2011 investigation of internal contamination with radioactive strontium following rubidium Rb 82 cardiac PET scan.

During routine screening in 2011, US Customs and Border Protection (CBP) identified 2 persons with elevated radioactivity. CBP, in collaboration with Los Alamos National Laboratory, informed the Food and Drug Administration (FDA) that these people could have increased radiation exposure as a result of undergoing cardiac Positron Emission Tomography (PET) scans several months earlier with rubidium Rb 82 chloride injection from CardioGen-82. We conducted a multistate investigation to assess the potential extent and magnitude of radioactive strontium overexposure among patients who had undergone Rb 82 PET scans. We selected a convenience sample of clinical sites in 4 states and reviewed records to identify eligible study participants, defined as people who had had an Rb 82 PET scan between February and July 2011. All participants received direct radiation screening using a radioisotope identifier able to detect the gamma energy specific for strontium-85 (514 keV) and urine bioassay for excreted radioactive strontium. We referred a subset of participants with direct radiation screening counts above background readings for whole body counting (WBC) using a rank ordering of direct radiation screening. The rank order list, from highest to lowest, was used to contact and offer voluntary enrollment for WBC. Of 308 participants, 292 (95%) had direct radiation screening results indistinguishable from background radiation measurements; 261 of 265 (98%) participants with sufficient urine for analysis had radioactive strontium results below minimum detectable activity. None of the 23 participants who underwent WBC demonstrated elevated strontium activity above levels associated with routine use of the rubidium Rb 82 generator. Among investigation participants, we did not identify evidence of strontium internal contamination above permissible levels. This investigation might serve as a model for future investigations of radioactive internal contamination incidents.

Outbreak of influenza A (H3N2) variant virus infection among attendees of an agricultural fair, Pennsylvania, USA, 2011.

During August 2011, influenza A (H3N2) variant [A(H3N2)v] virus infection developed in a child who attended an agricultural fair in Pennsylvania, USA; the virus resulted from reassortment of a swine influenza virus with influenza A(H1N1)pdm09. We interviewed fair attendees and conducted a retrospective cohort study among members of an agricultural club who attended the fair. Probable and confirmed cases of A(H3N2)v virus infection were defined by serology and genomic sequencing results, respectively. We identified 82 suspected, 4 probable, and 3 confirmed case-patients who attended the fair. Among 127 cohort study members, the risk for suspected case status increased as swine exposure increased from none (4%; referent) to visiting swine exhibits (8%; relative risk 2.1; 95% CI 0.2-53.4) to touching swine (16%; relative risk 4.4; 95% CI 0.8-116.3). Fairs may be venues for zoonotic transmission of viruses with epidemic potential; thus, health officials should investigate respiratory illness outbreaks associated with agricultural events.

The role of clinical toxicologists and poison control centers in public health.

BACKGROUND: Poison control centers and clinical toxicologists serve many roles within public health; however, the degree to which these entities collaborate is unknown. PURPOSE: The objective of this survey was to identify successful collaborations of public health agencies with clinical toxicologists and poison control centers. Four areas including outbreak identification, syndromic surveillance, terrorism preparedness, and daily public health responsibilities amenable to poison control center resources were assessed. METHODS: An online survey was sent to the directors of poison control centers, state epidemiologists, and the most senior public health official in each state and selected major metropolitan areas. This survey focused on three areas: service, structure within the local or state public health system, and remuneration. Questions regarding remuneration and poison control center location within the public health structure were asked to assess if these were critical factors of successful collaborations. Senior state and local public health officials were excluded because of a low response rate. The survey was completed in October 2007. RESULTS: A total of 111 respondents, 61 poison control centers and 50 state epidemiologists, were eligible for the survey. Sixty-nine (62%) of the 111 respondents, completed and returned the survey. Thirty-three (54%) of the 61 poison control centers responded, and 36 of the 50 state epidemiologists (72%) responded. The most frequent collaborations were terrorism preparedness and epidemic illness reporting. Additional collaborations also exist. Important collaborations exist outside of remuneration or poison control centers being a formal part of the public health structure. CONCLUSIONS: Poison control centers have expanded their efforts to include outbreak identification, syndromic surveillance, terrorism preparedness, and daily public health responsibilities amenable to poison control center resources. Collaboration in these areas and others should be expanded.

Transportation-related hazardous materials incidents and the role of poison control centers.

BACKGROUND: Department of Transportation (DOT) mandates reporting of all serious hazardous materials incidents. Hazardous material exposures may result in secondary contamination of emergency departments, or delayed clinical effects. Poison control centers specialize in the management of patients exposed to toxic substances; however, poison control center notification is not required. PURPOSE: The objective is to determine the frequency of poison control center notification after serious hazardous materials incidents when patients were transported to a hospital. METHODS: A retrospective analysis was conducted of serious hazardous materials incidents as reported by DOT, matched with data from the American Association of Poison Control Centers from 2002 through 2006 that involved patient transport. Incidents were divided into four groups: those reported to a poison control center within 0-360 minutes of the incident; those reported within 361-1440 minutes of the incident; those reported within 1441-4320 minutes of the incident; and no poison control center notification. Analyses were performed on variables including date, time, substance, and time to notification. Data were received in January 2008. RESULTS: One hundred fifty-four serious incidents met inclusion criteria. One hundred thirty-four incidents (87%) occurred without poison control center notification. Poison control centers were notified in 20 incidents (12.9%); 15 incidents (9.7%) were reported within 0-360 minutes of the incident (M=115 minutes, range=5-359 minutes); four incidents (2.6%) were reported within 361-1440 minutes of the incident (M=652 minutes, range=566-750 minutes); and one incident (0.7%) was reported after 4320 minutes following the incident. CONCLUSIONS: Most serious hazardous materials incidents involving patient transport are not reported to poison control centers. Opportunities exist to increase utilization of poison control center resources without increasing financial burdens of the hazardous materials incident.

Metropolitan and micropolitan statistical area estimates of depression and anxiety using the Patient Health Questionnaire-8 in the 2006 Behavioral Risk Factor Surveillance System.

OBJECTIVE: To examine the prevalence of depression and anxiety in the United States by state and MMSA. METHOD: The 2006 Behavioral Risk Factor Surveillance System collected depression and anxiety data on 74 metropolitan and micropolitan statistical areas (MMSAs) and 41 states/territories (n = 217,379). RESULTS: The national prevalence of current depression, lifetime diagnosis of depression, and lifetime diagnosis of anxiety is 8.7 %, 15.7 %, and 11.3 %, respectively. There is considerable variability within and across states for all three measures. The most striking within-state difference in current depression between MMSAs is in California: 5.4 % and 11.3 %. CONCLUSION: This variation in mental health at the state and MMSA levels calls for development and implementation of local programs.

A logic model for the integration of mental health into chronic disease prevention and health promotion.

Mental illnesses such as depression or anxiety affect an individual's ability to undertake health-promoting behaviors. Chronic diseases can have a profound impact on an individual's mental health; in turn, mental health status affects an individual's ability to participate in treatment and recovery. A group of mental health and public health professionals convened to develop a logic model for addressing mental health as it relates to chronic disease prevention and health promotion. The model provides details on inputs, activities, and desired outcomes, and the designers of the model welcome input from other mental health and public health practitioners.

Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults.

BACKGROUND: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking. METHODS: Data from the 2003 Behavioral Risk Factor Surveillance System, a population-based telephone survey of U.S. adults, was used to assess the prevalence of CVD risk factors and potential confounders among moderate drinkers and nondrinkers. Moderate drinkers were defined as men who drank an average of two drinks per day or fewer, or women who drank one drink or fewer per day. RESULTS: After adjusting for age and gender, nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors, social factors, behavioral factors, access to health care, and health-related conditions. Of the 30 CVD-associated factors or groups of factors that we assessed, 27 (90%) were significantly more prevalent among nondrinkers. Among factors with multiple categories (e.g., body weight), those in higher-risk groups were progressively more likely to be nondrinkers. Removing those with poor health status or a history of CVD did not affect the results. CONCLUSIONS: These findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding. Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States.

SARS in healthcare facilities, Toronto and Taiwan.

The healthcare setting was important in the early spread of severe acute respiratory syndrome (SARS) in both Toronto and Taiwan. Healthcare workers, patients, and visitors were at increased risk for infection. Nonetheless, the ability of individual SARS patients to transmit disease was quite variable. Unrecognized SARS case-patients were a primary source of transmission, and early detection and intervention were important to limit spread. Strict adherence to infection control precautions was essential in containing outbreaks. In addition, grouping patients into cohorts and limiting access to SARS patients minimized exposure opportunities. Given the difficulty in implementing several of these measures, control measures were frequently adapted to the acuity of SARS care and level of transmission within facilities. Although these conclusions are based only on a retrospective analysis of events, applying the experiences of Toronto and Taiwan to SARS preparedness planning efforts will likely minimize future transmission within healthcare facilities.