Date: Thu 14 Sep 2017
Source: El Salvador [in Spanish, machine trans. edited]
<http://www.elsalvador.com/noticias/nacional/397163/isss-confirma-muertes-por-infeccion-tras-ingerir-mariscos-crudos/>

A report from the Salvadoran Institute of Social Security (ISSS) confirms the deaths of 2 people from an infection caused by the bacterium _Vibrio vulnificus_, caused by eating raw seafood, particularly oysters or by exposing a [wound to] saltwater.

According to the document, which circulated in social networks, and was confirmed by the ISSS, those most vulnerable to the disease are people with liver diseases such as cirrhosis, or those who have a weak immune system because of chronic diseases, or the consumption of medicines that weaken it. The characteristic symptoms of the disease are fever, chills, nausea, vomiting, diarrhea, in addition to the presence of hemorrhagic blisters in the lower limbs of the body.

According to the document, on 8 Aug 2017, they treated a 61-year-old man in the emergency who had fever, diarrhea, red skin on his lower limbs, and, as part of his clinical condition, had liver cirrhosis. The patient died. Two days prior to the appointment, the patient consumed a cocktail of shells with shrimp and crab in a restaurant in Santa Tecla.

The other case was that of a 58-year-old woman, who was treated on 2 Sep 2017 and had 2 days of symptoms. The patient died within a few hours of admission and also had liver cirrhosis. The ISSS, in the same document, explained that it has not reported any more cases of the disease.

The ISSS information on the 2 deaths caused by the bacterium _Vibrio vulnificus_ has caused alarm among the population, but infectious diseases physicians affirmed that the country is not facing an epidemic or recommending a stoppage in consuming seafood because there are not a lot of cases. Dr. Jorge Panameno, after asking the population to keep calm, said that it is not a new bacterial agent but one that is already widely known in the country and has occasionally caused deaths here. He said that the bacterium, which is usually present in sea water, is only serious in people who have a weakened immune system because of chronic diseases such as cirrhosis, diabetes, insufficiency in kidney function disease, patients with heart problems, or with HIV.

"Two things are important to consider in relation to the Social Security document: 1st it was 2 people who have 2 characteristics in common, that both consumed uncooked shellfish (which had the bacterium); and 2nd, perhaps more relevant, is that they were 2 patients suffering from liver cirrhosis, or a debilitating chronic disease, which is where it has been known for a long time that is going to cause the worst damage, "he said. The specialist said that, in fact, the cases of people affected by infection because of this bacterium are seen sporadically in private practice, one or 2 a year.
 
He also explained that when a person ingests the bacterium, it usually presents with fevers, chills, diarrhea, nausea, and when they acquire it through a skin lesion, it starts to redden and blister. "I have had a few cases over the years, the last one I had was a patient who pricked himself with the shell of a crab ... It gave him (the disease), and he survived."
One of the doctors said, while emphasizing that this infection is considered a professional disease in fishermen: "The bacterium is present, particularly in climates like ours; it will be part of the flora that is in the water of the sea and of the rivers," he said.  [Byline: Violeta Rivas, Susana Joma]
======================
[_Vibrio vulnificus_ infections are not frequently reported from Central or South America but do occur there. The following is extracted from Heng S-P Letchumanan V, Deng C-Y: Vibrio vulnificus: An Environmental and Clinical Burden. Front Microbiol. 2017; 8: 997 doi: 10.3389/fmicb.2017.00997:

"_V. vulnificus infections have been reported in diverse climate zones throughout the world including Denmark, Sweden, Germany, Spain, Turkey, Holland, Belgium, Israel, Italy, Korea, Japan, Taiwan, India, Thailand, Australia, and Brazil (Oliver et al., 1983; Dalsgaard et al., 1996; Bisharat et al., 1999; Torres et al., 2002; Oliver, 2006a,b, 2013; Patridge et al., 2009; Huehn et al., 2014; Karunasagar, 2014). This bacterium is commonly found in seafood samples with studies having reported that 3.5-8 percent of seafood samples in Europe, 2.4 percent of shrimp from Southeast Asia, 75 percent of freshly harvested oysters in India and 100 percent of oysters harvested from the Gulf of Mexico during warm months (May to October) contained _V. vulnificus_. (Jones, 2014). Further, analysis of 180 cases in FDA records between 2002 and 2007 have shown that raw oysters is the main source of infection in the USA with 92.8 percent of infected patients having consumed raw oysters. Studies have shown that there are 95 cases reported with 85 hospitalizations and 35 deaths per year globally (CDC, 2013)."

There are 2 points to be emphasized: that vibrios are normal flora in warm saltwater (not indicative of any sewage contamination) and that most of the life-threatening illnesses occur in individuals with underlying medical illnesses, including immunocompromised states, chronic liver disease, and diabetes. So-called normal individuals often just get gastroenteritis.

It is not clear that the woman in this post had any well-defined risk factors. The range of disease due to _V. vulnificus_ can involve more northern geographical areas if the area is affected by a substantial heat wave. - ProMed Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/21>.]
Date: Fri, 12 May 2017 13:53:24 +0200

San Salvador, May 12, 2017 (AFP) - A magnitude 6.2 earthquake struck Friday in the Pacific off the coast of Central America, the US Geological Survey said.   The earthquake occurred at 1041 GMT some 50 miles (79 kilometres) south-southwest of Acajutla, El Salvador at a depth of six miles, according to USGS.   Relief agencies said the tremor was felt by the population in most of El Salvador and only caused alarm among some people who left their homes.   But there were no immediate reports of injuries or damage.   An aftershock of magnitude 5.4 struck about 10 minutes later, USGS said.
Date: Tue, 11 Apr 2017 03:27:20 +0200

San Salvador, April 11, 2017 (AFP) - A 5.1-magnitude earthquake killed at least one person and injured two others in El Salvador on Monday, officials said.   The quake struck four kilometres (2.5 miles) below the surface at 2352 GM in the town of Antiguo Cuscatlan near the capital, the environment ministry said on Twitter.

The National Civil Police said a person was killed when a rock fell on their vehicle on a highway west of the capital San Salvador.   The Red Cross said separately that two people were taken to hospital after being injured in the same area.   Civil Protection chief Jorge Melendez said some people had been evacuated from their homes due to rockslides.   "As we have had a 5.1-strength earthquake at a fairly shallow level of four kilometres we have decided to raise the level of alert to orange, meaning search and rescue operations," he said on the radio.

National radio said the quake caused traffic jams and power failures in some places. Ambulance sirens wailed around the capital as emergency services came out to assess the quake damage.   It was the strongest quake felt so far after a series of more than 100 tremors that have been felt since Sunday.

In November a 7.0 magnitude offshore quake shook El Salvador and Nicaragua but no damage or casualties were reported.   In November 2015 a 5.4-magnitude earthquake struck off the coast of El Salvador without causing any victims.   In October 2014, a powerful 7.3-magnitude quake struck off the Central American country's coast, killing one person and wrecking homes.
Date: Thu, 24 Nov 2016 20:57:38 +0100

San Salvador, Nov 24, 2016 (AFP) - A Pacific Ocean earthquake with a 7.0 magnitude shook El Salvador and Nicaragua on Thursday, officials said, an hour after a powerful hurricane hit Nicaragua's Caribbean coast.

Tsunami alerts were issued as a precaution by the authorities in Nicaragua and El Salvador, where residents were told to evacuate from the Pacific coast.   The 7.0-magnitude temblor occurred around 120 kilometres (75 miles) off the coast of El Salvador, at a depth of 10.3 kilometres (6 miles), according to the US Geological Survey.   The USGS had initially reported the quake's magnitude as 7.2, and its depth as 33 kilometres. 

Shaking was also felt in the Nicaraguan capital of Managua and as far as the Costa Rican capital San Jose.   There were no immediate reports of damage or casualties.   Just one hour earlier, a powerful hurricane, Otto, packing winds of 175 kilometers (110 miles) per hour made landfall on Nicaragua's other coast.   The heavy rains it was offloading were likely to cause dangerous flooding and mud slides, according to the US National Hurricane Center.
Date: Wed, 15 Jun 2016 03:37:11 +0200

San Salvador, June 15, 2016 (AFP) - El Salvador on Tuesday confirmed its first case of microcephaly in a baby that was linked to a Zika infection in the mother.   Microcephaly is a birth defect that causes an abnormally small head and deformed brain.   Health Minister Violeta Menjivar said the infant was born in April to a family living in the country's central La Paz province, and the Zika connection was proved "a short while ago."

Zika, a virus typically carried by mosquitos, was first detected in the Central American country in November and 10,476 cases of infection have been recorded.   Among them, the health ministry counted 274 pregnant women suspected to have been infected with Zika. Of those, 118 gave birth to babies without microcephaly.   Menjivar noted that cases of babies with microcephaly believed caused by Zika have also occurred in countries including Brazil, Colombia, Martinique, Panama, Puerto Rico and the United States.   Abortion is illegal in El Salvador, a predominantly Christian country.
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