Public Health Notices

Please see our Coronavirus (COVID-19) webpage for updates.

Facts

The CDC, FDA and local health departments are investigating a multi-state outbreak of lung injury associated with using e-cigarette products. As of February 4, 2020 there have been 2,758 lung injury cases associated with using e-cigarettes reported to the CDC from all 50 states, the District of Columbia, and 2 U.S. territories. 64 deaths have been confirmed in 28 states and the District of Columbia.

All patients who have been affected have reported using e-cigarette products. Most patients report using THC-containing products. Approximately 80% of patients are under 35 years old.

Cause

As of February 11, 2020 vitamin E acetate is strongly linked to the EVALI outbreak. Vitamin E acetate has been found in product samples tested by FDA and state laboratories and in patient lung samples tested by the CDC. Vitamin E acetate has not been found in the lung fluid of people who do not have EVALI. However, evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC or non-THC products.

CDC Recommendations

• Consider refraining from using e-cigarettes, particularly those containing THC.
• Vitamin E acetate should not be added to any e-cigarette, or vaping, products. Additionally, people should not add any other substances not intended by the manufacturer to products.
• If you are an adult who used e-cigarettes containing nicotine to quit cigarette smoking, do not return to smoking cigarettes. If you continue to use e-cigarettes, carefully monitor yourself for symptoms (see below) and see a healthcare provider right away if you have symptoms like those reported in this outbreak.
• If you use e-cigarette products you should not buy these products off the street and should not modify or add any substances to these products that are not intended by the manufacturer.
• If you have recently used an e-cigarette or vaping product and you have symptoms like those reported in the outbreak (see below), see a healthcare provider. You can also call your local poison control center at 1-800-222-1222.

Symptoms of Lung Injury Caused by Vaping

• Patients in this investigation have reported symptoms such as:
  • cough, shortness of breath, or chest pain
  • nausea, vomiting, or diarrhea
  • fatigue, fever, or abdominal pain
• Some patients reported that their symptoms developed over a few days, while others have reported that their symptoms developed over several weeks. A lung infection does not appear to be causing the symptoms.

Cases in the U.S.

From January 1 to December 31, 2019, 1,282 individual cases of measles were confirmed in 31 states. This is the largest number of cases reported in the U.S. since 1992. Most of the people infected were unvaccinated. There have been cases reported in Illinois in 2019, but there is not a current measles outbreak (defined as 3 or more cases) ongoing in Illinois (as of September 26, 2019).

Many cases in the U.S. have been the result of exposure during international travel. The top 3 countries where U.S. travelers have become infected with measles so far in 2019 are the Philippines, Ukraine, and Israel.

Spread and Symptoms

Measles is a virus that is spread though the air when an infected person breathes, coughs or sneezes. It is incredibly contagious. A person can catch measles just by being in a room where a person with measles has been, up to 2 hours after that person is gone. Almost everyone who has not had the MMR vaccine will get measles if they are exposed to the measles virus.

Measles typically begins with high fever, cough, runny nose and red, watery eyes. Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth. Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs and feet. When the rash appears, a person's fever may spike up to more than 104 degrees Fahrenheit. Serious complications of measles include permanent hearing loss, pneumonia, encephalitis (swelling of the brain), and death.

Prevention

The best way to prevent measles is by receiving the MMR (measles, mumps, rubella) vaccine:

• Most people receive these vaccines as children, generally one dose at 12-15 months of age and then one dose before kindergarten (4-6 years old).
• Infants age 6-11 months who are going to be traveling internationally should receive one dose of MMR before travel. They should then repeat the first dose after the age of 12 months.
• One dose of the MMR vaccine is considered sufficient for most U.S. adults born during or after 1957. If you are unsure of your vaccination status please discuss getting an MMR vaccine with your healthcare provider.
• Certain adults are considered to be high risk and need two doses of MMR separated by at least 28 days. These adults include:
  • Students at post-high school educational institutions
  • Healthcare personnel
  • International travelers

For more information please see the Center for Disease Control and Prevention's website.

Hepatitis C Facts

1. Hepatitis C is a type of virus that can damage the liver. It is the most common, chronic, blood- borne infection (spread by blood and body fluids) in the US affecting an estimated 3 million people.
2. For some people, hepatitis C is a short-term illness but for 70-85% of people who become infected with Hepatitis C, it becomes a long-term, chronic infection. It is the leading cause of liver transplants and liver cancer. Currently there is no vaccine for Hepatitis C.
3. As many as 50% of those with chronic Hepatitis C show no outward symptoms and do not know they are infected. This is why screening is important for high-risk populations.
4. When symptoms do occur they can include:
   • Fever
   • Fatigue
   • Dark urine
   • Clay-colored stool
   • Abdominal pain
   • Loss of appetite
   • Nausea
   • Vomiting
   • Joint pain
   • Jaundice (yellowing of skin and eyes)

Who Should Get Screened

1. It is estimated that 75% of those with chronic Hepatitis C were born during 1945-1965. Therefore, anyone born during this time period should get screened.

2. Others who possess certain risk factors should also be screened:

   • Current or former injection and intranasal drug users.
   • Those who received clotting factor concentrates made before 1987.
   • Those who received blood transfusions or solid organ transplants prior to July 1992.
   • Chronic hemodialysis patients.
   • People with known exposures to HCV, such as:
     • Health care workers after needle sticks involving HCV-positive blood
     • Recipients of blood or organs from a donor who tested HCV-positive
     • Anyone with HIV infection
     • Anyone with unexplained persistently high ALT levels (liver enzymes)
   • Incarcerated persons
   • People who get an unregulated tattoo

Testing

1. Testing for Hepatitis C is a simple blood test. This can be completed at the SXU Health Center or at your medical provider's office.
2. A positive blood test would result in a referral to a liver specialist for further treatment. Prompt referral is vital for Hepatitis C patients because early treatment has been shown to be more effective at early-stage disease.

Multi-state Outbreak of Coagulopathy

The CDC and IDPH are warning about a current outbreak (starting in March of 2018) of coagulopathy (difficulty clotting the blood) from exposure to synthetic cannabinoid products. The synthetic cannabinoids products associated with this outbreak are especially dangerous because they contain brodifacoum, a chemical used as rat poison that can cause uncontrolled bleeding.

The outbreak was discovered in March of 2018 by the Illinois Department of Public Health. This is now a multi-state outbreak with 202 reported cases, including 5 deaths. Illinois currently has the most cases reported (164 cases and 4 deaths).

What are Synthetic Cannabinoids?

1. Per the CDC, synthetic cannabinoids are not one drug. Hundreds of different synthetic cannabinoid chemicals are manufactured and sold and new ones with unknown health risks become available each year. These chemicals are called cannabinoids because they act on the same brain cell receptors as tetrahydrocannabinol (THC), the main active ingredient in marijuana; however, synthetic cannabinoids may affect the brain in different and unpredictable ways compared to marijuana.
2. Synthetic cannabinoids are used in a variety of ways including:
   • Sprayed onto plant material and then smoked
   • Used in electronic nicotine delivery devices (such as e-cigarettes)
   • Ingested when added to herbal tea or food.

Recommendations

1. The CDC recommends that you do not use synthetic cannabinoids as it is impossible to know exactly what chemicals are in the product, how much you are being exposed to, and how your body will react to the chemicals. This is especially important now given the outbreak of uncontrolled bleeding from the cannabinoids containing brodifacoum.
2. People who have used synthetic cannabinoids in the past three months and are concerned about their health should contact their healthcare provider. Synthetic cannabinoids users who develop any unusual bruising or bleeding should seek medical attention immediately.

Travel Health Notices

The CDC's Travel Health Notices are designed to inform travelers and clinicians about current health issues related to specific destinations. These issues may arise from disease outbreaks, special events or gatherings, natural disasters, or other conditions that may affect travelers' health. Be sure to check your destination before you travel.

Categories of risk include:

1. Level 1 (Watch): Usual baseline risk or slightly above baseline risk for destination and limited impact to the traveler. Reminder to follow usual health precautions.
2. Level 2 (Alert): Increased risk in defined settings or associated with specific risk factors; certain high-risk populations may wish to delay travel to these destinations. Follow enhanced precautions.
3. Level 3 (Warning): High risk to travelers. Avoid all non-essential travel to this area.

Travel Safety Advisories

The U.S. State Department provides Travel Advisories for every country in the world. Each country is assigned a level of travel advisory, with additional information given on the country-specific page. Every traveler is encouraged to check their destination before traveling, as well as enrolling in STEP (Smart Traveler Enrollment Program) to enroll their trip with the nearest U.S. Embassy or Consulate.

There are four levels of travel advisories:

1. Exercise normal precautions
2. Exercise increased precautions
3. Reconsider travel
4. Do not travel

Zika Virus Facts

1. Zika is an infection caused by the Zika virus, which is spread primarily by a certain type of mosquito. It can also be spread through unprotected sexual contact.
2. In 2018, no local mosquito-borne Zika virus transmission has been reported in the continental United States. Zika is still a threat internationally. Please see the CDC's Zika Travel Information for the most up-to-date information.
3. The best way to prevent the spread of Zika is to prevent mosquito bites. Wear insect repellent, wear long sleeves and pants and stay inside.
4. Many people who get Zika do not have any symptoms or very mild symptoms. These symptoms may include: fever, rash, joint pain, conjunctivitis (pink eyes), muscle pain and headache.
5. The CDC has issued specific advice for pregnant women and Zika. Zika has been linked to serious birth defects, such as microcephaly (babies born with small heads and brains). If you are pregnant or may become pregnant soon it is not advised for you to travel to areas where Zika has been transmitted. If you are pregnant and have a partner who lives in or has traveled to an area with Zika, do not have unprotected sex during your pregnancy as the virus can be spread through sexual contact. If you are pregnant or thinking about becoming pregnant, discuss all of your travel plans with your OB/GYN or midwife.

See the Center for Disease Control and Prevention's website for more information.