Question

The 2 patients, still in the hospital, were interviewed by a MoH epidemiologist. The interviews revealed that both patients were drivers for the same bus company and drove the same route and shift. The patients knew each other but worked on different days of the week.

The MoH contacted all employees of the bus company the patients worked for to identify others with similar symptoms suggestive of botulism. Hospitals in the area of Montevideo, where the cases occurred, were asked to report any patients with acute neurologic illnesses that could be associated with botulism. Family members and friends of cases were questioned about whether they also had symptoms of botulism. Additionally, the MoH developed a press release for distribution to the local news media.

Based on the results of the case finding efforts, n=7 additional patients with neurologic signs consistent with botulism were identified. Of these 7 additional cases, n=5 of the patients had sought medical attention and of these 5 patients, 4 were hospitalized. Botulinum toxin was identified in sera and/or stool from three patients, including one of the original cases reported on January 13. All patients were drivers from the same bus company as the original cases and drove the same route. From initial reports, all had eaten at a home located at the last stop of the bus route where the drivers ended their shift. Approximately 58 bus drivers worked this route; 27 in the morning shift, 16 in the late-afternoon shift, and 15 in the evening shift.

Given the information available at this point,

A. Would you initiate any control measures at this time?

Answer 1

INTRODUCTION :- The 2 patient,while in hospital were being interviewed by MoH epidemiologist. Both patient knew each other as they work as driver in the same company of bus,just their schedule of driving differs.Further MoH contacted other employees of the company in order to ensure if there is any such more case of botulism prevailed,and surprisingly 7 more cases were found,and out of which 5 were under medical treatment.Botulism toxin was found either in sera or stool of patient,including the one original case which was reported on January 13.It was noted that all the patient belongs to similar company,and even follows similar route,and had eaten the food at their similar last stop.Approximately 58 bus drivers,works in this route,27 in morning shift,16 in late afternoon,and 15 in evening shift.

WOULD YOU INITIATE ANY CONTROL MEASURES AT THIS TIME?

Since all the patients being diagnosed with Botulism toxins followed the similar route,and ate food at similar last stop,which thereby leads to their illness,so it is required some control measures to be take there so that,the toxins or illness may not spread even more to other,or again to those who have been already affected.These control measures can be taken according to the time of their shift,to get more effective result.Some of these measures are as follows :-

• As the time or shift has already been scheduled of all the bus drivers,that is the time they reach at that place,it is required that the stall where they eat food makes sure,that they would provide them with more fresh food,rather than the one which is not hygienic and are being preserved for long time.Further the owner of stall should take their work more responsibly,as their negligence could lead to illness of others.
• One more control measure that i would like to initiate is that to make sure food being served to people should be cooked properly,and along with that before providing it to drivers,it should be heated all over again.
• In case if the food being provided is in the form of can,and somehow there is any sort of leak in it,that is the can is already quite open,discard the food,as it should never be consumed.

So,following these control measure the cases of Botulism will not take place again.