Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears - Health Alert Network (HAN) No. 485

5 days 15 hours ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory about infections with an extensively drug-resistant strain of Verona Integron-mediated Metallo-β-lactamase (VIM) and Guiana-Extended Spectrum-β-Lactamase (GES)-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-GES-CRPA) in 12 states. Most patients reported using artificial tears. Patients reported more than 10 different brands of artificial tears, and some patients used multiple brands. The majority of patients who used artificial tears reported using EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles. CDC laboratory testing identified the presence of the outbreak strain in opened EzriCare bottles with different lot numbers collected from two states. Patients and healthcare providers should immediately discontinue using EzriCare artificial tears pending additional guidance from CDC and the Food and Drug Administration (FDA).

Increase in Pediatric Invasive Group A Streptococcal Infections - Health Alert Network (HAN) No. 484

1 month 2 weeks ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of a recent increase in pediatric invasive group A streptococcal (iGAS) infections. In November 2022, CDC was notified of a possible increase in iGAS infections among children at a hospital in Colorado. Potential increases in pediatric iGAS cases in other states were subsequently noted by contributors to the Infectious Diseases Society of America's provider-based Emerging Infections Network and by certain jurisdictions participating in CDC's Active Bacterial Core Surveillance System (ABCs). This increased number of pediatric iGAS cases in some jurisdictions has occurred in the setting of increased circulation of respiratory syncytial virus (RSV), influenza viruses, SARS-CoV-2, and other respiratory viruses. While the overall number of cases has remained relatively low and iGAS infections remain rare in children, CDC is investigating these reports.

Important Updates on COVID-19 Therapeutics for Treatment and Prevention - Health Alert Network (HAN) No. 483

1 month 2 weeks ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Update to supplement the CDC HAN Health Advisories issued on April 25, 2022 and May 24, 2022 to emphasize to healthcare providers, public health departments, and the public that the majority of Omicron sublineages circulating in the United States have reduced susceptibility to the monoclonal antibody, bebtelovimab and the monoclonal antibody combination, cilgavimab and tixagevimab (EvusheldTM). Antiviral therapeutics for the treatment of COVID-19, ritonavir-boosted nirmatrelvir (Paxlovid™), remdesivir (Veklury®), and molnupiravir (Lagevrio™), retain activity against currently circulating Omicron sublineages. These medications can prevent severe disease, hospitalization, and death and are widely available but have been underused. This HAN Health Update provides health care professionals, public health officials, and the public with guidance on improving use of therapeutics for treatment of COVID-19 and strategies to prevent serious outcomes of COVID-19.

Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir - Health Alert Network (HAN) No. 482

1 month 3 weeks ago
Seasonal influenza activity is high across the United States. The Centers for Disease Control and Prevention (CDC) estimates that in the 2022-2023 season to date, there have been at least 13 million illnesses, 120,000 hospitalizations, and 7,300 deaths from influenza (Weekly U.S. Influenza Surveillance Report | CDC). While the Food and Drug Administration (FDA) has not indicated shortages of oseltamivir (generic or Tamiflu) in any of its forms (capsules, oral suspension), CDC has received numerous anecdotal reports of availability issues for generic oseltamivir in some locations [1]. This may continue to occur in some communities as influenza activity continues. This Health Alert Network (HAN) Health Advisory provides clinicians and public health officials with guidance for prioritizing oseltamivir for treatment and information on other influenza antivirals that are recommended for treating influenza in areas where oseltamivir is temporarily unavailable.

Update on Managing Monkeypox in Patients Receiving Therapeutics - Health Alert Network (HAN) No. 481

2 months 2 weeks ago
Monkeypox cases have declined since mid-August 2022 in the United States; however, new cases-including clinically severe cases-continue to occur. While there are currently no treatments specifically approved for monkeypox, therapeutics developed for patients with smallpox have been deployed during the current outbreak. This Health Alert Network (HAN) Health Update provides clinicians and public health officials with new information about managing monkeypox in patients requiring therapeutics.

Update on Ebola Virus Disease (Sudan ebolavirus) Outbreak in Central Uganda - Health Alert Network (HAN) No. 480

3 months ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Update as a follow-up to a HAN Health Advisory (Outbreak of Ebola virus disease (Sudan ebolavirus) in Central Uganda) issued on October 6, 2022. This Health Update serves to inform public health departments, public health laboratories, and clinicians in the United States about the ongoing outbreak of Ebola virus disease (EVD) in Uganda caused by Sudan virus (species Sudan ebolavirus). No suspect or confirmed EVD cases related to this outbreak have been reported in the United States (U.S.) or other countries outside of Uganda to date. However, as a precaution because of increasing cases in Uganda, CDC is communicating with public health departments, public health laboratories, and healthcare workers in the United States to provide an update and raise awareness of this outbreak and the potential for importation of cases.

Increased Respiratory Virus Activity, Especially Among Children, Early in the 2022-2023 Fall and Winter - Health Alert Network (HAN) No. 479

3 months ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory about early, elevated respiratory disease incidence caused by multiple viruses occurring especially among children and placing strain on healthcare systems. Co-circulation of respiratory syncytial virus (RSV), influenza viruses, SARS-CoV-2, and others could place stress on healthcare systems this fall and winter. This early increase in disease incidence highlights the importance of optimizing respiratory virus prevention and treatment measures, including prompt vaccination and antiviral treatment, as outlined below.

Outbreaks of Nontuberculous Mycobacteria Infections Highlight Importance of Maintaining and Monitoring Dental Waterlines - Health Alert Network (HAN) No. 478

3 months ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to emphasize the importance of following existing recommendations for maintaining and monitoring dental waterlines. Multiple outbreaks of nontuberculous Mycobacteria (NTM) infections have occurred in children who received pulpotomies in pediatric dental clinics where the dental treatment water contained high levels of bacteria. CDC provides guidelines on infection control in dental settings which contain recommendations to treat dental unit waterlines and monitor water quality. Dental providers should be familiar with these recommendations on how to properly maintain and monitor their dental equipment to ensure that dental treatment water is safe for patient care.

Outbreak of Ebola virus disease (Sudan ebolavirus) in Central Uganda - Health Alert Network (HAN) No. 477

4 months ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory about a recently confirmed outbreak of Ebola virus disease (EVD) in Uganda caused by Sudan virus (species Sudan ebolavirus) to summarize CDC's recommendations for U.S. public health departments and clinicians, case identification and testing, and clinical laboratory biosafety considerations. No suspected, probable, or confirmed EVD cases related to this outbreak have yet been reported in the United States. However, as a precaution and to remind clinicians about best practices, CDC is communicating with public health departments, public health laboratories, and healthcare workers in the United States to raise awareness of this outbreak.

Hurricanes Fiona and Ian-Clinical Guidance for Carbon Monoxide (CO) Poisoning - Health Alert Network (HAN) No. 476

4 months ago
The Centers for Disease Control and Prevention (CDC) is reminding healthcare professionals seeing patients from areas affected by Hurricanes Fiona or Ian to maintain a high index of suspicion for carbon monoxide (CO) poisoning. Other people who may have been exposed to the same CO source may need to be identified and evaluated. The signs and symptoms of CO exposure are variable and nonspecific. A tension-type headache is the most common symptom of mild CO poisoning. Other common symptoms of CO poisoning are dizziness, weakness, drowsiness, upset stomach, vomiting, chest pain, and altered mental status (confusion). Clinical manifestations of severe CO poisoning include cardiovascular and neurological effects: tachycardia, tachypnea, hypotension, metabolic acidosis, dysrhythmias, myocardial ischemia or infarction, noncardiogenic pulmonary edema, irritability, impaired memory, cognitive and sensory disturbances, ataxia, altered or loss of consciousness, seizures, coma, and death, although any organ system might be involved. CO poisoning can be fatal for anyone. Children, pregnant people, babies and infants, persons with sickle cell disease, older adults, and persons with chronic illness (e.g., heart or lung disease) are at particularly high risk.

Severe Manifestations of Monkeypox among People who are Immunocompromised Due to HIV or Other Conditions - Health Alert Network (HAN) No. 475

4 months 1 week ago
The purpose of this Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN) Health Advisory is to inform healthcare providers that 1. Severe manifestations of monkeypox have been observed in the United States in the current outbreak. 2. People who are immunocompromised due to HIV or other conditions are at higher risk for severe manifestations of monkeypox than people who are immunocompetent. 3. Because people with HIV-associated immunocompromise are at risk for severe manifestations of monkeypox, the HIV status of all sexually active adults and adolescents with suspected or confirmed monkeypox should be determined. 4. There are diagnostic and clinical management strategies that may help address severe manifestations of monkeypox.

Severe Respiratory Illnesses Associated with Rhinoviruses and/or Enteroviruses Including EV-D68 - Multistate, 2022 - Health Alert Network (HAN) No. 474

4 months 3 weeks ago
Healthcare providers and hospitals in several regions of the United States notified the Centers for Disease Control and Prevention (CDC) during August 2022 about increases in pediatric hospitalizations in patients with severe respiratory illness who also tested positive for rhinovirus (RV) and/or enterovirus (EV). RVs and EVs can have clinically similar presentations and are indistinguishable from one another on multiplex assays often used in clinical settings. Upon further typing, some specimens have been positive for enterovirus D68 (EV-D68). Concurrently, pediatric acute respiratory illness sentinel surveillance sites are reporting a higher proportion of EV-D68 positivity in children who are RV/EV positive compared to previous years. Although it primarily causes acute respiratory illness, EV-D68 has been associated with acute flaccid myelitis (AFM), a rare but serious neurologic complication involving limb weakness.

Variant Influenza Virus Infections: Recommendations for Identification, Treatment, and Prevention for Summer and Fall 2022 - Health Alert Network (HAN) No. 473

5 months 1 week ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to provide updates on recent variant1 influenza virus infections and summarize CDC's recommendations for identification, treatment, and prevention of variant influenza virus infection for the summer and fall of 2022.

Update for Clinicians on Monkeypox in People with HIV, Children and Adolescents, and People who are Pregnant or Breastfeeding - Health Alert Network (HAN) No. 472

6 months 1 week ago
As of July 29, 2022, the Centers for Disease Control and Prevention (CDC) and state and local public health partners are reporting 5,189 cases of Monkeypox virus infections in the United States across 47 states, Washington, D.C., and Puerto Rico. CDC is also reporting multiple outbreaks of monkeypox have also been reported globally in 72 countries that do not normally report monkeypox activity. On Friday, July 22, CDC reported the first two cases of monkeypox in children in the United States during the current outbreak. This Health Alert Network (HAN) Health Update serves to alert clinicians to clinical considerations for preventing, diagnosing, and managing monkeypox in people with HIV, children, adolescents, and people who are pregnant or breastfeeding.

Update for Clinicians on Testing and Treatment for Monkeypox - Health Alert Network (HAN) No. 471

6 months 1 week ago
As of July 28, 2022, the Centers for Disease Control and Prevention (CDC) and state and local public health partners are reporting 4,907 cases of monkeypox in the United States across 46 states, Washington, D.C., and Puerto Rico. CDC is also tracking multiple clusters of monkeypox that have been reported globally, including in 71 countries that normally do not report monkeypox. This Health Alert Network (HAN) Health Update serves to alert clinicians on commercial testing capability, collecting clinical specimens for testing, and using TPOXX® (tecovirimat) for treating monkeypox.

Melioidosis Locally Endemic in Areas of the Mississippi Gulf Coast after Burkholderia pseudomallei Isolated in Soil and Water and Linked to Two Cases - Mississippi, 2020 and 2022 - Health Alert Network (HAN) No. 470

6 months 1 week ago
The Centers for Disease Control and Prevention (CDC) identified the bacterium Burkholderia pseudomallei (B. pseudomallei) for the first time in the environment in the continental United States. This bacterium causes a rare and serious disease called melioidosis. B. pseudomallei was identified through environmental sampling of soil and water in the Gulf Coast region of southern Mississippi during an investigation of two human melioidosis cases.

Recent Reports of Human Parechovirus (PeV) in the United States-2022 - Health Alert Network (HAN) No. 469

6 months 3 weeks ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform clinicians and public health departments that parechovirus (PeV) is currently circulating in the United States. Since May 2022, CDC has received reports from healthcare providers in multiple states of PeV infections in neonates and young infants. Parechoviruses are a group of viruses known to cause a spectrum of disease in humans. Clinicians are encouraged to include PeV in the differential diagnoses of infants presenting with fever, sepsis-like syndrome, or neurologic illness (seizures, meningitis) without another known cause and to test for PeV in children with signs and symptoms compatible with PeV infection (see below). Commercial laboratory assays, multiplex platforms for meningitis and encephalitis, and testing through state public health laboratories (SPHLs) are available to test cerebrospinal fluid (CSF) for PeV to confirm a diagnosis. CDC laboratory support is also available for testing and typing patient specimens.

Updated Case-finding Guidance: Monkeypox Outbreak-United States, 2022 - Health Alert Network (HAN) No. 468

7 months 3 weeks ago
Since May 2022, monkeypox cases, which have historically been rare in the United States, have been identified in 18 states and territories among both persons returning from international travel and their close contacts domestically. Globally, more than 1,600 cases have been reported from more than 30 countries; the case count continues to rise daily. In the United States, evidence of person-to-person disease transmission in multiple states and reports of clinical cases with some uncharacteristic features have raised concern that some cases are not being recognized and tested. This Health Alert Network (HAN) Health Update serves to alert clinicians to clinical presentations of monkeypox seen so far in the United States and to provide updated and expanded case definitions intended to encourage testing for monkeypox among persons presenting for care with relevant history, signs, and symptoms. In addition, this Health Update provides an update to a HAN Health Advisory that the Centers for Disease Control and Prevention (CDC) issued May 20, 2022 titled Monkeypox Virus Infection in the United States and Other Non-endemic Countries-2022. In people with epidemiologic risk factors, rashes initially considered characteristic of more common infections (e.g., varicella zoster, herpes, syphilis) should be carefully evaluated for concurrent characteristic monkeypox rash (see images and links to below) and considered for testing.

COVID-19 Rebound After Paxlovid Treatment - Health Alert Network (HAN) No. 467

8 months 2 weeks ago
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to update healthcare providers, public health departments, and the public on the potential for recurrence of COVID-19 or "COVID-19 rebound." Paxlovid continues to be recommended for early-stage treatment of mild to moderate COVID-19 among persons at high risk for progression to severe disease. Paxlovid treatment helps prevent hospitalization and death due to COVID-19. COVID-19 rebound has been reported to occur between 2 and 8 days after initial recovery and is characterized by a recurrence of COVID-19 symptoms or a new positive viral test after having tested negative. A brief return of symptoms may be part of the natural history of SARS-CoV-2 (the virus that causes COVID-19) infection in some persons, independent of treatment with Paxlovid and regardless of vaccination status. Limited information currently available from case reports suggests that persons treated with Paxlovid who experience COVID-19 rebound have had mild illness; there are no reports of severe disease. There is currently no evidence that additional treatment is needed with Paxlovid or other anti-SARS-CoV-2 therapies in cases where COVID-19 rebound is suspected.

Monkeypox Virus Infection in the United States and Other Non-endemic Countries-2022 - Health Alert Network (HAN) No. 466

8 months 2 weeks ago
The Massachusetts Department of Public Health and the Centers for Disease Control and Prevention (CDC) are investigating a confirmed case of monkeypox in the United States. On May 17, 2022, skin lesions that had several features suspicious for monkeypox-firm, well circumscribed, deep-seated, and umbilicated lesions-on a Massachusetts resident prompted specialized Laboratory Response Network (LRN) testing of swab specimens collected from the resident; preliminary testing confirmed the presence of DNA consistent with an orthopoxvirus using Orthopoxvirus generic and non-variola Orthopoxvirus real-time polymerase chain reaction (PCR) assays. This group of viruses includes monkeypox virus (the causative agent of monkeypox). Testing at CDC on May 18 confirmed the patient was infected with a West African strain of monkeypox virus. The patient is currently isolated and does not pose a risk to the public.
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