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RODS tracks symptoms, monitors clinical data
By Cheryl S. Splain, News Managing Editor
Wednesday, January 30, 2008
MOUNT VERNON — In the hospital setting, data about flu-like symptoms is collected in the emergency room. The RODS project — Real Time Outbreak and Disease Surveillance — provides software that monitors clinical data and data about the sale of over-the-counter medications, as well as other data. Epidemiologist Vaughn Anderson said over 90 hospitals use RODS statewide. The Center for Disease Control has been using RODS nationally since 1999.
“It all stems from a food borne outbreak in Michigan,” explained Anderson. “They saw a huge increase in anti-diarrheals just prior to confirmation of the outbreak.”
RODS can track symptoms of flu, respiratory illnesses, diarrhea and skin rashes, as well as neurologic and gastrointestinal symptoms. It can also be linked to track over-the-counter medications, which, said Anderson, is difficult because there are so many being sold.
“[But] you’ve got to be careful with the data,” said Anderson. “You’ve got to make sure there’s no anomaly with the data.”
For example, he said, there may be an increase in cough medicine reported, but it may just be a case of a particular pharmacy having a sale on the medicine.
“The first thing with public health is to confirm a diagnosis or outbreak,” he said. “RODS is syndromic, or early event, surveillance of a nonconfirmed disease before it becomes an outbreak.
“It’s not highly accurate, but again, it gives us an indication of potential problems to investigate.”
Anderson said he hopes to have the capability to track OTC medications next year.
According to Anderson, the information collected through RODS is anonymous in terms of patient identification. Data can be sorted by hospital location or by home location, through zip code. The advantage of sorting by zip code is that if a patient went to another hospital, such as Grady Memorial in Delaware or Children’s Hospital in Columbus, the information can be related back to Knox County. This helps health officials track the location or source of a possible outbreak.
According to Anderson, a spike in hospital admissions from a neighborhood, or notification that something is unusual by RODS standards, could simply indicate the presence of a flu bug, or, on the opposite end of the spectrum, it could mean a chemical or biological weapon has been released.
RODS was implemented in Utah in 2002 for the Olympic Winter Games, held Feb. 8 to March 16, 2002. In the wake of 9/11, and the anthrax releases in October 2001, health officials felt the need for bioterrorism surveillance during the Games. According to an article which appeared in the Journal of the American Medical Information Association in 2003, over 114,000 acute care encounters between Feb. 8 and March 16, but no outbreaks of public health significance were detected.
Anderson said there is about eight months of data entered thus far for Knox County in RODS.
This is an official CDC Health Advisory distributed via the Health Alert Network (HAN) on January 30, 2008, 19:17 EDT (07:17 PM EDT).
CDC Health Advisory
Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection
CDC is requesting that states report all cases of influenza-related pediatric mortality during the 2007-2008 influenza season. This health advisory contains updated information about influenza and bacterial co-infections in children and provides interim testing and treatment recommendations.
Background:
Since 2004, the Influenza-Associated Pediatric Mortality Surveillance System, part of the Nationally Notifiable Disease Surveillance System, has collected information on deaths among children due to laboratory-confirmed influenza, including the presence of other medical conditions and bacterial infections at the time of death. From October 1, 2006 through September 30, 2007, 73 deaths from influenza in children were reported to CDC from 39 state health departments and two city health departments. Data on the presence (or absence) of bacterial co-infections were recorded for 69 of these cases; 30 (44%) had a bacterial co-infection, and 22 (73%) of these 30 were infected with Staphylococcus aureus.
The number of pediatric influenza-associated deaths reported during 2006-07 was moderately higher than the number reported during the two previous surveillance years; the number of these deaths in which pneumonia or bacteremia due to S. aureus was noted represents a five-fold increase. Only one S. aureus co-infection among 47influenza deaths was identified in 2004-2005, and 3 co-infections among 46 deaths were identified in 2005-2006. Of the 22 influenza deaths reported with S. aureus in 2006-2007, 15 children had infections with methicillin-resistant S. aureus (MRSA).
The median age of children with S. aureus co-infection was older than children without S. aureus co-infection (10 years versus 5 years, p<.01) and children with co-infection were more likely to have pneumonia and Acute Respiratory Distress Syndrome (ARDS). Influenza strains isolated from these children were not different from common strains circulating in the community, and the MRSA strains have been similar to those associated with MRSA skin infection outbreaks in the United States.
Recommendations:
Health care providers should test persons hospitalized with respiratory illness for influenza, including those with suspected community-acquired pneumonia. Health care providers should be alerted to the possibility of bacterial co-infection among children with influenza, and request bacterial cultures if children are severely ill or when community-acquired pneumonia is suspected. Health care providers should be aware of the prevalence of methicillin-resistant S. aureas strains in their communities when choosing empiric therapy for patients with suspected influenza-related pneumonia. Clinicians, health care providers, and medical examiners are asked to contact their local or state health department as soon as possible when deaths among children associated with laboratory-confirmed influenza are identified.
CDC requests that state health departments report all cases of pediatric influenza-associated deaths to CDC through http://sdn.cdc.gov and that information about bacterial pathogens isolated from sterile sites and/or from sputum or endotracheal aspirates be completed on the Influenza-Associated Pediatric Mortality Surveillance System case report form. If the influenza death was complicated by S. aureus infection, state health departments are asked to please contact the clinical agency that reported the case to determine if the S. aureus isolate is available. CDC will receive S. aureus isolates in order to better characterize those S. aureus isolates from children who have died from influenza.
If you have any questions about this Health Advisory, please call the Influenza Division, Epidemiology and Prevention Branch at 404-639-3747.
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Intro: A 6.5 foot wall trying to keep the infected away from the “well.” Not a bad idea to try on our politicians.
Agence France Presse (01/27/08) :
As the number of patients diagnosed with extensively drug resistant tuberculosis (XDR TB) rises, healthcare providers and government officials worry about the conflict between individual rights and the risk to the public’s health.
Between January and October 2007, 391 cases of XDR TB were diagnosed, compared to just 74 in all of 2004, according to the South African Department of Health. XDR TB is resistant to most antibiotics, and can develop when patients with more treatable strains of TB fail to take their medication as prescribed. Those diagnosed with XDR TB are virtually untreatable, and many are kept in isolation at Cape Town’s Brooklyn Chest Hospital.
A fence 6.5 feet tall was recently erected around the XDR TB ward to dissuade patients from fleeing the hospital after four such patients repeatedly ran away last year. Doctors are hindered in their efforts to treat XDR TB patients and protect the public, as no legal mechanism allows them to confine patients involuntarily or compel them to take medication. “We encourage them not to leave — by law, you can’t force them,” said Dr. Simon Moeti, senior medical superintendent at Brooklyn Chest. Instead, doctors are forced to apply for individual court orders, which are both costly and time-consuming. “It is a process that takes a lot of time and energy. We are looking at whether we can find clauses in our legislation that will allow a general approach to the matter,” said Health Department Director-General Thami Mseleku.
FOR IMMEDIATE RELEASE
JANUARY 29, 2008 WWW.USDOJ.GOV/USAO/MA
BOSTON, MA – In an indictment that was unsealed in federal court in
Springfield, a Feeding Hills man was charged with possession of toxins
(ricin and abrin) for use as a weapon, and threatening to use weapons of
mass destruction against federal officials and property.
United States Attorney Michael J. Sullivan, Warren T. Bamford, Special Agent
in Charge of the Federal Bureau of Investigation – New England Field
Division, Glenn N. Anderson, Special Agent in Charge of the Bureau of
Alcohol, Tobacco, Firearms, and Explosives Boston Field Division and Randy
Miskanic, Inspector in Charge of the United States Postal Inspection
Service, announced today that MICHAEL A. CROOKER, age 53, formerly of
Feeding Hills, Massachusetts, was charged in a indictment with three counts
of possessing toxins (ricin and abrin) for use as a weapon; mailing a
threatening letter; threatening to use a weapon of mass destruction, to wit,
ricin; threatening to transfer a toxin to another for use as a weapon;
possession of a toxin by a “restricted person” and possession of a toxin
without the required registration, and of a type and in a quantity that was
not justified for peaceful purposes.
The indictment alleges that in or about June 2004, CROOKER possessed the
toxins ricin and abrin in the form of castor beans and rosary peas,
respectively, that is, “in its naturally occurring environment, that had not
been extracted from its natural source” with intent to extract the toxins
and use them as weapons. In addition, the indictment alleges that he
possessed a quantity of ricin that had been processed, and was recovered in
August 2004. Further, the indictment alleges that, in letters written in
July 2004 – one to a local newspaper and another to an Assistant United
States Attorney, CROOKER threatened to transfer the toxins to another and to
launch an attack on the federal building in Springfield, using a weapon of
mass destruction. CROOKER, as a convicted felon and drug user, was also
charged with possession of toxin by a “restricted person.” Finally, he was
charged with possession of toxin without proper registration, and possession
of a toxin of a type and quantity not justified by research or other
peaceful purpose.
If convicted of any of the three counts of possession of toxins for use as a
weapon, the count of threatening to transfer a toxin to another for use as a
weapon, or the count of threatening to use a weapon of mass destruction,
CROOKER faces up to life imprisonment on each of the counts, to be followed
by five years of supervised release, and a $250,000 fine. If convicted on
the charge of mailing a threatening communication, or the charge of
possession of a toxin by a restricted person, and of a type or quantity not
justified for peaceful purposes, CROOKER faces up to 10 years’ imprisonment,
to be followed by three years of supervised release, and a $250,000 fine, on
each count.
The case was investigated by the Federal Bureau of Investigation – New
England Field Division, the Bureau of Alcohol, Tobacco, Firearms and
Explosives – Boston Field Division and the U.S. Postal Inspection Service.
It is being prosecuted by Assistant U.S. Attorney Jeffrey Auerhahn of
Sullivan’s Anti-Terrorism and National Security Unit.
The details contained in the indictment are allegations. The defendant is
presumed to be innocent unless and until proven guilty beyond a reasonable
doubt in a court of law.
…1996, Colombia, Sri Lanka: A total of 91 people died following a Tamil Tiger suicide bomb blast in Colombo’s central bank. By the summer, the number of tourists visiting Sri Lanka had dropped by 40% while hotels laid off hundreds of workers and cut rates in a desperate effort to attract local holidaymakers.
BBC, 1996: At least 53 people have been killed and another 1,400 injured in a suicide attack in the capital of Sri Lanka.
One of the 1400 injured.
A lorry loaded with explosives crashed into the central bank in the heart of Colombo’s financial district.
The authorities said the explosion, which ripped through the business district at 1100 local time was the work of the separatist Tamil Tigers.
The group’s fight for an independent homeland has resulted in the deaths of nearly 40,000 people over the last 12 years.
It is believed that the intended target was the neighbouring navy headquarters.
Brigadier Sarath Munasinghe, a Sri Lankan military spokesman, said: “It had to be the Tamil Tigers. Who else would have done such a thing like this?”
The blast is thought to be in response to the army’s claim on the main Tiger guerrilla base at Jaffna, on the north of the island, during a long and bloody campaign that ended last December.
Guns blazing
Witnesses said a lorry stopped near the bank at about 1045 local time and the driver was confronted by security staff.
Three people jumped out of the vehicle with guns blazing and detonated two bombs.
Meanwhile, the lorry reversed into the central bank and blew up.
The police said the driver of the truck died in the blast.
Two youths wearing jackets filled with explosives were later arrested at the Fort railway station nearby.
The blast caused the first two floors of the 10-storey central bank to collapse and it shattered the windows of a 39-storey trade centre that was still under construction.
Office workers trapped on the upper floors of burning buildings nearby were lifted to safety by helicopters.
The Intercontinental Hotel, one of several luxury hotels in the area, was evacuated.
Most of the dead and wounded were in the Central Bank building, where Sri Lanka’s gold reserves are held and the country’s financial policy is made.
The director of the National Hospital’s trauma unit, Hector Weerasinghe, said 53 people had died so far.
Around 1,060 people were admitted to two hospitals nearby while hundreds of others were released after treatment.
The blast comes as the government prepares an ambitious political offensive to end more than a decade of fighting.
It also follows a major government victory last month, when the Sri Lankan Army seized the city of Jaffna, a former stronghold of the Tamil Tiger rebels.
Anuruddha Ratwatte, the deputy defence minister, said on state television: “If Velupillai Prabhakaran [the Tamil Tiger chief] thinks that by these acts he can stop our military offensive, he is dreaming.
“We say quite clearly that these acts will make us even more determined to destroy terrorism.”
The economic consequences of the blast for Sri Lanka will be catastrophic, both through direct losses and because of lost tourism and foreign investment.
…1953, Irish Sea: 130 die in ferry disaster. The inquiry concluded the ferry owners were to blame for the poor design of the stern doors which were torn open in the heavy seas. The highest civilian award for bravery, the George Cross, was given posthumously to the ferry’s radio operator, David Broadfoot, who remained at his post sending out messages for assistance until the ship sank. The captain went down with his ship.
BBC, 1953: A car ferry has sunk in the Irish Sea in one of the worst gales in living memory claiming the lives of more than 130 passengers and crew.
THE IRISH SEA
The Princess Victoria, a British Railways car ferry, bound for Larne in Northern Ireland, had left Stranraer on the south-west coast of Scotland an hour before when the stern gates to the car deck were forced open in heavy seas.
Water flooded into the ship and as the cargo shifted, the ferry, one of the first of the roll on-roll off design, fell onto her side and within four hours she sank. Among the passengers who perished were the Northern Ireland Finance Minister and Deputy Prime Minister Major J M Sinclair, and Sir Walter Smiles, the Ulster Unionist MP for North Down.
The Northern Ireland Prime Minister, Lord Basil Brookeborough, paid this tribute: “The waves that yesterday were mountainous are relatively calm again but they’ve become the tomb of 130 of our fellow citizens. Under this cruel stroke of fate, many families are sorrowing today, they have the heartfelt sympathy of us all.”
Captain radioed for help
Tragedy struck at 0845 GMT when Captain James Ferguson radioed the coastguard to say the ferry was “not under command and needed a tug”.
At 1252 the captain radioed to say the engine room was flooded and he had decided to abandon ship.
Later messages made clear that the ship was listing so much that it was impossible to launch the lifeboats.
One lifeboat was smashed against the ship’s side. Another, containing eight women and a child, was swamped by huge waves and sank.
RAF planes were alerted to the sinking at about 1500. They arrived at the scene half-an-hour later and dropped rubber dinghies but blinding squalls of sleet and rain hampered their efforts.
One of the lifeboatmen sent to the rescue said they spent two hours searching for survivors. One man was found clinging to a raft on which were four other people who had died from exposure.
The first survivors, including Petty Officer Jay Yeomans, were landed at Donaghadee, 20 miles east of Belfast.
Fusilier Jeoffrey Bingley was another survivor. “I didn’t expect to be alive… I was in the lower deck when the boat started to go over and I scrambled down the side of it and got into a lifeboat,” he said.
“We pushed away with about 20 on board and managed to pick a few up out of the sea. We didn’t have any oars – the sea just took its course.”
Debris smashed nearby cars and littered the streets
An explosion has killed at least 17 people and injured more than 40 at a textile firm’s premises in a suburb of Istanbul, Turkish officials say.The blast caused part of a five-storey building in the western Davutpasha district to collapse.
Injured people were carried out of the building, but some victims are said to be still under the rubble.
The city’s governor, Muammer Guler, says it is not yet clear what caused the blast. But he ruled out terrorism.
The explosion happened at about 0930 local time (0730 GMT), starting a fire in the building.
A second blast reportedly happened just minutes later.
“White smoke was rising into the sky from the factory as we came to the front of the building. People were running around,” a witness, who identified himself as Ali, told CNN Turk television.
Television pictures immediately after the blast showed survivors carrying the injured out of the building.
Rescue teams continued to search through the rubble for more survivors. A number of people were taken to hospital.
Mr Guler later said “right now, there is nothing linked to terror”.
Businesses in the building included textile makers and an unlicensed fireworks manufacturer, officials said.
This is by far the most serious accident of its kind for some time, the BBC’s Sarah Rainsford in Istanbul says.
COMMNENT: During times of economic crisis in our country, we are putting yet more people out of their jobs?
Hot button: Medical marijuana vending machines open in L.A.
Americans who have traveled to Japan are no doubt familiar with the ubiquitous jidoohanbaiki: standalone vending machines that dispense soft drinks, coffee, food, comic books, paperbacks, clothing (including underwear and stockings), videos, CDs, jewelry, flowers — and booze (beer, whiskey, sake).
California went a big step further today: Vending machines that dispense medical marijuana.
The first two were activated today in Los Angeles at licensed cannabis clubs. State voters approved doctor-prescribed marijuana in 1996 for patients suffering serious pain or nausea who don’t get relief from other drugs. (Here’s background on medical marijuana in California.)
This is how the AVMs — Anytime Vending Machines — work:
• Customers bring their prescriptions for approval at the AVMs, housed in enclosed room guarded 24/7.
• They are fingerprinted and photographed.
• They receive a pre-paid credit carded loaded with their individual profiles.
• They choose their dosage (3.5 grams or 7 grams) and one of five strains of marijuana.
• The marijuana is in capsule form and dispensed in vacuum-sealed packages.
• They can buy no more than 1 ounce a week.
Anticipated future vending: Viagra, Vicodin, Propecia and anti-depressants. (Seriously.)
COMMENT: If this is what goes down in a plant owned by “Supplier of the Year”, can you imagine what is taking place at plants that aren’t award winners???
Sick Cattle Used to Feed School Children
Hidden Camera Investigation Finds Slaughterhouse Used Banned ‘Downed Animals’
By BRIAN HARTMAN
WASHINGTON, Jan. 30, 2008—
A hidden camera investigation by an animal rights group has uncovered disturbing treatment of ailing cows at a California slaughterhouse that provides meat for school lunches.
The video, obtained during what the Humane Society of the United States said was a six-week undercover investigation, shows a sickly cow being dragged by a chain before being poked, prodded, rolled and lifted with a forklift. Workers also are seen hosing the faces of cows in a manner that HSUS described as “torture, right out of a waterboarding manual.”
An HSUS official said its investigator confirmed that at least some of the animals in the video were “spent dairy cows,” allegedly sold for meat after they had grown too old and sick to produce milk, and that they were slaughtered for use in the human food supply.
HSUS says Westland Meat Company, which owns the slaughterhouse in Chino, Calif., is the No. 2 supplier of beef to a USDA program that “distributes the beef to needy families, the elderly, and also to schools, through the National School Lunch Program.”
According to documents provided by HSUS, Westland was named a USDA “supplier of the year” for 2004-05. HSUS says the company “has delivered beef to schools in 36 states. More than 100,000 schools and child care facilities nationwide receive meat through the lunch program.”
Such treatment of cows is generally considered abuse and is prohibited. But slaughtering such sick cattle known as “downers” also is banned to protect humans from contracting mad cow disease. The USDA considers its enforcement of the ban aggressive; HSUS says it’s actually riddled with holes.
“Downed animals may be falling through the cracks as a result of poor oversight, anemic enforcement, and a loophole created by inconsistent agency regulations,” the group says.
Both the USDA and the meat packer responded quickly to the allegations.
The president of Westland and of Hallmark Meat Packing Co., where the video was recorded, said today two employees were fired, and a supervisor was suspended “pending his explanation.”
“We are shocked, saddened and sickened by what we have seen today,” Westland’s president Steve Mendell said in a prepared statement posted on the company’s Web site. “Operations have been immediately suspended until we can meet with all of our employees, and be assured these sorts of activities never again happen at our facility.”
Mendell’s plant is now under investigation by the USDA. Agriculture Secretary Ed Schafer has asked the USDA’s inspector general to look into violations at the facility, but he assured the public that the episode was not reason for public alarm.
In the interim, Schafer said he has “indefinitely suspended” Westland Meat Company from supplying meat to federal food programs, and all food from Westland that is already in the pipeline has been placed “on administrative hold.”
In a prepared statement released late today, Schafer said he’s “deeply concerned” about the allegations. But he’s also disappointed in the Humane Society.
“It is unfortunate that the Humane Society of the United States did not present this information to us when these alleged violations occurred in the fall of 2007,” Schafer said. “Had we known at the time the alleged violations occurred, we would have initiated our investigation sooner, and taken appropriate actions at that time.”
Humane Society officials said they did take action.
“The HSUS turned over, to appropriate California law enforcement officials, extensive videotape evidence, once the investigation was concluded,” Wayne Pacelle, president of the group, responded to Schafer’s barb. “Local authorities asked for extra time before public release of the information.”
Pacelle also asked the USDA to go further than just suspending operations at Westland, and is calling for the plant to be “locked up and shut down.”
Westland and the USDA also may be forced to answer questions on Capitol Hill.
Rep. Rosa DeLauro, one of the most vocal critics of the nation’s food safety program in Congress, e-mailed reporters today with a threat to hold a hearing that looks into “USDA policies” that “are allowing slaughtering and processing plants to use the National School Lunch Program as a dumping ground for bad meat.”
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One of the 1400 injured.
THE IRISH SEA
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