Rapport hebdomadaire des Canada Diseases maladies au Canada

Rapport  hebdomadaire  des Canada Diseases maladies  au  Canada
Rapport hebdomadaire des
maladies au Canada
Canada Diseases
Weekly Report
:;
Date of Publication : April 8, 1989
Date de publication: 8avril1989
ISSN 0382-232X
Vol.15·14
CONTAINED IN THIS ISSUE:
CONTENU DU PRESENT NUMERO:
Botulism Reference Service for Canada •••••••••• : ••.•, ••• n
BotullsmlnCanada·Summaryfor1988 •••••••••••••. : ••• 78
Botulism In Fort Ch Imo, Quebec •••••••••••••••••••••• 79
Announcement • • • • • • • • . • • • • • • • • • • • • • • • • • • • • • • • 80
Service de reference pour le botullsme au Canada • • • . • • • • • • • • n
Le botullsme au Canada· Resume pour1988 •••••••.••••••• 78
Botullsme iiFort Chlmo, Quebec • • • • • • • • • • • • • • • • • ••••• 79
Annonce ••••..•••••••••••••••••••••••••••••• 80
BOTULISM REFERENCE SERVICE FOR CANADA
SERVICE DE REFERENCE POUR LE BOTULISME AU
CANADA
The Botulism Reference Service (BRS) for Canada, established at the
Health Protection Branch in Ottawa in 1974, has the following objectives:
Le Service de reference pour le botulisme au Canada, mis sur pied en 1974
ala Direction generale de la protection de la sanre (Ottawa), a le mandat
suivant:
to assist physicians and Provincial Departments of Health when
botulism is suspected;
Aider les medecins et les ministeres provinciaux de la Sante en cas de
soupiron de botulisme;
to examine suspect foods and clinical specimens submitted for
analysis;
Examiner les echantillons d' aliments suspects et les prelevements cliniques presentes;
to rapidly alert responsible agencies when commercial foods are
involved;
Alerter rapidement les organismes responsables lorsque des aliments
de preparation commerciale sont incrimines;
to maintain reference cultures of Clostridium botulinum and a
supply of antisera; and
Conserver des cultures de reference de Clostridium botulin um, et tenir
une reserve d' antiserums; et
to maintain liaison with centres that have similar interests and
responsibilities in Canada and abroad.
Assurer la liaison avec des centres canadiens et etrangers qui ont des
interets et des responsabilites analogues.
Botulism is a neuroparalytic disease with mortality rates in Canada of
about 14%. Most foodborne outbreaks in Canada are due to homeprepared foods, especially fermented Inuit foods, and improperly
stored meat of marine origin; however, some involve commercially
prepared foods. Symptoms of foodborne botulism include ptosis,
visual disturbance, vomiting and diarrhea, dry mouth and sore throat,
followed by descending symmetrical flaccid paralysis in an alert
afebrile person. Similar symptoms are associated with wound
botulism, but vomiting does not occur. The earliest and most frequently observed symptom of infant botulism is constipation followed by
lethargy, poor feeding, ptosis, difficulty swallowing, hypotonia, and
generalized weakness ("floppy" baby). In cases of foodborne or
wound botulism, specific antitoxin is administered as soon as possible.
For all types of botulism, accessibility to respiratory support is essential.
Le botulisme est une rnaladie neuroparalytique dont le taux de mortalite est
d'environ 14% au Canada. La plupart des flambees d'origine alimentaire
recensees au pays sont attribuables ades aliments prepares a la maison,
particulierement ades plats inuit faisandes et a des viandes marines mat
entreposees. Certaines mettent toutefois en cause des aliments commerciaux. Les symptOmes du botulisme alimentaire sont les suivants: ptose,
troubles visuels, vomissement et diarrhee, secheresse de la bouche et mal
de gorge, suivis de paralysie flasque symetrique descendente chez un sujet
vigilant et afebrile. Le botulisme des plaies est associe a une
symptomatologie analogue, mais sans vornissement. Quant au botulisme
infantile, il s 'annonce le plus souvent par la constipation; viennent ensuite:
lethargie, anorexie, ptose, troubles de degludtion, hypotonie et faiblesse
generale (apparence de "poupee de son"). Devant un botulisme d'origine
alimentaire ou des plaies, on adrninistre sans tarder l' antitoxine specifique.
Pour toutes !es formes de botulisme, l' acces ades soins respiratoires est essentiel.
When botulism is suspected, a member of the BRS should be called
immediately, day or night. The possible diagnosis of botulism should
be validated by checking the case history, and plans for transporting
suspect food and clinical specimens to Ottawa for laboratory analaysis
can be finalized. The food samples may be leftovers or unopened containers. When commercial foods are involved, it is important to
En cas de soup~ons de botulisme, il faut appeler sans tarder un membre du
Service de reference, quelle que soit l'heure du jour ou de la nuit. Le diagnostic possible de botulisme devrait etre ratifie par la verification de
I' anarnnese, et des dispositions peuvent etre prises pour expedier aOttawa
!es echantillons d'aliments suspects et les prelevements cliniques devant
etre analyses. Si des aliments de fabrication commeiciale sont incrimines,
powrlcr dcla dcuxiCmo clusc ~ Bnmgistrcm.mtn• 5670
ferond Class Mail RogiJtration No. 5670
Health and Welfare
Canada
Sante et Bien-etre social
Canada
77
Canada
retrieve the label, the manufacturer's lot number, codes embossed on
the can or package, etc. Suitable clinical specimens for analyses include fecal samples (approximately 1Og) or enema fluid, gastric contents (adjusted to approximately pH 6.0 with lN NaOH, if possible)
and serum (from 20 mL of blood collected before administration of
antitoxin). When infant botulism is suspected, the essential material
for analysis is the infant's feces. If necessary, soiled parts of diapers
may be submitted.
il importe de noter le contenu de I' etiquette, le numero de lot du fabric ant,
Jes codes estampes sur la boite ou le paquet, ou toute autre information
pertinente. Sont juges adequats comme echantillons cliniques !es
pre!evemeri'ts de selles (environ 10 g) ou de liquide de lavement, du contenu gastrique (ajuste, si possible, a un pH d'a peu pres 6,0 avec
NaOH lN), et de serum (provenant de 20 mL de sang preleves avant
!'administration d'antitoxine). Si !'on soupyonne un botulisme infantile,
il est essentiel de prelever des selles pour analyse; au besoin, on peut
presenter les parties souillees des couches du hebe.
For safe shipment, the specimens must be in a watertight primary
receptable, in a watertight secondary container, with sufficient absorbent material between the 2 containers to absorb the entire contents of the primary receptable. The preferred method of preserving
the material during shipment is by cooling rather than freezing, i.e., ·
by including commercial cooling packs in the parcel. In urgent cases,
the parcels are picked up immediately upon arrival, usually at the airport or the bus terminal.
Pour etre expedies sans danger, Jes echantillons doivent etre places dans
un recipient etanche, lequel doit ensuite etre place clans un deuxieme contenant etanche isole du premier avec suffisamment de matiere absorbante
pour le contenu complet du premier recipient. Pour conserver le materiel
pendant le transport, il est preferable de le garder au froid plutot que de
le congeler, c'est-a-dire de glisser dans le paquet des sacs refrigerants vendus sur le marche. En cas d 'urgence, on passe prendre les paquets des leur
arrivee, generaJement a l'aeroport OU au terminus d'autobus.
The persons or agencies listed below may be called for laboratory services or medical consultation. Antis era may be obtained directly from
Connaught Laboratories.
Pour des services de laboratoire ou des conseils medicaux, communiquer
avec les personnes ou organismes mentionnes ci-apres; et pour
l' antiserum, s 'adresser directement aConnaueht Laboratoires.
Laboratory Services: K. Dodds, Ph.D., Chairman (office (613) 9570884, home (613) 830-5033); E. Todd, Ph.D., Vice Chairman (office
(613) 957-0887, home (613) 225-4316); B. Blanchfield, Analyst (office (613) 957-0885 (613) 225-4969), Health Protection Branch,
Health and Welfare Canada, Ottawa, Ontario, KlA OL2.
Services de laboratoire: K. Dodds, Ph.D., President (travail (613) 9570884, domicile (613) 830-5033); E. Todd, Ph.D., Vice-president (travail
(613) 957-0887, domicile (613) 225-4316); B. Blanchfield, Analyste
(travail (613) 957-0885, domicile (613) 225-4969), Directiongenerale de
la protection de la sante, Sante et Bien-etre social Canada, Ottawa
(Ontario), KlA OL2.
Medical Consultation: Dr. L. Cote, Centre hospitalier de
l'Universite Laval, Sainte-Foy, Quebec, G1 V 402, (418) 656-4141
ext. 7882) and Dr. J.A. Smith, Department of Health, Provincial
Laboratories, Vancouver, British Columbia, V6J 4M3, (604) 6606032.
Conseilsmedicaux: DrL. Core, Centrehospitalier del'Universite Laval,
Sainte-Foy (Quebec), GlV 402, (418) 656-4141 X7882; et Dr J.A.
Smith,
Ministere
de la Sante, Laboratoires
provmciaux,
Vancouver (Colombie-Britannique), V6J 4M3, (604) 660-6032.
Epidemiological Consultation: Dr. A.O. Carter; Chief, Disease Surveillance Division, Laboratory Centre for Disease Control, Health
and Welfare Canada, Ottawa, Ontario, KlA OL2, (613) 957-1339).
Conseil epldemlologlque: Dr A.O. Carter, Chef, Division de la surveillance des maladies, Laboratoire de Jutte contre la maladie, Sante etBienetre social Canada, Ottawa (Ontario), KlA OL2, (613) 957-1339.
Supplier of Antisera: Connaught Laboratories Ltd., 1755 Steeles
Avenue West, Willowdale, Ontario, M2R 3T4, (416) 667-2701.
Fournisseur de !'antiserum: Connaui:ht Laboratoires Ltd., 1755 Steeles
Avenue West, Willowdale (Ontario), M2R 3T4, (416) 667-2701.
BOTULISM IN CANADA • SUMMARY FOR 1988
LE BOTULISME AU CANADA • RESUME POUR 1988
Two botulism outbreaks, one in August and the other in November,
involving 3 cases with no deaths, were confirmed in 1988 (Table 1).
All 3 cases were Inuit. Both outbreaks, which were apparently unrelated, involved raw seal meat soaked in micerak, a traditional "fermented" food, and occurred at Fort Chimo, Quebec, an area which
continues to experience the highest incidence of botulism in Canada.
There have been 28 outbreaks in this area since 1971, all involving
type E strains. In21 of these outbreaks the incriminated food was seal
meat< 1>. Details on the November incident are presented separately.
En 1988, on a confirme 2 flambees de botulisme (l 'une en aofit et I' autre
en novembre) qui ont fait 3 cas, dont aucun n'a ete mortel (Tableau 1).
Les sujets vises etaient tous 3 inuit. Apparemment sans lien, les 2 flambees
mettaient en cause du phoque cru trempe dans du "rnicerak", un plat
"faisande" traditionnel. Elles sont survenues a Fort Chimo (Quebec),
region qui conserve le premier rang pour !'incidence du botulisme au
Canada et OU 28 poussees - toutes de type E - ont ete recensees depuis
1971. L' aliment incrimine clans 21 de ces pous sees etait la viande de phoque<1>. Les details de !'episode de novembre sontpresentes apart.
In addition to the 2 confirmed foodbome outbreaks, 7 other possible
Outre les 2 flambees d 'origine alimentaire confirmees, 7 autr es flambees
possibles et 7 cas de mort soudaine du nouveau-ne ont fait l'objet
d'investigations, mais aucune association n'a pu etre faite avec
foodbome outbreaks and 7 cases of sudden infant death syndrome
were investigated, but no association with Clostridium botulinum
could be found.
No cases of infant botulism were reported in 1988.
Clostridium botulinum.
Aucun cas de b,otulisme infantile n' a ete signale en 1988.
78
Table 1. Foodborne Botulism In Canada, 1988/
Tableau 1. Botulisme d'origine alimentalre au Canada, 1988
Incident/
Episode
2
Suspected
Food/
Aliment
suspect
Month/
Mois
Location/
Endrolt
Augusl/
AoOt
Fort Chlmo,
Quebec/
Quebec
Mlcerak,
raw seal
meat/
Mlcerak,
phoque
cru
November/
Novembre
Fort Chimo,
Quebec/
Quebec
Mlcerak,
raw seal
meat/
Micerak,
phoque
cru
Toxin
Type/
Type de
toxlne
Total
Cases/
Total des
cas
Fatal
Cases/
Cas
mortels
Specimens with
C. botulinum +/
Echantlllons
C. botullnum +
Toxin/
Microorganism/
Toxine
Microorganlsme
2
0
E
Serum,
Food/
Serum,
ailments,
0
E
Food/
aliments
Stool,
Food/
Sell es,
aliments
Reference:
Reference:
1. Hauschild A, Dodds K, Gauvreau L, Smith JA. Botulism in
Canada - Summary for 1987. CDWR 1988; 14:41-42.
1. Hauschild A, Dodds K, Gauvreau L, Smith JA. Le botulisme au Canada
- Resume pour 1987. RHMC 1988; 14:41-42.
SOURCE:
SOURCE:
K Dodds, PhD, A Hauschild, PhD, Botulism Reference
Service for Canada, Health Protection Branch, Otlawa,
Ontario; B Dubuc, MD, Ungava Hospital, Fort Chimo,
Quebec.
K Dodds, PhD, A Hauschild, PhD, Service de references pour le
bolulisme au Canada, Direction generale de la protection de la
sante, Ottawa (Ontario); D' B Dubuc, Hopital de l' Ungava, Fort
Chimo (Quebec).
BOTULISME
BOTULISM IN FORT CHIMO, QUEBEC
A
FORT CHIMO, QUEBEC
On 21November1988, a52-year-oldmalelnukpresented at Ungava
Hospital, Fort Chimo, complaining of constipation, weakness, dry
throat, and blurred vision. Questioning also revealed that the patient
had difficulty initiating urination, and greenish sputum was noted on
examination. The patient reported that 4 days earlier, on 17 November, he had consumed raw seal meat soaked in micerak, a traditional
"fermented" food (see below). Several hours after the meal, he suffered from vomiting, a dry and sore throat, muscular weakness,
blurred vision, constipation, and difficulty urinating. The nausea and
vomiting ceased after 24 h, but the other symptoms persisted. Physical and neurological examinations on 21 November were unremarkable except for the presence of greenish secretions in the throat and
the absence of bowel sounds. The patient was kept under observation
because botulism was suspected and there was an apparent bronchial
superinfection. The patient had a successful Fleet® enema and was
given a prescription for Amoxil® and discharged the next day after
all symptoms had disappeared. On 23 November, he returned to the
hospital again experiencing a dry throat, weakness and constipation.
He was given another enema and discharged after ashortobservation
period, again totally asymptomatic. Two days later the symptoms
recurred. Because the examination revealed the presence of bowels
sounds, a half bottle of CITRO-MAG® laxative was given and, after
4 h, the patient passed a large quantity of dry stool. Recovery was
then uneventful.
Le21novembre1988, unlnuitde52 ans sepresente al'Hopitaldel'Ungava,
a Fort Chimo, en raison de constipation, de faiblesse, de secheresse de la
gorge et de vision trouble. L'interrogatoirerevele une difficulte alamiction;
et I' examen, des crachats verdatres. Le malade precise avoir consomme 4
jours plus rot (le 17) du phoque cru trempe dans du "micerak", un plat
"faisande" traditionnel (voir plus bas). Plusieurs heures apres le repas, les
vomissements, la secheresse et le ma! de gorge, la faiblesse musculaire, la
vision trouble, la constipation et la difficulte alamiction se manifestent. La
nausee et les vomissements disparaissent au bout de 24 h, mais les autres
symptomes persistent. Les examens physique et neurologique pratiques le
21 novembre ne revelent rien de particulier si ce n'est la presence de
secretions verdatres dans la gorge et !'absence de bruits intestinaux. Le
malade est garde sous observation en raison de soup~ns de botulisme et
d 'une surinfection bronchique apparente. Un lavement Fleet® etantefficace,
on prescrit de l' Amoxil® et l'homme obtient son conge le lendemain, tous
les symptomes ayant disparu. Le 23 novembre, il se presente de nouveau a
l'hopital pour secheresse de la gorge, faiblesse et constipation. On lui fait un
autre lavement et, apres une courte periode d'observation, i1 rentre chez lui
- encore une fois tout a fait aysmptomatique. Deux jours plus tard, les
symptomes reapparaissent. L' examenrevelant des bruits intestinaux, on administre un demi-flacon delaxatif CITRO-MAG® et, 4 h plus tard, lepatient
elimine une grande quantite de selles seches. Le retablissement se deroule
ensuite sans incident.
Botulinal toxin type E and viable Clostridium botulinum spores were
confirmed in the micerak on 26 November. Viable type E C.
botulinum spores were recovered from stool samples taken on 27
November, 10 days after consuming the implicated food.
Le 26 novembre, la presence de toxine botulinique de type E et de spores
viables de C. botulinum est confirmee dans le "micerak", Des spores viables
de C. botulinum de type E sontmises en evidence dans des selles pre!evees
le 27 novembre, soit 10 jours apres l'ingestion de I' aliment incrimine.
79
Micerak can be included with other native "fermented" meat products
which present a real risk of botulism (l). To produce micerak, Inuits
take the fat of marine mammals (seal, whale or walrus), put it in a
skin, plastic bag or glass jar, and leave it to "ferment", usually under
a rock outside. The length of time of fermentation varies (1 to 4
months), as does the temperature (outdoor or room temperature).
Micerak is usually used as a dip for caribou, fish or seal meat. The
major problems with such foods is the lack of fermentable carbohydrate which precludes any significant pH reduction <ll.
Le "micerak" peut etre classe avec les autres produits carnes autochtones
"faisandes" qui posent un risque reel de botulisme< 1>. Les Inuit preparent le
micerak avec du gras de mam:mllere marin (phoque, baleine ou rnorse) qu'ils
placent dans une pochette de peau, un sac de plastique ou un pot de verre et
qu •ils laissent "faisander", en general dehors sous une roche. La periode de fermentation varie (de 1 a4 mois), de merne que la temperature (exterieure OU
interieure). Le micerak est generalement servi comme trempette pour le
caribou, le poisson ou le phoque. Le grand probleme de ces aliments est leur
rnanque de glucide fermentiscible, ce qui empeche toute reduction importante
dupH< 1>.
Reference:
Reference:
1. Hauschiled AHW, Gauvreau L. Food-borne botulism in Canada,
1971-84. Can Med Assoc J 1985; 133:1141-46.
1. HauschildAHW, Gauvreau L. Food-borne botulism in Canada, 1971-1984.
SOURCE:
K Dodds, PhD, Botulism Reference Service for Canada,
Health Protection Branch, 01/awa; B Dubuc, MD, Ungava
Hospital, Fort Chima, Quebec.
J Assoc med can 1985; 133:1141-46.
SOURCE:
K Dodds, PhD, Service de refirence pour le botulisme au Canada,
Direction generate de la protection de la sanle, 01/awa (Ontario); Dr B
Dubuc, Hopital de l' Ungava, Fort Chimo (Quebec).
Annonce
Announcement
CONFERENCE ON THE HAP GROUP
OF ORGANISMS
CONFERENCE ON THE HAP GROUP
OF ORGANISMS
An international conference on the Haemophilus, Actinobacillus,
Pasteure/la (HAP) group of organisms will take place at the University of Guelph from 21-24 June 1989.
Une conference internationale sur le groupe de microorganismes Haemophilus,
Actinobacil/us et Pasteurella (HAP) aura lieu aI 'Universite de Guelph, du 21
For further information, please contact Dr. P. Shewen, Department
of Veterinary Microbiology and Immunology, University of
Guelph, Guelph, Ontario, Canada, NlG 2Wl, (tel.: (519) 8238800 ext. 4759).
Pour plus de renseignements, s'adresser au Dr P. Shewen, Departement de
mlcrobiologie et d'lmmunologle veterinaires, Universite de Guelph,
Guelph (Ontario), Canada, NlG 2Wl; (tel.: (519) 823-8800, poste 4759).
au 24juin1989.
The Canada Diseases Weekly Report presents cunentinformation 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 confmnation may
be obtained from the sources quoted. The Department of National Health and Welfare does not ass\Dlle responsibility for accuracy or authenticity. Contributions are
welcome (in the official language of your choice) from anyone worlcing in the health
field and will not preclude publication elsewhere.
Le Rapport hebdomadaire des maladies au Canada, qui foumit des donn6es pertinentes
sur !es maladies infectieuses et les autres maladies dans le but de faciliter !eur surveillance, pcut etre obtenu gratuitemcnl SU! demande. Un grand nombre d'articles ne conticnnent quc des donnees sommaires mais des renseignernents complementaires peuvent
etre obtenus en s'adreosant amt sources citc\es. Le ministere de la Santi nationale et du
Bien-etresocial ne peut etre reaponsable del'exactitude, ni del'authenticite des articles.
Touteperaonne oeuvrant dans le domaine de la sante est invitee ii collaborer (dans la langue officielle de son choix) et la publication d'un article dans le present Rapport n'en
emp&he pas la publication ailleurs.
Scientific Advisor:
Editor:
Clrculatlon:
Desktop Publishing:
Conselller sclentlflque:
Redactrlce en chef:
Distribution:
Edlllque:
Dr. S. E. Acres (613) 957-0325
Eleanor Paulson (613) 957-1788
Dolly Riggins (613) 957-0841
Joanne Regnier (613) 957 -~22
Bureau of Communicable Disease Epidemiology
Laboratory Centre for Disease Control
Tunney'sPasture
OTTAWA, Ontario
Canada Kl A OL2
D' S.E. Acres
Eleanor Paulson
Dolly Riggins
Joanne Regnier
Bureau d'epidOmiologie des maladies transmissibles
Laboratoire de Jutte contre la maladie
Pre Tunney
Ottawa (Ontuio)
Canada KIA OL2
80
(613) 957-0325
(613) 957-1788
(613) 957-0841
(613) 957-0322
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