MENINGITIS AND SEPTIC ARTHRITIS

FROM: U.S. CENTERS FOR DISEASE CONTROL,

Case Definitions for Meningitis and Septic Arthritis

Probable Case
A person who received a methylprednisolone acetate (MPA) injection, with MPA that was definitely or likely produced by the New England Compounding Center (NECC), and subsequently developed any of the following
<sup>Meningitis1 of unknown etiology following epidural or para-spinal injection 2 after May 21, 2012;
Posterior circulation stroke without a cardioembolic source and without documentation of a normal cerebrospinal fluid (CSF) profile, following epidural or para-spinal injection2 after May 21, 2012;3
Osteomyelitis or abscess of unknown etiology in the spinal or para-spinal structures at the site of injection following epidural or para-spinal injection2 after May 21, 2012; or
Osteomyelitis or worsening inflammatory arthritis of a peripheral joint (e.g., knee, shoulder, or ankle) of unknown etiology diagnosed following joint injection after May 21, 2012.
1 Clinically diagnosed meningitis with one or more of the following symptoms: headache, fever, stiff neck, or photophobia, in addition to a CSF profile showing pleocytosis (>5 white blood cells, adjusting for presence of red blood cells by subtracting 1 white blood cell for every 500 red blood cells present) regardless of glucose or protein levels.

2 Para-spinal injections include, but are not limited to, spinal facet joint injection, sacroiliac joint injection, spinal or para-spinal nerve root/ganglion block, or blood patch.

3 Patients in this category who do not have any documented CSF results should have a lumbar puncture performed if possible.

Confirmed Case
A probable case with evidence (by culture, histopathology, or molecular assay) of a fungal pathogen associated with the clinical syndrome.

Post-ProceduralIinfection in Patients Exposed to Non-MPA NECC Products
A patient who developed an infection in a normally sterile site4 following use of one or more products labeled as sterile and prepared by NECC, excluding MPA.

4 Normally sterile sites include blood, CSF, pleural fluid, peritoneal fluid, pericardial fluid, surgical aspirate, bone, joint fluid, or internal body site (e.g., lymph node or brain).


　


　

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SCREENING FOR CONGENITAL HEART DEFECTS IN NEWBORNS

Photo Credit:  CDC
FROM: U.S. CENTERS FOR DISEASE CONTROL

Preventing Infant Deaths from Congenital Heart Defects
Kristine Brite McCormick had a healthy pregnancy and gave birth to her daughter, Cora, on November 30, 2009. Kristine and her husband soon brought baby Cora home, after getting a clean bill of health at the hospital. A few days after arriving home, Kristine was feeding Cora when the baby suddenly stopped breathing. Kristine and her husband rushed Cora to the hospital in minutes, but it was too late. Cora was gone. "We learned that she had an undetected congenital heart defect from the coroner," said Kristine. "Neither of us had ever even heard the term."

In the United States, every 15 minutes a baby is born with a congenital heart defect, the most common type of birth defect in this country.

After Cora’s death, her parents learned about newborn screening for critical congenital heart defects (CCHDs) using pulse oximetry. CCHDs are congenital heart defects that require surgery or intervention in the first year of life. Pulse oximetry is a simple bedside test to determine the amount of oxygen in a baby’s blood and the baby’s pulse rate. The test is done using a machine called a pulse oximeter, with sensors placed on the baby’s skin. The test is painless and takes only a few minutes. Low levels of oxygen in the blood can be the first sign of a CCHD. Cora’s mother Kristine wants to make sure that other parents know about newborn screening for CCHDs. In Indiana, where the McCormicks live, a new law requiring newborn screening for CCHDs is known as Cora’s Law, after Cora McCormick.

Congenital heart defects account for 24 percent of infant deaths due to birth defects. Like Cora, babies born with a CCHD can appear healthy at first and be sent home with their families before their condition is detected. These babies are at risk for serious complications and death within the first few days or weeks of life and often require prolonged hospitalizations and emergency care.

Newborn screening for CCHDs can identify some babies with these conditions before they show signs of illness. Once identified, these babies can be seen by pediatric cardiologists and can receive specialized care and treatment. Treatment can include medications and surgery. Detecting and treating CCHDs soon after birth can help to prevent death and disability early in life and can potentially improve the long-term health of individuals with these conditions.

In September 2011, U.S. Department of Health and Human Services Secretary Kathleen Sebelius approved adding CCHDs to the recommended list of conditions that are included in newborn screening. As newborn screening for CCHDs is implemented throughout the United States, the Centers for Disease Control and Prevention (CDC) will play an important role in helping the public understand the effectiveness of such screening. The National Center on Birth Defects and Developmental Disabilities (NCBDDD) at CDC is helping assess how well screening programs are detecting CCHDs. NCBDDD also is researching the costs associated with CCHD screening. These activities will help states make decisions about adding these conditions to their existing newborn screening programs and will provide information that will be helpful for states with new or proposed CCHD screening programs.

"While we’ll never know for sure if it would have made a difference for Cora, we sure wish she’d had the simple screening. I hope for a day when no mother finds out about her child’s heart defect from the coroner," Kristine said. "My ultimate hope is that one day no baby is born with a broken heart and that congenital heart defects are prevented in every pregnancy."

CDC WORKS TO HELP AMERICANS CONTROL THEIR BLOOD PRESSURE

FROM: U.S. CENTERS FOR DISEASE CONTROL
Million Hearts Launches New Educational Program to Improve Americans' Blood Pressure Control

Team Up. Pressure Down. encourages pharmacist-patient engagement
Customers at drugstores around the nation can get help to improve blood pressure control, through a collaboration among pharmacists, the U.S. Department of Health and Human Services, and other partners. The program, "Team Up. Pressure Down.," includes educational videos, a blood pressure control journal, and wallet card to track medication use.

The blood pressure initiative, part of the Million Hearts health education program and supported by the Affordable Care Act, was developed by the Centers for Disease Control and Prevention with practicing pharmacists and national pharmacist groups. The initiative’s tools will help pharmacists talk about current medications and ways in which patients can use the medications most effectively. The goal of Million Hearts is to prevent 1 million heart attacks and strokes by 2017.

"This valuable Million Hearts initiative will prevent heart attacks and strokes by bringing pharmacists into the care team to help patients control their blood pressure. Pharmacists are able to talk to patients and families about using medication to manage, high blood pressure, and they can also help patients address barriers to taking their medication," said Surgeon General, Regina M. Benjamin, MD.

In May, the Community Preventive Services Task Force, an independent, nonfederal, uncompensated body of public health and prevention experts, whose members are appointed by the Director of CDC, recommended team-based care—uniting the efforts of physicians, pharmacists, nurses, and other health care professionals—to improve blood pressure control. Its recommendation followed a review of evidence from more than 70 scientific publications.

"More than 36 million Americans, or more than half of those with hypertension, don’t have their blood pressure under control and every single day, more than one thousand Americans have a heart attack or stroke," said Janet Wright, M.D., a board-certified cardiologist and executive director of Million Hearts. "Through the ``Team Up. Pressure Down.’’ educational program for pharmacists, we are taking the first step in helping many more Americans achieve blood pressure control."

"Our organization trains the next wave of young pharmacists who are committed to making a difference in patients’ lives," said William Lang, M.P.H., vice president for policy and advocacy, American Association of Colleges of Pharmacy. "`Team Up. Pressure Down.’ recognizes and supports the critical role of pharmacists in improving blood pressure control through team-based care."

"`The Team Up. Pressure Down’. program will help pharmacists in any setting talk to their patients about the importance of staying on blood pressure medications and coach them on how to control hypertension," said Carolyn C. Ha, Pharm.D., director, professional affairs, National Community Pharmacists Association.

The materials can be tailored for any pharmacy setting. Continuing pharmacy education credit is available for pharmacists who participate.

Practicing pharmacists, pharmacist groups, and consumer groups actively participated in the development of the program over the past year. Contributing organizations included Academy of Managed Care Pharmacy, American Association of Colleges of Pharmacy, American College of Clinical Pharmacy, American Heart Association, American Pharmacist Association Foundation, Blue Ridge Mountain Group, Cardinal Health, Center for Medicare & Medicaid Services Innovation Center, Community Pharmacy Foundation, Compliant Pharmacy Alliance, Creative Pharmacist Healthy Heart Club, Indian Health Service, National Alliance of State Pharmacy Associations, National Association of Drug Store Chains, National Community Pharmacists Association, National Consumer League, Pharmacy Quality Alliance, PharmaSmart, University of Iowa School of Pharmacy, University of Maryland School of Pharmacy, USPHS/Pharmacist Professional Advisory Committee, WomenHeart.

For more information on public and private support for Million Hearts visit: http://millionhearts.hhs.gov/partners.shtmlHYPERLINK "http://www.cdc.gov/Other/disclaimer.html".

WATCH OUT FOR TURTLES

FROM: U.S. CENTERS FOR DISEASE CONTROL

Digital Press Kit

Multistate Outbreaks of Human Salmonella Infections Linked to Small Turtles

Contact with reptiles (such as turtles, snakes, and lizards) and amphibians (such as frogs and toads) can be a source of human Salmonella infections. Salmonella germs are shed in the droppings of reptiles and amphibians and can easily contaminate their bodies and the water in tanks or aquariums where these animals live, which can spread to people.

The Food and Drug Administration (FDA) has banned the sale and distribution of turtles with a shell length of less than 4 inches since 1975. However, small turtles continue to cause human Salmonella infections, especially among young children.

CDC is collaborating with public health officials in multiple states and the FDA to investigate 6 overlapping, multistate outbreaks of human Salmonella infections linked to exposure to turtles or their environments (e.g., water from a turtle habitat). More than 160 illnesses have been reported from 30 states; 64 percent of ill persons are children age 10 or younger, and 27 percent of ill persons are children age one year or younger. Fifty-six percent of ill persons are Hispanic.

Key Messages
Don’t buy small turtles from street vendors, websites, pet stores, or other sources.
Keep reptiles out of homes with young children or people with weakened immune systems.
Reptiles should not be kept in child care centers, nursery schools, or other facilities with young children.
ALWAYS wash your hands thoroughly with soap and warm water immediately after touching a reptile or anything in the area where they live and roam. Use hand sanitizer if soap and water are not readily available. Adults should always supervise hand washing for young children.

CDC SAYS TOO MANY HAVE OUT OF CONTROL HIGH BLOOD PRESSURE

FROM: U.S. CENTERS FOR DISEASE CONTROL
High blood pressure is out of control for too many AmericansSerious health risk needs more attention at every healthcare visit

The majority of people with high blood pressure are being treated with medicine and have seen a doctor at least twice in the past year, yet their condition is still not under control, according to a new Vital Signs report from the Centers for Disease Control and Prevention. Millions more are either aware they have high blood pressure but aren’t getting treated with medicine or don’t even know they have it, the report says.

Nearly 1 in 3 American adults (67 million) has high blood pressure, and more than half
(36 million) don’t have it under control, according to the report.

"We have to roll up our sleeves and make blood pressure control a priority every day, with every patient, at every doctor’s visit," said CDC Director Thomas R. Frieden, M.D., M.P.H. "With increased focus and collaboration among patients, health care providers and health care systems, we can help 10 million Americans’ blood pressure come into control in the next five years."

High blood pressure is a major risk factor for heart disease and stroke, the first and fourth leading causes of death in the United States, leading to nearly 1,000 deaths a day.

High blood pressure is defined as blood pressure greater than or equal to 140/90 mm- Hg. High blood pressure’s direct health care cost is almost $131 billion annually.

Pharmacists, nurses, dietitians, and community health workers can support doctors in identifying and treating patients with high blood pressure. This team-based approach is a way to provide patient support and follow-up care, manage medicines, and help patients stick to a blood pressure control plan. In addition, patients should be counseled to make important lifestyle changes that affect blood pressure, including eating a healthy, low sodium diet, exercising, maintaining a healthy weight and not smoking.

Key facts in the Vital Signs report about those affected:
About 67 million adults have high blood pressure.
More than half (36 million) have uncontrolled high blood pressure.
Nearly 22 million know they have high blood pressure, but don’t have it under control.
16 million take medicine, but still don’t have their blood pressure under control.

HEPATITIS C TESTING RECOMMENDATIONS

FROM: U.S. CENTERS FOR DISEASE CONTROL
PERCENT HEPATITIS C INFECTIONS BY AGE AND SEX

Digital Press Kit
Expanded Hepatitis C Testing Recommendations

To identify more hidden infections, provide prompt and appropriate care and treatment, and avoid tens of thousands of hepatitis C-related illnesses and deaths, CDC now recommends that all U.S. baby boomers get a one-time test for the hepatitis C virus.
Hepatitis C is an unrecognized health crisis in the United States. This life-threatening infection affects an estimated 3.2 million Americans, most of whom are "baby boomers" (those born from 1945 through 1965). One in 30 baby boomers has been infected with hepatitis C, and most don’t know it. Hepatitis C causes serious liver diseases, including liver cancer (the fastest-rising cause of cancer-related deaths) and is the leading cause of liver transplants in the United States.


More than 15,000 Americans, most of them baby boomers, die each year from hepatitis C-related illness, such as cirrhosis and liver cancer, and deaths have been increasing steadily for more than a decade and are projected to grow significantly in coming years.


CDC estimates one-time hepatitis C testing of baby boomers could identify more than 800,000 additional people with the virus. And with newly available therapies that can cure up to 75 percent of infections, expanded testing – along with linkage to appropriate care and treatment – would prevent the costly consequences of liver cancer and other chronic liver diseases and could save more than 120,000 lives.

MOST AMERICANS ARE WALKING ACCORDING TO THE CDC

FROM: U.S. CENTERS FOR DISEASE CONTROL
Six in 10 adults now get physically active by walking

Less than half get enough physical activity to improve their health

Sixty-two percent of adults say they walked for at least once for 10 minutes or more in the previous week in 2010, compared to 56 percent in 2005, according to a new Vital Signs report from the Centers for Disease Control and Prevention.

However, less than half (48 percent) of all adults get enough physical activity to improve their health, according to data from the National Health Interview Survey. For substantial health benefits, the CDC recommends at least 2 ½ hours per week of moderate-intensity aerobic physical activity, such as brisk walking. This activity should be done for at least 10 minutes at a time.

"More than 145 million adults are now getting some of their physical activity by walking," said CDC Director Thomas R. Frieden, M.D., M.P.H. "People who are physically active live longer and are at lower risk for heart disease, stroke, type 2 diabetes, depression and some cancers. Having more places for people to walk in our communities will help us continue to see increases in walking, the most popular form of physical activity among American adults."

The Vital Signs report notes that increases in walking were seen in nearly all groups surveyed. Walkers were defined as those who walked for at least one session of 10 minutes or more for transportation, fun or exercise. In the West, roughly 68 percent of people walk, more than any other region in the country. People living in the South had the largest increase in the percentage of people who walk, up by nearly 8 percentage points from about 49 percent in 2005 to 57 percent in 2010. The report also found that more adults with arthritis or hypertension are walking; there was no increase in walking among adults with type 2 diabetes.

"It is encouraging to see these increases in the number of adults who are now walking," said Joan M. Dorn, Ph.D., branch chief of the Physical Activity and Health Branch in CDC’s Division of Nutrition, Physical Activity and Obesity. "But there is still room for improvement. People need more safe and convenient places to walk. People walk more where they feel protected from traffic and safe from crime. Communities can be designed or improved to make it easier for people to walk to the places they need and want to go."

The report highlights ways to provide better spaces and more places for walking. These include:
State and local governments can consider joint use agreements to let community residents use local school tracks or gyms after classes have finished.
Employers can create walking paths around or near the work place and promote them with signs and route maps.
Citizens can participate in local planning efforts that identify best sites for walking paths and priorities for new sidewalks.

CDC SAYS 30% PRESCRIPTION PAINKILLER DEATHS INVOLVE METHADONE

FROM:  U.S. CENTERS FOR DISEASE CONTROL
Prescription Painkiller Overdoses
Use and Abuse of Methadone as a Painkiller
Prescription painkiller overdoses* were responsible for more than 15,500 deaths in 2009. While all prescription painkillers have contributed to an increase in overdose deaths over the last decade, methadone has played a central role in the epidemic. More than 30% of prescription painkiller deaths involve methadone, even though only 2% of painkiller prescriptions are for this drug. Six times as many people died of methadone overdoses in 2009 than a decade before.

Methadone has been used safely and effectively to treat drug addiction for decades. It has been prescribed increasingly as a painkiller because it is a generic drug that can provide long-lasting pain relief. But as methadone’s use for pain has increased, so has nonmedical use of the drug and the number of overdoses.

* "Prescription painkiller overdoses" refers to deaths from using harmful amounts of opioid or narcotic pain relievers, including drugs such as Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone.


Problem
Methadone use poses risks
Methadone is frequently prescribed for pain.
Methadone, like other painkillers, is commonly prescribed for chronic problems like back pain even though it might not help these problems in the long run.
More than 4 million methadone prescriptions were written for pain in 2009, despite US Food and Drug Administration warnings about the risks associated with methadone.
Methadone is available as a low-cost generic drug. It is often listed as a preferred drug by insurance companies.

Methadone's risks include:
The difference between appropriate prescribed doses and dangerous doses of methadone is small.
Methadone has special risks as a painkiller. For example, taking it more than 3 times a day can cause the drug to build up in a person’s body, leading to dangerously slowed breathing.
Methadone can seriously disrupt the heart’s rhythm.
Methadone can be particularly risky when used with tranquilizers or other prescription painkillers.
In one study, four in ten overdose deaths involving single prescription painkillers involved methadone, twice as many as any other prescription painkiller.


What Can Be Done

The US government is:
Enforcing federal laws to prevent nonmedical use of methadone.
Educating health care providers and consumers about the correct use of methadone.
Tracking prescription drug overdose trends and the impact of efforts to stop overdoses.

States can:
Develop and promote the use of safe prescribing guidelines for methadone.
Support the use of methadone as a treatment for opioid dependence in opioid treatment programs.
Use prescription drug monitoring programs to identify patients who are using methadone or other prescription painkillers for nonmedical purposes.

Health care providers can:
Follow guidelines for prescribing methadone and other prescription painkillers correctly, including
Screening and monitoring for substance abuse and mental health problems.
Prescribing only the quantity needed based on the expected length of pain.
Using prescription drug monitoring programs to identify patients who are misusing or abusing methadone or other prescription painkillers.
Monitor patients on high doses for heart rhythm problems.
Educating patients on how to safely use, store, and dispose of methadone and how to prevent and recognize overdoses.

Health insurers can:
Evaluate methadone’s place on preferred drug lists.
Consider strategies to ensure that pain treatment with any dose higher than 30 mg of methadone a day (the recommended maximum daily starting dose) is appropriate.

Individuals can:
Use methadone only as directed by a health care provider.
Make sure they are the only ones to use their methadone and never sell or share it with others.
Store methadone in a secure place and dispose of it properly. Seewww.cdc.gov/HomeandRecreationalSafety/Poisoning/preventiontips.htm for correct storage and disposal of medications.
Get help for substance abuse problems (1-800-662-HELP ).