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1] Date: 1 Oct 2005 From: ProMED-mail Source: The Globe and Mail [edited] _____________________________________________________________ Unidentified illness kills 4 Toronto seniors -------------------------------------------- Public health officials are investigating the deaths of 4 people from a "typical respiratory illness" at an east-end senior's residence, but say the outbreak is not SARS. --------------------------------- The 4 victims were residents at the Seven Oaks Home for the Aged in the city's east end, said Dr. Barbara Yaffe, Toronto Public Health's director of communicable disease control. --------------------------------- "We know from the testing that's been done so far that this is not influenza; we know this is not SARS; we know this is not avian influenza," said Dr. Allison McGeer, infectious disease consultant at Toronto's Mount Sinai Hospital. -------------------------------- "There are many other viruses it could be ... and the Ontario Public Health lab is working very hard on identifying which one of those viruses it might be." ---------------------------------- The unidentified illness has affected 68 residents and 5 employees at the facility. 3 of the victims died at the home while the 4th died in the hospital, she said. Dr. Yaffe said all of the 4 victims had severe pre-existing medical conditions. 2 were in their 90s, another in the late 70s, and the 4th in the 50s. ----------------------------------- She said outbreaks are typical, but this one set off alarms because of its severity. "We get hundreds of outbreaks every year, however in this situation we do have a particularly serious outbreak," Dr. Yaffe said. ---------------------------------- She said 15 people have been admitted to hospitals in the area, but are not being quarantined. "There is no quarantine necessary for this," Dr. Yaffe said, and emphasized that there was no threat to the greater public. ---------------------------------- The speed with which the illness spread led Dr. McGeer to speculate whether a presence of bacteria within the home contributed to the outbreak. --------------------------------- Dr. Yaffe also added that while this outbreak was serious, it was not the worst in recent memory. Last year [2004], 11 people died after an outbreak at a Cobourg, Ontario nursing home, she said. ---------------------------------- CFTO News reported that the 1st signs of the most recent illness were detected Tuesday [27 Sep 2005], but no residents were taken to the hospital until Saturday night [1 Oct 2005]. Dozens of family members were prevented from entering the home Saturday. ---------------------------------- Emergency room staff at Centenary Hospital donned gowns and masks Saturday [1 Oct 2005] as a procedural precaution, a standard practice in Ontario hospitals after the SARS outbreak in 2003. ---------------------------------- "Either people haven't been following precautions that we are supposed to follow now for all people with fever or respiratory illness ... or alternatively, somebody had brought it in from the community to the nursing home, and they weren't really that sick from it," infectious disease specialist Dr. Neil Rau told CTV News. ---------------------------------- Symptoms of the illness include fever, cough, runny nose, and malaise, Dr. McGeer said. ----------------------------------- She said the best way for the public to prevent such outbreaks from occurring is to wash their hands thoroughly and frequently. --------------------------------- -- ProMED-mail ______________________________________________________________ ****** [2] Date: 2 Oct 2005 From: Allison McGeer [ProMED-mail contacted Dr. Allison McGeer about this outbreak and received the following information:] -------------------------------- We have a significantly larger than usual outbreak (71 of 249 residents, and 6 of 290 staff, plus 2 visitors) in a long term care facility for the elderly that is relatively severe (4 deaths in residents, and one older staff member in the hospital with pneumonia). --------------------------------- [The epidemic] is rapidly progressive; ([the] 1st case [had onset on] 25 Sep [2005], what appears to be peak [in the epidemic] with more than 20 cases on 29 [Sep 2005], and only 7 cases with onset on 1 Oct [2005]). In addition, a few residents who initially appeared to have minor illness then deteriorated rapidly. ---------------------------------- All laboratory tests have been negative to date (EIA [enzyme immunoassay], DFA [direct fluorescent antibody] and PCR [polymerase chain reaction] for respiratory viruses all negative, including influenza A H3N2, A H1N1, A H5N1, influenza B, RSV [respiratory syncytial virus], Adenovirus, parainfluenza viruses 1-4, SARSCoV [SARS coronavirus]; several urines were negative for legionella, [there were] no positive bacterial cultures of blood or sputum). ------------------------------------ So it is certainly different than usual, but it does not appear to be out of range for a respiratory viral outbreak in a large long term care facility. A number of other smaller outbreaks have been recently reported in long term care facilities across the province, as is typical for this time of year; no positive viral tests have yet been obtained, suggesting the circulation of a virus that is relatively difficult to culture. ---------------------------------------------- -- Dr. Allison McGeer _____________________________________________________________ [ProMED-mail would like to thank Dr. Allison McGeer for sending us more information on this outbreak. One can speculate on the variety of respiratory viruses that may be responsible for this outbreak, most of which have already been ruled out according to the testing profiles presented above. One wonders whether there might be involvement of the human metapneumovirus or another member of the coronavirus family (other than the SARS CoV) that might be circulating and not as yet part of the routine test panels. More information as it becomes available would be appreciated. --------------------------------- Information from other geographical areas that might be experiencing similar patterns would also be appreciated, as it might help "point a finger" at the etiology of this outbreak. - Mod.MPP] ..............................mpp/msp/jw *######################################################