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Archive for September, 2006

E.Coli Spinach Info

Dear HAN Subscriber:

We have just released a DOHMH Alert concerning E. coli O157:H7 Infections Associated with Bagged, Fresh Spinach in Multiple States. It is available on the HAN home page , is appended to this email, and is also attached as a pdf file. To read the attachment, you will need the Adobe reader. If you do not have that software, it can be downloaded at no cost at http://www.adobe.com/products/acrobat/readstep2.html.

To log into the HAN, for this alert and many related documents, go to www.nyc.gov/health/nycmed

If you have any questions or problems, call 1-888-NYCMED9 or write to nycmed@health.nyc.gov

2006 Alert # 37
E. coli O157:H7 Infections Associated with Bagged, Fresh Spinach in Multiple States

. As of this morning, 50 E. coli O157:H7 cases had been reported in 8 states; all isolates demonstrate an indistinguishable PFGE pattern. Preliminary epidemiologic findings suggest that prepackaged, fresh spinach is the likely source of illness.
. Healthcare providers should specifically request testing for Shiga toxin producing E. coli (STEC) in patients being evaluated for bloody diarrhea or hemolytic uremic syndrome (HUS)
. Immediately report all suspected and confirmed cases of STEC infection or HUS to the New York City Department of Health and Mental Hygiene (DOHMH)
. Send culture confirmed STEC (including E. coli O157:H7) isolates to the Public Health Laboratory (PHL) for confirmation, serotyping, and pulsed-field gel electrophoresis (PFGE)
o Timely submission of STEC specimens is crucial to facilitate prompt recognition and investigation of potential outbreaks of E. coli O157:H7
o Laboratories should send original stool specimens (or broths) to PHL when patients are shiga toxin positive, even in the absence of culture confirmation

September 15, 2006

Dear Colleagues,

State and local public health officials in the United States and the Centers for Disease Control and Prevention (CDC) are investigating a large outbreak of E. coli O157:H7 infections. As of this morning, 50 cases with isolates demonstrating an indistinguishable PFGE pattern in CT, ID, IN, MI, OR, NM, UT, and WI have been reported. Of these, 8 patients developed HUS and one patient died. Of those with known illness onsets, onset dates ranged from August 25 to September 3, 2006. Preliminary case interviews indicate that prepackaged spinach is the likely source of illness. Additional investigation is ongoing to determine the specific brand(s) of prepackaged spinach involved and the geographic extent of the outbreak. Until the definite source of the outbreak is identified, given the severity of STEC and HUS illness, the Food and Drug Administration is advising persons to not eat any brands of bagged fresh spinach at this time.

Since August 1st, the NYC Department of Health and Mental Hygiene (DOHMH) has investigated 8 cases of STEC infection and 2 cases of Hemolytic Uremic Syndrome (HUS) in New York City residents. Although one of the cases had an isolate that matches the outbreak strain, this patient denied eating pre-packaged spinach. None of the other 7 E. coli O157:H7 isolates obtained from STEC/HUS cases in NYC matched the outbreak strain.

The E. coli O157:H7 bacterium causes diarrhea that is often bloody and accompanied by abdominal cramps, but fever is absent or mild. The illness typically resolves within a week. However, some patients, especially young children and the elderly, may develop HUS. HUS is characterized by the acute onset of microangiopathic hemolytic anemia, renal injury, and low platelet count. Treatment is supportive; anti-diarrheal medications and antibiotics are not recommended as both have been associated with adverse outcomes.

DOHMH advises healthcare providers to specifically request testing for STEC (including E coli O157:H7) in individuals, especially children, who present with bloody diarrhea, hemolytic anemia, or renal failure. E. coli O157:H7 is not detected by standard methods used for other common bacterial enteric pathogens. The medium of choice for isolation is sorbitol-MacConkey (SMAC) agar. Laboratories should attempt to isolate E. coli O157:H7 in addition to standard testing for detection of Shiga-toxin producing bacteria.
In order to completely investigate these reports it is necessary for all culture confirmed STEC (including E. coli O157:H7) isolates to be forwarded to the Public Health Laboratory (PHL) for confirmation, serotyping, and pulsed-field gel electrophoresis (PFGE). As laboratories are increasingly using non-culture based methods (e.g., rapid diagnostic tests for shiga toxin production), laboratories should send original stool specimens (or broths) to PHL when a patient is Shiga toxin positive and either culture negative or no culture test was done. Specimens that are both shiga toxin negative and culture negative do not need to be forwarded.

All STEC isolates should be forwarded to NYC DOHMH’s Public Health Laboratory (PHL) for confirmation, serotyping, and PFGE. Labs which are only performing rapid diagnostic testing to determine shiga toxin production should forward all original stool specimens or broths to PHL for culture. Please forward cultures and specimens to:
Lillian Lee MS, SM (NRM-ASCP), Chief of Microbiology Services
Public Health Laboratory, Rm 136
455 First Ave
New York, NY 10016
(212) 447-6970

All laboratory positive STEC cases and any suspected cases of HUS should be reported immediately, to help us identify outbreak-associated cases. Please contact us as follows:

During business hours: Bureau of Communicable Disease at (212) 788-9830. After hours: Poison Control Center at 800-222-1222.

As always, we appreciate your continued assistance in addressing emerging disease issues.

Sincerely,
Vasudha Reddy, MPH Marcelle Layton, MD
Vasudha Reddy, MPH Marcelle Layton, MD
Bureau of Communicable Disease Bureau of Communicable Disease

Written by phil

September 18th, 2006 at 7:03 pm

Posted in ID

Plaster Traps

Plaster traps have been installed in: the resus room sink by bed D, the pediatric treatment room, and the ortho room in UC.

Please use these sinks for your plaster needs, and avoid plaster in all other sinks.

(For those of you that don’t know- plaster builds up in plumbing and eventually causes high grade obstruction in sinks. Plaster traps solve this problem.)

Written by phil

September 7th, 2006 at 4:07 pm

Posted in Ortho