Outbreak Investigation: Botulism in Argentina - Essay Example

? Outbreak Investigation Report Outbreak Investigation Report Botulism in Argentina Foodborne botulism is a serious disease that is caused by eating food intoxicated by a bacterium called Clostridium botulinum. In absence of treatment, supportive care and timely of administration of antitoxin that minimizes mortality rates in the United States to not more than 10%, the disease can lead to death up to 60% . Previous outbreak of botulism condition in Argentina was chiefly caused by taking improperly cooked food such as vegetables .In case of an outbreak of botulism disease, it has been associated unacceptably preserved meat, fruits, and vegetables that include fermented fish and their products, sausages seafood, and fried meat. Physician in Buenos Aires hospital in January 13, 1998 called the Directorate of Epidemiology of the Argentine Ministry of Health (MOH) concerning the outbreak of the infectious disease. The telephone to the directorate was meant to report on two probable causes of botulism disease. The symptoms exhibited by patients who were males are drooping eyelids, respiratory complications, swallowing problem and double vision (Arias 2010, p.120). One of the patients showed the start of the signs on January 5 and the other on January 6 in the same year. The physician in the hospital had collected sera and stool specimens, which were obtained from men that were meant to test botulinum toxin but did not show any results. The two probable cases of outbreak of the disease caused a lot of concern in Buenos Aires hospital since botulism disease can be serious as it can affect other people. Single case of botulism disease can warrant public health emergency that can portent a larger outbreak. The outbreak of the disease was apparent since the victims of the disease were both drivers. The two proceeded and continued to drive their buses despite having double vision and blurred vision. It was expected that vision problem in the two drivers could have resulted to unsafe driving, hence causing accidents. Because of the severe implications of untreated botulism is extremely severe, the Argentine Ministry of Health has directed its efforts in conjunction with the local health facilities and other health care providers in their efforts to establish the source of botulism. The epidemiologists wanted the undertaken treatment to go in a slow pace thus enabling them to carry out extensive examination on the affected bus drivers. The epidemiologist wanted concrete information to enable them to understand the source of botulism. The available information according to epidemiologists could be adequate to make a definite conclusion. This is because they had not established the severity of the disease and they were not clear on the population that was a risk of the disease (Busto 1999, p.1332). The clinical condition of botulism is characterized by neurologic symptoms, which h includes dry mouth double vision and drooping eyelids are the earliest symptoms of this condition. The early symptoms and signs of the disease are followed by speech complications, difficulties in swallowing and weakness in the peripheral muscles. Lack of supportive care to contain the disease, there will be complications in the respiratory system that will eventually lead to death. It has been known that the incubation period for botulism disease is 18-36 hours; however the signs and symptoms of the disease can emerge after six hours. There is also the possibility that the signs can occur after 10 days in late situations. The botulism is a rare case in the medical field thus many physicians have little knowledge about the disease. Therefore victims who are suffering this condition can be diagnosed for the wrong disease such as stroke. This will in turn delay the administration of treatment for some days thus increasing the chances of death. (Greb 2006, p.86). Upon receiving the two cases of botulism in Buenos Aires hospital, the Directors of National Laboratory and Environmental Health and Sanitation Program were informed about the two cases while the patients were retained in hospitals. The Ministry of Health epidemiologist interviewed the two patients in the hospital. The two victims after they were interviewed by the epidemiologist, it emerged that they were both drivers of the same bus company and they belong to one route and shift. The two victims of botulism knew each other, but they worked at different days. The two had not taken food for the last one month together. To check if the botulism disease had affected the other employees within the company, the MOH contacted all the workers within the company to be tested (Busto 1999, p.1332). This was aimed at ascertaining if the disease had spread and if there were any indicative symptoms and signs of botulism. The hospitals which were located near the Buenos Aires area where the two cases were discovered were instructed to report any case they are suspecting to be likelihood of the disease. They were instructed to forward any patient with acute neurologic condition to the MOH for further examination. The family members and friends of the two patients were also interrogated on the possibility that they had at one time had botulism symptoms. The MOH further conducted a press release to create awareness of the botulism condition where the press release was circulated in the local media houses. The press release by the MOH was meant to identify other cases of botulism syndrome among the population that might be linked to the two cases (Greb 2006, p.86). There was other seven cases reported where the patients were had signs, which was consistent with that of botulism condition. The five of the seven victims of suspected botulism had sought medical attention and four of them were admitted for further investigation. After extensive treatment and diagnosis of the four patients, it was discovered that the patients were suffering from other complications like stroke, diabetes, and gravis. In the sera which had been extracted from the patients, botulism toxin was discovered (Busto 1999, p.1332). The patients who were admitted were all drivers from the same bus firm as the previous cases and use the same route. From the previous report, all the patients had taken food at a home situated at the terminal of bus station where the patients took their break. It was estimated at least 58 drivers used the same route, which comprised of 27 drivers in the morning shift, 15 drivers in the evening shift, and 16 in the afternoon shift. In this outbreak, there was need for the MOH to undertake follow-up strategy that will enable them to monitor the state of the drivers. This will enable the 58 drivers not to spread the disease and those who were still suffering get appropriate treatment. There was the need to suspend the eating food in the terminal point owing the nature of spread of the disease until there was further communication from the MOH (Arias 2010, p.121). The MOH invited the workers from the local health centre where the terminal bus station was situated to participate in the examination and testing of the botulism condition. The physicians who were participating in the give their demographic and clinical outcomes on the patients. The characteristics of all the patients who were recoded in the table below. The results were meant to provide a basis for the investigators to develop a hypothesis that will be analyzed to provide results to arrive at a decision. The results were provided by the physicians from Buenos Aires hospital in January 1998. Patient No. Age in years Gender (M) The work shift The start of the neurological signs and symptoms symptoms 1 42 M Morning January 6 The patient exhibited blurred vision, lower and upper abdominal severe weakness, breathing difficulty, and fatigue, drooping eyelids 2 31 M Morning January 5 Double vision, fatigue, blurred vision ,drooping eyelids, upper and lower abdominal severe weakness 3 23 M Morning January 9 The patient shows fatigue, blurred vision, drooping eyelids, and lower and upper abdominal severe weakness. 4 46 M Morning January 8 The patient shows difficulty in speaking and he had drooping eyelids. 5 54 M Morning January 5 The patient shows complications in speech, breathing difficulty, drooping eyelids, double vision, and blurred vision. 6 49 M Morning January 10 The patient had drooping eyelids, complications in speech, and blurred vision. 7 31 M Morning January 15 The patient had the following signs blurred vision, fatigue, lower and upper abdominal severe weakness, drooping eyelids, double vision, and respiratory complications. 8 44 M Morning January 14 The patient shows respiratory complications, fatigue and drooping eyelids. 9 24 M Morning January 12 The patient shows drooping eyelids and fatigue. All the patients under investigation were all male and they were all bus drivers from the same bus company and all worked in the morning shift. The median age was calculated and it came to 42 years and the range of the years of the patients was 23-54 .All the patients diagnosed of the disease had drooping eyelids (Arias 2010, p.122). In the all patients under study six of them had blurred; five of the patients had fatigue; four of the total patients had double vision, upper and lower abdominal severe weakness, respiratory complications; three had lower severe weakness. The start of neurologic symptoms and signs commenced from January 5 through to January 15. The cases on the victims did not peak at any specific point in the 11-day time. In generating the hypothesis, interviews administered on the cases and other bus drivers, being a driver during the morning shift of the bus road and taking food in the terminal point became the only exposures during the interview period. There were no instances of botulism on the bus drivers who were operating during the afternoon and evening shifts. It was established that the drivers from this shifts because they could not take their food in the terminal point as the terminal was meant only for lunch. The investigators involved in this process hypothesized that the outbreak of botulism syndrome was only confirmed to morning shift bus drivers plying the same route. The disease resulted from taking food or drinking in the bus terminal of a specific route between January 3 and January 7 (Greb 2006, p.87). In the process of testing the hypothesis, there was the need for investigators to compare particular exposures that are among the drivers who had been affected by the disease and the drivers who had not been affected by the disease. In this regard cohort study was used to find out the hypothesis. Cohort study was appropriate since the disease was restricted to a well-defined and comparatively smaller group of bus drivers (Busto 1999, p.1332). In order to establish the source of outbreak of the botulism condition, the investigators carried out a retrospective intensive study on the bus drivers who used the same route i9n the morning shift. The presented data were collected from January 15 to 19. The investigators critically defined one of the confirmed instances of botulism as one of the drivers in the morning shift. The bus drivers’ stool and sera showed that had the symptoms associated with botulism disease carried between January 5 and 15. A potential case of botulism was defined as a severe cranial nerve dysfunction which was characterized by blurred vision fatigue, drooping eyelids, and difficulty in swallowing because had no laboratory assurance. The comparison in the process of investigation comprised of all the bus drivers who were working in the morning shift of the concerned route who had no severe neurologic signs indicative of botulism. The MOH after consultation with the local health facility, where the bus terminal was situated and the bus company top management .In that respect the investigators on the botulism case developed well articulated questionnaire designed for epidemiology study (Arias 2010,p.123). References Arias, M.,2010,Outbreak Investigation, Prevention, and Control in Health Care Settings: Critical Issues for Patient Safety, Second Edition .New York,NY: Jones & Bartlett Publishers. Bowering D., 2002, Botulism from chopped garlic: Delayed recognition of a major outbreak. Annals of Internal Medicine, 108:363-68. Busto, P .,1999,Outbreak of Type A botulism among bus drivers and development of a botulism surveillance and antitoxin release system in Argentina. Medicine Journal, JAMA , 281:1334-1340. 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Swerdlow, L., 2001, Botulism surveillance and emergency response. A Public Health Strategy for a Global Challenge. JAMA, 278:433-435. Townes, J.,|& Cieslak P.,2004,An outbreak of Type A botulism associated with a commercial cheese sauce. Annals of Internal Medicine, 125:558-63. Read More