The Texas Department of State Health Services, with assistance from CDC, is investigating Brucella RB51 exposures and illnesses that may be connected to the purchase and consumption of raw (unpasteurized) milk from K-Bar Dairy in Paradise, Texas. Symptoms of brucellosis can include: fever, sweats, malaise, anorexia, headache, fatigue, muscle & joint pain, and potentially more serious complications (e.g., swelling of heart, liver, or spleen, neurologic symptoms).

Carbon monoxide (CO) is an odorless, colorless, poisonous gas that can cause sudden illness and death if present in sufficient concentration in the ambient air. During a significant power outage, persons using alternative fuel or power sources such as generators or gasoline powered engine tools such as pressure washers might be exposed to toxic CO levels if the fuel or power sources are placed inside or too close to the exterior of the building causing CO to build up in the structure. The purpose of this HAN advisory is to remind clinicians evaluating persons affected by the storm to maintain a high index of suspicion for CO poisoning.

The Centers for Disease Control and Prevention (CDC), State and Local Health Departments, and the Food and Drug Administration (FDA) are investigating an increase in reported cases of cyclosporiasis. The purpose of this HAN Advisory is to notify public health departments and healthcare facilities and to provide guidance to healthcare providers of the increase in reported cases. Please disseminate this information to healthcare providers in hospitals and emergency rooms, to primary care providers, and to microbiology laboratories. Healthcare providers should consider a diagnosis of cyclosporiasis in patients with prolonged or remitting-relapsing diarrheal illness. Testing for Cyclospora is not routinely done in most U.S. laboratories, even when stool is tested for parasites. Healthcare providers must specifically order testing for Cyclospora, whether testing is requested by ova and parasite (O&P) examination, by molecular methods, or by a gastrointestinal pathogen panel test. Cyclosporiasis is a nationally notifiable disease; healthcare providers should report suspect and confirmed cases of infection to public health authorities.

The Houston Health Department (HHD) in Texas tracks influenza-like illness (ILI) in the community through its Influenza Sentinel Surveillance Program, which began in 2008. After the influenza A(H1N1) pandemic (pH1N1) in 2009, investigators sought to assess the feasibility of this program as a non-traditional data source for tracking and monitoring care-seeking activities. Through the process of characterizing and describing patients who had 'return visits', or who were considered the heaviest...

Risk and protective processes are integrated developmental processes that directly or indirectly affect behavioral outcomes. A better understanding of these processes is needed, in order to gauge their contribution to sexual risk behaviors. This retrospective cross-sectional study modeled the ecodevelopmental chain of relationships to examine the social contexts of African-American (AA) adolescents associated with sexually transmitted disease (STD)- and HIV-risk behaviors. We used data from...

Eculizumab (Soliris®) recipients have a 1,000 to 2,000-fold greater risk of invasive meningococcal disease compared to the general U.S. population. The Food and Drug Administration (FDA)-approved prescribing information for eculizumab includes a black box warning for increased risk of meningococcal disease, and the Advisory Committee on Immunization Practices (ACIP) recommends meningococcal vaccination for all patients receiving eculizumab. Recent data show that some patients receiving eculizumab who were vaccinated with the recommended meningococcal vaccines still developed meningococcal disease, most often from nongroupable Neisseria meningitidis, which rarely causes invasive disease in healthy individuals.

CONCLUSION: Perspectives on health may differ among Asian Indians depending on gender, age, and nativity.

The U.S. Food and Drug Administration (FDA) has issued a safety communication warning about the use of Magellan Diagnostics' LeadCare® analyzers (LeadCare, LeadCare II, LeadCare Ultra and LeadCare Plus) with venous blood samples because they might result in falsely low test results. FDA is now advising that Magellan Diagnostics' LeadCare® analyzers should no longer be used with venous blood samples. The safety alert does not apply to capillary blood lead test results collected by fingerstick or heelstick. The purpose of this Health Advisory is to notify state and local health departments, healthcare providers, and laboratories about CDC's re-testing guidance in light of the safety alert.

In July 2016, CDC issued Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016 (https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm) that includes Zika virus immunoglobulin M (IgM) testing of pregnant women. However, some flavivirus infections can result in prolonged IgM responses (>12 weeks) that make it difficult to determine the timing of infection, especially in testing of asymptomatic people. Emerging epidemiologic and laboratory data indicate that Zika virus IgM can persist beyond 12 weeks in a subset of infected people. Therefore, detection of IgM may not always indicate a recent infection. Although IgM persistence could affect IgM test interpretation for all infected people, it would have the greatest effect on clinical management of pregnant women with a history of living in or traveling to areas with Zika virus transmission. Pregnant women who test positive for IgM antibody may have been infected with Zika virus and developed an IgM response before conception.

This Health Advisory describes the identification of emerging Shigella strains with elevated minimum inhibitory concentration values for ciprofloxacin and outlines new recommendations for clinical diagnosis, management, and reporting, as well as new recommendations for laboratories and public health officials. Current interpretive criteria provided by the Clinical and Laboratory Standards Institute (CLSI) categorize these strains as susceptible to ciprofloxacin, which is a fluoroquinolone antibiotic and a key agent in the management of Shigella infections.

CDC and health officials from Wisconsin and Illinois are conducting an investigation of Seoul virus infections among pet rats and persons exposed to rats at rat-breeding facilities in Wisconsin and Illinois. Seoul virus is a member of the hantavirus group of rodent-borne viruses. Trace-back and trace-out investigations of possibly infected rodents have identified distribution chains in other states that may require additional investigations. People who become infected with this virus often exhibit relatively mild or no symptoms, but some will develop a form of hemorrhagic fever with renal syndrome (HFRS) with death in approximately 1-2% of HFRS cases. Although serologic studies have indicated the presence of Seoul virus in wild rats in the United States, this is the first known outbreak associated with pet rats in the United States.

CONCLUSIONS AND IMPLICATIONS: Results illustrate that Chinese American children in this study practiced both Asian and non-Asian dietary behaviors. Findings corroborated existing acculturation research with parents and caregivers; supported constructs in the model of dietary acculturation; and provide guidance for research and programs related to dietary behaviors, determinants, and culture among this population.

On November 28, 2016, the Texas Department of State Health Services (TDSHS) reported the first case of locally acquired mosquito-borne Zika virus infection in the city of Brownsville, Cameron County, Texas. On December 9, 2016, four additional cases in people living in proximity to the first case were reported. TDSHS continues to investigate Zika virus transmission in Brownsville.

Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with...

View guidance and procedures for clinical settings for diagnosis.

The U.S. Centers for Disease Control and Prevention (CDC) previously issued travel, testing, and other guidance related to areas of active Zika virus transmission in Florida. Because local transmission of Zika virus continues to be reported in Miami-Dade County, CDC is strengthening travel recommendations for pregnant women to Miami-Dade County and also reinforcing recommendations for use of protective measures to prevent exposure to Zika. CDC is updating recommendations to emphasize testing for pregnant women with an epidemiologic link to Miami-Dade County. An epidemiologic link means that they lived in, traveled to, or had unprotected sex with someone who lived in or traveled to, the designated area. In addition, CDC has made specific recommendations for areas of identified active transmission.

The Centers for Disease Control and Prevention (CDC) is advising hospitals to notify patients who underwent open-heart (open-chest) surgery involving a Stöckert 3T heater-cooler that the device was potentially contaminated, possibly putting patients at risk for a life threatening infection. New information indicates that these devices, manufactured by LivaNova PLC (formerly Sorin Group Deutschland GmbH), were likely contaminated with the rare bacteria Mycobacterium chimaera during manufacturing. Hospitals should advise potentially exposed patients to seek medical care if they are experiencing symptoms such as night sweats, muscle aches, unexplained weight loss, fatigue, or unexplained fever. In addition, hospitals that use or have used this device are strongly encouraged to make and execute a plan to communicate with potentially exposed patients and to increase awareness among healthcare providers.

CONCLUSION: Smaller LHDs need additional resources to improve informatics-related capacity and engagement with the field.

CDC previously issued travel, testing, and other guidance related to local mosquito-borne Zika virus transmission (active Zika virus transmission) that the Florida Department of Health (FL DOH) identified in two areas of Miami-Dade County: (1) a one-square-mile area in Wynwood, and (2) a 1.5-square-mile area in Miami Beach. CDC has updated the guidance for people who live in or traveled to these areas.

On October 26, 2015, CDC issued HAN 384 (http://emergency.cdc.gov/han/han00384.asp) that alerted (1) public health departments, health care professionals, first responders, and medical examiners and coroners of the increase in fentanyl-related unintentional overdose fatalities in multiple states primarily driven by illicitly manufactured fentanyl (IMF) (i.e., non-pharmaceutical fentanyl); (2) provided recommendations for improving detection of fentanyl-related overdose outbreaks; and (3) encouraged states to expand access to naloxone and training for administering naloxone to reduce opioid overdose deaths.