10 dead, 1200 sick: Praise the lord and pass the guacamole: Holy water blamed for Ethiopia cholera outbreak

Faith-based food safety just doesn’t cut it.

According to Ooska News, a cholera outbreak in Ethiopia’s northern Tigray region has reportedly been blamed on holy water, after at least 10 people died over the past two weeks, while more than 1 200 people have contracted the disease. The authorities have also identified contaminated holy water in some of the region’s monasteries as being behind the outbreak. It was believed that the water is being taken from rivers that carry the disease.

Interfering in religious affairs is a very sensitive matter in the region, but the local government is working with religious leaders to temporarily stop the use of holy water.

Vibrio cholera in Mexico City

On September 2 and 6, 2013, Mexico’s National System of Epidemiological Surveillance identified two cases of cholera in Mexico City. Rectal swab cultures from both patients were confirmed as toxigenic Vibrio cholerae serogroup O1, serotype Ogawa, biotype El Tor. Pulsed-field gel electrophoresis and virulence gene amplification (ctxA, ctxB, zot, and ace) demonstrated that the strains were identical to vibrio.choleraone another but different from strains circulating in Mexico previously. The strains were indistinguishable from the strain that has caused outbreaks in Haiti, the Dominican Republic, and Cuba (1,2). The strain was susceptible to doxycycline, had intermediate susceptibility to ampicillin and chloramphenicol, was less than fully susceptible to ciprofloxacin, and was resistant to furazolidone and trimethoprim-sulfamethoxazole. An investigation failed to identify a common source of infection, additional cases, or any epidemiologic link between the cases. Both patients were treated with a single, 300-mg dose of doxycycline, and their symptoms resolved.

On September 12 and 13, four cases of cholera were identified by the Hidalgo Public Health Laboratory among residents of La Huasteca region, located approximately 75 miles (121 km) east of Mexico City and inhabited mainly by Otomi and Nahuatl speakers. During September 19–December 15, 2013, a total of 175 cases of cholera were confirmed in La Huasteca (159 in Hidalgo, 14 in Veracruz, and two in San Luis Potosí). Cases were defined according to World Health Organization (WHO) guidelines (3). A case of cholera was suspected if, in an area where the disease is not known to be present, a patient aged ≥5 years developed severe dehydration or died from acute watery diarrhea (3). All cases were laboratory-confirmed at the Instituto de Diagnóstico y Referencia Epidemiológicos as toxigenic V. cholerae, serogroup O1, serotype Ogawa, biotype El Tor, identical to the Mexico City isolates and indistinguishable from the strain circulating in the Caribbean. All of the cases have been reported to WHO by Mexico’s International Health Regulations Focal Point (4).

Among the 175 cases, 86 (49%) were in females, and the median age of patients was 32 years (range = 3 months–83 years). Only 40 (23%) patients required hospitalization, with an average hospital stay of 36 hours. All patients had acute and watery diarrhea, and 46 (26%) passed “rice-water” stool; 63 (36%) had fewer than five bowel movements per 24 hours, 86 (49%) had vomiting, and 30 (17%) had cramps. Some degree of dehydration was noted in 75 (43%) patients; 37 (21%) suffered mild dehydration (<5% loss of body weight), 32 (18%) moderate dehydration (6%–9% loss), and five (3%) severe dehydration (≥10% loss). One patient died, a woman aged 67 years with a history of diabetes and chronic renal failure. The spectrum of disease seen in this outbreak differed from that of outbreaks in the Caribbean; the proportion of infected persons, incidence of dehydration, mortality rate, and numbers of hospitalizations and complications were smaller in La Huasteca than in the Caribbean (5).

Three quarters of patients were residents of areas neighboring El Tecoluco and El Chinguiñoso streams flowing into the Panuco River. V. cholerae isolates recovered from both streams were identical to the outbreak strain. Samples obtained from municipal sewers, fish vendors, restaurants, and drinking water sources were tested to identify potential outbreak sources.

In Mexico, during 1991–2001, a total of 45,062 confirmed cases of cholera occurred, with a 1.1% case-fatality rate. Cases of infection by V. cholerae serogroup O1 have occurred sporadically since the end of that epidemic; regular, active surveillance allowed the identification of one case in 2010, one in 2011, and two in 2012, all in the northwestern state of Sinaloa. The first two cases were caused by toxigenic V. cholerae O1 serotype Inaba, and the other two by toxigenic V. cholerae O1 serotype Ogawa. All of the isolate strains were characterized by Instituto de Diagnóstico y Referencia Epidemiológicos and were identical to the strains circulating in Mexico during 1991–2001 (6).

Health professionals at different levels of the health-care system in Mexico are being trained in cholera prevention, treatment, and control. Public awareness campaigns to safeguard food and water quality, including national radio messages on the prevention of diarrhea, are being carried out in Spanish, Nahuatl, and Otomi languages. Health authorities continue to increase epidemiologic capacity at the national level, ensure the availability of adequate medical management, increase sanitation and access to potable water at the community level, and monitor chlorine levels in drinking water. In addition, continuous microbiologic surveillance for cases of V. cholerae infection and V. cholerae contamination of reservoirs is in place to promptly detect strains with pathogenic potential.

As a result of these actions, the outbreak in La Huasteca, in which samples from 88% of the cases were collected, was controlled within the first 13 weeks. A mobile microbiology laboratory was used in this area to quickly diagnose and treat patients and to interrupt transmission. Ongoing and continuous microbiologic surveillance of area reservoirs and laboratory investigation of all cases of acute diarrhea have not detected any new cases of cholera since December 17, 2013.

Heston stopped serving raw oysters; FDA links cholera outbreak to Florida raw oysters; at least 9 sick

After making 529 people sick in a March 2009 outbreak of norovirus at his Fat Duck restaurant, Heston Blumenthal says he has stopped serving raw oysters.

At least that’s what he told the New Zealand Herald yesterday.

"I’ve not served an oyster in here, in the Crown, in the Duck or in London since that happened. I don’t know if I’ll ever change."

Today, the U.S. Food and Drug Administration advised consumers, restaurant operators, commercial shippers and processors of shellfish not to eat, serve, purchase, sell or ship oysters from Area 1642 in Apalachicola Bay, Fla. because the oysters may be contaminated with toxigenic Vibrio cholerae serogroup O75.

• Nine persons have been reported with illness. For eight, the illness was confirmed as caused by toxigenic Vibrio cholerae O75; laboratory confirmation is pending in the other person. No one was hospitalized or died.

• All ill persons reported consumption of raw or lightly steamed oysters.

• Traceback indicates that oysters harvested from Area 1642 in Apalachicola Bay, Fla., between March 21 and April 6, 2011, are associated with illness.

Go to city hall next time: cholera crashes wedding in Dominican

In an impressive display of microorganisms ignoring political borders, rhetoric and social class, a south Asian strain of cholera suspected to have originated with Nepalese United Nations peacekeepers stationed in central Haiti is thought to have contaminated lobsters collected served at a lavish wedding at a luxury resort in the Dominican Republic and sickened many guests.

Dozens of international guests at a family celebration – some reports said it was a wedding – were stricken with vomiting and diarrhea after eating apparently contaminated lobster.

Dominican health officials said that at least 37 of the 500 guests at Casa de Campo, a five-star complex in the Dominican Republic, had tested positive for cholera, including Fernando Hazoury, whose family owns a separate luxury resort, and guests from Spain, Mexico and the U.S.

The health minister, Bautista Rojas, said lobsters for last Saturday’s wedding came from Pedernales, a town bordering Haiti, where about 3,800 have died and 189,000 fallen ill since October.

Venezuelan Health Minister Eugenia Sader said Friday that 111 people went to the hospital to be checked for cholera after attending the wedding.

Authorities were still trying to locate the rest of the 452 Venezuelans who traveled to the Dominican Republic for the January 22 wedding.

Vietnam closes 60 dog meat slaughterhouses and restaurants after cholera bacteria found

Continuing on with the cultural preferences for various protein sources, Vietnam closed around 60 dog meat restaurants and slaughterhouses in outlying parts of Hanoi after cholera bacteria were found in two of the animals.

Le Anh Tuan, director of the Hanoi health department, said businesses will be allowed to reopen in two weeks provided they are cholera-free and the owners can show their meat comes from hygienic sources.

Dog meat is a delicacy for many Vietnamese, who believe eating it in the second half of the lunar calendar month helps dispel bad luck.

Malaysian cooks blamed for cholera outbreak

Non-compliance with personal hygiene by cooks, food handlers and the public is the main cause of the recent cholera outbreak in Terengganu, Director-General of Health Tan Sri Dr Ismail Merican said yesterday.

"We took a number of samples from cholera-contaminated food premises, ice manufacturing factories, factories that produce keropok lekor and wet markets. We found that the drinking water at these outlets was not contaminated, showing that the spread was from the people infected with the disease. … We need public cooperation, especially from those who prepare and handle food. They must adhere to personal hygiene."

The disease broke out in October and affected 188 people. One of them died.