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Disease outbreaks and public health response: coordination makes a difference
Spice
 

By Talia Gad

Three outbreaks stand out as examples of the Public Health Division’s high level of response and preparedness during the past year. Ranging from the seasonal to the unexpected, each illustrates collaborative action with local health departments that is the basis of effective public health response.

2013 influenza

Meningococcus

“Spice”-related kidney disease


2013 influenza

The influenza season came a bit earlier than recent years. There have been 31 laboratory-confirmed outbreaks since the beginning of January, many of them in long-term care facilities.

“Some people are at especially high risk for bad complications and death from influenza,” said Richard Leman, M.D., chief medical officer for HSPR and a public health physician in the Oregon Public Health Acute and Communicable Disease Prevention Program. “When there’s an outbreak of influenza in a place where many people at high risk live, we want to stop it quickly before it affects more people.”

When influenza outbreaks occur, the Public Health Division and local health departments work together to help implement control measures that prevent additional infections. Preparedness includes vaccinating staff and residents at long-term care facilities as well as promoting simple prevention techniques such as hand-washing and avoiding contact between those who are sick and those who aren’t. Sharing this and other prevention information ensures that there’s a plan in place for what to do when influenza strikes.

Related:

Oregon Vaccines and Immunization

Oregon Influenza Surveillance Data

Oregon Flu Prevention and Safety

"People, Pigs, and Flu," CD Summary – August 28, 2012 (pdf)


Meningococcus

Three people in the Prineville area contracted the bacteria meningococcus, a bug that can cause potentially fatal meningitis and infections in the blood stream, between November 2011 and February 2012.

The emerging cluster led to collaborative efforts between the Crook County Health Department, the Oregon Public Health Division, and the Centers for Disease Control and Prevention. When the first infections were reported, Crook County and Public Health Division staff interviewed the patients and their families, as well as two additional people who had experienced the same infection earlier in the year. They were seeking clues about the infections' cause and any links between those who became ill.

The Crook County Health Department and OHA’s Health Security Preparedness and Response (HSPR) program each activated emergency plans to support the response. Both Crook and Deschutes counties experienced a high volume of calls from concerned citizens and healthcare providers, and a partnership with the 2-1-1 Call Center allowed calls to be received through the weekend and beyond.

Laboratory results confirmed that all three infections involved the same type of meningococcus. Together the Crook County Health Department, the Public Health Division, and the CDC agreed that the outbreak warranted a vaccination campaign, and steps to put it in motion got immediately underway.

The Crook County Health Department worked with area health care providers, health facilities and pharmacists as well as the state Immunization Program to make the vaccine available as quickly as possible. Within days, more than 1,500 people in the target age group had been immunized as part of a campaign that continued for the next three months.

Since the introduction of the vaccine, there have been no additional cases.

Related:

"Invasive Meningococcal Disease," CD Summary - Feb. 14, 2012 (pdf)

Centers for Disease Control and Prevention Meningococcus website


“Spice”-related kidney disease

One non-communicable outbreak began making the rounds in Oregon and southwest Washington in August 2012 when a call came in from a kidney doctor who reported a young man with a sudden loss of kidney function.

The cause was “spice,” a synthetic marijuana-like compound. Other names for the designer drug are “K2,” “herbal incense” and “potpourri.” It doesn’t contain marijuana but instead is made by spraying a chemical with marijuana-like effects onto a plant material. It is then dried, packaged, and sold in gas stations, adult bookstores and “head shops.”

People sometimes use synthetic cannabinoids to avoid positive urine tests for marijuana byproducts, although newer tests can detect them. In the past seven months (as of press time), nine people in Oregon and Southwest Washington have been affected by kidney damage as a result of the drug.

“These synthetic cannabinoids may be toxic in unpredictable ways,” said Genevieve Buser, public health physician in the Oregon Public Health Division Acute and Communicable Disease Prevention Program. “Unfortunately most of the cases with kidney injury were healthy, young adults who are less than 20 years old.”

Illegal in Oregon, “spice” is still distributed throughout the state because retail outlets are often misled into believing that the product is both safe and legal. Across the United States, synthetic cannabinoids have been linked to more than 11,400 drug-related emergency department visits, mostly in young males.

Part of the challenge in understanding and stopping the illness is that it’s still unknown what toxin is causing the reaction: the plant, an additive, or a reaction in the body caused by one of the ingredients. Staff from the Public Health Division and local health departments have worked with kidney doctors and people at the Oregon Poison Center to learn about and interview those who have been affected.

In one case, public health investigators managed to retrieve a sample of the left-over product smoked by one of the ill people, and a specially equipped California  laboratory is testing it to attempt to find the toxic substance that caused the kidney damage.  

“We hope to make parents and youth aware of the dangers of synthetic drugs,” said Buser. “Clinicians, public health and law enforcement officials must be alert to the emerging adverse health effects from synthetic drugs, which is why addictions and mental health staff are working together to understand the burden of synthetic cannabinoid use in Oregon and collaborating with drug educators to alert communities to this new threat.”

Parents and youth can find information on the dangers of synthetic drugs at the Substance Abuse and Mental Health Services Administration and the Office of National Drug Control Policy. In case of adverse reactions, people are encouraged to call the Oregon Poison Center at 1-800-222-1222.

Related:

CDC MMWR Report (pdf)

"Spice"-y Toxicity, CD Summary - October 9, 2012 (pdf)

For more information, contact Richard Leman, MD, chief medical officer for HSPR, at Richard.F.Leman@dhsoha.state.or.us or (971) 673-1089.

Next: Multnomah county health department awarded coveted Public Health Preparedness Recognition

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