Global & Disaster Medicine

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CDC has now confirmed 132 cases in 32 states tied to the use of kratom, an herbal alternative to opioids.

CDC

What’s New?

  • Forty-five more ill people from 19 states were added to this investigation since the last update on March 15, 2018.
  • Three additional states have reported ill people: Connecticut, Iowa, and Idaho.

 

Highlights

  • At this time, CDC recommends that people not consume any brand of kratom in any form because it could be contaminated with Salmonella.
    • Kratom products from several companies have been recalled because they might be contaminated with Salmonella. The list of recalled kratom products is available on the U.S. Food and Drug Administration website.
    • Kratom is also known as Thang, Kakuam, Thom, Ketom, and Biak.
    • Kratom is a plant consumed for its stimulant effects and as an opioid substitute.
  • CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Salmonella infections.
  • Epidemiologic and laboratory evidence indicates that kratom is the likely source of this multistate outbreak.
    • No common brands or suppliers of kratom products have been identified at this time.
    • Because no common source of Salmonella-contaminated kratom has been identified, CDC is recommending against consuming any kratom.
  • A total of 132 people infected with outbreak strains of Salmonella I 4,[5],12:b:- (61), Salmonella Javiana (15), Salmonella Okatie (21), or Salmonella Thompson (35) have been reported from 38 states.
    • Forty percent of ill people have been hospitalized, and no deaths have been reported.
  • This investigation is ongoing. CDC will provide updates when more information is available.

People infected with the outbreak strains of Salmonella, by state of residence, as of April 5, 2018


A multistate Salmonella outbreak linked to kratom supplements has sickened 47 more people and expanded to 8 more states, raising the total to 87 cases from 35 states,

CDC

At A Glance

  • Case Count: 87
  • States: 35
  • Deaths: 0
  • Hospitalizations: 27
  • Recall: Yes

People infected with the outbreak strain of Salmonella, by state of residence, as of March 14, 2018


Multistate Outbreak of Salmonella I 4,[5],12:b:- Infections Linked to Kratom

CDC

  • Case Count: 40
  • States: 27
  • Deaths: 0
  • Hospitalizations: 14

People infected with the outbreak strain of Salmonella I 4,[5],12:b:-, by state of residence, as of February 28, 2018

People infected with the outbreak strain of Salmonella I 4,[5],12:b:- by date of illness onset as of February 28, 2018*


CDC is dramatically downsizing its epidemic prevention activities in 39 out of 49 countries because money is running out

Washington Post

“…..The CDC plans to narrow its focus to 10 “priority countries,” starting in October 2019, the official said. They are India, Thailand and Vietnam in Asia; Jordan in the Middle East; Kenya, Uganda, Liberia, Nigeria and Senegal in Africa; and Guatemala in Central America.

Countries where the CDC is planning to scale back include some of the world’s hot spots for emerging infectious disease, such as China, Pakistan, Haiti, Rwanda and Congo……”

 


CDC plans to scale back or discontinue its work to prevent infectious-disease epidemics and other health threats in 39 foreign countries because it expects funding for the work to end

WSJ

“….The CDC currently works in 49 countries as part of an initiative called the global health security agenda, to prevent, detect and respond to dangerous infectious disease threats. It helps expand surveillance for new viruses and​ ​drug-resistant bacteria, modernize laboratories to detect dangerous pathogens​and train workers who respond to epidemics.The package included $582 million in funds to work with countries around the world after the Ebola crisis in 2014 and 2015. But that funding runs out at the end of fiscal 2019……..[T]he CDC said it anticipates that if its funding situation remains the same, it will have to narrow activities to 10 “priority countries” starting in October 2019……..

 

The 10 countries where global health security activities will remain are India, Thailand, Vietnam, Kenya, Uganda, Liberia, Nigeria, Senegal, Jordan and Guatemala, according to the email—countries of strategic or regional importance for the CDC….”

 


January 7-13: Folic Acid Awareness week

CDC

Facts About Folic Acid

Woman reading nutritional information on a cereal box. Nutrition label highlighting 100% Folic Acid.

CDC urges women to take 400 mcg of folic acid every day, starting at least one month before getting pregnant, to help prevent major birth defects of the baby’s brain and spine.

About folic acid

Folic acid is a B vitamin. Our bodies use it to make new cells. Everyone needs folic acid.

Why folic acid is so important

Folic acid is very important because it can help prevent some major birth defects(https://www.cdc.gov/ncbddd/birthdefects/index.html) of the baby’s brain and spine (anencephaly(https://www.cdc.gov/ncbddd/birthdefects/anencephaly.html) and spina bifida(https://www.cdc.gov/ncbddd/spinabifida)).

How much folic acid a woman needs

400 micrograms (mcg) every day.

<div class=”noscript”><a href=”//www.youtube-nocookie.com/embed/kPtCoBSmisE?autohide=0&enablejsapi=1&playerapiid=41053&modestbranding=1&rel=0&origin=https://www.cdc.gov&famp;wmode=opaque” target=”_blank”>Folic Acid and You: Your Healthy Pregnancy</a></div>

When to start taking folic acid

For folic acid to help prevent some major birth defects, a woman needs to start taking it at least one month before she becomes pregnant and while she is pregnant.

Every woman needs folic acid every day, whether she’s planning to get pregnant or not, for the healthy new cells the body makes daily. Think about the skin, hair, and nails. These – and other parts of the body – make new cells each day.

How a woman can get enough folic acid

There are two easy ways to be sure to get enough folic acid each day:

  1. Take a vitamin that has folic acid in it every day.
    1. Most multivitamins sold in the United States have the amount of folic acid women need each day. Women can also choose to take a small pill (supplement) that has only folic acid in it each day.
    2. Multivitamins and folic acid pills can be found at most local pharmacy, grocery, or discount stores. Check the label to be sure it contains 100% of the daily value (DV) of folic acid, which is 400 micrograms (mcg).
  2. Eat a bowl of breakfast cereal that has 100% of the daily value of folic acid every day.
    1. Not every cereal has this amount. Check the label on the side of the box, and look for one that has “100%” next to folic acid.

CDC :: Anatomy of an Outbreak: A Disease Threat Anywhere is a Threat Everywhere.

Today’s world is more connected than ever. In as little as 36 hours1, a pathogen from a remote village can spread to all major cities in six continents. That is why it is critical to detect, report and respond to outbreaks in a timely manner.

NATOMY OF AN OUTBREAK

A Disease Threat Anywhere is a Threat Everywhere.

Today’s world is more connected than ever. In as little as  36 hours1, a pathogen from a remote village can spread to all major cities in six continents. That is why it is critical to detect, report and respond to outbreaks in a timely manner.

  1. Incident Occurs

A new or existing pathogen is introduced to a community and starts to spread.

Humans or animals start to feel ill or even die with similar symptoms.

CDC performs 24/7 global disease monitoring to identify potential incidents.

 

  1. Outbreak Suspected

An outbreak is suspected. There are several ways to detect and verify  a disease through reported cases or from event information.

Local clinics and hospitals see more people with symptoms such as fever, persistent diarrhea, cough and unexplained bleeding.

Laboratory confirms cases of disease found at local clinic.

Disease detective and surveillance teams capture and organize information about events that are a potential risk.

Teams monitor official and unofficial reports of potential disease events from a wide variety of sources including media, rumors, blogs, community members, etc.

CDC works with partners and Ministries of Health to find potential  outbreaks through routine reporting of symptoms, lab test  results and official and unofficial reports.

 

  1. Investigation Started

Countries conduct lab tests or send specimens for testing.

CDC trains countries how to test, handle and safeguard samples.

Disease detectives investigate to determine the source and size of the outbreak.

CDC trains disease detectives around the world to stop the outbreak at the source.

Lab results confirm if patients test positive or negative for illness.

Health authorities are alerted.

 

  1. Reporting

Authorities report disease outbreak to appropriate national and international organizations in accordance with the International Health Regulations.

 

  1. Global Response Initiated

CDC’s global rapid responders are deployed when a country requests additional support to:

Implement infection prevention and control measures and distribute medical countermeasures

Conduct public health communication and education

Enhance local surveillance systems to track outbreaks

Improve local lab testing for faster diagnosis

CDC is at the frontline of disease detection and response, working 24/7  to protect the health, safety, and security of American people. CDC’s work

ensures that outbreaks are contained before they can spread and reach the U.S.

 

  1. Jonas, Olga B.. 2013. Pandemic Risk. World Bank, Washington, DC. © World Bank. https://openknowledge.worldbank.org/handle/10986/16343 License: CC BY 3.0 IGO.

This is a snapshot of an outbreak investigation and does not reflect all the steps that may occur. Information presented in this example depicts a prompt outbreak identification. Several factors affect the investigation and can prolong the timing and results. Delays in response activities can lead to outbreaks spreading quickly and spillover to other communities.


CDC: During week 51 (December 17-23, 2017), influenza activity increased sharply in the United States.

CDC

During week 51 (December 17-23, 2017), influenza activity increased sharply in the United States.

  • Viral Surveillance: The most frequently identified influenza virus subtype reported by public health laboratories during week 51 was influenza A(H3). The percentage of respiratory specimens testing positive for influenza in clinical laboratories increased.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
  • Influenza-associated Pediatric Deaths: Three influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate of 8.7 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance:The proportion of outpatient visits for influenza-like illness (ILI) was 5.0%, which is above the national baseline of 2.2%. All 10 regions reported ILI at or above region-specific baseline levels. Twenty-one states experienced high ILI activity; New York City and five states experienced moderate ILI activity; eight states experienced low ILI activity; 14 states experienced minimal ILI activity; and the District of Columbia, Puerto Rico and two states had insufficient data.
  • Geographic Spread of Influenza:The geographic spread of influenza in 36 states was reported as widespread; Puerto Rico and 13 states reported regional activity; one state reported local activity; and the District of Columbia, the U.S. Virgin Islands, and Guam did not report.

INFLUENZA Virus Isolated

Click on image to launch interactive tool

Click on graph to launch interactive tool

national levels of ILI and ARI

 

 


CDC on hepatitis

CDC

Viral hepatitis is the term that describes inflammation of the liver that is caused by a virus. There are actually five types of hepatitis viruses; each one is named after a letter in the alphabet: A, B, C, D and E.

The most common types of viral hepatitis are A, B and C. These three viruses affect millions of people worldwide, causing both short-term illness and long-term liver disease. The World Health Organization estimates 325 million people worldwide are living with chronic hepatitis B or chronic hepatitis C. In 2015, 1.34 million died from viral hepatitis, a number that is almost equal to the number of deaths caused by tuberculosis and HIV combined.

Hepatitis B and hepatitis C are the most common types of viral hepatitis in the United States, and can cause serious health problems, including liver failure and liver cancer. In the U.S., an estimated 3.5 million people are living with hepatitis C in the US and an estimated 850,000 are living with Hepatitis B. Unfortunately, new liver cancer cases and deaths are on the rise in the United States. This increase is believed to be related to infection with hepatitis B or hepatitis C.

Many people are unaware that they have been infected with hepatitis B and hepatitis C, because many people do not have symptoms or feel sick. CDC developed an online Hepatitis Risk Assessment to help determine if you should get tested or vaccinated for viral hepatitis. The assessment takes only five minutes and will provide personalized testing and vaccination recommendations for hepatitis A, hepatitis B, and hepatitis C.

Hepatitis A

Hepatitis A is a short-term disease caused by infection with the hepatitis A virus. Hepatitis A is usually spread when a person ingests the virus from contact with objects, food, or drinks contaminated by solid waste from an infected person. Hepatitis A was once very common in the United States, but now less than 3,000 cases are estimated to occur every year. Hepatitis A does not lead to liver cancer and most people who get infected recover over time with no lasting effects. However, the disease can be fatal for people in poor health or with certain medical conditions.

Hepatitis A is easily prevented with a safe and effective vaccine, which is believed to have caused the dramatic decline in new cases in recent years. The vaccine is recommended for all children at one year of age and for adults who may be at risk, including people traveling to certain international countries.

Hepatitis B

Hepatitis B is a liver disease that results after infection with the hepatitis B virus. Hepatitis B is common in many parts of the world, including Asia, the Pacific Islands and Africa. Like Hepatitis A, Hepatitis B is also preventable with a vaccine. The hepatitis B virus can be passed from an infected woman to her baby at birth, if her baby does not receive the hepatitis B vaccine. As a result, the hepatitis B vaccine is recommended for all infants at birth.

Unfortunately, many people got infected with hepatitis B before the vaccine was widely available. This is why CDC recommends anyone born in areas where hepatitis B is common, or who have parents who were born in these regions, get tested for hepatitis B. Treatments are available that can delay or reduce the risk of developing liver cancer.

Hepatitis C

Hepatitis C is a liver disease that results from infection with the hepatitis C virus. For reasons that are not entirely understood, people born from 1945 to 1965 are five times more likely to have hepatitis C than other age groups. In the past, hepatitis C was spread through blood transfusions and organ transplants. However, widespread screening of the blood supply in the United States began in 1990.The hepatitis C virus was virtually eliminated from the blood supply by 1992. Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment to inject drugs. In fact, rates of new infections have been on the rise since 2010 in young people who inject drugs.

There is currently no vaccine to prevent hepatitis C. Fortunately, new treatments offer a cure for most people. Once diagnosed, most people with hepatitis C can be cured in just 8 to 12 weeks, which reduces their risk for liver cancer.

Find out if you should get tested or vaccinated for viral hepatitis by taking CDC’s quick online Hepatitis Risk Assessment.

For more information visit www.cdc.gov/hepatitis.

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Everyone Needs Somewhere to Go: World Toilet Day (11/19/17)

CDC

We use toilets every day – at home, school, and work – yet 40% of the world’s population does not have this luxury.  Clean and safe toilets are more than just a place to use the restroom.  They are essential for health, human dignity, and improved education.  Sadly, 2.3 billion people lack even a basic sanitation service, which in many ways represents an ongoing public health crisis that puts much of the world’s population at risk for diseases such as cholera, dysentery, hepatitis, and typhoid fever. Almost 1 billion face the indignity every day of defecating outside without privacy. The 2015 Sustainable Development Goals include a target to ensure universal access to adequate and equitable sanitation and use of safely managed sanitation services by 2030, making sanitation a global development priority. To raise awareness of this issue, the United Nations General Assembly designated November 19 as World Toilet Day.

The Center for Global Health’s Emergency Response and Recovery Branch (ERRB), with support from the National Center for Emerging and Zoonotic Infectious Diseases’ Waterborne Disease Prevention Branch (WDPB), joined the United Nations and other development partners to reach the Sustainable Development Goal by evaluating the safety and acceptability of urine-diverting dry toilets (UDDTs).  These types of toilets collect feces (poop) and urine separately for treatment, and because they are installed above ground, they are appropriate for areas where traditional options (e.g., dug pit latrines) are not feasible. This increases the potential for access to clean and safe toilets in difficult environments, such as flood-prone or dry areas.

In 2014, CDC was awarded a grant from Research for Health in Humanitarian Crises (R2HC), an organization working to improve health outcomes by strengthening the evidence for health interventions in humanitarian crises. This grant funds a study of UDDTs in a refugee camp setting to provide guidance on their potential use in humanitarian crises.

Sanivation’s waste processing system in action – a full-scale operational and portable manufacturing plant for treating feces with solar thermal energy and manufacturing charcoal briquettes from them.
Sanivation’s waste processing system in action – a full-scale operational and portable manufacturing plant for treating feces with solar thermal energy and manufacturing charcoal briquettes from them. (Photo courtesy of Eric Mintz, CDC)

WDPB is also involved in efforts to improve sanitation by partnering with a start-up company, Sanivation, to provide in-home container-based urine-diverting toilets to households and to collect and turn the feces into fuel.  In 2013, Sanivation received a CDC Innovation Fund Award to begin this waste-to-fuel conversion project in Kenya.  Sanivation uses concentrated solar heat to treat the waste and make it safe; then the mix the treated waste with charcoal dust from agricultural waste and transform it into briquettes that widely used for cooking.  This method of waste treatment has worked in refugee camp settings and provides a cost-effective and environmentally friendly way to reuse human waste. The project has been so successful, that in 2017, Sanivation received a special CDC Innovation Fund Award to scale-up their waste collection and treatment activities beyond its household subscribers. This new award will enable Sanivation to collect and treat waste from overflowing latrines, leaking septic tanks and other unsafely managed sanitation systems throughout the community, and to expand from one ton of waste collected and treated per month to over four tons. Ultimately, Sanivation plans to expand to other regions of East Africa with the goal of serving over 1 million people by 2020.

Through these efforts, CDC is working to increase the evidence base needed to provide clean and safe toilets and safely managed sanitation services in developing countries with limited resources. CDC’s efforts to improve sanitation are part of a worldwide initiative to break the silence surrounding the sanitation crisis.

To learn more about CDC efforts and other current sanitation initiatives visit:


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