• Effects: Listeriosis shakes one of the foundations of the government "of change"
  • Cultivation.This is the WhatsApp photo that activated the health alert for the meat that was contaminated with listeria
  • Assessment.Moreno Bonilla takes chest in the listeriosis crisis: "We are writing a new story in the fight against bacteria"

Dr. José Miguel Cisneros (Chiluevar, Jaén, 1960) has become the voice and face of the crisis that has caused the listeriosis outbreak in Andalusia. But, in addition, he is a recognized expert and is head of the Infectious Service of the Virgen del Rocío Hospital in Seville. He has fought the outbreak since the trench and is reasonably satisfied, although he is cautious about the evolution of the outbreak and does not forget the victims left by the bacteria. All this, he thinks, should serve for something, to at least learn more.

There are three fatalities in this outbreak of listeriosis, could there be more? It may be because we know the severity of the infection by this bacterium and the outbreak is not over. Therefore, it is possible, although we are doing everything in our power to avoid it. With the two acquaintances on Friday, abortions are already rising to four and there are more than twenty pregnant women hospitalized. What risk is there? Two abortions happened before the alert and the two we have just reported are under study to know if it is Listeria monocytogenes that has caused the abortion. The clinical suspicion is that chorioamnionitis, which is the infection produced by bacteria of any type when they generate an abortion, is caused by listeria because the two have a history of having eaten roasted meat. More than 20 have been fired. % users in emergencies, how have these services been reinforced? SAS has reinforced emergency services to make possible care, but the most important thing has been the response of citizens who, logically passed the initial phase, where the concern and even fear, together with information on non-contrasted occasions, little responsible, caused that very important increase in people who came: some because they clearly had symptoms and others, with less reason. But the response has been very good and the current situation is that of a responsible use of the citizens of the emergency services. Do you think that the calls to calm have served? I think the daily information, accurate, with the cases diagnosed , one by one, the distribution by provinces and the distribution of patients, either with suspicions or confirmed, their clinical situation and the consequences they may have had, which we have given at conferences and press releases daily has contributed to send information . An immediate, real information, without speculation or conjecture, that this can generate, but concrete and this has surely helped the necessary serenity in a health alert of this magnitude. It seems obvious that something has failed in this crisis ... The whole sequence of What has happened requires a report at the end of the outbreak, when finished and with sufficient detail and precision to see what could have been done better, what has failed. Why do they discard cross contamination and analyze cutters and other utensils? I believe that at all times we have transmitted the need to maintain hygienic measures. Another issue is to focus on the origin of this contamination, of this toxiinfection, which is a specific and identified food and that its withdrawal is confirming by evolution, which was the source of the infection. Look at the last seven days: the number of cases is between 0 and 3. If the focus, the contaminated food, had not been withdrawn, we would still have a situation that does not correspond to this evolution, but the possibility is also being considered other Magrudis products have been infected ... Look, all the production of that factory has been withdrawn, the factory is closed and there is an identification that they are part of suspicious foods that cannot be consumed and thus communicated and transmitted, without He doubts because, with this level of irregularities that we have known, there is no other question from the point of view of prevention. This message is transmitted through the General Directorate of Public Health and extends to all the products of this company because it really is a factory to which, with all the information we have, it indicates that it was in a situation of continued irregularities .Magrudis only underwent three public inspections in four years, made an extension of which he did not inform the administrations and now we have known that he did not have an activity license. How is this possible? This is part of the questions that the institutions have to answer and that they should ask and they will surely do it and will answer if they have been in accordance with the legislation and the necessary regulations or have not been so. It seems, at least from the outside, that coordination between administrations has not been desirable, with cross-declarations, leaks ... Has it been like this? An outbreak of this magnitude, a health crisis like this puts the health system to the test, to institutions, civil society and the press. I believe that the qualification and the result of each of these parts will already be seen as this outbreak happens. So, I think this is, from the point of view of responsibility, very important to understand. Faced with an extraordinary situation like this, only extraordinary behaviors of all fit. Logically, the more responsibility they have and this is the only possible answer. Who does not do this is not doing the right thing. Was the Andalusian health system ready for an outbreak of these characteristics? Well, look, that question can only be answered when an outbreak has happened. What I can tell you is that the emergencies have not collapsed, the patients have been treated and the mortality as of today is what you mentioned. This mortality and the pregnancies that have unfortunately been lost, although it is still necessary to see the clinical impact with much more perspective because a pregnancy is nine months and there are still patients admitted to the ICU, it is well below what can be expected by analyzing the history of this disease written in other outbreaks and other situations, which is much higher, including the percentage of abortions. What needs to be improved for the future? I believe that this type of health crisis should not be in vain because all this suffering suffered by sick people and pregnant women who have been the ones most worried, afraid, restless, have suffered and are suffering and people at risk, because It is essential that it be analyzed to the last detail to ensure that it is not repeated. This undoubtedly requires a requirement of responsibilities that is required so that it does not happen again because if things had been done well (at this moment I can not tell you which ones have not been done well and which badly) because a contamination should not have happened of a food If the regulations, which are very strict and demanding in food production in Europe and in our country, had been complied with, this would not have happened. You have to find out how many things have not been fulfilled and demand the responsibilities to whom it may concern so that it is an example and avoids behaviors that can cause future outbreaks. At this point, we all know how resistant the bacteria is, but what measures of prevention can be taken against it? Prevention measures are very well described. On an industrial level it has an extraordinarily demanding regulation so that it does not contaminate food during the manufacturing and packaging process. The measures for citizens are also very well described and are recommended systematically and, particularly, for pregnant women because listeria is one of the causes of abortion known even in pregnant women out of outbreaks, so they are made recommendations of the type of food that can not consume.Is it safe at this time to consume products similar to those infected? I hope so, that what has happened in this factory is exceptional and the rest of industrial production is done safely and maintain the level of responsibility that surely all entrepreneurs have. Of course, the epidemiological evolution demonstrates that this inflection and reduction of the outbreak in a sustained manner, coinciding with the removal of the clearly contaminated product, is being effective and this is very encouraging in this regard. In what sense is a new story being written in the fight against listeria, as said the president of the Board, Juanma Moreno Bonilla? An outbreak of this extraordinary magnitude had not occurred with these characteristics, it is not described, which is also an obligation on our part to analyze it in order to take out the lessons that can allow that, if this happens, I hope that never again here, in another place, these lessons help to improve the management that is done in another latitude. We are using indications that are not described in the literature because after assessing the first cases, we thought it was adequate and correct. Measuring the impact of all this requires the time needed when the outbreak is included and all the information is analyzed. What type of indications does it refer to? The main one is that we have begun to treat patients that in conventional recommendations were not recommended. The international guidelines of scientific societies of the USA, Canada, industrialized countries, modern countries. This we have to measure. We have to measure the impact that this clinical management has had and if it is positive compared to the knowledge of this disease, then communicate it, transfer it and that it can be applied to future outbreaks elsewhere.

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