February 18th, 2012
posted by Paul Rega, MD, FACEP February 18, 2012 @ 1:34 am
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By Erin Allday
The San Francisco Chronicle
SAN FRANCISCO — “Injecting patients in the thigh with a drug-loaded syringe is a safe and effective way to stop a seizure in an emergency………, a finding that could pave the way toward making such syringes as widely available as EpiPens used to treat severe allergic reactions.
The two-year study……concluded that a single stab from an auto-injector was more effective in stopping a prolonged seizure than the traditional method of inserting an intravenous line and delivering the drug directly into the bloodstream……
The study……..involved 79 hospitals nationwide, including several in the Bay Area. More than 4,000 paramedics…..and 893 patients were treated.
Every patient was given both the auto-injector shot, usually to the thigh, and an intravenous injection. But in half the cases the auto-injector was filled with a placebo, and in the other half the IV drug was a placebo. Neither patients nor paramedics knew which treatment was the placebo in any given case.
…….73 percent of patients who were given the auto-injector drug had stopped seizing by the time they reached the emergency room; 63 percent of patients who got the IV drug were seizure-free.
Patients who were given the auto-injector drug were less likely than the IV group to be admitted to the hospital after their seizure.
……..Although two different drugs were used in the trial – midazolam for the auto-injector and lorazepam for the intravenous injection – researchers don’t believe that the drugs made a difference in how effective the treatments were. Rather, they said, the auto-injectors are simply easier to use……”
QuickStats: Drug Poisoning Death Rates,* by Intent — United States, 1999–2009
February 17, 2012 / 61(06);111
* Age-adjusted to the 2000 U.S. standard population. Drug poisoning deaths were defined as those having International Classification of Diseases, 10th Revision codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 (undetermined intent). Age-adjusted drug poisoning rates for homicides, legal interventions, and operations of war are <0.1 per 100,000 population each year and are not shown.
During 1999–2009, the age-adjusted drug poisoning death rate nearly doubled, from 6.1 per 100,000 population in 1999 to 12.0 in 2009. The age-adjusted unintentional drug poisoning death rate more than doubled during that period, from 4.0 per 100,000 population in 1999 to 9.3 in 2009. Drug poisoning suicide rates also increased, from 1.1 per 100,000 population in 1999 to 1.6 in 2009. Rates of drug poisoning deaths from undetermined intent remained stable, with a rate of 0.9 per 100,000 population in 1999 and 1.0 in 2009.
Sources: National Vital Statistics System mortality data (1999–2009). Available at http://www.cdc.gov/nchs/deaths.htm.
Warner M, Chen LH, Makuc DM, Anderson RA, Minino AM. Drug poisonings deaths in the United States, 1980–2008. NCHS data brief no. 81. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2011. Available at http://www.cdc.gov/nchs/data/databriefs/db81.htm.
Alternate Text: The figure above shows drug poisoning death rates, by intent during 1999-2009, in the United States. During 1999-2009, the age-adjusted drug poisoning death rate nearly doubled, from 6.1 per 100,000 population in 1999 to 12.0 in 2009. The age-adjusted unintentional drug poisoning death rate more than doubled during that period, from 4.0 per 100,000 population in 1999 to 9.3 in 2009. Drug poisoning suicide rates also increased, from 1.1 per 100,000 population in 1999 to 1.6 in 2009. Rates of drug poisoning deaths from undetermined intent remained relatively stable, with a rate of 0.9 per 100,000 population in 1999 and 1.0 in 2009.
Notes from the Field: Norovirus Infections Associated with Frozen Raw Oysters — Washington, 2011
February 17, 2012 / 61(06);110
On October 19, 2011, Public Health – Seattle & King County was contacted regarding a woman who had experienced acute gastroenteritis after dining at a local restaurant with friends. Staff members interviewed the diners and confirmed that three of the seven in the party had consumed a raw oyster dish. Within 18–36 hours after consumption, the three had onsets of aches, nausea, and nonbloody diarrhea lasting 24–48 hours. One ill diner also reported vomiting. The four diners who had not eaten the raw oysters did not become ill.
An inspection of a walk-in freezer at the restaurant revealed eight 3-pound bags of frozen raw oysters, which the restaurant indicated had been an ingredient of the dish consumed by the ill diners. The oysters had been imported from South Korea by company A and shipped to a local vendor, which sold them to the restaurant. All eight bags were sent to the Food and Drug Administration’s Gulf Coast Seafood Laboratory for norovirus testing and characterization by real-time reverse transcription–polymerase chain reaction (rRT-PCR).
A stool specimen from one of two ill diners collected 17 days after symptom onset tested positive for norovirus; sequence analysis identified GI.1 and GII.17 strains. Sequence analysis of the oysters identified a GII.3 strain. Because oysters can harbor multiple norovirus strains that are unequally amplified by rRT-PCR, discordance between stool specimens and food samples in shellfish-associated norovirus outbreaks is common and does not rule out an association. On November 4, 2011, company A recalled its frozen raw oysters.*
The frozen oysters implicated in this outbreak were distributed internationally and had a 2-year shelf-life. Contamination of similar products has been implicated previously in international norovirus transmissions (1). Such contamination has potential for exposing persons widely dispersed in space and time, making cases difficult to identify or link through traditional complaint-based surveillance. To facilitate investigation of foodborne norovirus outbreaks, CDC recently implemented CaliciNet, the national electronic norovirus outbreak surveillance network (2). During suspected norovirus outbreaks, CDC recommends collection of stool specimens to confirm the diagnosis, characterize norovirus strains, and upload sequence results into CaliciNet. Additionally, all suspected and confirmed norovirus outbreaks should be reported to CDC by state and local health departments through the National Outbreak Reporting System (3).
- Webby RJ, Carville KS, Kirk MD, et al. Internationally distributed frozen oyster meat causing multiple outbreaks of norovirus infection in Australia. Clin Infect Dis 2007;44:1026–31.
- Vega E, Barclay L, Gregoricus N, Williams K, Lee D, Vinjé J. Novel surveillance network for norovirus gastroenteritis outbreaks, United States. Emerg Infect Dis 2011;17:1389–95.
- CDC. Updated norovirus outbreak management and disease prevention guidelines. MMWR 2011;60(No. RR-3).