Unwanted reruns
The holiday season was marked by a rise in respiratory infections making the headlines lately, including a diarrhea outbreak. In a recent communication with a good friend and infectious disease colleague in Baguio, she relayed that water analysis from some of the major water supply resources have so far tested negative for coliforms, cases have decreased, and they hope to be able to identify the underlying cause in the week to come.
Reviewing the event-based disease surveillance report of the Epidemiology Bureau of the Department of Health for the first two quarters of last year, food and waterborne diseases (FWBD) were topmost among the notifiable health events. As a brief review, these organisms are generally acquired when an individual ingests contaminated food or water. Causative agents may be viral, bacterial, or parasitic in origin and are described as referring to a “limited group of illnesses characterized by diarrhea, nausea, vomiting with or without fever, abdominal pain, headache and or body malaise.” Included in the list classified under FWBD are the following: acute bloody diarrhea, acute viral hepatitis, hepatitis A, cholera, rotavirus, and typhoid fever.
Some strains of E coli, Shigella, salmonella, and Campylobacter may cause acute bloody diarrhea and affect both pediatric and adult populations. In general, if diagnostics are available, knowledge of the causative agent and immune status of the patient is of valuable assistance in deciding whether antimicrobial treatment is necessary, if further workup is needed, and helps reinforce needed isolation and control measures. As an example, individuals infected with hepatitis A are already highly infectious a week or two before they manifest jaundice.
If one were to be asked as to why all these persist despite all the administrative orders, policies, and programs that have been in place, just think about the number of communities or households that still do not have access to safe and clean water or toilet facilities which sadly promotes open defecation. If you ever had the opportunity to visit, or have been fortunate enough to serve impoverished communities, or just happen to find yourselves in remote, far-flung rural areas, then you would understand why the resulting living conditions fuel the vicious cycle of infection and malnutrition.
So how can we help? First, we need to observe and practice good personal hygiene. If we went into an almost obsessive-compulsive mode during the pandemic, now is not the time to be less so. Wash hands with soap and water when available, especially if visibly soiled. As a friendly reminder, pets may also carry some organisms in their feces so don’t forget to sanitize. When dining outside your home, ensure that the meals partaken are well cooked and be wary of taking home and consuming leftovers that easily spoil. if you want to have a cold drink, skip the ice and stick to bottled beverages if you are unsure of the safety of their water supply.
First aid measures: It would be safe to say that no one goes through one’s lifetime without having experienced diarrhea, as no one lives in a bubble or is exempt, no matter how scrupulous one is about cleanliness. The most important thing to do is to address and manage the dehydration that inevitably follows as a result of excessive losses of fluid and electrolytes from vomiting, frequent stooling, or loss of appetite. If one were to ask what would be the things that should be readily available in the medicine cabinet, oral rehydration preparations would always come in handy. Avoid intake of sports or highly concentrated juices as these are not enough to replace needed losses and may, at times, worsen the condition. Do not restrict your consumption of food save for avoiding those with high-fat content. In children, do not resort to confining them to a BRAT diet, which stands for bread, rice, applesauce, and toast, as it may provide an insufficient amount of essential calories. Offer small but frequent meals. Avoid resorting to the use of anti-motility, anti-emetics, and antimicrobials. Such a decision is best left to your physician.
In keeping with the resolution to stay upbeat as it is the New Year, let’s focus on the positive outcome of the recent outbreak. First, the importance of surveillance was reinforced and the quick action starting with a public declaration led to the employment of measures to help resolve the problem. Second, the general public was reminded of the continuous need to reinforce hygienic practices and the importance of preventive measures. Some of these food and waterborne diseases may also be vaccine-preventable, so please take time to review your list. While we realistically do not aim to have zero cases, we can always help control the situation by preventing future outbreaks.
