Virulent Virus Kills Dozens in Montreal and Calgary

June 4, 2004
The Globe and Mail
 
MONTREAL (CP) -- A virulent infection has killed dozens of people in Montreal and Calgary, it was announced Friday.
 
Local hospital officials in Montreal said that at least three dozen people had died of the virus. The Canadian Medical Association Journal said the toll could be as high as 89, including 10 in Calgary.
 
The infection, Clostridium difficile, is the most common cause of infectious diarrhea in the industrialized world, and research suggests that 20 per cent of people who contract it get it from taking antibiotics.
 
Dr. Francoise Chagnon, director of professional services at the McGill University Health Centre in Montreal, said that she stands by the hospital's decision not to alert the public immediately but feels now that it is time for Canadians to be notified.
 
As hospital officials in Quebec are working with Montreal health officials in tracking the illness, one spokesman said it is too early to sound the alarm.
 
"It's not a new infection," said Dr. John Carsley, head of the infectious disease unit of the Montreal public health department.
 
"I think what we're going to see here in our investigation of this is that there may be particular factors, maybe it's a particular strain or strains of this germ that may be more persistent in the environment or more difficult to treat," he said. "Frankly speaking, as a public health physician, I'm not sure what you would warn the public about or what particular preventive measures you would want to take. Are you just warning them to make them nervous?"
 
Dr. Chagnon said that the centre's five hospitals are reviewing procedures for disinfecting their premises as well as looking at protocols for administering antibiotics to combat further outbreaks.
 
She told a news conference that a few dozen of 780 patients treated for C. difficile in the past year had died.
 
"In the past year, we have approximately 36 deaths here at the MUHC that were attributed primarily to this disease," she said. "It's not a very high figure considering the number of patients who were infected who were treated successfully and considering the mortalities we have from other diseases."
 
Dr. Thomas Louie of the Calgary Regional Health Authority confirmed that Calgary is experiencing an outbreak of the infection.
 
Officials are recording about 10 new cases of C. difficile per month at each of the city's three main hospitals. The normal rate is between three and five new cases a month.
 
"We're seeing an increased trend and we're alarmed," Dr. Louie said.
 
However, he said the latest outbreak is mild compared with one in 2001, in which the 10 patients referred to in the Journal article died.
 
Almost all the patients infected recently have been treated and are responding well, he said.
 
Dr. Chagnon said while the outbreak in Montreal has lasted longer than previous incidents, the situation is not new.
 
"It's not a unique problem to our hospitals," she said. "It is one throughout the city and throughout Canada. Other health insitutions are experiencing this and we deal with the patients that are hospitalized who pose the greatest risk of contacting the disease."
 
News of the deaths followed a report in the CMAJ's July edition on research on how the illness is caused. The article said increased cases of the disease had also been reported in Calgary.
 
The CMAJ study, which was conducted by various researchers, was carried out between Aug. 1, 2002, and April 30, 2003. It also examined data for 2003 and the first few months of 2004.
 
Dr. Sandra Dial, an intensive-care doctor at the Montreal Chest Institute, said her team's hypothesis is that patients taking antibiotics and acid suppressors known as proton pump inhibitors are more susceptible to C. difficile. The inhibitors reduce stomach acids.
 
"I found that if you got these drugs as well as antibiotics, your risk of getting it was even higher," said Dr. Dial, one of the study's main researchers.
 
She said she could not address the mortality rate suggested by the CMAJ article and could speak only to deaths at Montreal's Royal Victoria Hospital where she did her research in a chart review.
 
"For sure there were 17 deaths that I'm absolutely sure were related to the disease and another 13 more that I think are most likely related to the disease," she said.
 
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