Rapport hebdomadaire Canada Diseases MAY 2 8 1q37 Weekly Report

Rapport  hebdomadaire Canada Diseases MAY  2 8 1q37 Weekly Report
Rapport hebdomadaire
Canada Diseases
'
maladies au Canada MAY 2 8 1q37
Weekly Report
Date of publication:
Date de publication:
ISSN 0382-232X
CONTAINED IN THIS ISSUE:
Ciguatera
A Large Common-Source
Outbreak in Canadian Vacationers in Cuba .
Norwalk-Like Virus Outbreak in a Nursing
Home - Ontario .
Announcement • . . . . . . . .
de~ANA~IAN,\·.
May 23, 1987
23 mai 1987
Vol. 13-20
CONTENU DU PRESENT NUMERO:
Ciguatera
Importante poussee d'origine
commune chez des vacanciers canadiens
Cuba • . . . • • . • . . . . • .
Poussee
virus pseudo-Norwalk dans un foyer
pour personnes agees - Ontario. . .
Ann once . . . . . . . . . . . . •
a
87
a
89
90
87
89
90
CIGUATERA-A LARGE COMMON-SOURCE
OUTBREAK IN CANADIAN
VACATIONERS IN CUBA
CIGUATERA - IMPORT ANTE POUSSEE D'ORIGINE
COMMUNE CHEZ DES VACANCIERS
CANADIENS A CUBA
The following is a report on a large common-source
outbreak of ciguatera fish toxin poisoning in Canadian
tourists arising from a single meal in Cuba on 27 March
1987. Forty-nine cases have been diagnosed, all with a
clinical onset within 8 hours of eating a fish meal at a
hotel.
L'expose qui suit fait etat d'une importante poussee de
toxi-infection alimentaire de type ciguatera qui s'est
manifestee chez des touristes canadiens ayant consomme un
meme plat de poisson dans un hotel de Cuba le 27 mars 1987.
Pour _les 49 cas diagnostiques, !'installation clinique s'est
produite dans !es 8 heures suivant ce repas.
The index case was seen and diagnosed on 30 March
They
and community health authorities advised.
contacted the travel agency involved which quickly
notified all available passengers by phone of the outbreak
and probable diagnosis and referred them to the McGill
University Centre for Tropical Diseases in Montreal,
Quebec. One hundred and twenty-five of 140 Canadians
identified as staying at this hotel on the southwest Cuban
coast the day of the outbreak were interviewed and 60 of
these admitted having eaten a fish casserole on the
evening of 27 March. This was served 4 hours before most
of them departed by plane for Montreal.
Le 30 mars, le cas de reference est examine et
diagnostique. Alertees, les autorites sanitaires communiquent avec l'agence de voyage concernee qui telephone sans
tarder tous les voyageurs disponibles pour !es avertir de la
poussee et du diagnostic probable, et pour !es adresser au
Centre de l'Universite McGill pour !es maladies tropicales,
Montreal (Quebec). Sur !es 140 Canadiens identifies comme
pensionnaires de !'hotel vise sur la c8te sud-ouest de Cuba le
jour de la poussee, 125 sont interroges, 60 declarant avoir
mange un plat de poisson dans la soiree du 27 mars. Ce repas
est servi 4 heures avant que la plupart des vacanciers ne
prennent l'avion pour Montreal.
The fish was properly cooked, did not look spoiled,
and tasted good. In 38 of the 49 cases, the illness began
during the flight to Montreal, with understandable stress
on the aeroplane's sanitary facilities. In addition to these
. cases, other people who had been vacationing at the same
hotel, shared the same meal, and returned to Canada on
later flights were also traced, and 11 additional cases
were identified with a similar illness onset on 27 March.
Le poisson est bien prepare, semble frais et a bon goOt.
Dans 38 des 49 cas, la maladie se declare pendant le vol vers
Montreal, ce qui entratne evidemment la monopolisation des
toilettes de l'avion. Outre ces cas, on relance egalement
d'autres personnes qui sejournaient a l'h8tel vise, ont
consomme le meme repas, et sont rentrees au Canada par des
vols ulterieurs; on identifie ainsi 11 autres cas s'etant
presentes de fac;:on analogue le 27 mars.
The presenting history was as follows: 2 to 6 hours
after consuming the fish, 94% developed gastrointestinal
symptoms consisting of one or more of nausea, vomiting,
diarrhea, or abdominal pain. In 92%, typical neurological
symptoms began 8 to 48 hours after eating the fish and
included one or more of perioral and acral "tingling"
sensations, numbness, "pins and needles", severe pruritus,
or most characteristically, a marked sensitivity to cold
presenting as a burning sensation over hands, feet, and in
the mouth. More general but very prevalent symptoms
included headaches, insomnia (often secondary to the
paresthesias), severe myalgias, and an extreme weakness.
Table 1 lists the frequency of symptoms in 56 of the
cases. Most often the gastrointestinal symptoms had
resolved in 96 hours, but the constitutional and neurological symptoms persisted and, in a significant number,
were unresolved in 3 weeks.
Le tableau revelateur est le suivant: 2 6 heures apres
!'ingestion du poisson, 94% des sujets manifestent au moins un
sympt8me
gastro-intestinal,
savoir:
nausees,
vomissements, diarrhee ou douleurs abdominales. Chez 92%
des malades, au moins un symptome neurologique se declare 8
a 48 heures apres !'ingestion du poisson, notamment:
fourmillements, engourdissement, picotements ou prurit
grave a la region buccale et aux extremites ou, de fac;:on plus
caracteristique, une sensibilite marquee au froid se
presentant comme une sensation de brQlure aux mains, aux
pieds et a la bouche. Parmi des symptomes plus generaux,
quoique tres frequents, notons: cephalees, insomnie (souvent
secondaire aux paresthesies), myalgies intenses, et faiblesse
extreme.
Le Tableau l fait etat de la frequence des
symptomes dans 56 des cas. L'atteinte gastro-intestinale se
resolut le plus souvent en 96 heures, mais il en va differemment des sympt8mes generaux et neurologiques qui, dans un
grand nombre de cas, durent plus de 3 semaines.
!Second Clus M.IU Reghtratlon No. 56701
Health and Welfare
Canada
Sante et Bien-etre social
Canada
a
a
a
o r ter de la dewcteme elaue • !nn iatrement n
- 87 -
67
Canada
Table 1. Frequency of Symptoms in 56 Cases of Ciguatera Fish Toxin Poisoning in a Common-Source Outbreak
in Canadian Vacationers in Cuba/
Tableau 1. Frequence des symptomes dans 56 cas de ciguatera d'origine commune observes chez des
vacanciers canadiens a Cuba
82%
78%
Nausea/Nausee
Diarrhea/Diarrhee
Vomiting/Vomissements
Tingling extremities/Fourmillements aux extremites
Numbness/Engourdissements
Pruritus/Prurit
Cold Sensitivity/Sensibilite au froid
- hand/feet/mains/pieds
- mouth/bouche
Perioral tingling/Fourmillements perioraux
Pins/Needles Sensations/Picotements
Myalgias/M yalgies
Headache/Cephalee
Insomnia/Insomnie
Toothache/Mal de dents
Weakness/Faiblesse
44%
84%
72%
68%
72%
50%
46%
46%
66%
58%
56%
24%
8496
All patients presenting with the typical clinical
syndrome of gastrointestinal and neurological symptoms had
eaten the same fish meal prior to being ill. Of the 60
interviewed persons who ate the fish for supper on
27 March, 56 became ill shortly after ( <12 hours), and 49 of
these 56 presented with the typical gastrointestinal and
neurological syndrome. An additional 7 of the 56 had only
gastrointestinal symptoms or minor symptoms and might
have experienced milder forms of ciguatera. Only 4 exposed
persons who were interviewed were not ill.
Tous les malades presentant le syndrome clinique typique de
symptomes gastro-intestinaux et neurologiques ont consomme le
meme plat de poisson avant leur atteinte. Sur les 60 personnes
interrogees qui ont pris le poisson au diner du 27 mars, 56 se sentent
mal peu de temps apres (<12 heures) - 49 d'entre elles manifestant
le syndrome gastro-intestinal et neurologique caracteristique.
Toujours parmi ces 56 personnes, 7 autres presentent uniquement
des symptomes gastro-intestinaux ou mineurs, leur atteinte pouvant
avoir ete une forme moins grave de ci9uatera. Sur toutes 1es
personnes exposees qui sont interrogees, 4 seulement sont
epargnees.
Twelve of these patients in addition to being
interviewed were seen and examined at the McGill
University Centre for Tropical Diseases and all had a normal
physical and neurological exam.
En plus d'etre interroges, 12 de ces malades sont examines au
Centre de l'Universite McGill pour les maladies tropicales, examen
qui se revele normal sur le plan physique et neurologique.
Ciguatera fish poisoning has been reported sporadically
La ciguatera a ete signalee de fa<_;:on sporadique dans les
in the Caribbean in association with eating large fish such as Antilles en association avec 1'ingestion de gros poissons tels que:
grouper, barracuda, red snapper, amberjack, and kingfish. merou, barracuda, vivaneau, seriole, et poisson-roi. L'intoxication
Poisoning is mediated by a heat-stable toxin contained in the ciguaterique est causee par une toxine thermostable contenue dans
flesh of the fish; small fish acquire the toxin when feeding la chair de poisson; 1es petits poissons sont contamines en se
upon the marine plankton dinoflagellate Gambiardiscus nourrissant de dinofla&elles Gambiardiscus toxicus du plancton, et
toxicus and larger fish acquire and accumulate the toxin by les gros poissons acquierent et accumulent la toxine en mangeant les
plus petits.
eating the smaller fish.
A study is underway to define the clinical course of
disease from this single common-source outbreak, the cost
implications of such an outbreak, and potential therapeutic
modalities.
SOURCE:
C Frenette, JD MacLean, MD, L Cedilotte,
McGill University Centre for Tropical Diseases,
Montreal General Hospital; A Adrien, MD,
Community Health Department,
Montreal
General Hospital, Montreal, Quebec.
Une etude se deroule presentement dans le but de definir le
cours clinique de l'atteinte observee dans le cadre de cette poussee
d'origine commune, ainsi que les coCits entratnes par une telle
poussee, et des modalites therapeutiques possibles.
SOURCE:
C Frenette, Dr JD MacLean, L Cedilotte, Centre de
l'Universite McGill pow· les maladies tropicales, H6pital
general de Montreal; Dr A Adrien, Sant€ communautaire, H6pital general de Montreal, Montreal (Quebec).
Editorial Note: In a recent issue(l), the Tropical Disease
Unit at the Toronto General Hospital reported being aware
of several cases of ciguatera poisoning in residents of the
Toronto area. Additional information reveals that between
6 and 27 April 1987, a total of 12 cases were examined in
the Unit and diagnosed as having ciguatera poisoning, and a
further 4 cases were discussed by telephone with family
physicians. Illness experienced by these cases was only mild
to moderate.
All of the cases had vacationed in the
Dominican Republic during the last 2 weeks of March and
had consumed either grouper, sea bass or barracuda. They
had stayed at resorts on both the north and south coasts.
Note de Ia redaction: Dans un numero recent0), le Service des
maladies tropicales de l'Hopital general de Toronto signalait avoir
ete avise de plusieurs cas de ciguatera chez des habitants de la
region torontoise. Des donnees additionnelles revelent que, du 6 au
27 avril 1987, 12 cas ont ete examines au Service et ont fait l'objet
d'un diagnostic de ciguatera, et que des consultations tetephoniques
portant sur 4 autres cas ont eu lieu avec des medecins de famille.
Dans tous ces cas, le degre de l'atteinte variait entre benin et
modere.
Tous les sujets vises avaient pris des vacances en
republique Dominicaine pendant les 2 dernieres semaines de mars et
avaient Consomme du merou, du serran OU du barracuda, IJs avaient
tous sejourne dans des hotels sur !es cotes nord et sud.
Reference:
Reference:
1.
Philpott JP. CDWR 1987; 13:71.
l.
Philpott JP. RHMC 1987; 13:71.
- 88 -
Notifiable Diseases Suonary (Concluded) - Sommaire des naladles
declaration obligatoire (fin)
liorthwest
British
Co I umb I a
Ontario
Ho. Disease
I C0-9
No
CIM-9
Haladle
Cur. Cum.
87
AIDS - SIDA
Amoebiasis ~ Amibiase
Botulism - Botulisme
Brucellosis - Brucellose
5.
Campylobacteriosis -
Campylobacter iose
6. Chickenpox - Varicelle
7. Cholera - Cholera
8. Diphtheria - Diphterie
052
001
032
001. 1
9. Giardiasis - Giardiase
10. Gonococcal Infections Infections gonococciques Ill
11. Gono Ophth neonat - Oph gono du
nouveau-ne
12. Haemoph i I us inf luen ZDe
invasive
006
005. 1
023
a
098
Territories
Alberta
Yukon
Territoires du
Nord-Ouest
Colomb I eBr I tann ique
Cum.
86
Cou.
1.
2.
3.
4.
Saskatchewan
Man I toba
11
81
333
2276
63
308
Cur. Cum. Cum.
87
86
Cur. Cum. Cum.
87
86
Cur. Cum. Cum.
87
86
Cur. Cum. Cum.
87
86
Cou.
Cou.
Cou.
Cou.
49
242
1407
9101
4
4
15
3
20
1084
7879
23
181
10
67
498
34
586
1
36
12
44
1822
283
1055
1018
56
149
63
96
822
3285
3893
310
985
938
128
489
482
330
11
27
77
43
83
213
26
77
250
3
60
25
4
11
105
13
22
12
1
50
52
11
140
36
10
12
II
12
9
9
8
8
23
333
1
13
285
12
10
8
31
147 122
5896 2451
312
5
27
36
101
1
26
96
6
96
29
237
111
188
331
300
321
99
1362 1258
221
Cur. Cum. Cum.
87
86.
Cou.
2
61
a
a
I
81
97
2 72
345
13
10
31
59
6
3
1636
12
25
18
42
59
58
17
94
51
9
10
I
2
1
2
5
2
4
190
491
59
14
5
8
34
15
35
78
8
38
75
13
78
2
3
15
1
11
47 5020
II
25
7
27
37
106
I
3
25
236
416
94
96
353
49
1354
195
1070
133
16
93
52
395
83
205
38
208
I
4
4
14
23
96
14
3
26
16
18
12
101
4
65
9
9
23
41
8
26
2
11
11
15
2
15
35
67
178
359
10
25
21C
105
100
59
138
43
10
162
44
213
38
66
21
195
37
168
23
3
11
45
2
11
18
36
30
36
19
72
103
1
2
4
18
3
55
13
50
28
5
11
15
28
45
I
17
26
5
3
1
(1)
(21
(31
141
10
32
23
II
1
11
1
Includes al I 098 categories except 098.4.
Comprend toutes les rubriques 098, saul 098.4.
Includes 070.4 to 070.9 and unspecified. - Comprend 070.4
070.9 et sans precision.
Includes encephalitis. - Comprend encephal ite.
All othet categories except Haemophilus 320.0, Meningococcal 036 and Tuberculosis 013.0. - Toutes les autres rubriques sauf;, Haemophilus 320.0,
meningocoques 036 et tuberculose 013.0.
15) All categories except Measles 055, Poliomyelitis 045, Rubella 056, Yellow Fever 060. - Toutes les rubriques sauf rougeole 055, poliomyelite 045,
rubeole 056, flevre )aune 060.
(61 Excludes Typhoid 002.0 and Paratyphoid 002.1 to 002.9. - Saul typho"ide 002.0 et paratypho'i'de 002.1
002.9.
a
a
NOTE: Cumulative totals for both years correspond to the same period of time.
NOTA: Les totaux cumulatifs pour les deux ann0es sont comparatifs
a la
SYMBOLS:
SIGNES CONVEHTIONHELS:
• Not reportable
.• Hot avai I able
No cases reported
declaration non obligatoire
.. Non disponible.
meme p0riode de temps.
a
Aucun cas dSclare.
SOURCE:
Stat istique de I 'etat civi I et de la sante,
Division de la sante,
Stat istique Canada,
Ottawa, Canada. KIA 016
telephone !613) 991-1769
This Tab! e has been produced by the use of CANSIM.
Ce tableau
ete produit avec le concours de CAHSIM.
a
110
098. 4
13. Hepatlt A 070.0, 010. I
14 . Hepa ti t B 070.2, 070.3
15. Hepatitis other Hepat i te autres (21
16. Legionel losis .. L0gionel lose
17. leprosy - Lepre
030
18. Malaria - Paludisme
084
19. Measles - Rougeol e
055
20. Pneumococca I meningitis Men i ng i te
pneu01ocoques !31
320. 1
21. Other bact. meningitis Autres meningite bacterienne!41
22. Viral meningitis - Meningite
vi rale (51
23. Meningococcal infections Infections
mBningocoques
036
24. Humps - Ore i I ions
072
25. Paratypho Id Paratypho"ide
002. 1-002. 9
26. Pertussis· Coqueluche
033
27. Pl ague - Pesta
020
28. Poliomyelitis - Pol iomyel ite
045
29. Rabi es - Rage
071
30. Rubel la • Rubeo le
056
31. Congen i ta I Rube II a Rubeo I e con gen I ta I e
771. 0
32. Salmonellosis - Salmonellose{6)
003
33. Shigellosis - Shigellose
004
34. Syph iii s. Early. Symptomatic 091
Symptomat i que, recent
35. Other - Autres
090, 092-097
36. Tetanus - TStanos
037
31. Trichinosis - Triohinose
124
38. Tuber cu los is - Tubercu lose
010-018
39. Typhoid - Typho"ide
002.0
40. Yellow Fever - Fievre jaune
060
Vital Statistics and Health Status.
Health Division,
Statistics Canada,
Ottawa, Canada. KIA OT6
telephone 16131 991-1769
31
4
12
1052 1028
Cur. Cum. Cum.
87
86
Cou.
10
It is possible that members of either the staff or
residents may have introduced the infection into the nursing
home from the community. It is interesting to note that
residents from one of the floors visit in the community
much more often than do any of the other residents. In
fact, the first 2 residents to become ill were 2 of the most
mobile individuals on the floor.
11 est possible que !'infection contractee au sein de la
collectivite ait ete introduite dans le foyer soit par des employes,
soit par des pensionnaires de l'eta9e vise. 11 est interessant de noter
que des pensionnaires d'un des etages se rendent beaucoup plus
souvent que Jes autres dans la collectivite. En fait, Jes 2 premiers
cas etaient 2 des pensionnaires Jes plus mobiles de l'etage.
This nosocomial outbreak of Norwalk-like virus
gastroenteritis was typical of many reported last winter.
Cette poussee nosocomiale de gastro-enterite a virus pseudoNorwalk est caracteristique d'un grand nombre de poussees
recensees l'hiver dernier.
Acknowledgements: The assistance and cooperation of
B. O'Donnell, Deputy Director and D. Durocher, Staff
Inspector, Algoma Health Unit, the staff at the Sault Ste.
Marie and Central Public Health Laboratories, and
Ms. L. Ryan, Director of Care and Ms. L.Dedman, Infection
Control Nurse at the nursing home is greatly appreciated.
Remerciements: Nous tenons
remercier de leur collaboration
B. O'Donnell, Directeur adjoint, et D. Durocher, Inspecteur, Service
de sante d'Algoma, ainsi que le personnel des laboratoires de Sante
publique (Sault-Sainte-Marie; centraux) et, enfin L. Ryan, Directrice
des soins, et L. Dedman, Infirmiere en lutte anti-infectieuse, de
l'etablissement vise.
SOURCE:
SOURCE:
DR Brown, MD, DPH, Acting Medical Officer
of Health, W Terry, CPHI(C), Director of Public
Health Inspection, Algoma Health Unit, Sault
Ste. Marie, Ontario (initially reported in ODSR,
Vol 8, No 6, 1987).
Announcement
a
Dr DR Brown, DPH, Medecin-hygieniste par interim,
W Terry, CPHI(C), Directeur des inspections de sante
publique, Service de sante d1Algoma, Sault-SainteMarie, Ontario (d'abord signal€ dans:
ODSR, Vol 8,
no 6, 1987).
--
Ann once
INFECTION CONTROL
LUTTE ANTI-INFECTIEUSE
This short intensive course in infection control,
Ce cours concis et intensif en Jutte anti-infectieuse est
organized jointly by !'Association des professionnels pour la organise conjointement par !'Association des professionnels pour la
prevention des infections in Quebec and the Bureau of prevention des infections (Quebec) et le Bureau de l'epidemiologie
Communicable Disease Epidemiology, LCDC, is designed to des maladies transmissibles du LLCM. I1 est con~u pour repondre
meet the needs of newly appointed infection control aux besoins des praticiens qui viennent d'etre nommes dans ce
practitioners. The course will be given from 25-30 October domaine. Le cours se donnera du 25 au 30 octobre 1987, au Centre
1987, at the Centre Hospitalier Cote-des-Neiges, Montreal. Hospitalier Cote-des-Neiges a Montreal; et ne sera presente qu'en
The program will be presented in French only. This is the fran~ais. II s'agit de la premiere annonce a ce sujet; le programme
first announcement.
The complete program will be complet sera disponible sous peu. Pour plus de renseignements,
available soon. For additionnel information, please contact communiqer avec:
Beverly Campbell, Infirmiere-conseil, Lutte
Beverly Campbell, Nurse Consultant, Division of Infection anti-infectieuse, Bureau de l'epidemiologie
des
maladies
Control, Bureau of Communicable Disease Epidemiology, transmissibles, Laboratoire de lutte contre la maladie, Ottawa
Laboratory Centre for Disease Control, Ottawa, Ontario, (Ontario), KIA OL2.
KlA OL2.
Two courses, similar in content to the above, will also
be available in English this year. Details on the first course,
Infection Control I, co-sponsored by the Bureau of
Communicable Disease Epidemiology and the College of
Nursing, University of Saskatchewan, were given in an
earlier issue (CDWI?. 1987; 13:50). It is being presented in
Regina from 25-29 May. The second course, also entitled
Infection Control 1, which is offered each year by the
Bureau and the Canadian Hospital Infection Control
Association, will be given in Ottawa from 14-18 September.
Additional information on this course will be available at a
later date.
Cette annee, deux autres cours - analogues au precedent sur le
plan du contenu - se donneront en anglais. Se reporter au RHMC
1987; 13:50 pour Jes details du premier cours, Lutte antiinfectieuse I, presente H.egina du 25 au 29 mai et coparraine par
le Bureau de l'epidemiologie des maladies transmissibles et le
College of Nursing de l'Universite de la Saskatchewan. Le deuxieme
cours, aussi intitule Lutte anti-infectieuse I, offert chaque annee
par le Bureau et par !'Association canadienne de controle de
!'infection dans les hopitaux, sera donne
Ottawa du 14 au 18
septembre. D'autres renseignements sur ce cours seront publies plus
tard.
The Canada Diseases Weekly Report presents current information on Infectious
and other diseases for surveillance purposes and is available free of charge upon
request. Many of the articles contain preliminary information and further
confirmation may be obtained from the sources quoted. The Department of
National Health and Welfare does not assume responsibility for accuracy or
authenticity, Contributions are welcome (in the official language of your
choice) from anyone working in the health field and will not preclude
publication elsewhere.
Le Rapport hebdomadaire des maladies au Canada, qui fournit des donnees pertinentes sur Jes
maladies lnfectieuses et Jes autres maladies dans le but de faciliter leur surveillance, peut
8tre obtenu gratuitement sur demande. Un grand nombre d'artlcles ne contiennent que des
donnees sommalres mais des renselgnements complementaires peuvent 8tre obtenus en
s'adressant aux sources citees. Le minlst~re de la Sante natlonale et du Bien-8tre social ne
peut 8tre tenu responsable de !'exactitude, ni de l'authenticite des articles. Toute personne
oeuvrant dans le domaine de la sante est Invitee collaborer (dans la langue officielle de son
choix) et la publication d'un article dans le present Rapport n'en emp8che pas la publication
ailleurs,
Editor: Dr. S.E. Acres (613) 957-1339
Managing Editor: Eleanor Paulson (613) 957-1788
Circulation: Elizabeth Beckett (613) 957-0841
Bureau of Communicable Disease Epidemiology
Laboratory Centre for Disease Control
Tunney's Pasture
OTTAWA, Ontario
Canada KIA OL2
R&!acteur en chef: or S.E. Acres (613) 957-1339
Redacteur administratif: Eleanor Paulson (613) 957-1788
Distribution: Elizabeth Beckett (613) 957-0841
Bureau d'epidemlologie des maladies transmlssibles
Laboratolre de iutte centre la maladie
Pare Tunney
Ottawa (Ontario)
Canada KI A OL2
a
a
a
- 90 -
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