Deaths Stir Alarm Over Raw Gulf Oysters

Raw oysters contaminated with a potentially deadly strain of bacteria have recently claimed the lives of four people in Los Angeles, prompting officials to take emergency actions aimed at protecting the Latino communities that have been most severely affected.

State officials said this week they will step up testing of oysters from the Gulf of Mexico, which have been linked to the fatal cases. They also are preparing emergency regulations to require that warnings about the dangers of eating raw oysters be printed in Spanish as well as English.

And at a meeting that begins today, a national regulatory commission will consider a warm-weather ban on sales of raw Gulf oysters, its director said.

Health officials have not been able to determine why victims of the infection locally have been almost exclusively Latino and mostly male. Most had conditions that put them at a high risk for contracting the infection, such as diabetes or liver disease.

Since May 1993, 16 cases of infection by the bacteria--Vibrio vulnificus--have been recorded in Los Angeles County and all involved Latinos. Of the 16 victims, eight died. And in 15 cases, Spanish was the primary language spoken by the victim.

The infection claimed three lives in May and another in June, an unusually high cluster of fatal cases.

Medical Mystery

The cases have sparked a medical mystery that has scientists perplexed because there is no medical data to suggest why Latinos would be more prone to contract the illness. Previous outbreaks of V. vulnificus reported in California and other states have crossed ethnic lines, but speculation on the cluster of Los Angeles cases centers on possible cultural, language and economic factors.

Raw seafood, particularly shellfish, is a familiar part of the diet of many Latino immigrants, who would be more likely to purchase the cheaper Gulf Coast oysters at the restaurants, mariscos stands and food trucks that are found in many communities, health officials say.

And it is customary among some Latino men to gather after work with friends to eat raw oysters and drink beer, say specialists who deal in Latino health matters. Heavy drinking--defined by the U.S. Food and Drug Administration as more than two drinks a day--is one of the factors associated with an increased risk of contracting the infection. Others at particular risk include those with immune disorders such as HIV infection and cancer patients.

Yesenia Mansour, who does outreach in the Latino community for the American Diabetes Assn., said physiological, cultural and economic patterns may play a role in the current outbreak. Latinos have a higher incidence of diabetes than the population at large, she noted. And they would be likely to purchase as inexpensive an oyster as possible.

This week, for example, the Grand Central Market in downtown Los Angeles was selling Gulf oysters in the shell at one dozen for $3, or 25 cents each. At Bristol Farms in South Pasadena, oysters from Canada’s Prince Edward Island were 99 cents each.

“We know it’s very typical for people in this community to go to a truck selling seafood off the back or a low-end restaurant and that is where you eat seafood,” Mansour said. “A higher incidence of diabetes combined with a higher number of people who are likely to be buying [in this way] could yield a higher number of cases.”

The Victims

Health officials were able to trace the source of sickness in the four most recent deaths because of regulations requiring food retailers, whether grocers or restaurateurs, to maintain records of oyster shipments for 90 days. While the names of the victims were not released because of confidentiality requirements, federal health officials provided an outline of the circumstances leading to their deaths.

The first victim, a 38-year-old male diabetic and heavy drinker, was hospitalized two days after eating raw oysters purchased from an Eastside retail outlet. He died three days later of a blood infection. Investigators traced the oysters to a lot harvested in Galveston Bay, Texas, on April 27.

The second victim, a 46-year-old male with alcohol-related liver disease, was hospitalized two days after consuming raw oysters from a Cerritos retail store. He died the next day. Officials traced the oysters to a lot from Galveston Bay on May 4; but it was harvested by fishermen different from the first case.

The third victim, a 51-year-old woman with chronic hepatitis, ate raw oysters bought in Lynwood and served at a party. She was hospitalized two days later with a temperature of 105 degrees and lesions. She died the next day. The oysters served at the party were traced to a lot harvested in Eloi Bay, La., on May 14.

A 47-year-old male with cirrhosis was the fourth victim. In June, he ate raw Gulf oysters from waters off Buras, La., in a South Los Angeles restaurant. He died after an eight-day hospitalization.

The Background

V. vulnificus is a naturally occurring bacteria carried by warm-water shellfish, particularly oysters harvested in Texas, Louisiana, Florida, Mississippi and Alabama. The contaminant is undetectable by smell, taste or odor. Symptoms from infection include fever, nausea and abdominal cramps and in many of the fatal cases, death is swift, coming within 48 hours.

About 20 million Americans eat raw oysters each year, but most do not become ill and the estimate of those at particular risk varies.

However, the state considered the potential harmful effects of V. vulnificus so serious that since 1991 it has mandated warning signs at restaurants and markets where the Gulf oysters are sold.

But compliance with the regulation in Los Angeles County has been lax at best. County health officials earlier this year surveyed 103 restaurants serving Gulf oysters and found only 47 properly displayed the required warning sign.

The California advisory, moreover, did not require posting in any language other than English, and information about the potentially deadly effects of eating raw oysters is apparently not reaching the Latino community.

Dr. Eric Mouzin, a medical epidemiologist with the federal Centers for Disease Control and Prevention who is assigned to the Los Angeles County Department of Health Services, helped to investigate the four recent deaths and speculated that inability to read English-language warning signs has contributed to the cluster of Latino cases.

He added that those grocery stores and restaurants that do display the warning signs often place them where they are not readily seen.

Proposals and Actions

The Interstate Shellfish Sanitation Conference, a regulatory agency that oversees the shellfish industry, meeting today in Colorado Springs, Colo., may move to ban sales of raw Gulf oysters from April to October.

Its director, Ken Moore, said the group is concerned about the Los Angeles cases and was working to reduce the dangers from the V. vulnificus bacteria.

“You will see some changes in the control of V. vulnificus, and our approach to educating the public will change,” Moore said.

Last year, the shellfish conference tabled an FDA proposal to require that all Gulf oysters harvested during warm weather months be shucked, placed in containers and labeled with a warning to cook fully.

FDA officials have threatened to impose such a requirement if they find actions taken at the shellfish conference to be inadequate. In Los Angeles, officials have issued an advisory to doctors who treat those at higher risk to inform their patients about the dangers of V. vulnificus from eating raw oysters and, as part of their rounds, county health inspectors are trying to make sure that restaurants and markets post warning signs. But the county lacks the resources to vigorously police food outlets, and inspections at most restaurants are limited to once or twice a year, said Shirley Fannin, director of disease control programs for the county’s Health Services Department.

“That is all we can do at this point,” said Fannin. “It’s a serious problem, but a specific problem and not one you can handle by a general announcement very effectively, because most people just ignore it if they don’t have liver disease and assume it doesn’t apply to them.”

Fannin also said the nature of the bacteria--it can only be detected by laboratory analysis-- works against total protection from the infection.

“It’s hard to know whether anything will be effective,” she said. “We can try to do our best to make sure these things don’t get sold but it’s [impossible] with this organism to tell which ones are or are not contaminated--it would be like trying to test every hamburger.”

The state’s proposed regulations to mandate Spanish-language warnings would be adopted on an emergency basis, which would allow them to become effective immediately. Ordinarily, administrative regulations must go through a time-consuming procedure that can take months to complete.

Stuart Richardson, chief of food and drug regulation for the California Department of Health Services, said the proposed measures stemmed from the four recent deaths of Latinos in Los Angeles.

Federal data put the risk of illness from eating raw clams, oysters or mussels at one case per every 1,000 servings, or far in excess of any other commodity. The risk of illness from all seafood, including molluskan shellfish, is one case per every 250,000 servings. For chicken, the risk is one case of illness per every 25,000 servings.

Merchants can circumvent the state’s Gulf oyster warning if they sell shellfish harvested from the Atlantic or Pacific coasts.

A Controversy

The safety of Gulf Coast raw oysters has been a matter of controversy for years. California is one of only three states that require warnings aimed at high-risk individuals.

“[The L.A. County cases] clearly show the limitations of any warning program to alert consumers to the dangers of raw shellfish,” said Caroline Smith DeWaal, food safety director of the Center for Science in the Public Interest, a Washington-based advocacy group. “A warning, of any degree, does not replace the need for a really safe product. . . . The Gulf Coast industry continues to produce deadly oysters that are shipped all over the country.”

Gulf oyster producers defended their industry, which generates about $200 million in revenue nationally each year.

“As far as the Louisiana seafood industry is concerned, we have complied with all the government rules and regulations,” said Karl D. Turner, executive director of the Louisiana Seafood Promotion and Marketing Board in New Orleans.

“We are saddened by any one fatality that has resulted from this,” Turner said. “But, again, we find it interesting that those four cases [in Los Angeles County] all fit the profile of the high-risk individuals. And we have said all along that certain people should cook oysters before consuming them.”

The deadliness of the infection prompted Kenneth Kizer, the former director of the California Department of Health Services, who enacted the state’s warning precaution, to portray consumption of Gulf Coast oysters as “gastronomic roulette.” The fatality rate for V. vulnificus far exceeds those of other leading food-borne illnesses. In 1994, the last year for which complete data was available, there were 2,094 cases of salmonella in Los Angeles County. Of those, 22, or 1.1%, were fatalities.

Kizer said V. vulnificus has emerged as the leading cause of deaths resulting from food-borne illness in some areas of the country. From 1981 to 1992, 72 cases of the infection from eating raw oysters were reported in Florida and 36 (50%) of these people died, according to the California Health and Welfare Agency.

In California, from 1983 through July 1993, 24 cases of V. vulnificus were reported to authorities with 18 deaths (75%) recorded, according to the state, and in all cases where their source could be determined the oysters were from the Gulf Coast.

“Most food-borne illnesses only make you sick, even though you may feel like you want to die,” said Kizer, who is now undersecretary for health in the Department of Veterans Affairs. “This is one of the relatively few types of food-borne illness that is fatal.”

Times staff writers Terence Monmaney in Los Angeles and Carl Ingram in Sacramento contributed to this story.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Oyster Danger

The U.S. Food and Drug Administration has issued health warnings about the dangers of eating raw or inadequately cooked oysters. To prevent illness, oysters shold always be fully cooked, health officials say. For detailed cooking and handling instructions in English or Spanish, or to obtain a pamphlet on the topic, call the FDA Seafood Hotline at (800) 332-4010.

Those at risk of illness or death from eating raw oysters:

* People with liver disease, either as a result of excessive alcohol intake, viral hepatitis or other causes

* Cancer patients

* Individuals with immune disorders, including HIV infection

* Diabetics

* Those with persistent stomach ailments including previous stomach surgery or low-stomach acid from prolonged antacid use

* Long-term steroid users, such as for asthma or arthritis

* The elderly, and those with the iron disorder hemochromatosis

Source: FDA; full text available on the Internet at https: //vm.cfsan.fda.gov/~lrd/oyster.html

Cuidado con los Ostiones

La Administracion de Drogas y Alimentos (FDA) del gobierno federal ha emitido advertencias sobre el riesgo de comer ostiones crudos o mal cocidos. Los ostiones deben star siempre bien cocidos para evitar enfermedades, segun informaron funcionarios de salud. Para obtener instrucciones precisas para manajarlos y cocinarlos, o para recibir un panfleto, sirvase llamar a la Linea de Informacion Especial Gratuita de Pescados y Mariscos de la FDA al (800) 332-4010.

Las personas que corren riesgo de enfermarse o hasta de morir por comer ostines crudos son:

* Quienes tienen enfermedades del higado por tomar bebidas alcoholicas en exceso, por padacer de hepatitis viral o por otras causas

* Quienes padecen de cancer

* Personas con problemas del sistema immunologica, incluyendo VIH.

* Los diabeticos

* Quienes padacen del malestar estomacal cronico, que han sido operados del estomago, o que tienen niveles muy bajos de acido estomacal debido al uso prolongado de antiacidos

* Quienes llevan mucho tiempo tomando esteroides, como los que padacen de asma o artritis

* Las personas mayores y aquellos que padacen de hemocromatosis, un mal relacionado al nivel de hierro en el sistema