RESUMO
CONTEXT: Botulism is an important public health problem in Argentina, but obtaining antitoxin rapidly has been difficult because global supplies are limited. In January 1998, a botulism outbreak occurred in Buenos Aires. OBJECTIVES: To determine the source of the outbreak, improve botulism surveillance, and establish an antitoxin supply and release system in Argentina. DESIGN, SETTING, AND PARTICIPANTS: Cohort study in January 1998 of 21 drivers of a specific bus route in urban Buenos Aires. MAIN OUTCOME MEASURE: Occurrence of botulism and implication of a particular food as the vehicle causing this outbreak. RESULTS: Nine (43%) of 21 bus drivers developed botulism, presenting with gastroenteritis, symptoms of acute cranial nerve dysfunction including ptosis, dysphagia, blurred vision, and motor weakness. One driver experienced respiratory failure. Type A toxin was detected from 3 of 9 patients' serum samples. All drivers received botulism antitoxin; there were no fatalities. Consumption of matambre (Argentine meat roll) was significantly associated with illness. Among 11 persons who ate matambre, 9 developed illness, compared with none of those who did not eat it (P<.001). The matambre had been cooked in water at 78 degrees C to 80 degrees C for 4 hours, sealed in heat-shrinked plastic wrap, and stored in refrigerators that did not cool adequately. Subsequently, a botulism surveillance and antitoxin release system was established. CONCLUSIONS: Insufficient cooking time and temperatures, storage in heat-shrinked plastic wrap, and inadequate refrigeration likely contributed to Clostridium botulinum spore survival, germination, and toxin production. A rapid-response botulism surveillance and antitoxin release system in Argentina should provide more timely distribution of antitoxin to patients and may serve as a model for other nations.
Assuntos
Antitoxina Botulínica , Botulismo/epidemiologia , Clostridium botulinum/isolamento & purificação , Controle de Doenças Transmissíveis/organização & administração , Surtos de Doenças , Carne/microbiologia , Adulto , Argentina/epidemiologia , Antitoxina Botulínica/uso terapêutico , Botulismo/tratamento farmacológico , Botulismo/prevenção & controle , Estudos de Coortes , Contaminação de Alimentos , Manipulação de Alimentos , Humanos , Masculino , Preparações Farmacêuticas/provisão & distribuiçãoRESUMO
We analyzed causes of death before and after the March 1985 earthquake in Valparaíso, Chile. Causes of death were obtained from death certificates. Apart from death directly due to trauma during the earthquake, a significant increase was observed in deaths due to accidents (+51), cardiovascular disease (+38), malnutrition (+13) and psychiatric disorders (+13). Retired males over age 65 were most affected.