- Dr. McKeown reported the following update:
- * The outbreak has so far affected a total of 68 residents,
eight employees and three visitors at Seven Oaks.
- * There have been no new cases since yesterday, but
there have been two additional deaths, for a total of six in the outbreak.
- * The majority of cases are improving but some have
worsened as the illness takes it course.
- * 30 residents from Seven Oaks have been admitted to
- * Toronto Public Health staff have followed up 170 contacts
connected to Seven Oaks. This includes families of children who attend
the adjacent day nursery.
- The above comments from the press release of Toronto
Health indicates the number dead has risen to six, the number of employees
infected is up to eight, the number of visitors infected is up to three
and the number of residents admitted is up to 30.
- Since the outbreak began on Sept 25, it seems likely
that these numbers will increase, especially in secondary contacts like
employees and visitors. Increases in these categories suggest the etiological
agent is infectious via casual contact and is not due to bacterial agents
in the hospital.
- Monitoring of the contacts will be important, since there
is no quarantine and this category is growing. Testing out autopsy material
may help in the isolation of the etiological agent, which will be necessary
for the validation of the negative data. Generation of false negatives
in viral infections is common, and the increasing numbers demand an aggressive
investigation of the etiological agent.
- © 2005 Recombinomics. All rights reserved.
- Mystery Illness Spreads to Patient Vistors in Toronto
- Recombinomics Commentary
- October 3, 2005
- Seventy-one of the 249 residents at Seven Oaks Home for
the Aged in Toronto's east end are sick. Six employees and two visitors
are also ill.
- The Ontario Public Health Lab has been running several
tests on samples taken from hospitalized patients.
- "We've run tests for over a dozen different viruses
and bacteria, from run-of-the-mill influenza to bird flu and SARS,"
said Dr. Donald Low, the lab's medical director. "So far, everything's
come up negative."
- Residents at the nursing home began to show symptoms
one week ago. The first patient died on Sept. 29. A coroner will begin
performing autopsies on Monday.
- Low said once they have tissue samples from the deceased
patients, lab technologists will be able to run more sophisticated tests.
- He added it's unfortunate the autopsies weren't done
- Although all tests thus far are negative, false negatives
are common in the absence of the correct clinical samples. Frequently,
autopsy material is required to isolate the etiological agent.
- The above comments indicate that those infected include
six employees and two visitors, demonstrating that the infectious agent
is easily transmitted. The number of residents infected is up to 73 from
a 249 bed facility, and since the outbreak is less than a week old, that
number will likely rise. Similarly, the number of employees infected has
gone up as have the number of infected visitors, so those two groups likely
trail the residents in exposure dates.
- More details on ages in symptoms of the casual contacts
would be useful.
- There has been little discussion of tracing contacts,
and visitors have been kept out of the nursing home and in the community.
Since the highly infectious agent is unknown, this policy seems dangerous.
The failure to have begun autopsies of the dead, who died last week, is
cause for concern
- Toronto seems more focused on early press conferences
than early identification and control of the agent. Since the agent has
not been identified, this complacency is cause for concern.
- H5N1 Not Ruled Out In Mystery Illness That Killed Four
- Recombinomics Commentary
- October 2, 2005
- We know from testing that it's not influenza, we know
that this is not SARS, we know this is not avian influenza," said
infectious disease consultant Dr. Alison McGeer.
- Although the above comments were made at the 5 PM news
conference, later in the same news conference both statements were qualified.
- SARS was excluded because the clinical signs did not
match SARS and there was "no SARS in the world". However, papers
published this week in Science and PNAS described coronaviruses closely
related to SARS CoV in horseshoe bats and those sequences became available
at GenBank this week (bat SARS coronavirus HKU3-1, bat SARS coronavirus
HKU3-2, bat SARS coronavirus HKU3-3 ). In addition, the newly discovered
related coronviruses NL63 and HKU-1 are found in respiratory diseases
- Dr McGeer admitted that there was no data yet on coronavirus
- Similarly, when asked if influenza could be ruled out,
she said no, but she expected to be able to rule out influenza when test
results became available in a few hours.
- Thus, the data available at the time of the statement
above did not rule out a SARS, or SARS-like illness, or an influenza illness,
- Although the test for these viral etiologies may be negative,
the best way to strongly rule them out is to first get negative data for
SARS and H5N1, and the get positive data for another agent.
- Until those two results are in, the viral-like fevers
and rapid spread raise the possibility that the respiratory disease sweeping
through the nursing home in Scarborough, Canada is linked to coronaviruses
or influenza viruses like H5N1.
- Patricia A. Doyle, PhD
- Please visit my "Emerging Diseases" message
- Zhan le Devlesa tai sastimasa
- Go with God and in Good Health