on CNN - 5 dead due to cholera related bacteria

[jpigott]

man - i thought cholera was an old school ailment. just what we need, a plague from the dark ages

[Mac]

Yeah, this has the potential to spread through the population like wildfire. Unfortunately, there are no vaccines for Cholera prodcued or distributed in the U.S. There are some vaccines available through other nations--Dukoral, Biotec AB, and Mutacol, for example. But I would be very surprised if:

a. They had enough already manufactured to provide for the massive need; and
b. Whether they could get it here in time to curtail the spread.

[soonertwister]

I read comments by an expert on spread of diseases after natural disaster, and he said that cholera is not a danger. He said it is not endemic to the Gulf region, and those who are shouting the danger of cholera are completely wrong. I suspect early and inaccurate reporting in this case.

Also, threat from typhoid isn't a threat. Poisonous snakes are a very minimal threat. Sharks are a zero threat. And alligators almost not a threat at all.

And more. When people report these things research them, and you will find out what the real dangers are. Cholera isn't one of those, and I strongly suspect that a cholera-mimicking condition such as dysentery is actually the situation, but panic has made people jump to conclusions.

[Praxus]

Cholera is really serious and typically found in nasty third world places.
Luckily its cured by antibiotics; but can kill quick by dehydration so victims need lots of IV fluids.

Its fairly rare even in the third world though...so this seems a bit doubtful.

[LSU2001]

I read comments by an expert on spread of diseases after natural disaster, and he said that cholera is not a danger. He said it is not endemic to the Gulf region, and those who are shouting the danger of cholera are completely wrong. I suspect early and inaccurate reporting in this case.

Also, threat from typhoid isn't a threat. Poisonous snakes are a very minimal threat. Sharks are a zero threat. And alligators almost not a threat at all.

And more. When people report these things research them, and you will find out what the real dangers are. Cholera isn't one of those, and I strongly suspect that a cholera-mimicking condition such as dysentery is actually the situation, but panic has made people jump to conclusions.

Sooner, would you provide a link from that expert. I know that there are several strains of Vibrio bacterium in the area and are endemic. I would like to do a little reading up on this and study some historic docs. I do believe that in the early days of NO there were several Cholera outbreaks which would suggest that Cholera is indeed endemic to the region. I may be mistaken but I would like to do a little research.
TIm

Ps. Agree with the rest though I believe that Typhoid fever is a threat though typhus is not. they are two distinct diseases.

[LSU2001]

After disastrous fires in both 1788 and 1794, the Spanish Cabildo passed building laws that forbade the construction of wooden buildings within the center of the city, "requiring walls to be of brick or of brick between posts protected by at least an inch of cement plaster."3 New Orleans became a city of brick buildings and these building practices also became the norm for tomb and cemetery wall construction. After 1803 the rapid increase in population, together with the inroads made by yellow fever and cholera, created a real municipal problem. Rigid regulations regarding methods of burial were issued. Interment in the ground was forbidden, and brick tombs were required in all cemeteries, which were enclosed within high brick walls.4 It was at this time that burials within the church were also abolished.

Source: http://cml.upenn.edu/nola/14history/L3h ... gstl1.html

[gunner1551]

I think the key term here is "cholera related bacteria" It hasnt been cinfirmed that it is full blown cholera. Just a related bacteria. We still have to be concerned becuase there is a real possiblity of an outbreak occuring. But what is worse IMO is the threat from E. Coli. The water is 45,000 times more contaminated than an acceptable level. Now that is dangerous!!!



http://www.ctv.ca/
Click on the top story "Waters recede, fires pose new threat to city"

[LSU2001]

Sooner the CDC disagrees with your expert. Please see the exerpt below from CDC update on western Hemispere Cholera Epidemics.
Tim

As of August 12, 15 epidemic-associated Vibrio cholerae infections have occurred in the United States (4,5); no secondary spread from these cases has occurred. Since 1973, 65 cholera cases unrelated to the Latin American epidemic have occurred in the United States that were caused by the Gulf Coast strain of toxigenic V. cholerae serotype O1; most cases were related to the consumption of raw and undercooked shellfish from the Gulf of Mexico (6). In addition, approximately two cases of cholera are reported each year among travelers returning to the United States from non-Western Hemisphere countries.

In July, toxigenic V. cholerae O1 resembling the Latin American strain was isolated by Food and Drug Administration (FDA) researchers from oysters taken from closed oyster beds in Mobile Bay, Alabama, off the Gulf of Mexico. No human illness has been associated with these oysters, and further sampling of commercial seafoods from the Gulf by the FDA has not identified other foci of contamination.

Reported by: Enteric Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.

Entire Article:

http://www.cdc.gov/mmwr/preview/mmwrhtml/00014993.htm

[LSU2001]

I think the key term here is "cholera related bacteria" It hasnt been cinfirmed that it is full blown cholera. Just a related bacteria. We still have to be concerned becuase there is a real possiblity of an outbreak occuring. But what is worse IMO is the threat from E. Coli. The water is 45,000 times more contaminated than an acceptable level. Now that is dangerous!!!



http://www.ctv.ca/
Click on the top story "Waters recede, fires pose new threat to city"

I cut and pasted my response to a similar thread earlier. Please read my response and the article at the link I provide. Trust me, though e-coli is a definite indicator of fecal contamination the real killers in those waters are the Vibrio species.
TIm

E-coli is actually the least of the problems with bacterial contamination. There are several naturally occuring bacteria of the Vibro genus. One is the bug that causes cholera another is a flesh eating bacterium Vibrio vulnificus Many of the skin and wound infections that you will see in the coming days and weeks will be from this particularly nasty bug that lives in the warm saltwater of the region. This bacterium causes about 40 cases a year under the best of circumstances, I imagine that the cesspool that is now NOLA will provide perfect conditions for its spread. Check out the link below for explanation of this bug. Besides these bugs there are also bugs that will cause hepatitis, west nile, typhoid fever, malaria, yellow fever, etc. Modern sanitation and pest control have kept these diseases completly under control for years but with the current conditions and lack of sanitation this entire area is a breeding ground for numerous diseases.

LInk: http://louisianasportsman.com/stories/2 ... -death.htm

Source: Louisiana Sportsman Magazine

[Windy]

Here's what I got from PROMED, an infectious disease list I'm on. After the news article is a post from a local doctor with more detail on the case and what Vibrio vulnificus is.

Newest peril from flooding is disease
- -------------------------------------
Authorities said on Mon, 5 Sep 2005 that some of Hurricane Katrina's
evacuees have contracted a bacterial disease that is considered a more
benign cousin of cholera, but is potentially fatal in people whose immune
systems have been compromised. Officials at the Centers for Disease Control
and Prevention in Atlanta said the bacterium _Vibrio vulnificus_ might have
been picked up by people with open wounds who were forced to wade through
polluted floodwaters for a long time.

Von Roebuck, a CDC spokesman, said officials had detected the disease among
some storm evacuees and stragglers but had not been able to determine how
many cases there were. It does not appear that anyone has died from the
disease, Roebuck said [see 2nd posting - Mod.LL].

Since flooding began, authorities have predicted that New Orleans could be
stricken with a host of diseases. This appears to be the 1st confirmation
of illness caused by the storm and the flood.

[byline: Scott Gold]

******
[2]
Date: Mon, 5 Sep 2005
From: Steven Seidenfeld <seidenfeld_steven@hotmail.com>


A 60 year old man, a refugee from the New Orleans hurricane disaster, was
admitted to our Dallas TX hospital on 2 Sep 2005 complaining of pain in
both legs. Blood cultures drawn on admission grew _Vibrio vulnificus_
within 12 hours. The patient developed characteristic hemorrhagic bullous
skin lesions on both lower extremities. He died within 36 hours from
complications of septic shock despite treatment with doxycycline, cefepime,
and levofloxacin as well as activated protein C. The organism was
susceptible in vitro to all 3 antibiotics.

The patient was on medication for hypertensive cardiomyopathy with a
history of congestive heart failure. Otherwise, there was no history of
underlying liver disease. Liver function studies were normal on hospital
admission, and serologic studies for viral hepatitis were negative.

- --
Steven M Seidenfeld, MD
Health Care Provider
ID Consultants
<seidenfeld_steven@hotmail.com>

[The following information was extracted from the FDA's Center for Food
Safety & Applied Nutrition Bad Bug Book
<http://www.cfsan.fda.gov/~mow/chap10.html>:

"Wound infections with _V. vulnificus_ result either from contaminating an
open wound with sea water harboring the organism, or by lacerating part of
the body on coral, fish, etc, followed by contamination with the organism.
The ingestion of _V. vulnificus_ by healthy individuals can result in
gastroenteritis. The "primary septicemia" form of the disease follows
consumption of raw seafood containing the organism by individuals with
underlying chronic disease, particularly liver disease (see below). In
these individuals, the microorganism enters the blood stream, resulting in
septic shock, rapidly followed by death in many cases (about 50 per cent).
Over 70 per cent of infected individuals have distinctive bulbous skin lesions.

"The infective dose for gastrointestinal symptoms in healthy individuals is
unknown but for predisposed persons, septicemia can presumably occur with
doses of less than 100 total organisms.

"In a survey of cases of _V. vulnificus_ infections in Florida from 1981 to
1987, Klontz, et al (Ann Intern Med 1988; 109: 318-23) reported that 38
cases of primary septicemia (ingestion), 17 wound infections, and 7 cases
of gastroenteritis were associated with the organism. Mortality from
infection varied from 55 per cent for primary septicemia cases, to 24 per
cent with wound infections, to no deaths associated with gastroenteritis.

"Ingestion of the organism by individuals with some type of chronic
underlying disease (such as diabetes, cirrhosis, leukemia, lung carcinoma,
AIDS), or asthma requiring the use of steroids) may cause the "primary
septicemia" form of illness. The mortality rate for individuals with this
form of the disease is over 50 per cent."

The much more severe disease in diabetes, cirrhotics, and other
immunologically challenged individuals draws a parallel to melioidosis,
which clustered in the area of the recent tsunami. - Mod.LL]

[LSU2001]

Thats what I figured Vibrio vulnificus it is quite common in the waters down here.
TIm

[Eye10TX]

The docs at the Astrodome and GRB Center in Houston said on TV last night (meaning Monday night, not Tuesday night) said there have been "0" cases of cholera among the evacuees here, "despite rumors to the contrary."

There have been, however, 300 cases of Norwalk fever. From what I can ascertain, this has been primarily in children.

They said they had examined and/or treated 4000 evacuees. That would be out of the 29,400 who had been processed through and who stayed at the shelters. Others who are staying elsewhere in Houston are also eligible to go to the clinic there, so the total "universe" of evacuees, both healthy and non-healthy, could be larger.

[JQ Public]

Actually being a microbiology major one of the first things I learned about in intro micro was that the first bacterium ever directly related to a mass epidemic was CHOLERA. Where was this epidemic you may ask? ENGLAND!!! LONDON ENGLAND TO BE MORE SPECIFIC. People cholera is not a "third world" problem. You can thank John Snow for that little tidbit

[soonertwister]

CDC's Gerberding sought to put to rest concern about disease from exposure to dead bodies in the flooding — the corpses aren't infectious — or from agents not typically seen in this country, such as cholera.

Instead, doctors are being urged to watch for more likely causes of diarrheal illnesses: E. coli bacteria; the easy-to-spread noroviruses that, while seldom life-threatening, can cause days of misery; or Vibrio vulnificus, cholera-like bacteria that every year kill more than a dozen Gulf Coast residents. The deaths reported Tuesday were among elderly people or those with weak immune systems, CDC's Skinner said.

From this article: http://www.foxnews.com/story/0,2933,168630,00.html

[x-y-no]

E-coli is actually the least of the problems with bacterial contamination.

Yes. It's mainly used as a marker for fecal contamination. Being by far the most thoroughly studied bacterium in the world, the tests for it are especially easy.

[HurriCat]

"Here's what I got from PROMED, an infectious disease list I'm on. "
You're ON the list? Eh, just reads funny when I needed something to giggle at.

Anyways, what's getting me with all of the reports on how hideous this water is - is seeing the helicopter rescuers still down there in it, with the rotor-wash spraying it all over them, including their faces! So much for nobody caring about the victims. These aircrews are risking life and limb in more ways than one for these people. They risk the inherent dangers of aerial operations, GUNFIRE, and now a good soaking in possibly disease-ridden filth.

Another quick one: A report on Tuesday night showed some "expert" in a little boat, who volunteered to do water testing. The whole report is about the huge numbers of nasties in the water. So, here's the EXPERT, riding along, dipping his bare hand and arm down above the wrist to fill the sample bottles! And you just know he was scratching himself, pushing his glasses back up, etc - plus handling things in the boat. Niiiice. And the reporter-ettes! One is going on all about e-coli this-and-that, while kneeling down in the filthy water while wearing "waders". Well, time for the Hep-A shot - hopefully right in the butt!

[alicia-w]

seems to me that we had to have shots for cholera when i was in the AF, so someone in the DoD has cholera shots somewhere.

[Windy]

Another PROMED post:

VIBRIO VULNIFICUS, POST-HURRICANE - USA (02)
********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Sponsored in part by Elsevier, publisher of
Journal of Clinical Virology
<http://intl.elsevierhealth.com/journals/jocv>

Date: Wed 7 Sep 2005
From: ProMED-mail <promed@promedmail.org>
Source: News24.com [edited]
<http://www.news24.com/News24/World/Hurricane_Katrina/0,,2-10-1942_1766717,00.html>


1st deaths from tainted water
- -----------------------------
5 people have died in the southern USA after coming into contact with
contaminated water after Hurricane Katrina ravaged the Gulf Coast, the
Centers for Disease Control and Prevention said on Wed 7 Sep 2005.

Tom Skinner, a spokesperson for the CDC, said there had been one case in
Texas and others in Mississippi this week [1st week September 2005].

He said the 5 had been killed by infections with _Vibrio vulnificus_, "a
bacteria that can enter somebody through a cut, a scratch or a wound."
Skinner said the elderly or those with a fragile immune system were most at
risk.

- --
ProMED-mail
<promed@promedmail.org>

[It is not surprising that additional deaths have occurred. One of these 5
is probably the Texas case about whom we posted a report yesterday (6 Sep
2005) from a primary source. Only fatal cases are noted here, so the total
number of _V. vulnificus_ cases is probably substantially higher. - Mod.LL]

[see also:
Vibrio vulnificus, post-hurricane - USA 20050906.2642
Vibrio vulnificus, salt water exposure - USA (MD) 20050905.2622
Hurricane Katrina - USA (Gulf coast): links 20050904.2618
Food poisoning, tsunami-related - Indonesia (Aceh) 20050212.0474
Diarrhea, tsunami-related - Asia (India, Sri Lanka) 20050102.0005
2004

[mahicks]

The docs at the Astrodome and GRB Center in Houston said on TV last night (meaning Monday night, not Tuesday night) said there have been "0" cases of cholera among the evacuees here, "despite rumors to the contrary."

There have been, however, 300 cases of Norwalk fever. From what I can ascertain, this has been primarily in children.

They said they had examined and/or treated 4000 evacuees. That would be out of the 29,400 who had been processed through and who stayed at the shelters. Others who are staying elsewhere in Houston are also eligible to go to the clinic there, so the total "universe" of evacuees, both healthy and non-healthy, could be larger.

Noro-virus such as Norwalk disease is soooo easily spread. 300 cases, if that figure is real, should spread really quickly.

BTW....the best way to prevent Norwalk??.........#1 priority after #2=WASH YOUR HANDS

[soonertwister]

Norovirus = acute viral gastroenteritis in many cases.

Seriously contagous, the best policy is to isolate those who have been stricken and those who have been exposed. Washing hands helps but isn't nearly enough. In normal populations it's seldom fatal, but among those with compromised health or who have been recently exposed to severe emotional and environmental stress, the mortality rate can rise dramatically.