CDC HAN Update On Fungal Meningitis Outbreak

 

Photo Credit FDA

# 6796

 

While the number of new meningitis cases linked to contaminated steroid injectables produced by NECC have slowed in recent weeks after their recall in late September, the number of slower-to-develop  paraspinal/spinal & peripheral joint (site of injections) infections continues to rise.

 

 

 

In many cases, the symptoms of fungal infection are subtle - and since these patients (by definition) already had joint/spinal pain when they received these injections - it isn’t always easy to identify patients who develop pockets of these slow growing organisms.

 

The CDC, in reviewing diagnostic imaging of a number of patients who received these injections, has determined that there may be a substantial number of as-yet unrecognized infections out there. 

 

So today they have issued a HAN Health Update.

 

 

December 20, 2012, 11:55 ET (11:55 AM ET)
CDC HAN-0338-2012-12-20-U-N

Update: Multistate Outbreak of Fungal Infections among Persons Who Received Injections with Contaminated Medication

Summary
New information from diagnostic imaging of patients exposed to contaminated methylprednisolone acetate (MPA¹) from the New England Compounding Center (NECC) in Framingham, Mass., demonstrates the need for assertive clinical evaluation of these patients for the possibility of an unrecognized, localized spinal or paraspinal infection. This Health Alert Network (HAN) notice provides updated guidance and information about the ongoing multistate outbreak of fungal infections as follows:

• CDC and state partners have analyzed new preliminary data based on recent Magnetic Resonance Imaging (MRI) studies among patients who had spinal or paraspinal injection with contaminated MPA from NECC. These findings demonstrate that among patients with no previous evidence of infection, and with new or worsening symptoms at or near the site of their injection, more than 50% had findings suggestive of a localized spinal or paraspinal infection, including epidural abscess, phlegmon, arachnoiditis, discitis, or vertebral osteomyelitis.
• This new information suggests that some patients who received spinal or paraspinal injections with implicated MPA from NECC may currently have an unrecognized, localized spinal or paraspinal infection.
• CDC is therefore re-emphasizing the guidance from the November 20 HAN advisory that recommended clinicians remain vigilant for evidence of fungal infection in these patients and use an assertive approach for clinical management and follow-up of these patients. CDC continues to recommend MRI with contrast of the symptomatic area(s) in patients with new or worsening symptoms at or near their injection site following spinal or paraspinal injection of implicated MPA.
• In addition, CDC is recommending that clinicians should consider obtaining an MRI with contrast of the injection site in patients with persistent but baseline symptoms because the presentation of these spinal or paraspinal infections can be subtle and difficult to distinguish from a patient’s baseline chronic pain.

 

(Continue . . .)

 

 

The CDC’s Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page.

 

There are 4 types of HAN releases, starting from the highest priority to the lowest.

• Health Alert - Conveys the highest level of importance; warrants immediate action or attention.
• Health Advisory - Provides important information for a specific incident or situation; may not require immediate action.
• Health Update - Provides updated information regarding an incident or situation; unlikely to require immediate action.
• Info Service -Provides general information that is not necessarily considered to be of an emergent nature.

 

Complicating matters, last week the FDA updated their list of contaminates detected in injectable drugs produced by this compounding pharmacy.

 

Laboratory Testing and Results

 

[12-12-2012] FDA and CDC have identified bacterial and/or fungal contamination in unopened vials of betamethasone, cardioplegia, and triamcinolone solutions distributed and recalled from NECC. These include bacteria known as Bacillus, and fungal species including Aspergillus tubingensis,  Aspergillus fumigatus,  Cladosporium species,and Penicillium species.

Although rare, some of the identified Bacillus species can be human pathogens.  Some of the fungal organisms identified, particularly Aspergillus fumigatus, are known to cause disease in humans.  It is not known how product contamination with these organisms could affect patients clinically.

 

»» Read More

CDC HAN Advisory: Additional NECC Products Found Contaminated

# 6690

 

 

Last night the CDC – as part of their investigation into the multistate fungal meningitis outbreak linked to contaminated steroid products distributed by the New England Compounding Center (NECC) -  issued a pair of HAN Advisories. 

 

• The first, is a notification that two additional products produced by NECC (betamethasone and cardioplegia solution) have tested positive for bacterial contamination.  
• The second advisory is essentially a HAN version of the FDA’s announcement on Wednesday of a total recall of all Ameridose products.  Ameridose is a a sister company to NECC.

 

The CDC’s Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page

 

There are 4 types of HAN releases, starting from the highest priority to the lowest.

 

• Health Alert - Conveys the highest level of importance; warrants immediate action or attention.
• Health Advisory - Provides important information for a specific incident or situation; may not require immediate action.
• Health Update - Provides updated information regarding an incident or situation; unlikely to require immediate action.
• Info Service -Provides general information that is not necessarily considered to be of an emergent nature.

 

Yesterday, the CDC also updated the number of confirmed infections due to these contaminated pharmaceuticals, which now total 377 cases of fungal meningitis, and 9 peripheral joint infections.

 

 

 

The following are excerpts from last night’s HAN Advisory on NECC contamination issues.

 

Contamination Identified in Additional Medical Products from New England Compounding Center

Summary: As part of the ongoing investigation of the multistate outbreak of fungal meningitis and other infections, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to test medical products from the New England Compounding Center (NECC) in Framingham, Mass.

NECC is the firm that distributed and recalled injectable steroid medications implicated in the current outbreak of fungal meningitis and other infections. CDC and FDA are reporting today that product testing has identified bacterial contamination with several Bacillus species and closely related bacterial organisms in unopened vials of betamethasone and cardioplegia solution that were distributed and later recalled by NECC on October 6, 2012. These bacteria are commonly found in the environment and have been rarely reported as a cause of human disease; it is not known how product contamination with these species might affect patients.

Although clinical infection is possible, CDC has not received reports of laboratory-confirmed cases of infection due to Bacillus or closely related organisms linked to these products. CDC’s recommendations to healthcare providers for diagnosing and treating symptomatic patients who have received NECC products have not changed as a result of these findings. Additional microbial organisms may be identified in recalled NECC products as additional laboratory testing is completed.

<SNIP>

As part of the ongoing investigation, FDA and CDC have been testing various NECC products for evidence of contamination. Laboratory testing at CDC and FDA has found multiple species of Bacillus and closely related bacterial organisms in unopened vials of betamethasone and cardioplegia solution, as shown in the table below.

Medication
Lot number
Microbial contamination

Betamethasone
08202012@141
Paenibacillus pabuli/amolyticus, Bacillus idriensis, Bacillus flexus, Bacillus simplex, Lysinibacillus sp.

Betamethasone
07032012@22
Bacillus niabensis, Bacillus circulans

Betamethasone
07302012@52
Bacillus lentus, Bacillus circulans

Cardioplegia solution
09242012@55
Bacillus halmapalus, Brevibacillus choshinensis

Other cultures for these products, including fungal cultures, are pending.

Recommendations to Healthcare Providers
CDC and FDA have previously advised that healthcare professionals should cease use of any product produced by NECC. On October 15, FDA issued a MedWatch Safety Alert advising clinicians to follow-up with patients who received any injectable NECC product, including betamethasone or cardioplegia solution purchased from or distributed by NECC after May 21, 2012. Clinicians were also requested to report any suspected adverse events following use of these products to FDA's MedWatch program.

 

CDC continues to investigate reports of potential infections in patients receiving other NECC products. As of November 1, CDC has received no reports of confirmed infections resulting from injection of any NECC product except those from the three recalled lots of preservative-free methylprednisolone acetate.^[1]

 

CDC’s recommendations to healthcare providers for diagnosing and treating symptomatic patients who have received NECC products have not changed as a result of these findings. CDC continues to recommend routine laboratory and microbiologic tests, including bacterial and fungal cultures, deemed necessary by treating clinicians.

 

These bacteria have been rarely reported as a cause of human disease. Nevertheless, clinicians should consider these product findings when reviewing laboratory results from patients who have been exposed to a NECC product, since Bacillus and related bacteria are often considered in clinical results to be possible skin contaminants. Physicians should continue to report infections potentially related to NECC products to FDA’s MedWatch and to state health departments.

---

1. NECC lots of methylprednisolone acetate (PF) 80mg/ml:

• Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #05212012@68, BUD 11/17/2012
• Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #06292012@26, BUD 12/26/2012
• Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #08102012@51, BUD 2/6/2013

»» Read More

CDC HAN Advisory & Updates On Fungal Meningitis

 

*304 cases of fungal meningitis, stroke due to presumed fungal meningitis, or other central nervous system-related infection meeting the outbreak case definition, plus 4 peripheral joint infections (e.g., knee, hip, shoulder, elbow). No deaths have been associated with peripheral joint infections.

 

# 6658

 

Proof this morning that they are burning the midnight oil over at the CDC - as they issued no fewer than seven updates on the fungal meningitis outbreak at 11pm last night – including an updated HAN Advisory.

 

Six of the seven are guidance documents are designed for practitioners treating exposed, or infected, patients, while the final one is an updated Q&A for patients.

 

NEW: Health Alert Network (HAN) - Oct 23, 2012 Tuesday, October 23, 2012 11:00 PM

 

UPDATE: Interim Treatment Guidance for Central Nervous System (CNS) and Parameningeal Infections Associated with Injection of Contaminated Steroid Products Tuesday, October 23, 2012 11:00 PM

 

UPDATE: Interim Treatment Guidance for Osteoarticular Infections Associated With Injection of Contaminated Steroid Products Tuesday, October 23, 2012 11:00 PM

 

UPDATE: Interim Guidance for Management of Asymptomatic Persons Exposed to Potentially Contaminated Steroid Products Tuesday, October 23, 2012 11:00 PM

 

NEW: Guidance on Management of Asymptomatic Patients Who Received Epidural or Paraspinal Injections with Contaminated Steroid Products Tuesday, October 23, 2012 11:00 PM

 

UPDATE: Frequently Asked Questions for Clinicians: Multistate Fungal Meningitis Outbreak Investigation Tuesday, October 23, 2012 11:00 PM

 

UPDATE: Frequently Asked Questions for Patients: Multistate Fungal Meningitis Outbreak Investigation Tuesday, October 23, 2012 11:00 PM

 

 

The stickiest issue for the CDC, patients, and physicians has been whether to institute some kind of prophylactic anti-fungal treatment in those who have been exposed, but are thus far asymptomatic.

 

And if the drugs needed were well tolerated, and plentiful in supply, that might be an option.

 

But the truth is, taking these anti-fungal drugs is not without risk, as they have been linked to liver, heart, and kidney damage. 

 

Simply put, they are not something you’d want to take for several months, unless you had to.

 

And there are also concerns that there may not be sufficient supply of these drugs to provide prophylactic treatment to 14,000 patients.

 

So far, of the 14,000 patients believed exposed, just 2.2 % have developed symptoms.

 

While that number will likely rise, the CDC believes that patients who have gone more than 42 days since their last injection without showing signs of illness are at a substantially reduced risk of developing meningitis.

 

Therefore the CDC continues to advise against prophylactic treatment of asymptomatic individuals who may have been exposed.  

 

This excerpt from last night’s HAN advisory.

 

October 23, 2012, 22:00 ET (10:00 PM ET)
CDCHAN-00330-2012-10-23-UPD-N

Issuance of Guidance on Management of Asymptomatic Patients Who Received Epidural or Paraspinal Injections with Contaminated Steroid Products

CDC analysis suggests that the period of greatest risk for development of fungal meningitis among patients who received epidural or paraspinal injections with contaminated products¹ is during the first 6 weeks (42 days) after injection; therefore, additional monitoring of these patients should be considered. Accordingly, CDC provides guidance for asymptomatic patients who received epidural or paraspinal injections with contaminated steroid product¹ within the last 6 weeks (42 days), and those who received such products longer than 6 weeks (42 days) ago. For specific details about the updated guidance, see Guidance on Management of Asymptomatic Patients Who Received Epidural or Paraspinal Injections with Contaminated Steroid Products.

 

As stated above, CDC does not recommend initiation of antifungal treatment in the absence of diagnostic test results indicating fungal meningitis in exposed patients who are asymptomatic. Currently available data do not suggest an added benefit to this approach in comparison to the strategies outlined in the updated guidance, and patients may experience serious adverse drug events associated with treatment.

(Continue . . . )

 

 

Watchful waiting is always difficult, particularly when you are dealing with a potentially fatal condition. But sometimes it really is the lesser of two evils.

 

Patients who go more than 42 days without developing symptoms are believed to be at reduced risk of illness - but as we saw last week (see Revisiting An Earlier Fungal Meningitis Outbreak) during a similar outbreak 10 years ago in South Carolina - infections cropped up as much as six months post-exposure.

 

All of which means that this story, and the ordeal for those exposed, isn’t likely to be over anytime soon.

»» Read More

CDC Teleconference & HAN Advisory On H3N2v

Credit Wikipedia

# 6472

 

 

Today has been a busy day at the CDC as they addressed the recent spike in swine H3N2v flu infections across the heartland.  There have been 16 human cases identified over the past 3 weeks, and of those, 12 are from this week.

Earlier today we saw an update (see The CDC On Recent H3N2v Cases) giving the current case counts, and background information.  At 12pm EDT today, the CDC held a teleconference for the media.

 

Dr Joe Bresee of the CDC’s influenza division and Dr. Lisa Ferguson from the National Animal Health Policy Program office at the USDA answered reporter’s questions for roughly 40 minutes.

 

While providing no major revelations beyond what had already been reported the past couple of days, today’s conference does provide clarity on some of details of these novel outbreaks, and a good feel for how the CDC is approaching the situation.

 

Fair warning, the audio link has 20 minutes of canned music before the conference begins.

 

Press Briefing Transcript

CDC Telebriefing: Influenza A (H3N2) Variant Virus

Friday, August 3, 2012, Noon ET

• Audio recording (MP3, 12.3MB)

 

 

The CDC also published a HAN (Health Alert Network) advisory today on the H3N2v. These HAN releases are designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

There are 4 types of HAN releases.

 

Health Alert

Conveys the highest level of importance; warrants immediate action or attention.

Health Advisory

Provides important information for a specific incident or situation; may not require immediate action.

Health Update

Provides updated information regarding an incident or situation; unlikely to require immediate action.

Info Service
Provides general information that is not necessarily considered to be of an emergent nature.

 

Today’s HAN Message is an ADVISORY.

 

This is an official

CDC HEALTH ADVISORY

Distributed via the HAN Info Service
August 3, 2012, 11:00 EST
CDCHAN-00325-ADV-N

Increase in Influenza A H3N2v Virus Infections in Three U.S. States

Summary and Background

Multiple infections with variant* influenza A (H3N2v) viruses have been identified in 3 states in recent weeks. From July 12 through August 3, 2012, 16 cases of H3N2v were reported and confirmed by CDC. This virus was first detected in humans in July 2011. It has also been isolated in U.S. swine in many U.S. states. Since July 12, 2011, there have been 29 cases of H3N2v virus infection, including the 16 cases occurring in the last three weeks.  All 29 cases were infected with H3N2v viruses that contain the matrix (M) gene from the influenza A (H1N1)pdm09 virus. This M gene may confer increased transmissibility to and among humans, compared to other variant influenza viruses. All cases have been laboratory-confirmed at CDC. Each of the 16 cases identified since July 12, 2012, reported contact with swine prior to illness onset; in 15 cases, contact occurred while attending or exhibiting swine at an agricultural fair. While the viruses identified in these cases are genetically nearly identical, separate swine exposure events in each state were associated with human infections. There is no indication that the cases in different states are epidemiologically related.

 

Clinical characteristics of the 16 H3N2v recent cases have been generally consistent with signs and symptoms of seasonal influenza, and have included fever, cough, pharyngitis, myalgia, and headache. No hospitalizations or deaths have occurred among the 16 confirmed cases since July 2012. Public health and agriculture officials are investigating the extent of disease among humans and swine, and additional cases are likely to be identified as the investigation continues.

 

Novel influenza A virus infection has been a nationally notifiable condition in the United States since 2007. Since that time, human infection with animal-origin influenza viruses has been rare, with ≤6 cases reported each year, until 2011 when 14 cases were identified. While most of the cases are thought to have been infected as a result of close contact with swine, limited human-to-human transmission of this virus was identified in some cases in 2011. Therefore, enhanced influenza surveillance is indicated, especially in regions and states with confirmed H3N2v cases.

(Continue . . . .)

The bottom line right now is that the CDC is obviously concerned over the increase in H3N2v infections being reported, but is not particularly alarmed.

 

The virus does not yet appear capable of efficient and sustained transmission among people, and until that happens, poses only a relatively minor public health threat.

The rub is, the virus could acquire that ability at any time. It could happen tomorrow, or it might not happen for years.

 

Or perhaps, not at all.

 

For now the risks are primarily to those who come in contact with pigs, so the CDC is offering advice to fair goers, and those who raise swine, on how to best reduce the risk of infection.

 

More cases are likely to be announced over the next few weeks as the epidemiological investigation continues, but we’ll simply have to wait and see if this virus manages to adapt well enough to human physiology to present a significant public health threat.

 

For some of my earlier posts on this week’s surge in H3N2v cases, you may wish to revisit:

 

Indiana: Swine Flu Information Call Center To Open

CDC Confirms H3N2v In Butler County Outbreak

ISDH: Fifth H3N2v Case In Indiana

A Variant Flu Review

Ohio Investigating Possible H3N2v Outbreak

Hawaii’s DOH on H3N2v Flu Detected On Maui

Swine Flu Precautions Close Pig Barn At Indiana County Fair

»» Read More

CDC Health Advisory (HAN) On Measles

 

 

# 5645

 

Earlier this year I wrote about the recent rise of measles cases across much of Europe (see Measles: Forgotten, But Not Gone), with details gleaned from the WHO’s WER (Weekly Epidemiological Record), and including a referral to an excellent 5-part series on measles by Ian York.

 

The WER report (Measles outbreaks in Europe) detailed an outbreak, which had – as of April 18th –had infected more than 6,500 people in 33 nations.

 

This spring a significant number of measles cases have been imported into the United States from this outbreak, and with the summer travel season upon us, the potential for seeing more cases is great.

 

For this reason, the CDC released a HAN Advisory on measles last night.

 

The CDC’s Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page.

 

There are 4 types of HAN releases.

 

Health Alert

Conveys the highest level of importance; warrants immediate action or attention.

Health Advisory

Provides important information for a specific incident or situation; may not require immediate action.

Health Update

Provides updated information regarding an incident or situation; unlikely to require immediate action.

Info Service
Provides general information that is not necessarily considered to be of an emergent nature.

 

 

This is an official

CDC HEALTH ADVISORY

Distributed via Health Alert Network
June 22, 2011, 16 :00 EST (04:00 PM EST)
CDCHAN-00323-11-06-22-ADV-N

High Number of Reported Measles Cases in the U.S. in 2011—Linked to Outbreaks Abroad

Summary and Background

The United States is experiencing a high number of reported measles cases in 2011, many of which were acquired during international travel. From January 1 through June 17 this year, 156 confirmed cases of measles were reported to CDC. This is the highest reported number since 1996. Most cases (136) were associated with importations from measles-endemic countries or countries where large outbreaks are occurring. The imported cases involved unvaccinated U.S. residents who recently traveled abroad, unvaccinated visitors to the United States, and people linked to these imported cases. To date, 12 outbreaks (3 or more linked cases) have occurred, accounting for 47% of the 156 cases. Of the total case-patients, 133 (85%) were unvaccinated or had undocumented vaccination status. Of the 139 case-patients who were U.S. residents, 86 (62%) were unvaccinated, 30 (22%) had undocumented vaccination status, 11 (8%) had received 1 dose of measles-mumps-rubella (MMR) vaccine, 11 (8%) had received 2 doses, and 1 (1%) had received 3 (documented) doses.

 

Measles was declared eliminated in the United States in 2000 due to our high 2-dose measles vaccine coverage, but it is still endemic or large outbreaks are occurring in countries in Europe (including France, the United Kingdom, Spain, and Switzerland), Africa, and Asia (including India). The increase in measles cases and outbreaks in the United States this year underscores the ongoing risk of importations, the need for high measles vaccine coverage, and the importance of prompt and appropriate public health response to measles cases and outbreaks.

 

Measles is a highly contagious, acute viral illness that is transmitted by contact with an infected person through coughing and sneezing. After an infected person leaves a location, the virus remains contagious for up to 2 hours on surfaces and in the air. Measles can cause severe health complications, including pneumonia, encephalitis, and death.

Recommendations for Health Care Providers

• Ensure all patients are up to date on MMR vaccine* and other vaccines.
• For those who travel abroad, CDC recommends that all U.S. residents older than 6 months be protected from measles and receive MMR vaccine, if needed, prior to departure.
  • Infants 6 through 11 months old should receive 1 dose of MMR vaccine before departure.†
  • Children 12 months of age or older should have documentation of 2 doses of MMR vaccine (separated by at least 28 days).
  • Teenagers and adults without evidence of measles immunity** should have documentation of 2 appropriately spaced doses of MMR vaccine.

• Consider measles as a diagnosis in anyone with a febrile rash illness lasting 3 days or more, a temperature of 101ºF (38.3ºC) or higher, and clinically compatible symptoms (cough, coryza, and/or conjunctivitis) who has recently traveled abroad or who has had contact with someone with a febrile rash illness. Immunocompromised patients may not exhibit rash or may exhibit an atypical rash. The incubation period for measles from exposure to fever is usually about 10 days (range, 7 to 12 days) and from exposure to rash onset is usually 14 days (range, 7 to 21 days).

• Isolate suspect measles case-patients and immediately report cases to local health departments to ensure a prompt public health response.

• Obtain specimens for testing, including viral specimens for confirmation and genotyping.

 

 

 

Measles was considered eliminated in the United States by the year 2000 due to the introduction of the measles vaccine in the mid-1960s.

 

 

Despite this success, there remain enough unvaccinated individuals to create cracks in our hard won `herd immunity’, and that allow the virus an opportunity to spread.

»» Read More

CDC Health Advisory (HAN) On Shiga-Toxin Producing E. Coli 0104

 

 

# 5599

 

 

The CDC’s Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page.

 

There are 4 types of HAN releases.

Health Alert

Conveys the highest level of importance; warrants immediate action or attention.

Health Advisory

Provides important information for a specific incident or situation; may not require immediate action.

Health Update

Provides updated information regarding an incident or situation; unlikely to require immediate action.

Info Service
Provides general information that is not necessarily considered to be of an emergent nature.

 

Today we have a HAN ADVISORY on the outbreak of EHEC or Shiga-Toxin producing E. Coli in Europe, with instructions for Health Care providers to be on the lookout of possible symptoms in travelers returning from Europe.

 

As of May 31st, the CDC has been made aware of 3  cases of HUS among travelers who recently entered the United States after leaving Germany.

 

While most of the information below is of greatest interest to clinicians, this illustrates that in today’s highly mobile society, even an outbreak of a food borne illness can impact countries oceans apart.

 

 

 

This is an official

CDC HEALTH ADVISORY

Distributed via Health Alert Network
June 3, 2011, 9:30 a.m. EST
CDCHAN-00322-ADV-N

Notice to Health Care Providers — Shiga Toxin-producing E. coli O104 (STEC O104:H4) Infections in U.S. Travelers Returning from Germany

 

CDC is monitoring a large outbreak of Shiga toxin-producing Escherichia coli O104:H4 (STEC O104:H4) infections ongoing in Germany. The responsible strain shares virulence characteristics with enteroaggregative E. coli (EAEC). As of May 31, 2011, the Robert Koch Institute (RKI) reported 470 patients with hemolytic uremic syndrome, or HUS (a severe condition associated with STEC infection that can lead to kidney failure), and nine deaths. The strain of STEC that is causing this illness, STEC O104:H4 is very rare. The illness that it causes is similar to that caused by E. coli O157:H7 or STEC O157:H7, which is also a Shiga toxin-producing E. coli.

 

CDC is not aware of any cases of STEC O104:H4 infection ever being previously reported in the United States. However, as of May 31, 2011, three cases of HUS in the United States have been reported in persons who recently traveled to Hamburg, Germany. CDC is working with state health departments to learn more about these suspected cases and obtain bacterial isolates for further characterization.

 

CDC has recommended that any person who has recently traveled to Germany and has signs or symptoms of STEC infection, or HUS, should seek medical care and let the medical provider know about the outbreak of STEC infections in Germany and the importance of being tested for STEC infection.

 

Symptoms of STEC infection include severe stomach cramps, diarrhea (which is often bloody) and vomiting. If there is fever, it usually is not very high. Most people get better within 5–7 days, but some patients go on to develop HUS, usually about a week after the diarrhea starts. 

 

(Continue . . . )

»» Read More

CDC HAN Advisory: Fukushima Radiation Monitoring

 

 

 

# 5455

 

The CDC’s  Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page

 

There are 4 types of HAN releases.

 

Health Alert

Conveys the highest level of importance; warrants immediate action or attention.

Health Advisory

Provides important information for a specific incident or situation; may not require immediate action.

Health Update

Provides updated information regarding an incident or situation; unlikely to require immediate action.

Info Service
Provides general information that is not necessarily considered to be of an emergent nature.

 

Today we have a HAN ADVISORY on the monitoring of radiation from the Fukushima reactors. The `money quote’ reads:

 

At this time, there continues to be no indication for anyone in the United States to take potassium iodine or switch to bottled water on the basis of the events in Japan.

 

But I’ve reproduced the entire HAN message below.  My thanks to Sharon Sanders of FluTrackers for sending this link.

 

 

 

This is an official
CDC HEALTH ADVISORY

Distributed via Health Alert Network
Sunday, March 27, 2011, 0:20 EDT (12:20 PM EDT)
CDCHAN-00320-2011-03-27-ADV-N

This is an official
CDC HAN Info Service Message

 

Monitoring for Increased Levels of Radioactive Material in the US as a Result of the Incident with the Fukushima Nuclear Incident in Japan

Summary

As a result of the incident with the Fukushima nuclear plant in Japan, highly sensitive radiation monitors operated by EPA and others are detecting very low levels of radioactive material in the air in the United States. These levels were expected and consistent with estimated releases from the damaged nuclear reactors and are far below levels of public health concern.

 

Elevated levels of radioactive material in rainwater have also been expected as a result of the nuclear incident after the events in Japan, since radiation is known to travel in the atmosphere. There have been reports received that several states including Pennsylvania and Massachusetts have detected elevated levels of radiation in rainwater following recent precipitation events.

 

Background

The numbers of the elevated levels of radioactive material being reported in Massachusetts are 79 picocuries (pCi) per liter (one picocurie is a trillionth of a curie). The numbers reported in Pennsylvania range from 40-100 picocuries per liter. Although these are levels above the background levels historically reported in these areas, they are still about 25 times below the level that would be of concern for use as a sole source of water over a short period of time, even for infants and pregnant or breastfeeding women, who are the most sensitive to radiation.

 

While short-term elevations such as these do not raise public health concerns – and the levels seen in rainwater are expected to be relatively short in duration – the U.S. EPA has taken steps to increase the level of monitoring of precipitation, drinking water, and other potential exposure routes to continue to verify that.

 

Given the release of radiation in Japan, it was expected that radiation monitors in this country and elsewhere will detect minute quantities of radiation. These monitors are highly sensitive and can detect amounts of radiation in trillionths of a Curie. We expect environmental monitors will continue to detect low levels of radiation in surface waters due to radioactive material in the air. When it rains or snows, the radioactive material is washed to the ground and onto surface waters.

 

What the US Federal Government is Doing

EPA’s Radiation air monitoring network continues to conduct near-real-time air monitoring in networks across the nation. With these recent reports, the US EPA has increased monitoring across the country to ensure that the American people have the most up to date information.

 

What information is available to the public:

The EPA has posted information on its website at http://www.epa.gov/japan2011/

CDC has posted FAQs on our website at http://emergency.cdc.gov/radiation/isotopes/iodine131surfacewater.asp.

USA.gov continues to consolidate federal guidance related to this situation at http://www.usa.gov/Japan2011.shtml.

Recommendations

 

The federal government’s only recommendation to state and local governments at this time is to continue to share their testing results with the appropriate federal authorities. EPA will continue to communicate nationwide sampling results as they come in.

 

At this time, there continues to be no indication for anyone in the United States to take potassium iodine or switch to bottled water on the basis of the events in Japan.

 

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

»» Read More