The Yale/Tulane Planning and Response Program, in conjunction with the Yale University Department of Emergency Medicine, has produced this special report as a result of the recent outbreaks in China involving Avian Influenza (H7N9). This power point presentation was compiled entirely from open source materials and is periodically updated. It can be downloaded and shared with healthcare and emergency response personnel. The Yale-Tulane ESF #8 Program is a multidisciplinary, multi-center, graduate level program designed to produce ESF #8 planners and responders with standardized skill sets that are consistent with evolving public policy, technologies, and best practices. The group that produced this summary and analysis includes graduate students from Yale and Tulane Universities.

A manufacturer of purified protein derivative (PPD) used in the tuberculin skin test (TST) is experiencing delays in production of Tubersol, resulting in a nationwide shortage expected to last through the end of May 2013. Additionally, the manufacturer for APLISOL is also expecting shortages to become more widespread. APLISOL is a recommended substitution for TUBERSOL for skin testing. The Centers for Disease Control and Prevention (CDC) has issued the following recommendations for three general approaches for addressing the shortages of tuberculin skin test antigens. (more)

All physicians who see patients with influenza illness in travelers returning from China -- regardless of season -- should contact the Rhode Island Department of Health (HEALTH) Division of Infectious Disease and Epidemiology at (401) 222-2577. As of April 4, 2013, public health officials in China have reported the first known human infections and deaths identified with a novel avian influenza A (H7N9) virus, according to the Centers for Disease Control and Prevention (CDC). Of the 14 patients hospitalizations associated with this strain, all had severe respiratory illness and six deaths have resulted. Read the complete CDC Health Alert Network Advisory: emergency.cdc.gov/HAN

On Tuesday, March 5, the Centers for Disease Control and Prevention (CDC) released a press release calling upon the entire health care community to work urgently – individually, regionally, and nationally – to protect patients against Carbapenem-Resistant Enterobacteriaceae (CRE). The announcement cites findings published in CDC's Vital Signs report, provides links to a prevention toolkit and other resources for healthcare providers, and presents data that illustrates how more inpatients are suffering infections from CRE that is resistant to all or nearly all antibiotics. This family of bacteria has become increasingly resistant to last-resort antibiotics during the past decade, and more hospitalized patients are getting lethal infections that, in some cases, are impossible to cure...

Summary of CDCHAN-00342: CDC continues to receive new reports of fungal infection among patients who were given injections of contaminated methylprednisolone acetate (MPA1) from the New England Compounding Center (NECC) in Framingham, Mass. Most of these recent cases have been localized spinal or paraspinal infections (e.g., epidural abscesses) in patients, although new cases of meningitis or arachnoiditis also have been reported. Because many of these new cases are among patients with minimal symptoms, CDC is re-emphasizing the recommendation for clinicians to remain vigilant for fungal infections, especially in patients with mild or even baseline symptoms, and consider evaluation with magnetic resonance imaging (MRI) if clinically warranted...

This is an official CDC Health Advisory distributed via the Health Alert Network on February 14, 2013 at 12:30:00 ET (CDCHAN-00341). Summary: Carbapenem-resistant Enterobacteriaceae (CRE) are untreatable or difficult-to-treat multidrug-resistant organisms that are emerging in the United States. Because of increased reports of these multidrug-resistant organisms, CDC is alerting clinicians about the need for additional prevention steps regarding CRE.

Healthcare providers should be aware that out of an abundance of caution HEALTH continues to follow up with patients exposed to contaminated methylprednisolone acetate (MPA1) from the New England Compounding Center (NECC) in Framingham, Mass. Any concerns over lingering infections may result in referrals to area healthcare providers. For the latest CDC updates and clinical guidance related to this outbreak, visit http://emergency.cdc.gov/HAN/han00338.asp.

The Food and Drug Administration (FDA) reported a shortage of doxycycline on January 18, 2013. Doxycycline is a recommended therapy for some sexually transmitted infections and syndromes including chlamydia, nongonococcal urethritis, epididymitis and pelvic inflammatory disease and as an alternative treatment for syphilis in patients with a penicillin allergy. For more information and alternative treatment regimens, view Doxycycline Shortage on the CDC website: http://www.cdc.gov/std/treatment/doxycyclineShortage.htm?s_CID=govd-std-004

Manufacturers of purified protein derivative (PPD) used in the tuberculin skin test (TST) are experiencing delays in production resulting in a nationwide shortage. Additionally, There is an ongoing, nationwide shortage of Isoniazid (INH) 300 mg and other formulations of INH (100 mg tabs, Rifamate, etc.)

Shortages of isoniazid (INH), a cornerstone drug for treating tuberculosis disease (TB) and latent Mycobacterium tuberculosisinfection (LTBI), are continuing. This notice gives an update on the shortages and expands general guidance about how to adjust practices in response to the shortages from that outlined in CDC's December 21, 2012, Morbidity and Mortality Weekly Report (MMWR) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6150a4.htm ). It also outlines national plans for restoring INH supplies and lists published guidance that could assist in making treatment decisions when INH is unavailable.

The Rhode Island State Health Laboratory (RISHL) instituted a new HIV screening test two years ago which is called the Abbott HIV Ab/Ag Combo test. This test is capable of detecting HIV infections earlier than the previous generation Abbott test utilized at the RISHL, giving us the capacity to detect acute infections. This notice serves to provide additional guidance on interpreting results.

The Rhode Island Department of Health (HEALTH) has confirmed two cases of pertussis in Coventry involving two Grade 6 students at the Alan Shawn Feinstein Middle School. We are working with the schools and families to identify and recommend prophylaxis for close contacts and high-risk individuals. At this time public health nurses are directing these contacts to see a pediatrician, family physician, or nurse practitioner to ensure prophylaxis. Parents of students at the school are being advised by email and/or letter to be vigilant for cough illness, and this notice might prompt calls to area healthcare providers.