Health officials intensified their search for more cholera victims Friday as the number of passengers and crew members from an Aerolineas Argentinas flight showing symptoms of the potentially fatal disease more than doubled to 57.
Another eight passengers on the Feb. 14 flight from Buenos Aires and Lima, Peru, to Los Angeles International Airport are confirmed to have contracted cholera, and one of those--a 70-year-old man--has died, officials said.
Medical personnel in California, Arizona and Nevada joined forces with federal officials in Washington and World Health Organization representatives in Argentina, Japan and Canada in the attempt to find more of the 336 passengers aboard the Boeing 747 jumbo jet.
In Los Angeles County, a team of three doctors, four epidemiologists and three nurses working 14-to-16-hour shifts was staffing a hastily connected bank of telephones at an office in the City of Commerce that usually is used by personnel from the district attorney's office.
"It's busy, busy, busy down there," said Dr. Shirley Fannin, director of disease control for the County's Department of Health Services. "It's like a war room."
The county health officials were forced to use the makeshift quarters because of the fire that severely damaged their high-rise headquarters in downtown Los Angeles last Saturday.
Members of the county team were working on two fronts.
Some were fielding calls from passengers on Flight 386 who had heard about the spreading infection through news reports. Others, working with addresses found on U.S. Customs debarkation lists and telephone numbers gleaned from reverse directories, were attempting to find passengers who had not reported in.
Passengers were questioned at length, with many questions focusing on what health officials say is the strong likelihood that the travelers were infected on the plane, probably from food or water served to passengers and crew.
"We ask them where they sat in the plane," Fannin said. "If they ate, we ask them what they ate. If they drank, we ask them what they drank. If they have symptoms of the disease, like diarrhea, we ask them when they first had the symptoms."
Fannin said this information was being relayed to nurses at public health facilities throughout the county, who went out and collected blood and stool samples for analysis. Prompt detection of the disease usually leads to successful treatment and there is little likelihood of cholera spreading from one person to another.
By noon Friday, there were six confirmed cases of cholera among the passengers in Los Angeles County, including Anibal Cufre, the man who died Tuesday, two days after being admitted to Arcadia Methodist Hospital. Two others remained hospitalized Friday.
Dr. George Rutherford, an expert on infectious diseases with the state Department of Health Services, said the other two confirmed cases were in San Bernardino County and in San Francisco.
In addition, he said, there were 57 who had reported symptoms of the disease by Friday, up from 25 on Thursday
Of those 57, he said, 31 were in Los Angeles County and another 12 scattered throughout the state, with eight more in Nevada and one in Arizona. The other five--all crew members--are in Argentina.
Rutherford said that for a single exposure to cholera bacteria, the infection rate appeared to be unusually high.
"That could indicate high doses of bacteria, something very contaminated," he said.
Rutherford said that contamination often results from water sources polluted by sewer systems. He said the infection could be spread by food prepared with the water, by ice made from the water or by the water itself.
Lou Ann Lebon, a spokeswoman for the airline, said Friday that Flight 386 took on food prepared by Aerolineas Argentinas in Buenos Aires and food prepared by a Lima-based catering company that serves a number of airlines. She said all water on the jetliner was put on board in Buenos Aires.
Lebon said meals, water and iced beverages were served on the 4 1/2-hour leg from Argentina to Peru and the eight-hour leg from Peru to the United States.
While cholera has swept over much of South America--including Argentina--in recent years, Lebon emphasized that the year-old epidemic has claimed almost 3,000 lives in Peru. Because of the widespread incidence of the disease there, Aerolineas Argentinas is suspending its stopovers in Lima, she said.
All Passengers' Calls Sought
Even if they have not developed any symptoms of cholera, passengers from Aerolineas Argentinas Flight 386 are being asked to call county health officials at (213) 725-5411 or (213) 725-5413. The officials say information from these passengers will provide some of the most important clues in determining the source of the infection among those on board the Feb. 14 flight.