NEWS SCAN: Cholera surge; E coli from soil; imported malaria, polio; vaccine referendum

Nov 4, 2010

Haiti reports sharp rise in cholera cases
Haiti's health ministry said that cholera cases have risen sharply and that the outbreak has spread to previously unaffected rural areas, according to a report yesterday from the Pan American Health Organization (PAHO). The number of cases has climbed to 6,742, including 442 deaths, an increase of 1,978 cases and 105 deaths since PAHO's last report on Nov 1. Cases have been detected in five of the country's 10 departments: Artibonite, Center, North, Northwest, and West. The reports of new cases and further spread of the disease come as Haitians and emergency workers prepare for the landfall tomorrow of tropical storm Tomas, which has recently intensified and been upgraded from a tropical depression. The storm could reach hurricane strength by the time it reaches Haiti, PAHO said. Haiti's government, the United Nations, and humanitarian agencies have activated their hurricane response plans.
Nov 3 PAHO cholera outbreak update

E coli can spread from soil to leaves of produce
Escherichia coli can live for weeks around the roots of produce plants and spread to the leaves, but the organism has limited persistence once on the leaves, according to a study from Purdue University. Researchers applied manure containing an antibiotic-resistant strain of E coli around lettuce plants and found that the bacterium established itself around the roots, according to the study in the Journal of Food Protection. Fifteen days after the E coli took hold in the soil, it was found on the lettuce leaves. The organism persisted in the soil around the roots for more than 40 days, but it was not found on the external parts of the leaves after 27 days. In a Purdue news release, co-author Ron Turco said harvesting produce at least 40 days after planting should reduce the possibility of contamination. He also said producers should apply manure to fields well in advance of planting and harvesting, so that the interval between manure application and harvesting is 90 to 120 days. But he warned that plants could be contaminated by other sources, such as animals.
Nov 3 Purdue news release
Nov J Food Prot abstract

CDC reports malaria cases imported from Ghana
The Centers for Disease Control and Prevention (CDC) reported today that two US pilots and two flight attendants who had stayed in the same hotel in Ghana contracted malaria. All four had traveled to Accra, Ghana, from Aug 24 to Sep 2, two of them on the same flight, according to the current issue of Morbidity and Mortality Weekly Report (MMWR). All spent time outdoors near the hotel swimming pool and in restaurants without air conditioning. About 2 weeks later, all experienced fever, headache, nausea, vomiting, and diarrhea. All were diagnosed as having acute Plasmodium falciparum–associated malaria. One flight attendant was hospitalized but recovered after 2 days of treatment. The two pilots and the other flight attendant, however, were severely ill and required intravenous treatment. In addition, both pilots had respiratory distress and required intubation. All eventually recovered after 6 to 15 days of hospitalization. None of the flight crew members had taken antimalarial drugs before travel, in spite of their company's policy of providing it for free. Accra is in a known high-risk area for malaria.
Nov 5 MMWR report

Polio reported in Congo; other regions experienced periodic importations
The Republic of Congo has reported 120 cases of acute flaccid paralysis caused by polio and 58 deaths, with half the case reported in the past 10 days, the World Health Organization (WHO) said today. Two cases have been confirmed to have been caused by wild poliovirus (WPV) type 1 as lab testing continues. Among the 43 cases for which data are available, 33 (77%) are in patients between 15 and 25 years old. Only 1 patient is under 5. Nearly all are in the port city of Pointe Noire. The update says the outbreak is caused by imported poliovirus; the country had recorded its last case of indigenous polio in 2000. The Congo government has launched an emergency response plan, with support from the WHO and CDC. At least three nationwide vaccination campaigns are expected, and a multi-country campaign will likely be required to cover risk areas in bordering nations.
Nov 4 WHO update
In related polio news, the CDC reported in MMWR today on importations of WPV into previously polio-free countries in Europe, Asia, and Africa over the past several years, representing an "ongoing risk until polio is eradicated.". This year, the first WPV importation into the WHO's European Region (which includes part of Asia) since the region was declared polio-free in 2002 resulted in 476 confirmed cases: 458 in Tajikistan, 14 in Russia, 3 in Turkmenistan, and 1 in Kazakhstan. The outbreak began in Tajikistan. In 2010 Africa and Asia saw 11 new importations into six countries (Liberia, Niger, Mali, Nepal, Senegal, and Uganda), resulting in 32 confirmed cases. In 2008 and 2009, Africa had 30 importations that resulted in 215 cases. All 2009 outbreaks in Africa appear to have been interrupted—meaning no cases in 6 months—and this year's outbreaks in three countries appear to have been stopped. The CDC report stated, "WPV importations from reservoir countries into polio-free areas will continue to occur until transmission is interrupted everywhere."
Nov 5 MMWR report

Chicago suburb passes resolution on vaccine information
Voters in the Chicago suburb of Oak Park on Nov 2 approved a nonbinding resolution that asks healthcare providers to disclose vaccine ingredients and provide more information about each injection, the Chicago Tribune reported yesterday. Oak Park resident Barbara Mullarkey, who heads the Illinois Vaccine Awareness Coalition, pushed for the referendum, which required only 15 signatures from registered voters and a simple majority at Oak Park township's annual meeting in March to be placed on the ballot. The ballot referendum prompted physicians to express concern that the wording was misleading and could discourage people from getting vaccinated. The wording says that vaccines containing thimerosal may contain toxic doses. However, scientific research has consistently found no link between thimerosal, a preservative used in some vaccines, and autism. Despite the referendum's overwhelming approval, Margaret Provost-Fyfe, director of the Oak Park Department of Public Health, told the Tribune that it won't be enforced.
Nov 3 Chicago Tribune story

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