http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,79951
Archive Number 20091105.3818
Published Date 05-NOV-2009
Subject PRO/EDR> Undiagnosed deaths - Dominican Rep: (BR) lepto susp RFI
UNDIAGNOSED FATALITIES - DOMINICAN REPUBLIC: (BAHORUCO) LEPTOSPIROSIS
SUSPECTED, REQUEST FOR INFORMATION
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
[1]
Date: Wed 4 Nov 2009
Source: El Nuevo Diario [in Spanish, trans. Mod.MPP, edited]
<http://elnuevodiario.com.do/app/article.aspx?id=174445>
The public health secretary, Bautista Rojas Gomez, confirmed that lab tests
from the people who died in El Salado, Galvan Municipality, Bahoruco
province, indicated that the deaths were caused by leptospirosis.
He explained that specimens were sent to the Centers for Disease Control
[and Prevention] in Atlanta [Georgia], USA to obtain a definitive diagnosis.
He said that he has maintained direct contact with the health authorities
in the Sur [South] Region, and specialists have been sent to the area,
where they have established a strict sanitary control. He said that several
of the affected individuals had been discharged to their homes and that the
22 who remain in hospital under treatment are in stable condition.
"The situation is under control, and we hope that there will be no further
deaths from the disease. Our epidemiologists and public health
professionals have worked hard over the last few days in order to resolve
the problem," he said and added that the work has been carried out since
the weekend [31 Oct-1 Nov 2009], when they received information that a
significant number of residents of El Salado showed symptoms of disease.
He claimed that more than 100 samples were taken from residents of
different communities in the Sur Region by a mobile laboratory sent by the
State Secretariat of Health as part of control actions against
leptospirosis and other diseases.
He said the team of specialists was reinforced with psychiatrists and
psychologists, who provide care for families impacted by the disease and
that staff from the Department of Environmental Health have been working on
rodent [rats] control, one of the animal transmitters of leptospirosis.
The official said that since the outbreak has been controlled, tranquility
has begun to return to the communities of Bahoruco and Barahona provinces.
In Barahona, 21 persons, including 15 children and 6 adults from of El
Salado, in the municipality of Galvan, continue to be hospitalized in the
Jaime Mota regional university hospital in this city. They were affected by
a virus, supposedly influenza, although not yet specified by the public
health authorities. Dr Gilberto Ariel Suero Cavallo, director of the health
center, said that so far, approximately 33 patients have been treated in
the hospital, all natives of that locality in Bahoruco province.
"We currently have 21 patients, of which 15 are children and 6 are adults,
4 men and 2 women. Of the children, the youngest is 8 years old, and all
have been admitted with symptoms of fever after the outbreak in Salado," he
said and added that the patients are stable, and "They have had specimens
taken for dengue and leptospirosis in order to determine what type of
infection is responsible for the outbreak."
Dr Suero Cavallo said that many experts think that the outbreak involves
one type of dengue, "but until we have definitive evidence, we cannot say
what the true diagnosis is."
He indicated that patients in this hospital are being closely monitored.
"None of the patients are in serious but rather stable condition." He said
that they expect all patients to be discharged to their homes in good
health over the coming days.
The official said the health center is providing all essential services so
that patients regain their health as soon as possible, so they are
monitored and on hydration, which is crucial in these types of diseases.
In the community of El Salado of Galvan municipality, 2 people have died
from a rare disease that has not been identified yet by the Public Health
Authorities.
One of the people died in El Salado and the other in the Jaime Mota
regional university hospital, where others have been hospitalized and under
medical observation for several days.
[byline: Teuddy A Sanchez]
--
communicated by:
ProMED-mail
<promed@promedmail.org>
******
[2]
Date: Wed 4 Nov 2009
Source: Barrigaverde [in Spanish, trans. Mod.MPP, edited]
<http://www.barrigaverde.net/?q=node/5657>
The director of health has not determined the cause of the disease outbreak
in El Salado.
The number of cases is beginning to decrease, said Juan Pablo Guillermo,
the provincial director of health.
When the 15 year old boy was admitted to the San Bartolome hospital last
Saturday [31 Oct 2009], he never imagined that dozens of his townspeople
would suffer the same symptoms of a disease that had claimed the lives of 2
boys, 17 and 22 years old.
The panic that has began to subside, gripped the residents of El Salado
when they saw tens of residents taken to medical centers suffering from
fever, vomiting, headache, and stomach aches. Only last Monday [2 Nov
2009], 20 people were treated for the same symptoms at the San Bartolome de
Neyba hospital.
Of the 14 individuals admitted this past Tuesday afternoon [27 Oct or 3 Nov
2009?], only one was awaiting discharge, having recovered from the crisis
that affected him.
The epidemiologist Fredy Medina Barahona reported that 9 patients remain
hospitalized in Barahona, but the director of health of Bahoruco province,
Juan Pablo Guillermo, indicated that there were 29 patients. Other affected
individuals were referred to the capital, but he said that the numbers of
individuals involved were not known, as many were taken to [the referral
hospitals] by their families.
Dr Freddy Medina reported that about 300 people were examined, of which 10
were identified to have a fever. Medications have been distributed to avoid
some of the suspected diseases being transmitted to more residents in El
Salado.
In addition, almost all of the houses in El Salado had been fumigated, an
action that will be extended to the entire municipality of Galvan,
according to the Provincial director of health, who said they have taken
samples in order to determine if the water was contaminated or if the use
of pesticides and poisons are related to this health problem.
Juan Pablo Guillermo reported that when they learned of the deaths, the
health authorities proceeded to medicate against leptospirosis and
meningococcemia to prevent spread of these diseases to more people, as
these were [on the list of] suspected etiologies of the outbreak.
In the operation on Tuesday [3 Nov 2009?], influenza H1N1 virus infection,
malaria, and dengue were added to the list of possible etiologies. Results
from the collected specimens are awaited to hopefully clear the doubts and
concerns of the population of this impoverished community.
Seeing that with the passing of hours, the number of patients increased,
the residents of El Salado blocked the road linking the provinces of
Bahoruco and Independencia to motivate a rapid intervention of the [health]
authorities that appeared to be passive addressing this situation.
Teuddy Jimenez, criticized the health professionals for failing to identify
the focal point of the disease that lead to the hospitalization of tens of
his neighbors and asked the secretary of health, Bautista Rojas Gomez, to
intervene in dealing with the issue.
Facing the claim of the affected residents, there was an emergency meeting
held between the governor Luis Emilio, the provincial director of health
and other authorities of Bahoruco, who immediately committed all efforts to
meet the needs of El Salado.
Denying that there had been negligence, Juan Pablo Guillermo pointed out
that until there are laboratory results, they are unable to confirm the
etiology of the disease that has affected tens of the residents of El
Salado. "One has to wait for the results; in addition, an autopsy is being
conducted on one of the fatalities [cases?]," he said.
[byline: Ramon Antonio Medina]
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[From the newswires above, while one mentions that leptospirosis has been
identified as the etiologic agent, there appear to be some concerns that a
final diagnosis is still pending. The differential diagnosis of the
clinical picture of fever, headache, abdominal pain, and vomiting is
extensive and includes all of the possible etiologies mentioned in the
newswires (dengue, influenza, leptospirosis, malaria, and meningococcemia)
as well as other possible etiologies such as bacterial enteric organisms
(including salmonellosis, shigellosis, and typhoid fever). From the
newswires description, it does appear as though the outbreak is a fairly
explosive outbreak, with cases occurring over the course of less than a
week, suggesting there might be a common source of exposure. But it is also
possible that the newswires became alerted after the occurrence of deaths,
and investigations found many individuals hospitalized over the course of a
somewhat longer period.
Borrowing from Mod. ML's prior discussions on leptospirosis, "it is a
zoonosis caused by one of the many pathogenic serotypes of the spirochete
_Leptospira_. It is transmitted to humans by exposure of abraded skin or
mucous membranes to water or wet soil (such as after flooding due to heavy
rainfall) that has been contaminated by urine from asymptomatic,
chronically infected animals, especially rodents."
ProMED-mail has reported on 2 prior outbreaks of leptospirosis in the
Dominican Republic, one in 2007 following a hurricane that affected the
Barahona province and south to the coast, and another outbreak in 2006 in
Santiago that was attributed to significant problems with garbage disposal
management leading to increased rodent activity in crowded neighborhoods.
The newswires above do not give information on the background situation in
the area to attribute this current outbreak to any specific event, although
this is still the tail end of the hurricane/tropical storm season in the
Caribbean.
We await further information from knowledgeable sources on results of
confirmatory laboratory testing on this outbreak.
For mapa of the Dominican Republic, see
<http://en.wikipedia.org/wiki/Provinces_of_the_Dominican_Republic#Map> and
the HealthMap/ProMED interactive map at <http://healthmap.org/r/00Z*>. -
Mod.MPP]
[see also:
2007
---
Leptospirosis - Dominican Republic 20071124.3804
2006
---
Leptospirosis - Dominican Republic 20060110.0085]
.................mpp/msp/mj/sh
Archive Number 20091105.3818
Published Date 05-NOV-2009
Subject PRO/EDR> Undiagnosed deaths - Dominican Rep: (BR) lepto susp RFI
UNDIAGNOSED FATALITIES - DOMINICAN REPUBLIC: (BAHORUCO) LEPTOSPIROSIS
SUSPECTED, REQUEST FOR INFORMATION
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
[1]
Date: Wed 4 Nov 2009
Source: El Nuevo Diario [in Spanish, trans. Mod.MPP, edited]
<http://elnuevodiario.com.do/app/article.aspx?id=174445>
The public health secretary, Bautista Rojas Gomez, confirmed that lab tests
from the people who died in El Salado, Galvan Municipality, Bahoruco
province, indicated that the deaths were caused by leptospirosis.
He explained that specimens were sent to the Centers for Disease Control
[and Prevention] in Atlanta [Georgia], USA to obtain a definitive diagnosis.
He said that he has maintained direct contact with the health authorities
in the Sur [South] Region, and specialists have been sent to the area,
where they have established a strict sanitary control. He said that several
of the affected individuals had been discharged to their homes and that the
22 who remain in hospital under treatment are in stable condition.
"The situation is under control, and we hope that there will be no further
deaths from the disease. Our epidemiologists and public health
professionals have worked hard over the last few days in order to resolve
the problem," he said and added that the work has been carried out since
the weekend [31 Oct-1 Nov 2009], when they received information that a
significant number of residents of El Salado showed symptoms of disease.
He claimed that more than 100 samples were taken from residents of
different communities in the Sur Region by a mobile laboratory sent by the
State Secretariat of Health as part of control actions against
leptospirosis and other diseases.
He said the team of specialists was reinforced with psychiatrists and
psychologists, who provide care for families impacted by the disease and
that staff from the Department of Environmental Health have been working on
rodent [rats] control, one of the animal transmitters of leptospirosis.
The official said that since the outbreak has been controlled, tranquility
has begun to return to the communities of Bahoruco and Barahona provinces.
In Barahona, 21 persons, including 15 children and 6 adults from of El
Salado, in the municipality of Galvan, continue to be hospitalized in the
Jaime Mota regional university hospital in this city. They were affected by
a virus, supposedly influenza, although not yet specified by the public
health authorities. Dr Gilberto Ariel Suero Cavallo, director of the health
center, said that so far, approximately 33 patients have been treated in
the hospital, all natives of that locality in Bahoruco province.
"We currently have 21 patients, of which 15 are children and 6 are adults,
4 men and 2 women. Of the children, the youngest is 8 years old, and all
have been admitted with symptoms of fever after the outbreak in Salado," he
said and added that the patients are stable, and "They have had specimens
taken for dengue and leptospirosis in order to determine what type of
infection is responsible for the outbreak."
Dr Suero Cavallo said that many experts think that the outbreak involves
one type of dengue, "but until we have definitive evidence, we cannot say
what the true diagnosis is."
He indicated that patients in this hospital are being closely monitored.
"None of the patients are in serious but rather stable condition." He said
that they expect all patients to be discharged to their homes in good
health over the coming days.
The official said the health center is providing all essential services so
that patients regain their health as soon as possible, so they are
monitored and on hydration, which is crucial in these types of diseases.
In the community of El Salado of Galvan municipality, 2 people have died
from a rare disease that has not been identified yet by the Public Health
Authorities.
One of the people died in El Salado and the other in the Jaime Mota
regional university hospital, where others have been hospitalized and under
medical observation for several days.
[byline: Teuddy A Sanchez]
--
communicated by:
ProMED-mail
<promed@promedmail.org>
******
[2]
Date: Wed 4 Nov 2009
Source: Barrigaverde [in Spanish, trans. Mod.MPP, edited]
<http://www.barrigaverde.net/?q=node/5657>
The director of health has not determined the cause of the disease outbreak
in El Salado.
The number of cases is beginning to decrease, said Juan Pablo Guillermo,
the provincial director of health.
When the 15 year old boy was admitted to the San Bartolome hospital last
Saturday [31 Oct 2009], he never imagined that dozens of his townspeople
would suffer the same symptoms of a disease that had claimed the lives of 2
boys, 17 and 22 years old.
The panic that has began to subside, gripped the residents of El Salado
when they saw tens of residents taken to medical centers suffering from
fever, vomiting, headache, and stomach aches. Only last Monday [2 Nov
2009], 20 people were treated for the same symptoms at the San Bartolome de
Neyba hospital.
Of the 14 individuals admitted this past Tuesday afternoon [27 Oct or 3 Nov
2009?], only one was awaiting discharge, having recovered from the crisis
that affected him.
The epidemiologist Fredy Medina Barahona reported that 9 patients remain
hospitalized in Barahona, but the director of health of Bahoruco province,
Juan Pablo Guillermo, indicated that there were 29 patients. Other affected
individuals were referred to the capital, but he said that the numbers of
individuals involved were not known, as many were taken to [the referral
hospitals] by their families.
Dr Freddy Medina reported that about 300 people were examined, of which 10
were identified to have a fever. Medications have been distributed to avoid
some of the suspected diseases being transmitted to more residents in El
Salado.
In addition, almost all of the houses in El Salado had been fumigated, an
action that will be extended to the entire municipality of Galvan,
according to the Provincial director of health, who said they have taken
samples in order to determine if the water was contaminated or if the use
of pesticides and poisons are related to this health problem.
Juan Pablo Guillermo reported that when they learned of the deaths, the
health authorities proceeded to medicate against leptospirosis and
meningococcemia to prevent spread of these diseases to more people, as
these were [on the list of] suspected etiologies of the outbreak.
In the operation on Tuesday [3 Nov 2009?], influenza H1N1 virus infection,
malaria, and dengue were added to the list of possible etiologies. Results
from the collected specimens are awaited to hopefully clear the doubts and
concerns of the population of this impoverished community.
Seeing that with the passing of hours, the number of patients increased,
the residents of El Salado blocked the road linking the provinces of
Bahoruco and Independencia to motivate a rapid intervention of the [health]
authorities that appeared to be passive addressing this situation.
Teuddy Jimenez, criticized the health professionals for failing to identify
the focal point of the disease that lead to the hospitalization of tens of
his neighbors and asked the secretary of health, Bautista Rojas Gomez, to
intervene in dealing with the issue.
Facing the claim of the affected residents, there was an emergency meeting
held between the governor Luis Emilio, the provincial director of health
and other authorities of Bahoruco, who immediately committed all efforts to
meet the needs of El Salado.
Denying that there had been negligence, Juan Pablo Guillermo pointed out
that until there are laboratory results, they are unable to confirm the
etiology of the disease that has affected tens of the residents of El
Salado. "One has to wait for the results; in addition, an autopsy is being
conducted on one of the fatalities [cases?]," he said.
[byline: Ramon Antonio Medina]
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[From the newswires above, while one mentions that leptospirosis has been
identified as the etiologic agent, there appear to be some concerns that a
final diagnosis is still pending. The differential diagnosis of the
clinical picture of fever, headache, abdominal pain, and vomiting is
extensive and includes all of the possible etiologies mentioned in the
newswires (dengue, influenza, leptospirosis, malaria, and meningococcemia)
as well as other possible etiologies such as bacterial enteric organisms
(including salmonellosis, shigellosis, and typhoid fever). From the
newswires description, it does appear as though the outbreak is a fairly
explosive outbreak, with cases occurring over the course of less than a
week, suggesting there might be a common source of exposure. But it is also
possible that the newswires became alerted after the occurrence of deaths,
and investigations found many individuals hospitalized over the course of a
somewhat longer period.
Borrowing from Mod. ML's prior discussions on leptospirosis, "it is a
zoonosis caused by one of the many pathogenic serotypes of the spirochete
_Leptospira_. It is transmitted to humans by exposure of abraded skin or
mucous membranes to water or wet soil (such as after flooding due to heavy
rainfall) that has been contaminated by urine from asymptomatic,
chronically infected animals, especially rodents."
ProMED-mail has reported on 2 prior outbreaks of leptospirosis in the
Dominican Republic, one in 2007 following a hurricane that affected the
Barahona province and south to the coast, and another outbreak in 2006 in
Santiago that was attributed to significant problems with garbage disposal
management leading to increased rodent activity in crowded neighborhoods.
The newswires above do not give information on the background situation in
the area to attribute this current outbreak to any specific event, although
this is still the tail end of the hurricane/tropical storm season in the
Caribbean.
We await further information from knowledgeable sources on results of
confirmatory laboratory testing on this outbreak.
For mapa of the Dominican Republic, see
<http://en.wikipedia.org/wiki/Provinces_of_the_Dominican_Republic#Map> and
the HealthMap/ProMED interactive map at <http://healthmap.org/r/00Z*>. -
Mod.MPP]
[see also:
2007
---
Leptospirosis - Dominican Republic 20071124.3804
2006
---
Leptospirosis - Dominican Republic 20060110.0085]
.................mpp/msp/mj/sh