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.
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."
The 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."
Fannin said the cholera cases here are believed to be the first confirmed in Los Angeles County since health records began in about 1915, although a visitor from India may have had incidental exposure to the disease before his arrival here several years ago.
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.
Reports from most counties are not in, but officials in Orange County said at least two people there have shown symptoms of the disease.
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."
Fannin said that patients, conditions permitting, are being questioned about where they had been and what they had eaten and drunk.
Of the first four cases, two boarded the plane in Buenos Aires and two in Lima, she said. "The only thing they had in common was the plane."
Health Services personnel obtained a passenger list for Flight 386 from U.S. Customs officials Wednesday that listed the cities of final destination and, in many cases, street addresses.
"We could have used phone numbers, but the list didn't include that," Fannin said.
Armed with this information, Los Angeles County health officials began their search.
Of those with the symptoms, two were confirmed Wednesday night to have the disease, a woman in Los Angeles County and a man from Los Angeles County who was found to have the disease in San Bernardino County.
Culture samples were being taken from all contacted and Fannin said a more precise estimate of the scale of the infection here should emerge in the next few days.
She said the rate of symptoms--reported by 44% of those contacted in Los Angeles County by noon Thursday--was unusually high, even for people known to have eaten the same food or drunk the same water.
Aerolineas Argentinas officials were not available for comment Thursday, but the airline issued a statement saying it was cooperating with health officials.
"Aerolineas Argentinas has been in the forefront of those who are involved in the prevention of the spread of disease by the traveling public," the statement read. "Once the outbreak of cholera was reported in Peru, we immediately put into effect a series of strict measures to ensure that all food served on our flights is well-cooked and prepared observing the highest standards of cleanliness and care."