The number of passengers from an Aerolineas Argentinas flight showing symptoms of cholera grew to 25 on Thursday as health officials worked furiously to locate other passengers in order to limit repercussions of the disease.
Nearly half of the 52 passengers contacted in Los Angeles County have shown symptoms of the disease in the outbreak, which is known to have killed one and infected five others, health officials said.
Two passengers from the flight who continued on to San Diego also have symptoms of the disease, said Dr. Michele Ginsberg, chief of epidemiology with the San Diego County health department.
There were 336 people aboard last Friday's Flight 386, which landed at Los Angeles International Airport from Buenos Aires and Lima, Peru. The high incidence of symptoms in those contacted could mean that greater numbers have been afflicted with the disease, health officials fear. They said the outbreak here poses little threat to the public, but people living with those who have the disease are at risk.
"We have to presume that something on this plane--food or water--caused this exposure," said Dr. Shirley Fannin, director of disease control for the Los Angeles County Department of Health Services. "We have to find out what went wrong."
Seven of the passengers from last Friday's Flight 386 traveled on to San Diego, where health officials had tracked down three by Thursday evening, Ginsberg said. Of the three--all of whom are county residents--only one has no symptoms.
The other two, who traveled together, are not food handlers or individuals whose occupations would help spread the disease, Ginsberg said. These two had the symptoms before they boarded the plane, she said.
It is not yet known whether these individuals are actually infected with cholera or are suffering another illness. The symptoms of cholera include diarrhea, vomiting, cramps and dehydration--symptoms that are common to other diseases as well.
Not everyone infected with cholera will have symptoms, so everyone from the flight will be tested. It takes 48 hours to get results from the tests.
"Symptoms appear within hours or as long as five days after exposure," said Dr. Donald Ramras, county health officer in San Diego, "but the majority of people do not have symptoms so persons may not know they have been exposed. It is important for everyone, whether or not they have symptoms, to be tested since they may pass the illness on to others."
In San Diego, health officials have been unable to find four of the seven passengers. With only sketchy information about the passengers' intended destination, health officials realize these passengers might be tourists or might have already left San Diego. But the manhunt for the other four passengers will continue for at least several days.
"It's unlikely that we'd have a big problem here but we have got these seven people who are potentially in San Diego County with a disease that can kill very rapidly," Ramras said. "The risk is very, very minimal, but with a disease where some people can be dead within a day, we think it's worthwhile to get everybody in."
As a cholera epidemic leapfrogged across the Americas, San Diego health officials established an early detection system last fall, believing that the border area might be among the first stricken. Health officials test the sewage every day and will be particularly vigilant in looking for signs of the spread of the disease.
As ruptured sewage pipes continue to spew 180 gallons a day into the ocean along the San Diego coast, health officials realize they may face additional questions about whether the potential threat of cholera increases existing health concerns about the polluted area.
But it is unlikely that anyone would contract cholera from exposure to the sewage--even if there are carriers in San Diego, Ginsberg said. For other health reasons, however, Ginsberg cautions swimmers, divers and surfers to avoid the contaminated waters.
"The reality is that with the dilution, swimmers or surfers are highly unlikely to be exposed to an amount that would infect them," Ginsberg said.
Cholera infection--which normally is spread through food and water contaminated with human waste--has killed almost 3,000 in Peru since an epidemic began there a year ago.
Fannin stressed that cholera can be treated effectively if diagnosed quickly. But if left untreated, "the time from onset of symptoms to demise can be only a few hours," she said. "It's hardest on those who are most fragile--young children, the elderly and those with chronic illnesses."
The only fatality confirmed among the passengers is 70-year-old Anibal Cufre, who was admitted to Arcadia Methodist Hospital on Sunday and died Tuesday.
Fannin said that, since the outbreak among Flight 386 passengers was confirmed Wednesday, health officials here and overseas have been working to find those who are infected and rush them to treatment.
Customs documents show that 320 of the 366 aboard the plane disembarked at Los Angeles International Airport. Of the 320, 211 listed final destinations in Los Angeles County.
By midday Thursday, health officials in Los Angeles County were able to contact 52 of the 211. Twenty-three of those contacted reported the gastrointestinal problems that can indicate onset of the disease, Fannin said.
Another 40 from the flight are believed to be scattered about the state--15 in Orange County, seven in San Diego County, three in Ventura County, three in San Francisco, two each in Monterey, San Mateo, Contra Costa and Santa Clara counties, and one each in Santa Barbara, Riverside, Kern and Kings counties.
Officials in Orange County said at least two people there have shown symptoms of the disease, but reports from most of the other counties are not in.
The national Centers for Disease Control in Atlanta is attempting to track down seven more people in Nevada and two in Arizona, said Pete Wizer, spokesman for the state Department of Health Services in Sacramento. He said there may be a few passengers scattered throughout the United States.
Wizer said that among those who continued to other destinations, 37 are believed to have ended up in Japan and two in Canada. He said health officials in both countries have been notified through the World Health Organization.
Because of the growing epidemic in South America, which has infected an estimated 390,000 people during the last few years, health officials here have asked local hospitals to report any suspected cases of cholera, Fannin said.
"Last Sunday night, we got a call from Queen of Angels (Hospital)," she said. "They said they had a suspected case, a woman."
Fannin said a culture sample was taken from the woman and sent to the Health Services Department laboratory for analysis. Reports of three more victims in Los Angeles County--two women and the 70-year-old man--came in this week and three more samples were sent to the laboratory.
"On Wednesday, we got confirmation from the laboratory," she said. "Cholera."
Aerolineas Argentinas officials were not available for comment Thursday, but the airline issued a statement saying it was cooperating with health officials.