Public Health Alerts

CDC, public health and regulatory officials in several states, Canada, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (E. coli O157:H7) infections linked to romaine lettuce.

CDC is advising that U.S. consumers not eat any romaine lettuce, and retailers and restaurants not serve or sell any, until we learn more about the outbreak. This investigation is ongoing and the advice will be updated as more information is available.

• Consumers who have any type of romaine lettuce in their home should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick.
  • This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.
  • If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away.
  • Wash and sanitize drawers or shelves in refrigerators where romaine was stored. Follow these five steps to clean your refrigerator.
• Restaurants and retailers should not serve or sell any romaine lettuce, including salads and salad mixes containing romaine.
• Take action if you have symptoms of an E. coli infection:
  • Talk to your healthcare provider.
  • Write down what you ate in the week before you started to get sick.
  • Report your illness to the health department.
  • Assist public health investigators by answering questions about your illness.

Advice to Clinicians

• Antibiotics are not recommended for patients with E. coli O157 infections. Antibiotics are also not recommended for patients in whom E.coli O157 infection is suspected, until diagnostic testing rules out this infection.
• Some studies have shown that administering antibiotics to patients with E. coli O157 infections might increase their risk of developing hemolytic uremic syndrome (a type of kidney failure), and the benefit of antibiotic treatment has not been clearly demonstrated.

 

For more information on this food safety alert, visit the CDC’s website.

Warm weather in Texas brings a higher risk of marine water-related infections, including those caused by the Vibrio bacteria which are naturally found in coastal water. Most infections occur between May and October, when the warmer water temperatures in the Gulf of Mexico promote the growth of these bacteria. Texas has averaged 90 Vibrio infections per year for the last 10 years.

People can become ill after eating raw or undercooked contaminated seafood, particularly oysters, or when a person has an open wound that is exposed to seawater. Illness due to eating raw or undercooked seafood usually includes gastrointestinal symptoms such as vomiting, diarrhea, abdominal pain, nausea, fever, and chills. These symptoms frequently occur within 24 hours of eating and last approximately three days. Wound infections can cause redness, swelling, large blisters on the skin, skin ulcers, and, in serious cases, may even lead to limb amputation or death. People with a weakened immune system, liver disease, diabetes, cancer, or other chronic diseases or who have decreased gastric acidity are at highest risk for severe illness.

People who develop a skin infection or gastrointestinal symptoms that may be due to Vibrio bacteria should contact their medical provider immediately. They should inform their medical provider if their skin has been in contact with brackish water or seawater, raw seafood, raw seafood juices, or if they ate raw or undercooked seafood before they became ill.

DSHS recommends the following precautions to reduce the risk of infection:

• People with pre-existing wounds, including cuts, scrapes, fresh tattoos, blisters, or bites, should avoid contact with seawater and any kind of raw seafood.
• People with a weakened immune system should wear protective water shoes.
• If a wound is exposed to seawater or raw seafood, thoroughly wash the wound with soap and water, and see a medical provider if the area begins to look infected.
• Do not eat raw shellfish, especially oysters; cook seafood thoroughly.
• Wear protective clothing like gloves when handling raw seafood.
• Keep raw seafood separate from other food to avoid cross-contamination, immediately clean up raw seafood spills with hot, soapy water, and thoroughly wash hands, utensils and surfaces after preparing or handling raw seafood.

In 2017, 30 percent of Vibrio cases reported in Texas were due to water exposure and another 21 percent to shellfish consumption with the exposure unknown in the remaining cases. Most cases with water exposure had cuts, bites, scratches or other pre-existing wounds. The majority of cases with shellfish consumption had eaten raw oysters before becoming ill.

Additional information on Vibrio infections in Texas is available at http://www.dshs.texas.gov/idcu/disease/vibrio/default/

This is an official
CDC Health Advisory
Distributed via the CDC Health Alert Network
October 24, 2017, 13:30 ET (1:30 PM ET)
CDCHAN-00408

Advice for Health Care Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and the US Virgin Islands

Summary 
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.
The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.
Background 
Hurricanes Irma and Maria made landfall in Puerto Rico and USVI in September 2017, causing widespread flooding and devastation. Natural hazards associated with the storms continue to affect many areas. Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted and personal hygiene is difficult to maintain. Additionally, vector borne diseases can occur due to increased mosquito breeding in standing water; both Puerto Rico and USVI are at risk for outbreaks of dengue, Zika, and chikungunya.
Health care providers and public health practitioners should be aware that post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas; including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI.
In addition, providers in health care facilities that have experienced water damage or contaminated water systems should be aware of the potential for increased risk of infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other Gram-negative bacteria associated with water (e.g., Pseudomonas), especially among critically ill or immunocompromised patients.
Cholera has not occurred in Puerto Rico or USVI in many decades and is not expected to occur post-hurricane.

Recommendations 
These recommendations apply to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas (e.g., within the past 4 weeks), during the period of September 2017 – March 2018. 
Health care providers and public health practitioners in hurricane-affected areas should look for community and healthcare-associated infectious diseases.
Health care providers in the continental US are encouraged to ask patients about recent travel (e.g., within the past 4 weeks) to hurricane-affected areas.
All healthcare providers should consider less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some particularly important infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
In the context of limited laboratory resources in hurricane-affected areas, health care providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.
For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests— treatment for leptospirosis is most effective when initiated early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.
Local health care providers are strongly encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.
Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.

This is an official

 

CDC Health Advisory- Potential for Falsely Low Blood Lead Test Results from LeadCare Analyzers

CDC has published a new article in the Morbidity and Mortality Weekly Report entitled “Update: Interim Guidelines for Healthcare Providers Caring for Infants and Children with Possible Zika Virus Infection — United States, February 2016”

Access the Article Here:  http://dx.doi.org/10.15585/mmwr.mm6507e1er

CDC has updated its interim guidelines for healthcare providers who care for infants and children with possible Zika virus infection. The guidance, which has been expanded to cover children up to 18 years old, includes these updates:

• A new recommendation that  infants with typical head size, normal ultrasounds, and a normal physical exam born to mothers who traveled to or lived in areas with Zika do not require any special care beyond what is routinely provided to newborns.
• A new recommendation to suspect Zika virus disease in children, in addition to infants, who have traveled to or lived in an area with Zika within the past 2 weeks and have at least two of these symptoms: fever, rash, red eyes, or joint pain. Because transmission of Zika virus from mother to infant during delivery is possible, this recommendation also applies to infants during the first 2 weeks of life whose mother traveled to or resided in an affected area within 2 weeks of delivery.

 

Parents in families traveling to or living in areas with Zika can help protect their children by strictly following steps to prevent mosquito bites. Based on what we know now, Zika virus disease in children, as for adults, is usually mild.  As an arboviral disease, Zika virus disease is a nationally notifiable condition; healthcare providers should report suspected cases to their local, state, or territorial health department.  CDC’s guidance will continue to be updated as we learn more.

For more information, please visit:

CDC Zika Virus Home Page

CDC Travel Alert

CDC Zika Virus Information for Healthcare Providers