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Public Health Information

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FDA Warning

FDA Warns About Fraudulent Tamiflu
Thu, 17 Jun 2010

The U.S. Food and Drug Administration today warned consumers about a potentially harmful product represented as Generic Tamiflu sold over the Internet. FDA tests revealed that the fraudulent product does not contain Tamiflu’s active ingredient, oseltamivir, but cloxacillin, an ingredient in the same class of antibiotics as penicillin.

For more information visit: FDA Warns About Fraudulent Tamiflu

CDC Information

CDC Updates for Clinicians

Upcoming Clinician Outreach and Communication Activity (COCA)Conferences and Training Opportunities

Upcoming COCA Conference Call: Immunization - July 27, 2010

Previous Health Alerts

We will keep the two most current Health Alerts here.

To see all posted Delaware Health Alerts-click here

Delaware Health Alert Network #232

Delaware Health Alert Update, July 23, 2010

Subject: Delaware Health Alert Network Health Advisory #232 - Increased Potential for Dengue Infection

Message: Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas

The Delaware Division of Public Health is forwarding this Health Alert from the Centers for Disease Control and Prevention (CDC).

Summary: Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics. Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF). The Centers for Disease Control and Prevention (CDC) strongly advises that health care providers in the United States should: 1) consider DF and DHF when evaluating patients returning from dengue-affected areas--both domestic and abroad--who present with an acute febrile illness within two weeks of their return, 2) submit serum specimens for appropriate laboratory testing, and 3) report all presumptive and confirmed cases of DF and DHF to their local or state health department.

Background

Dengue transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild. Dengue-affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean. This calendar year, more than 50 countries have reported evidence of dengue transmission; including 17 countries in Asia, 17 in the Americas, 10 in Africa, seven in the Caribbean, and one in the Pacific. With an extensive dengue outbreak occurring in Puerto Rico and evidence of continued transmission in Key West, Florida, travel to certain domestic locations may also pose a risk for the traveler. The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission.

Symptoms

Dengue virus infections can manifest as a subclinical infection or DF, and may develop into potentially fatal DHF. DF is a self-limited febrile illness that is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia. Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel. Clinical management of DF consists of symptomatic treatment (avoid aspirin, NSAIDS and corticosteroids, as they can promote hemorrhage) and monitoring for the development of severe disease at or around the time of defervescence. A small proportion of patients develop DHF, which is characterized by presence of resolving fever or a recent history of fever, lasting 2â€“7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count â‰¤100,000/mm3), and increased vascular permeability, evidenced by hemoconcentration, hypoalbuminemia or hypoproteinemia, ascites, or pleural effusion. DHF can result in circulatory instability or shock. Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids. There is no antiviral drug or vaccine against the dengue virus. Updated guidelines for the management of dengue can be found at http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

Recommendations

Health care providers seeing patients with dengue-like illness who have recently traveled to Puerto Rico, Key West, Florida or international dengue-affected areas (See world distribution of dengue maps at http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx) should report cases to the local or state health department and send specimens for laboratory testing. DF and DHF are now nationally notifiable conditions in the United States. Please remember that apart from individuals traveling for tourism, individuals responding to international disasters (e.g., Haiti earthquake), participating in medical or religious missionary work, and visiting friends and relatives are often returning from dengue-affected areas and should be evaluated for dengue infection if they present with dengue-like illness during or after their travel.

Reporting to local public health officials and consideration of hospitalization to initiate supportive care should not be delayed pending test results. Reporting suspected dengue cases will trigger a public health investigation and the implementation of prevention measures.

Specimens from patients with acute febrile illness, who returned from dengue-affected areas within the past 14 days, should be submitted to their local or state health department, if the health department laboratory offers dengue testing. State health departments with the capacity to test for dengue include: AZ, CA, CT, FL, NY, PR, and TX.

If the local or state health department does not perform dengue testing, submit specimens directly to CDC laboratories in San Juan, Puerto Rico (address below). CDC offers free diagnostic testing for health care providers and confirmatory dengue testing for health department and private laboratories. A completed CDC Dengue Case Investigation Form

(http://www.cdc.gov/Dengue/resources/DCIF_English_ColorSept1508_FINAL_.pdf) must accompany the specimens for the appropriate testing to be performed.

Whenever possible, submit paired acute and convalescent specimens (2 ml of centrifuged serum.) Accuracy is increased when both acute and convalescent specimens are available for testing. But providers should not wait and should submit acute specimens as soon as available; a convalescent specimen can be submitted when available.

Acute specimens should be collected with 5 days of initial onset of symptoms. The appropriate analysis RT-PCR for dengue virus. Convalescent specimens should be collected within 6 to 30 days of initial onset of symptoms and analyzed by ELISA for dengue IgM.

Centers for Disease Control & Prevention

Dengue Branch

1324 Cañada Street

San Juan, Puerto Rico 00920

Tel: (787) 706-2399; Fax (787) 706-2496

For More Information

Instructions for the preparing and delivering specimens for dengue testing to the CDC Dengue Branch is available at: www.cdc.gov/Dengue/resources/TestpolEng_2.pdf.

Additional information about dengue is available at: www.cdc.gov/dengue Call CDC's toll-free information line, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every day.

Delaware Health Alert Network #231

Delaware Health Alert Update, June 8, 2010

Subject: Presumptive Case of Brucellosis in Delaware

Message:

On June 9, 2010, the Delaware Public Health (DPH) Laboratory confirmed brucellosis by culture in a 58 year old, female, New Castle County resident. The patient had no history of recent travel, or contact with pets, farm animals or wildlife, and has been unemployed since 2008. The patient experienced similar symptoms following consumption of unpasteurized milk and cheese products one year ago and was treated at that time with a short course of antibiotics.

While person-to-person transmission is rare, humans can be infected by eating or drinking raw milk and cheese made with unpasteurized dairy products. They can also be exposed to bacteria through skin wounds when hunting or working in slaughterhouses, meat packing plants, and poultry plants.

About Brucellosis

· Brucellosis is a bacterial disease transmitted from animals to humans. Approximately 100 to 200 human cases are reported annually in the United States. If aerosolized, brucellosis has the potential for use as an agent of bioterrorism.

· Transmission occurs through direct contact with infected mammals (commonly through abrasions of the skin). In the United States, transmission occurs more frequently by ingesting unpasteurized milk or dairy products. Transmission may occur through inhalation of aerosols, and while handling cultures in laboratory settings. There is no evidence of person-to-person transmission. Brucellosis is most often seen in farmers, ranchers, veterinarians, and others who work directly with animals. Employees in certain types of laboratories, slaughterhouses and meat inspectors may also be infected. Sporadic cases and outbreaks occur among consumers of unpasteurized milk and milk products, especially soft cheeses.

· The incubation period is variable, ranging from 5-60 days but may be several months.

· Symptoms may last for several days, months, or even a year or more if not adequately treated. The onset of the disease can be acute or insidious and include fever, night sweats, headache, weakness, sweating, arthralgia, myalgias, weight loss and anorexia. Physical findings include lymphadenopathy, splenomegaly, hepatomegaly, and occasionally arthritis. Complications of brucellosis include meningitis, endocarditis, and osteomyelitis.

· Laboratory criteria for diagnosis: Isolation of Brucella species from a clinical specimen; or fourfold or greater rise in Brucella agglutination titer between acute and convalescent phase serum specimens obtained >2 weeks apart and studied at the same laboratory; or demonstration by immunofluorescence of Brucella species in a clinical specimen.

· Prolonged antibiotic treatment for at least 6 weeks is necessary to achieve a cure. Combination therapy (2 antibiotics) is recommended. Monotherapy is associated with a high rate of relapse. Doxycycline and rifampicin are the treatments of choice.

For More Information:

· CDC website at: www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_g.htm

· DPH, Bureau of Epidemiology: (302) 744-1033 or 1-888-295-5156

Delaware Cancer Registry Website

Updates were recently posted to the DE Cancer Registry website and can be found at the following link: http://www.dhss.delaware.gov/dhss/dph/dcr/home.html 1-14-2010
The DCR website has a new section entitled "Memos to Cancer Reporters"- Click Here For More Information
Neoplasms that are currently reportable to the Delaware Division of Public Health, please check the link for further information: State of Delaware’s Cancer Prevention and Control Program
Click here to go to The Delaware Cancer Registry

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