaited in some areas, the outbreak of severe respiratory illness in kids that we saw pop up N.W. Missouri a little over a week ago (see Kansas City Outbreak Identified As HEV 68), and then a few days later in St. Louis (see Missouri Health Alert On Enterovirus 68), has now been reported in at least four more states.

This week we’ve seen media reports of hospitals being slammed with (mostly young) patients with respiratory infections in Ohio, Illinois, Kansas, Missouri, and most recently Colorado.  While test results haven’t come back for all of these locations, local doctors are pointing their fingers at the emerging EV 68 virus.

 

A sampling of some of the media coverage overnight includes:

 

Severe respiratory virus impacting hundreds of kids reaches Colorado

kdvr.com - ‎15 hours ago‎

DENVER — A potentially severe virus that has plagued hundreds of children across a 900-mile stretch in the Midwest in recent weeks has made its way to Colorado.

Colorado children's hospitals see spike in severe respiratory illness

The Denver Post - ‎12 hours ago‎

Children's hospitals in Denver are experiencing an alarming spike in a severe respiratory illness — especially among very young children and those with asthma — that may be caused by an uncommon viral pathogen.

Hospitals across Denver are on alert for a respiratory illness that can leave ...

The Denver Channel - ‎4 hours ago‎

At Rocky Mountain Hospital for Children, physicians report about 10 of the 20 beds in their pediatric intensive care unit are young people battling the virus. "Our pediatric floor is full of patients with pretty severe respiratory distress," said Dr.Raju Meyappan

Denver hospitals see virus spike in kids

9NEWS.com - ‎10 hours ago‎

DENVER - Denver hospitals and pediatricians offices are seeing a spike in a respiratory virus that is hitting kids hard who have histories of asthma and wheezing. ... "It seems to be what's happening with this virus which is more severe than other viruses.".

 

Often called EV 68, this virus is primarily known for producing respiratory symptoms - similar to that seen with rhinoviruses - although in some cases it can be severe enough to require hospitalization. There are reports of a number of children ending up in intensive care, some requiring ventilatory assistance, over the past week.

 

While children are usually the hardest hit, adults are not immune. Co-morbidities – such as asthma – can exacerbate the symptoms.

 

The virus (genus Enterovirus - family Picornaviridae – species HEV-D) –  is just one of a large family of small RNA viruses that include the three Polioviruses, along with myriad non-polio serotypes of Human Rhinovirus, Coxsackievirus, echovirus, and human, porcine, and simian enteroviruses.

 

HEV-D68  was first indentified in 1962, but until about 5 years ago, had not been often reported. The CDC called attention to its emergence several years ago - (see MMWR: Clusters Of HEV68 Respiratory Infections 2008-2010) – which looked at a half dozen  HEV 68 associated clusters that occurred in Asia, Europe, and the United States during 2008--2010.

 

EV 68’s rarity up until now in North America likely equates to very low levels of community immunity, which probably explains its rapid dissemination over the past couple of weeks, spurred on by the start of the school year.

 

For most kids (and adults) this will likely prove little more than a nasty `cold’ or virus.  But in a small percentage of cases, it can turn severe, and so parents need to pay particular attention this fall.  This virus appears to have `legs’, and so we could see a busy start to the winter respiratory illness season. 

 

While rarely seen in the United States, over the past 10 years we’ve seen this virus on the ascendant in China, The Netherlands, Japan, and the Philippines, sometimes producing significant outbreaks. 

 

A few recent studies include:

 

J Med Microbiol. 2014 Mar;63(Pt 3):408-14. doi: 10.1099/jmm.0.068247-0. Epub 2013 Dec 9.

Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China.

Lu QB¹, Wo Y, Wang HY, Wei MT, Zhang L, Yang H, Liu EM, Li TY, Zhao ZT, Liu W, Cao WC.

Author information

Abstract

Human enterovirus 68 (HEV-68) is an enterovirus associated with respiratory illness. In China, no information about HEV-68 is available for children yet. This study aimed to investigate the presence of HEV-68 in mainland China between 2009 and 2012 and to explore the migration events of HEV-68 across the world.

Among 1565 samples tested from children, 41 (2.6%) were positive for HEV and 223 (14.3%) for human rhinovirus (HRV). Seven (17.1%) of 41 HEVs were HEV-68. Two HEV-68- and five HRV-positive samples were detected in 585 adult samples. HEV-68 is the predominant type of enterovirus in children with acute respiratory tract infection (ARTI), followed by HEV-71 and coxsackievirus A6. Three HEV-68-infected children presented with severe pneumonia and one presented with a severe asthma attack.

The viruses were attributed to two novel distinct sublineages of HEV-68 based on phylogenetic analysis of partial VP1 gene sequences. Migration events analysis showed that the USA and the Netherlands were possible geographical sources of HEV-68, from where three strains migrated to China.

In conclusion, HEV-68 may play a predominant role among the enteroviruses associated with ARTI in children. Additional surveillance is needed to clarify the reason why HEV-68 causes such a wide spectrum of disease, from asymptomatic to severe respiratory disease and even death.

Virology. 2012 Feb 5;423(1):49-57. doi: 10.1016/j.virol.2011.11.021. Epub 2011 Dec 15.

Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010

Meijer A¹, van der Sanden S, Snijders BE, Jaramillo-Gutierrez G, Bont L, van der Ent CK, Overduin P, Jenny SL, Jusic E, van der Avoort HG, Smith GJ, Donker GA, Koopmans MP.

Author information

Abstract

Following an increase in detection of enterovirus 68 (EV68) in community surveillance of respiratory infections in The Netherlands in 2010, epidemiological and virological analyses were performed to investigate the possible public health impact of EV68 infections.

We retrospectively tested specimens collected from acute respiratory infections surveillance and through three children cohort studies conducted in The Netherlands from 1994 through 2010. A total of 71 of 13,310 (0.5%) specimens were positive for EV68, of which 67 (94%) were from symptomatic persons. Twenty-four (34%) of the EV68 positive specimens were collected during 2010. EV68-positive patients with respiratory symptoms showed significantly more dyspnea, cough and bronchitis than EV68-negative patients with respiratory symptoms. Phylogenetic analysis showed an increased VP1 gene diversity in 2010, suggesting that the increased number of EV68 detections in 2010 reflects a real epidemic.

Clinical laboratories should consider enterovirus diagnostics in the differential diagnosis of patients presenting with respiratory symptoms.

J Clin Virol. 2011 Oct;52(2):103-6. doi: 10.1016/j.jcv.2011.06.019. Epub 2011 Jul 29.

Upsurge of human enterovirus 68 infections in patients with severe respiratory tract infections

Rahamat-Langendoen J¹, Riezebos-Brilman A, Borger R, van der Heide R, Brandenburg A, Schölvinck E, Niesters HG.

 

Abstract

BACKGROUND:

Enterovirus 68 (EV68) belongs to species Human enterovirus D. It is unique among enteroviruses because it shares properties with human rhinoviruses. After the first isolation in 1962 from four children with respiratory illness, reports of (clusters of) EV68 infections have been rare. During the autumn of 2010, we noticed an upsurge of EV68 infections in the Northern part of the Netherlands in patients with severe respiratory illness.

OBJECTIVES:

To give a detailed description of the clinical and virological data of patients with EV68 infection identified in 2010, and compare these with data collected in 2009.

STUDY DESIGN:

We systematically collected clinical data from patients with an EV68 infection detected in 2010. We added four patients with an EV68 infection from 2009. Further characterization of EV68 was performed by partial sequence analysis of the VP1 genomic region.

RESULTS:

In 2010, EV68 was identified as the only cause of respiratory illness in 24 patients, of which 5 had to be admitted to the intensive care unit. Sequence analysis revealed different lineages in the majority of EV68 detected in 2010 as compared to the 2009 isolates.

CONCLUSIONS:

We noticed an increase of EV68 infections and present clinical as well as sequence data, in which two distinct phylogenetic clusters could be identified.

The advice being given this year is pretty standard, but worth repeating:

• Get your flu shot (no, it won’t prevent EV 68, but it could help prevent a dual flu - Enterovirus infection)
• stay home if you are sick & obtain consultation from your health care provider 
• avoid contact with those who are sick
• practice good `flu hygiene’  (cover coughs & sneezes)
• Avoid touching your face, mouth, and eyes with unwashed hands
• and wash your hands often

 

 

Kansas City Outbreak Identified As HEV 68

Credit CDC – Non Polio-Enteroviruses

 

See Update Sept 6th:  Enterovirus D-68 (HEV-D68) Update

 

# 9016

 

Local media reports (see Unusual respiratory virus strikes metro kids) from Kansas City, Mo. indicate that a rarely seen – and not yet well understood – respiratory virus called HEV 68 (Human Enterovirus 68) has sickened hundreds of kids in the region this week, and that the local Children’s Hospital is unusually at full census in late August.

Without specifying the pathogen, Children’s Mercy Hospital posted the following notice yesterday on their website: Viruses in the Community Prompt Inpatient Visiting Restrictions.

 

I’ve checked the local and state Health departments but can find no official statement regarding this respiratory outbreak.  Hopefully we’ll get some official confirmation soon, but assuming local media reports are correct . . .

 

Enteroviruses encompass a large family of small RNA viruses that include the three Polioviruses, along with myriad non-polio serotypes of Human Rhinovirus, Coxsackievirus, echovirus, and human, porcine, and simian enteroviruses.  We’ve looked at EV-71 and the Coxsackieviruses on numerous occasions in regards to AFP (Acute Flaccid Paralysis) and HFMD (see here,  here & here).

 

According to the CDC  Non-Polio Enteroviruses (NPEVs) cause 10 to 15 million – mostly mild and often asymptomatic – infections in the United States each year, primarily among infants, children, and teenagers. Fever, runny nose, sneezing, coughing, a skin rash or mouth blisters, and body and muscle aches are the most commonly reported symptoms.

 

First isolated in 1962, EV 68 (genus Enterovirus - family Picornaviridae – species HEV-D) has only rarely been identified over the years.  In 2011 – in MMWR: Clusters Of HEV68 Respiratory Infections 2008-2010 – we looked at a half dozen  HV 68 associated clusters which occurred in Asia, Europe, and the United States during 2008--2010.

A few excerpts from that report:

 

HEV68 infection was associated with respiratory illness ranging from relatively mild illness that did not require hospitalization to severe illness requiring intensive care and mechanical ventilation. Three cases, two in the Philippines and one in Japan, were fatal. In these six clusters, HEV68 disproportionately occurred among children.

<SNIP>

This report highlights HEV68 as an increasingly recognized cause of respiratory illness. Clinicians should be aware of HEV68 as one of many causes of viral respiratory disease and should report clusters of unexplained respiratory illness to the appropriate public health agency.

<SNIP>

The spectrum of illness caused by HEV68 remains unclear. HEV68, like other enteroviruses, has been associated with central nervous system disease (9). Further investigation could help clarify the epidemiology and spectrum of disease caused by HEV68. Some diagnostic tests might not detect HEV68 or might misidentify it as an HRV

Unlike influenza, classic enteroviruses tend to break out in summer-to-fall, although EV 68 has been observed to occur well into the winter season. The largest outbreak characterized by this MMWR report involved 28 children and adolescents from Pennsylvania in the fall of 2009. 

Since the vast majority of  mild-to-moderate respiratory infections are never tested, the actual incidence of this viral infection isn’t well understood, but it tends to be among the least commonly identified enteroviruses.

 

In recent years, with advances in microbiology and sequence-independent amplification of viral genomes, the ability of laboratories to identify new or rarely seen viruses has steadily improved, and so it is hard to know whether these recent clusters indicate that the incidence of EV 68 is increasing, or they are a result of better surveillance and testing.

 

Unlike other enteroviruses which can produce a wide spectrum of respiratory, gastrointestinal, and neurological symptoms – EV 68 is mainly associated with respiratory symptoms – although it was tentatively linked to two of five children (see Acute Flaccid Paralysis Cases In California) who developed a rare polio-like syndrome last winter.

 

Whether EV-68 was actually the cause of these paralysis cases, or simply an incidental finding, is something that will require more research to establish.

 

Although there is no vaccine and no specific treatment for this virus, there are things that can be done to protect yourself.  In addition to the standard `flu’ etiquette urged every year (hand washing, covering coughs, sneezes, staying home when sick), the CDC’s recommendations to prevent NPEV transmission include:

 

You can help protect yourself and others from non-polio enterovirus infections by—

• Washing your hands often with soap and water, especially after using the toilet and changing diapers,
• Avoiding close contact, such as touching and shaking hands, with people who are sick, and
• Cleaning and disinfecting frequently touched surfaces.

According to Dr. Mary Anne Jackson, an infectious disease specialist interviewed yesterday by local media, roughly 10%-15% of the children currently affected in Kansas City are experiencing serious illness, and that it is hitting kids with asthma particularly hard.

 

With schools just letting in for the fall, we’ll want to keep a close eye on this outbreak to see how it progresses, and if it spreads to other areas of the country.

WHO: DRC Outbreak `Definitely Not Ebola’

 

# 8983

 

 

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.

 

While early speculation centered around the possibility of Ebola, today,  Gregory Hartl – spokesperson for the World Health Organization – confirmed that it definitely isn’t Ebola.

 

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.

DRC: Gastroenteritis hits Kinshasa, kills 77 children

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.

Montgomery County Flu Updates – Dec 19th

 

# 8092

 

We’ve a brief statement from the Montgomery County Public Health Department this evening on their ongoing investigation into a number severe `flu-like’ illnesses that now confirms that 2 of the 8 suspect cases have tested positive for the H1N1 virus.  Additional testing is underway.

 

We also have a news story, and some Tweets from the KHOU-TV Managing Editor, that provide additional details not included in the official release.  After which I’ll be back to try to put this into some kind of perspective. 

 

First stop, the MCPH update from their Facebook page.

Contact: Jennifer Nichols-Contella FOR IMMEDIATE RELEASE

Cell: (936) 444-9724 12/19/13
Email: jnichols@mchd-tx.org

UPDATE - INFLUENZA LIKE ILLNESS ARISES IN MONTGOMERY COUNTY

As of Thursday afternoon, one additional case of H1N1 has been confirmed in Montgomery County. This patient is currently in an area hospital receiving treatment. Labs are being repeated on all remaining cases by the CDC. There are currently two confirmed H1N1 cases in Montgomery County.

The Montgomery County Public Health District is coordinating with regional and state resources to manage the case investigations. Health officials continue to encourage the public to be vaccinated for the flu, especially those who are at high risk.

Montgomery County Public Health District is monitoring the situation closely and will provide more information as it arises.
###

 

Meanwhile KHOU-TV is reporting that doctors now suspect that all eight of the Conroe Medical Center cases are infected with the (new in 2009) H1N1 virus, and that additional severe cases have been reported from two other counties in the region.

H1N1 kills 6 people, leaves 14 critically ill in Greater Houston area

By Jeremy Desel / KHOU 11 News and KHOU.com staff

Posted on December 19, 2013 Updated today at 5:28 PM

HOUSTON – Health officials say there have been six confirmed deaths from H1N1 in the Houston area recently, KHOU 11 News confirmed Thursday afternoon. That includes the four deaths at Conroe Regional Medical Center.

At least 14 people have become critically ill in Harris, Montgomery and Jefferson counties, including the four patients at Conroe Regional Medical Center.

This is the same strain of H1N1 that caused a pandemic in 2009. Doctors have been seeing hundreds of new cases recently in Texas and nationwide. In fact, H1N1 is one of the viruses included in this year’s flu shot.

Health officials from all over the region spent Thursday afternoon in a conference call comparing notes about all the cases. They suspect that all of the cases at the Conroe Regional Medical Center are H1N1, or what used to be called the “swine flu.”

(Continue . . .)

 

In the past couple of hours, Bill Bishop, Managing Editor fro KHOU-TV News has tweeted the following updates from his account.

 

 

 

While the 2009 H1N1 virus is no longer a `pandemic’ virus, it – like all seasonal influenza viruses – still has the ability to cause considerable morbidity and mortality.  Last year, we had a fairly serious flu season, but it was dominated by the H3N2 virus – one that traditionally impacts those over the age of 65 the hardest. 

 

And as one would expect, the elderly were particularly hard hit last winter.

 

This year, early reports (see MMWR Update: Influenza Activity — United States, September 29–December 7, 2013) indicate that H1N1 – not H3N2 virus – is the dominant strain in the United States right now.   One of that strain’s characteristics is that it hits younger patients particularly hard.  Here is what the CDC had to say about the impact of the virus during the pandemic.

 

2009 H1N1 Pandemic Hits the Young Especially Hard

This study estimated that 80% of 2009 H1N1 deaths were in people younger than 65 years of age which differs from typical seasonal influenza epidemics during which 80-90% of deaths are estimated to occur in people 65 years of age and older. To illustrate the impact of the shift in the age distribution of influenza deaths to younger age groups during the pandemic, researchers calculated the number of years of life lost due to 2009 H1N1-associated deaths. They estimated that 3 times as many years of life were lost during the first year of 2009 H1N1 virus circulation than would have occurred for the same number of deaths during a typical influenza season.

 

While it may be distressing, it wouldn’t be surprising to see the H1N1 virus causing the same lopsided impact today.  The virus remains antigenically very similar to what emerged in 2009, and for many people who may have not bothered to get a flu shot this year, their immunity levels may be waning.

 

Nor would it be unusual to see a resurgence of a pandemic strain several years after the pandemic has ended.  In fact, that has been the pattern in year’s past.   The chart below shows that type of activity in the six years following the H2N2 pandemic of 1957.  Notice how the mortality rates dropped in 1958-59, and 1960-1962, only to jump again in 1963.

 

H2N2  Pandemic Waves - NEJM 2009

 

All of this is a not-so-gentle reminder that seasonal flu can still pack a wallop, and that individual immunities wane over time, making it a good move to update that flu shot every year. It is certainly not too late to get the shot, as we have several months of flu ahead.

I’m sure we’ll revisit this story as more details become available.

CDC Update Of Fungal Meningitis Cases

 

# 6717

 

The CDC - which now issues updates on Mondays, Wednesday, and Friday - indicates that 23 new cases of fungal infection from contaminated steroids have been identified since last Friday’s report (Monday was a Federal Holiday).

 

*451 cases of fungal meningitis, stroke due to presumed fungal meningitis, or other central nervous system-related infection meeting the outbreak case definition, plus 10 peripheral joint infections (e.g., knee, hip, shoulder, elbow). No deaths have been associated with peripheral joint infections.

 

The bulk of these newly identified cases (20) are listed as coming from Michigan, although no details are given.  A quick check of the Michigan Department of Health’s website still shows case counts current as of November 9th.

 

As of November 9, 2012, Michigan's case count associated with the Centers for Disease Control and Prevention multi-state meningitis investigation is 128 total cases and eight deaths [64 cases of meningitis, eight deaths*, 57 epidural abscess, one stroke and six joint infections].

 

Since these reports don’t tell us the date of onset of symptoms, we really can’t tell how many of these cases are `new’ in the past couple of weeks, and how many are older, but just now being identified. 

 

The assumption is that no contaminated steroids were administered to patients after the recall notice was announced in late September.

 

The danger of developing meningitis is believed greatest during the first six weeks after injection, so there is some hope that the number of new cases will begin to decline soon.

 

We’ve also seen reports of epidural abscesses and arachnoiditis among some of these patients. These are localized pockets of fungal infection that are slow to grow, difficult to identify, and even more difficult to treat.

 

The CDC updated their Frequently Asked Questions for Clinicians late last week, with the following information.

Epidural Abscess and Arachnoiditis

There have been media reports of spinal epidural abscesses and arachnoiditis among patients who received treatment for meningitis. What are these conditions and their symptoms?

CDC has received preliminary reports of spinal epidural abscesses and arachnoiditis occurring among a portion of patients undergoing treatment for fungal meningitis due to this outbreak. CDC does not know at this time how many patients developed these disorders or why they occurred.  Both conditions are rare but serious disorders in the general population that require prompt medical attention. 

• A spinal epidural abscess is characterized by inflammation and a collection of pus around the spine. Spinal epidural abscesses sometimes result in swelling in the affected area (e.g., near the site where contaminated steroid mediation was injected).
  • Common symptoms can include fever, headache, back pain, and neurological problems (e.g., weakness, unusual changes in sensation)
• Arachnoiditis is a disorder caused by the inflammation of the arachnoid, one of the membranes that surrounds and protects the nerves of the spinal cord. The condition can be caused by irritation from chemicals, infection, or direct injury to the spine.
  • Symptoms can include numbness, tingling, and a characteristic stinging and burning pain in the lower back or legs.  Some people with arachnoiditis may have debilitating muscle cramps, twitches, or spasms.  The condition may also affect the bladder, bowel, and sexual function.  In severe cases, arachnoiditis may cause paralysis of the lower limbs. 
  • For more information about arachnoiditis, see the National Institute of Neurological Disorders and Stroke’s website.

 

The emergence of these new syndromes linked to fungal tainted steroid injections adds yet another level of uncertainty for those who are waiting to see if they will develop symptoms.

 

And finally, the head of the embattled pharmacy that created and distributed these steroid products appeared before a congressional committee today, but declined to testify.   This from the Boston Globe.

 

 

Pharmacy head pleads Fifth at meningitis outbreak hearing

WASHINGTON Barry Cadden, the owner and director of the specialty pharmacy tied to deadly fungal meningitis outbreak declined to testify Wednesday morning before a congressional committee investigating the matter.

CDC HAN Advisory: Additional NECC Products Found Contaminated

# 6690

 

 

Last night the CDC – as part of their investigation into the multistate fungal meningitis outbreak linked to contaminated steroid products distributed by the New England Compounding Center (NECC) -  issued a pair of HAN Advisories. 

 

• The first, is a notification that two additional products produced by NECC (betamethasone and cardioplegia solution) have tested positive for bacterial contamination.  
• The second advisory is essentially a HAN version of the FDA’s announcement on Wednesday of a total recall of all Ameridose products.  Ameridose is a a sister company to NECC.

 

The CDC’s Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page

 

There are 4 types of HAN releases, starting from the highest priority to the lowest.

 

• Health Alert - Conveys the highest level of importance; warrants immediate action or attention.
• Health Advisory - Provides important information for a specific incident or situation; may not require immediate action.
• Health Update - Provides updated information regarding an incident or situation; unlikely to require immediate action.
• Info Service -Provides general information that is not necessarily considered to be of an emergent nature.

 

Yesterday, the CDC also updated the number of confirmed infections due to these contaminated pharmaceuticals, which now total 377 cases of fungal meningitis, and 9 peripheral joint infections.

 

 

 

The following are excerpts from last night’s HAN Advisory on NECC contamination issues.

 

Contamination Identified in Additional Medical Products from New England Compounding Center

Summary: As part of the ongoing investigation of the multistate outbreak of fungal meningitis and other infections, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to test medical products from the New England Compounding Center (NECC) in Framingham, Mass.

NECC is the firm that distributed and recalled injectable steroid medications implicated in the current outbreak of fungal meningitis and other infections. CDC and FDA are reporting today that product testing has identified bacterial contamination with several Bacillus species and closely related bacterial organisms in unopened vials of betamethasone and cardioplegia solution that were distributed and later recalled by NECC on October 6, 2012. These bacteria are commonly found in the environment and have been rarely reported as a cause of human disease; it is not known how product contamination with these species might affect patients.

Although clinical infection is possible, CDC has not received reports of laboratory-confirmed cases of infection due to Bacillus or closely related organisms linked to these products. CDC’s recommendations to healthcare providers for diagnosing and treating symptomatic patients who have received NECC products have not changed as a result of these findings. Additional microbial organisms may be identified in recalled NECC products as additional laboratory testing is completed.

<SNIP>

As part of the ongoing investigation, FDA and CDC have been testing various NECC products for evidence of contamination. Laboratory testing at CDC and FDA has found multiple species of Bacillus and closely related bacterial organisms in unopened vials of betamethasone and cardioplegia solution, as shown in the table below.

Medication
Lot number
Microbial contamination

Betamethasone
08202012@141
Paenibacillus pabuli/amolyticus, Bacillus idriensis, Bacillus flexus, Bacillus simplex, Lysinibacillus sp.

Betamethasone
07032012@22
Bacillus niabensis, Bacillus circulans

Betamethasone
07302012@52
Bacillus lentus, Bacillus circulans

Cardioplegia solution
09242012@55
Bacillus halmapalus, Brevibacillus choshinensis

Other cultures for these products, including fungal cultures, are pending.

Recommendations to Healthcare Providers
CDC and FDA have previously advised that healthcare professionals should cease use of any product produced by NECC. On October 15, FDA issued a MedWatch Safety Alert advising clinicians to follow-up with patients who received any injectable NECC product, including betamethasone or cardioplegia solution purchased from or distributed by NECC after May 21, 2012. Clinicians were also requested to report any suspected adverse events following use of these products to FDA's MedWatch program.

 

CDC continues to investigate reports of potential infections in patients receiving other NECC products. As of November 1, CDC has received no reports of confirmed infections resulting from injection of any NECC product except those from the three recalled lots of preservative-free methylprednisolone acetate.^[1]

 

CDC’s recommendations to healthcare providers for diagnosing and treating symptomatic patients who have received NECC products have not changed as a result of these findings. CDC continues to recommend routine laboratory and microbiologic tests, including bacterial and fungal cultures, deemed necessary by treating clinicians.

 

These bacteria have been rarely reported as a cause of human disease. Nevertheless, clinicians should consider these product findings when reviewing laboratory results from patients who have been exposed to a NECC product, since Bacillus and related bacteria are often considered in clinical results to be possible skin contaminants. Physicians should continue to report infections potentially related to NECC products to FDA’s MedWatch and to state health departments.

---

1. NECC lots of methylprednisolone acetate (PF) 80mg/ml:

• Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #05212012@68, BUD 11/17/2012
• Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #06292012@26, BUD 12/26/2012
• Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #08102012@51, BUD 2/6/2013

CDC: Update On Fungal Meningitis Outbreak – Oct 10th

 

 

# 6623

 

We’ve updated numbers from the CDC this afternoon on the cases of meningitis across the country linked to potentially contaminated injectable steroids, along with an updated Q&A sheet for patients and revised case definitions for clinicians.

 

 

While the numbers continue to climb, it is important to note that this type of meningitis is not contagious. All of these cases received an epidural injection from a potentially contaminated steroid.

 

 

I’ve only excerpted the opening of the FAQ page for Patients below, follow the link to read it in its entirety.

 

Frequently Asked Questions For Patients: Multistate Meningitis Outbreak Investigation

October 10, 2012 12:45 PM EDT

About the Outbreak

Background
The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are currently coordinating a multistate investigation of fungal meningitis among patients who received an epidural steroid injection with a potentially contaminated product. Several of these patients also suffered strokes that are believed to have resulted from their infection.

 

How many cases have been reported?
Updates about the investigation, including case counts, are available at http://www.cdc.gov/hai/outbreaks/meningitis.html.

 

Is the source of the outbreak known?
CDC is investigating medications and products that are associated with this outbreak of meningitis. At this point, the original source of the outbreak has not been determined. However, injectable steroid medication has been linked to the outbreak. The lots of medication that were given to patients have been recalled by the manufacturer.

 

The type of epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.

(Continue . . . .)

 

Of interest primarily to clinicians, here is a link to the updated case definitions.

 

Multistate Outbreak of Meningitis Associated with Injection of Potentially Contaminated Steroid Products

 

 

And finally, a report from Maggie Fox of NBC News on the growing controversies surrounding compounding pharmacies.

 

Compounding pharmacies -- heroes or outlaws?

By Maggie Fox, NBC News

A single compounding pharmacy, one that mixes up drugs to order, appears to be the source of contamination that has killed 12 people and made more than 100 sick with a rare form of fungal meningitis. Some consumer advocates want the Food and Drug Administration to crack down harder on such pharmacies, but the legal battle for regulate them has been long and convoluted.

(Continue . . . )

HPA Updates The Stoke-On-Trent Legionella Outbreak

 

Legionella Bacteria - Photo Credit CDC PHIL

# 6450

 

Yesterday Crof reported on the UK: Legionnaires' disease outbreak in Stoke-on-Trent that involved 7 patients hailing from that city in Staffordshire, England.

 

Today, we’ve an update from the HPA indicates that two more cases have been identified, and that early microbiology testing is consistent with there being an (as yet, unidentified) common source.

 

 

3.00pm update on Legionnaires' disease in Stoke-on-Trent

25 July 2012

Two further case of Legionnaires' disease have been confirmed in the Stoke-on-Trent outbreak bringing the total number of cases to nine. All those affected are between their late 40s and mid 70s and are being treated at University Hospital of North Staffordshire. The Health Protection Agency (HPA) is also investigating two cases identified in early summer as being possibly linked to the current cluster.

 

Professor Harsh Duggal, Director of the Health Protection Unit in Stafford, said: “Early microbiology typing results back from the HPA laboratories show that samples taken from some of the patients look very similar so far and this is consistent with the cases having caught their infection from the same environmental source. We are taking detailed histories of the movements of the patients to see if there are similar patterns which would indicate a local source of infection.

(Continue . . . )

 

 

While an infectious pneumonia, Legionella is not a contagious disease.  It is transmitted environmentally, usually through water.

 

Legionella got it’s name after it was identified as the bacterial cause of a large pneumonia outbreak at Philadelphia’s Bellevue Stratford Hotel during an American Legion convention in 1976.

 

During this outbreak, 221 people were treated and 34 died.

 

We now know Legionella to be a major cause of infectious pneumonia, and that it can sometimes spark large outbreaks of illness.  According to the CDC between 8,000 and 18,000 Americans are hospitalized with Legionnaire's Disease each year, although many more milder cases likely occur.

 

For more information on the disease, the CDC maintains a fact sheet at Patient Facts: Learn More about Legionnaires' disease.

The bacteria thrives in warm water, such as is often found in air-conditioning cooling towers, hot tubs, and even ornamental water fountains. Improper maintenance or poor design can lead to the bacteria blooming.

 

When water is sprayed into the air the bacteria can become airborne, and if inhaled by a susceptible host, can cause a serious (and sometimes fatal) form of pneumonia.

 

While large outbreaks of Legionella are often traced to specific causes, quite often the source of the infection for sporadic cases remains a mystery.  

 

Today’s HPA announcement stresses that these cases are not hospital acquired, and that the authorities are working to identify the source.

That Duck May Look Clean, But . . .

 

 

# 6410

 

The CDC is investigating an outbreak of Salmonella Montevideo involving 66 persons across 20 states linked to the handling of live poultry (baby chicks or ducklings or both) sold via mail-order hatcheries and  agricultural feed stores.

 

You may recall that similar warnings have gone out in the past regarding Human Salmonella Infections Linked to Small Turtles.   Like turtles, poultry can sometimes carry and spread the salmonella bacteria, which makes good hand hygiene particularly important after touching these birds. 

 

In this case, the CDC’s investigation has traced the infected birds to a Hatchery in Springfield, Missouri.  You can read the details at:

 

 

Multistate Outbreak of Human Salmonella Montevideo Infections Linked to Live Poultry

Highlights

• Read the Advice to Consumers »
• A total of 66 persons infected with the outbreak strain of Salmonella Montevideo have been reported from 20 states.
  • The number of ill persons identified in each state is as follows: Alaska (1), California (2), Colorado (1), Georgia (1), Illinois (1), Indiana (8), Iowa (2), Kansas (10), Kentucky (1), Massachusetts (1), Missouri (22), Nebraska (5), Nevada (1), New York (1), North Carolina (1), Ohio (1), Oklahoma (4), South Dakota (1), Vermont (1), and Wyoming (1).
  • 16 ill persons have been hospitalized.  One death was reported in Missouri, but Salmonella infection was not considered a contributing factor in this person’s death.
  • 35% of ill persons are children 10 years of age or younger.
• Epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella infections to contact with chicks, ducklings, and other live baby poultry from Estes Hatchery in Springfield, Missouri.
• Mail-order hatcheries, agricultural feed stores, and others that sell or display chicks, ducklings, and other live poultry should provide health-related information  [PDF - 1 page] to owners and potential purchasers of these birds prior to the point of purchase. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.

 

 

There are over 2,500 serotypes of Salmonella, and . Salmonella Montevideo ranks among the 10 most common strains.  According to the CDC, the Clinical Features/Signs and Symptoms of infection are:

 

Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12-72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts from 4 to 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with weakened immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics.

 

 

For more  information about Salmonella, you may wish to check out the CDC’s Salmonella FAQ.

More Tales From The Crypto

 

 

# 6375

 

 

A little more than a week ago, in Tales From The Crypto, I wrote about an HPA (Health Protection Agency) investigation into an unusually large number of gastrointestinal illnesses being reported across England due to the Cryptosporidium parasite, or as it is commonly called, “Crypto”.

 

Over the past 7 days another 60 people have been diagnosed with this (generally) waterborne illness from the four regions of the North East, Yorkshire, West Midlands and East Midlands, bringing the total since early May to 327 (compared to 82 during the same period in 2011).

 

While still elevated above normal, the number of new cases over the past week is less than was seen during the previous two weeks, and not all of these may be attributed to this outbreak.

 

It is too soon to know if this outbreak has peaked.

 

The source of infection has yet to be identified. Local water authorities reassure that there is no evidence of contamination of the public water supply.

 

While generally thought of a waterborne illness, Crypto may be found in soil, food, water, or on surfaces that have been contaminated with the feces from infected humans or animals.

 

Photo Credit CDC PHIL

 

Here is the latest Health Protection Agency update on the Crypto outbreak, followed by some prevention advice from the CDC.

 

Update 8 June: Increase in cases of cryptosporidiosis

8 June 2012

The Health Protection Agency (HPA) continues to lead a multi-agency investigation to determine whether recent cases of cryptosporidiosis are linked to a common source.

 

The English regions most affected by the increase in cases continue to be the North East, Yorkshire, West Midlands and East Midlands. An additional 60 cases of cryptosporidiosis have been confirmed across the four regions between 01 June and 07 June 2012, taking the total number of cases confirmed in these regions since 11 May 2012 to 327. This compares to 82 cases of the infection confirmed across the four regions within the same period the previous year (11 May 2011 to 07 June 2011).

 

Most people affected had a mild to moderate form of illness and the HPA is not aware that any cases reported in the past week (since 1 June) have been hospitalised.

 

So far investigations have not identified a likely source of infection. The Drinking Water Inspectorate has confirmed that there is currently no evidence that public water supplies are implicated.

 

Cryptosporidiosis is caused by an organism called Cryptosporidium, which is found in soil, food, water or surfaces that have been contaminated with infected human or animal droppings. People can become infected by consuming contaminated water or food, by swimming in contaminated water, for example in lakes or rivers, or through contact with infected animals. The most common symptom is diarrhoea, which can range from mild to severe.

 

Dr Stephen Morton, who is leading the investigation for the HPA, said: “The latest figures show that the sudden upturn in cases seen in May 2012 has not continued into the first week of June. The majority of cases became ill between 11 and 18 May. Whilst the increase is higher than we might expect at this time of year, it is not unusual to see an increase in cryptosporidiosis cases in the early summer and not all of the cases reported since 11 May are likely to be linked.

(Continue . . . )

 

Crypto infections occur around the globe, and according to an EID Journal study published last year, there are estimated to be nearly 750,000 Crypto infections in the United States each year (see Foodborne Illness Acquired in the United States—Major Pathogens).

 

For most healthy individuals, a Crypto infection is an unpleasant, but not life threatening illness.  The most common symptoms (which generally last 1 to 2 weeks) are:

 

• Watery Diarrhea
• Stomach cramps or pain
• Dehydration
• Nausea
• Vomiting
• Fever
• Weight loss

 

Although rarely fatal in healthy individuals, `Crypto’ can be deadly for the very young, the very old, and those with compromised immune systems.

 

 

All of which makes prevention key.  The CDC gives the following advice to reduce exposure to Crypto.

 

Practice Good Hygiene

Everywhere

• Wash hands with soap and water for at least 20 seconds, rubbing hands together vigorously and scrubbing all surfaces:
  • Before preparing or eating food
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • Before and after tending to someone who is ill with diarrhea
  • After handling an animal or animal waste

At child care facilities

• To reduce the risk of disease transmission, children with diarrhea should be excluded from child care settings until the diarrhea has stopped.

At recreational water venues (pools, interactive fountains, lakes, ocean)

• Protect others by not swimming if you are experiencing diarrhea (this is essential for children in diapers). If diagnosed with cryptosporidiosis, do not swim for at least 2 weeks after diarrhea stops.
• Shower before entering the water.
• Wash children thoroughly (especially their bottoms) with soap and water after they use the toilet or their diapers are changed and before they enter the water.
• Take children on frequent bathroom breaks and check their diapers often.
• Change diapers in the bathroom, not at the poolside.

Around animals

• Minimize contact with the feces of all animals, particularly young animals.
• When cleaning up animal feces, wear disposable gloves, and always wash hands when finished.
• Wash hands after any contact with animals or their living areas.

Outside

• Wash hands after gardening, even if wearing gloves.