Botulism: Ontario
The Ontario Ministry of Health and Long-Term Care sent a health notice to all health care professionals informing them of two confirmed cases of botulism in Toronto. Both patients are seriously ill with paralysis. Carrot juice found in the patients' homes tested positive for botulinum toxin. There has been a product recall of Bolthouse Farms 100% Carrot Juice, Earthbound Farm Organic Carrot Juice and President's Choice Organics 100% Pure Carrot Juice with best before date of 11 November 2006. Some of the products still may be found in both retail settings and in individual homes. Public health units are taking steps to ensure the product is not offered for sale and the public is being advised through the media to not drink the product. In the USA four cases of botulism poisoning have also been reported.
Source: Health Notice, Ontario Ministry of Health and Long-Term Care, 8 October 2006, Canadian Food Inspection Agency, 7 October 2006

Outbreaks of Multidrug-Resistant Shigella sonnei Gastroenteritis Associated with Day Care Centers, 2005: Kansas, Kentucky and Missouri
In 2005, Kansas, Kentucky, and Missouri reported increases in shigellosis cases associated with day care centers caused predominantly by multidrug-resistant (MDR) (i.e., resistant to ampicillin and trimethoprim-sulfamethoxazole [TMP/SMX]) strains of S. sonnei. Pulsed-field gel electrophoresis (PFGE) patterns for isolates from Kansas and Missouri were similar, suggesting a common outbreak in the Kansas City area, whereas isolates from Kentucky had a different pattern. During 1 May to 31 December 2005, a total of 201 confirmed S. sonnei infections (median age was 7 years, range 1-70 years) were reported among residents of Kansas City Metropolitan Area (Kansas) and a total of 645 confirmed and 85 probable shigellosis cases (median age was 6 years, range 0-67 years) in the Kansas City Metropolitan Area (Missouri). During 1 May to 31 August 2005, a total of 148 confirmed cases of S. sonnei infection (median age was 4 years, range 0-61 years) were reported in Fayette County in Kentucky. This report describes the investigation of two outbreaks of MDR shigellosis associated with day care centers and reviews measures for prevention and control of S. sonnei infection in these settings. Given the current rates of resistance to antibiotics available to treat children with shigellosis safely, public health measures initiated during shigellosis outbreaks should focus on promoting appropriate handwashing and diapering practices in day care centers. Shigellosis is a reportable disease in all three states.
Source: Morbidity and Mortality Weekly Report, Volume 55, No. 39, 6 October 2006

Hepatitis A: Bulgaria
Since the beginning of 2006, 4793 viral hepatitis cases have been reported in Bulgaria (1498 cases more than the same period in 2005, when a total of 3295 cases occurred). The increase of viral hepatitis incidence in 2006 is related mainly to two hepatitis A outbreaks in the regions of Sofia and Plovdiv. The first outbreak occurred in Svoge municipality (Sofia region) in July-August 2006, and was probably associated with contamination of the drinking water supply. The incidence in the area has now returned to pre-outbreak levels. The second outbreak began at the end of June 2006 in Plovdiv, a city in southern central Bulgaria. Since the beginning of the year, 1727 cases of acute jaundice due to hepatitis A virus have been reported in the Plovdiv region, including 1393 cases notified between 23 June and 26 September 2006. This compares with 179 cases reported during the same period in 2005. Sanitation and hygiene conditions in the Plovdiv area are poor, and include illegal dung hills, a substandard sewage system, and an irregular water supply. In response to the outbreak, the Bulgarian government is releasing emergency funds to help improve sanitation and food safety. The Bulgarian Ministry of Health, in collaboration with Roma non-governmental organisations, launched an immunisation campaign against hepatitis A in Plovdiv on 13 September 2006. The immunisation campaign is targeting all children 2 to 18 years of age, living in Stolipinovo neighbourhoods.
Source: Eurosurveillance Weekly, Volume 11, Issue 10, 5 October 2006

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.