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Updated Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology

5/12/2022

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Distributed via the CDC Health Alert Network
May 11, 2022, 12:15 PM ET
CDCHAN-00465
Summary
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Update to provide clinicians and public health authorities with updated information about an epidemiologic investigation of pediatric cases of hepatitis of unknown etiology in the United States. This investigation focuses on collecting information to describe the epidemiology, etiology, clinical presentation, severity, and risk factors related to illness and to identify any relationship between adenovirus infection or other factors and hepatitis. As of May 5, 2022, CDC and state partners are investigating 109 children with hepatitis of unknown origin across 25 states and territories, more than half of whom have tested positive for adenovirus with more than 90% hospitalized, 14% with liver transplants, and five deaths under investigation. Because this investigation is ongoing and includes reviewing cases of hepatitis of unknown cause with onset since October 2021, patients under investigation are not limited to current or newly diagnosed pediatric hepatitis illnesses.
This HAN Health Update also provides updated recommendations for testing specimens from patients under investigation. It is an update to a HAN Health Advisory that CDC issued on April 21, 2022, that initially notified clinicians and public health authorities of children identified with hepatitis of unknown origin and adenovirus infection.
Background
A cluster of pediatric cases of hepatitis without an apparent etiology was identified and reported to CDC in November 2021. A possible association between pediatric hepatitis and adenovirus infection is under investigation after laboratory testing identified adenovirus infection in all nine patients in the initial cluster; the five specimens that could be typed were all adenovirus type 41. Investigators continue to examine the role of other possible causes and identify contributing factors.
Recommendations for Clinicians
  • Clinicians should continue to follow standard practice for evaluating and managing patients with hepatitis of known and unknown etiology.
  • Clinicians are recommended to consider adenovirus testing for patients with hepatitis of unknown etiology and to report such cases to their state or jurisdictional public health authorities.
  • Because the potential relationship between adenovirus infection and hepatitis is still under investigation, clinicians should consider collecting the following specimen types if available from pediatric patients with hepatitis of unknown cause for adenovirus detection:
    • Blood specimen collected in Ethylenediaminetetraacetic Acid (EDTA) (whole blood, plasma, or serum); whole blood is preferred to plasma and serum)
    • Respiratory specimen (nasopharyngeal swab, sputum, or bronchioalveolar lavage [BAL])
    • Stool specimen or rectal swab; a stool specimen is preferred to a rectal swab
    • Liver tissue, if a biopsy was clinically indicated, or if tissue from native liver explant or autopsy is available:
      • Formalin-fixed, paraffin embedded (FFPE) liver tissue
      • Fresh liver tissue, frozen on dry ice or liquid nitrogen immediately or as soon as possible, and stored at ≤ -70°C
TO CONTINUE READING:​ https://emergency.cdc.gov/han/2022/han00465.asp?ACSTrackingID=USCDC_511-DM81924&ACSTrackingLabel=HAN%20465%20-%20General%20Public&deliveryName=USCDC_511-DM81924
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Why Forced Addiction Treatment Fails

5/1/2022

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April 30, 2022  NY TIMES OPINION
By Maia Szalavitz-Ms. Szalavitz is a contributing Opinion writer. She covers addiction and public policy.
​
Jason Norelli, a San Francisco native, spent several years homeless in and around the city’s Tenderloin district, addicted to methamphetamine. In 2001, he was legally mandated to attend rehab and has been in recovery ever since. Today he helps others like him get care.
Mr. Norelli’s experience makes him seem like a poster child for legally mandated addiction treatment. At least 37 states now have laws on the books that allow parents, police or concerned others to petition courts to compel rehab through civil commitment if a judge deems someone a threat to themselves or others.

Twenty-five such laws were passed or expanded between 2015 and 2018 alone, according to a recent investigation by The Intercept, and this growth continues. This month, Massachusetts proposed an increase in funding to its civil commitment program for addiction, bringing it to about $23 million. In March, Gov. Gavin Newsom of California proposed a new system of “CARE Courts,” to expand civil commitment for homeless people with schizophrenia and often addiction.

But voluntary rehab has a better track record and is less likely to harm the people it is intended to help. Criminalization and coercion have helped create a patchwork of addiction programs that is harsh, low quality, underfunded, understaffed and too often fraudulent. Since legally mandated care is often the only way to get immediate and free treatment, a damaging cycle continues.

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OPINIONGUEST ESSAY
Why Forced Addiction Treatment Fails
April 30, 2022
Credit...Julianna Brion
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By Maia Szalavitz
Ms. Szalavitz is a contributing Opinion writer. She covers addiction and public policy.
Jason Norelli, a San Francisco native, spent several years homeless in and around the city’s Tenderloin district, addicted to methamphetamine. In 2001, he was legally mandated to attend rehab and has been in recovery ever since. Today he helps others like him get care.
Mr. Norelli’s experience makes him seem like a poster child for legally mandated addiction treatment. At least 37 states now have laws on the books that allow parents, police or concerned others to petition courts to compel rehab through civil commitment if a judge deems someone a threat to themselves or others.
Twenty-five such laws were passed or expanded between 2015 and 2018 alone, according to a recent investigation by The Intercept, and this growth continues. This month, Massachusetts proposed an increase in funding to its civil commitment program for addiction, bringing it to about $23 million. In March, Gov. Gavin Newsom of California proposed a new system of “CARE Courts,” to expand civil commitment for homeless people with schizophrenia and often addiction.
But voluntary rehab has a better track record and is less likely to harm the people it is intended to help. Criminalization and coercion have helped create a patchwork of addiction programs that is harsh, low quality, underfunded, understaffed and too often fraudulent. Since legally mandated care is often the only way to get immediate and free treatment, a damaging cycle continues.
To do better, the United States needs more evidence-based treatment. And since the data shows that the best treatment is compassionate and inviting, coercion should be the last resort, not the first.

Mr. Norelli opposes compulsory drug treatment. He feels that being forced into treatment can push people in the other direction if they are not ready to quit. “Of the hundred people that came in at the same time I did, only a few completed it,” he said, adding that he is still disturbed by the “humiliating” way they were treated.

TO CONTINUE READING: https://www.nytimes.com/2022/04/30/opinion/forced-addiction-treatment.html?


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