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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
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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.
Continue reading the main story OPINIONGUEST ESSAY Why Forced Addiction Treatment Fails April 30, 2022 Credit...Julianna Brion
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? AUTHORDavid Brand DATEMarch 30, 2022 CITY LIMITS
The Adams administration has touted Safe Havens as an alternative for those who would rather sleep outside than in a traditional homeless shelter. But there are too few of the facilities to accommodate the majority of unsheltered New Yorkers. After more than a year sleeping in parked cars and city parks, Michael Torres got a chance to try something new earlier this month. When a bed opened up in a Safe Haven shelter near Crotona Park, Torres, 45, received a referral from an outreach team and moved into a room he shares with one other person. Safe Havens have fewer restrictions than most facilities in the city’s sprawling shelter system and allow people to come and go as they please. Along with similar so-called stabilization shelters, they are designed to appeal to homeless New Yorkers, like Torres, who have left or avoided other congregate facilities—typically due to autonomy, privacy or safety considerations—and have instead opted to bed down in public spaces. The arrangement is not perfect—Torres says he really wants a permanent apartment—but the flexibility is working for him. “I don’t need a curfew,” Torres said outside a Manhattan drop-in center Tuesday. “I just need to eat a bowl of oatmeal and go out looking for work.” The specialized shelters also feature on-site services and, ideally, a pathway to housing via case managers and social workers who assist residents with rental subsidy or supportive housing applications. But there are too few of the facilities to accommodate the majority of unsheltered New Yorkers. That means outreach workers can rarely offer placement to people in need, even as police, under the direction of Mayor Eric Adams, drive them off the trains and sanitation workers throw their belongings into garbage trucks. Adams, who came into office pledging to evict homeless New Yorkers from the subway system, said last Friday that he also plans to order the removal of every homeless encampment in the city, stepping up a practice that his predecessor Bill de Blasio accelerated at the tail end of his tenure. TO CONTINUE READING: https://citylimits.org/2022/03/30/the-city-is-pushing-homeless-new-yorkers-off-the-streets-and-subways-where-will-they-go/ Published April 19, 2022 | Originally published on The Scientist MD Linx
Scientists and public health officials in the UK, US, and Spain are investigating the cause of a number of cases of severe hepatitis in children younger than 10. On April 5, public health officials in Scotland notified the World Health Organization of 10 cases of severe hepatitis—liver inflammation—in children under the age of 10 years old, according to a WHO press release. Within three days, 74 cases had been identified throughout the United Kingdom. All of the children were admitted to and diagnosed in the hospital. As of April 12, none of the children had died, but some were severely ill. Seven have had to receive liver transplants. “This is a severe phenomenon,” Deirdre Kelly, a pediatric hepatologist at Birmingham Children’s Hospital in England, tells Science. “These [were] perfectly healthy children . . . up to a week ago. Most of [the children] recover on their own,” Kelly notes. According to New Scientist, doctors in the UK have been advised to watch out for children age under age 16 who have symptoms of hepatitis, which include jaundice (a yellowish tinge to the skin), discoloration of the urine or feces, itchy skin, fever, nausea, and abdominal pain. On April 14, the Centers for Disease Control (CDC) reported that nine cases of hepatitis have been identified in children ages one to six in Alabama since last fall. Two of the nine needed liver transplants, Science reports. In a statement issued to STAT, the CDC says it’s working with the Alabama Department of Public Health and other state departments to investigate the cause of the outbreak. STATreports that the Alabama public health department issued an alert to doctors in early February that mentioned a case in another state, but the alert did not give details. Meanwhile, in Spain, the government of the Madrid region announced on April 13 that three regions—Madrid, Aragón, and Castilla-La Mancha—have each reported one case of severe hepatitis of indeterminate origin in young children, according to Science, and one of those children has received a liver transplant. Hepatitis is typically caused by pathogens, most commonly the hepatitis C virus. That virus, along with the hepatitis A, B, and E viruses, was not present in any of the UK or Spanish cases, according to Science. According to STAT, hepatitis viruses have also been ruled out as a potential cause of the outbreak in Alabama. Severe cases of hepatitis are rarely found in children who are not immunocompromised, and the cause of the current outbreak is still unknown. “Seeing children with severe [hepatitis] in the absence of severe underlying health problems is very rare,” pediatrician Karen Landers, a district medical officer for the Alabama Department of Public Health, tells STAT in an interview. “That’s what really stood out to us in the state of Alabama.” Experts tell Science that an adenovirus, a virus that typically causes colds, may be the culprit. Adenoviruses typically attack the respiratory tract but have occasionally been linked to hepatitis. Researchers in Scotland published a study on April 14 detailing cases of children with hepatitis in five children ages three to five this year, writing that an adenovirus infection is “the leading hypothesis.” According to Science,as many as half of the affected children in Spain and the UK tested positive for an adenovirus upon entering the hospital. Five of the nine children in Alabama also tested positive for an adenovirus. TO CONTINUE READING: https://www.mdlinx.com/news/mysterious-hepatitis-cases-reported-in-young-children/5Wu8skb3qpDTFgmCmSMHZF?show_order=5&article_type=sele LEGAL MATTERS What can be done to fix EHRs? PhysicianSense OBESITY New study on mice sheds light on the anti-obesity effects of vitamin E Newswise Gastrointestinal System Disorders > Hepatitis (Viral) Mysterious hepatitis cases reported in young childrenPublished April 19, 2022 | Originally published on The Scientist Scientists and public health officials in the UK, US, and Spain are investigating the cause of a number of cases of severe hepatitis in children younger than 10. On April 5, public health officials in Scotland notified the World Health Organization of 10 cases of severe hepatitis—liver inflammation—in children under the age of 10 years old, according to a WHO press release. Within three days, 74 cases had been identified throughout the United Kingdom. All of the children were admitted to and diagnosed in the hospital. As of April 12, none of the children had died, but some were severely ill. Seven have had to receive liver transplants. “This is a severe phenomenon,” Deirdre Kelly, a pediatric hepatologist at Birmingham Children’s Hospital in England, tells Science. “These [were] perfectly healthy children . . . up to a week ago. Most of [the children] recover on their own,” Kelly notes. According to New Scientist, doctors in the UK have been advised to watch out for children age under age 16 who have symptoms of hepatitis, which include jaundice (a yellowish tinge to the skin), discoloration of the urine or feces, itchy skin, fever, nausea, and abdominal pain. ADVERTISEMENT -SCROLL TO KEEP READING On April 14, the Centers for Disease Control (CDC) reported that nine cases of hepatitis have been identified in children ages one to six in Alabama since last fall. Two of the nine needed liver transplants, Science reports. In a statement issued to STAT, the CDC says it’s working with the Alabama Department of Public Health and other state departments to investigate the cause of the outbreak. STATreports that the Alabama public health department issued an alert to doctors in early February that mentioned a case in another state, but the alert did not give details. Meanwhile, in Spain, the government of the Madrid region announced on April 13 that three regions—Madrid, Aragón, and Castilla-La Mancha—have each reported one case of severe hepatitis of indeterminate origin in young children, according to Science, and one of those children has received a liver transplant. Hepatitis is typically caused by pathogens, most commonly the hepatitis C virus. That virus, along with the hepatitis A, B, and E viruses, was not present in any of the UK or Spanish cases, according to Science. According to STAT, hepatitis viruses have also been ruled out as a potential cause of the outbreak in Alabama. Severe cases of hepatitis are rarely found in children who are not immunocompromised, and the cause of the current outbreak is still unknown. “Seeing children with severe [hepatitis] in the absence of severe underlying health problems is very rare,” pediatrician Karen Landers, a district medical officer for the Alabama Department of Public Health, tells STAT in an interview. “That’s what really stood out to us in the state of Alabama.” Experts tell Science that an adenovirus, a virus that typically causes colds, may be the culprit. Adenoviruses typically attack the respiratory tract but have occasionally been linked to hepatitis. Researchers in Scotland published a study on April 14 detailing cases of children with hepatitis in five children ages three to five this year, writing that an adenovirus infection is “the leading hypothesis.” According to Science,as many as half of the affected children in Spain and the UK tested positive for an adenovirus upon entering the hospital. Five of the nine children in Alabama also tested positive for an adenovirus. Published April 19, 2022 | Originally published on MedicalXpress Breaking News-and-Events
MD Linx Proposed changes to the CDC's opioid prescribing guideline are inadequate and will not undo the damage caused to patients and the practice of pain management, according to a large new survey by Pain News Network, an independent, non-profit news organization. Most survey respondents (63%) want the guideline revoked, not revised. The U.S. Centers for Disease Control and Prevention released a long-awaited draft revision of its 2016 guideline in February, giving healthcare providers more flexibility in how they manage pain with opioids. Although voluntary, the original guideline was misapplied as a rigid "standard of care" by many states, insurers, doctors and law enforcement, causing millions of patients to be taken off opioids or tapered to lower doses. Although the revised guideline states that "opioids can be essential medications for the management of pain" and encourages doctors to use their own best judgment when prescribing them, many patients and providers believe the changes don't go far enough and may even make the crisis in pain care worse. "Appreciate the effort, but too little too late. These revisions are like trying to prevent disaster by course correcting the Titanic after it hit the iceberg," one patient said. "The revisions offer no protection against overzealous DEA interference and prosecution, and are meaningless in court. Until the draconian laws spawned by the guidelines are changed, things will only continue to get worse." TO CONTINUE READING: https://www.mdlinx.com/news/patients-and-providers-say-changes-to-cdc-opioid-guideline-inadequate/lUZ9coUonQm7BXOXtj39a?show_order= Feb. 18, 2022: National Advocacy Update- AMA
The AMA asked the Biden administration to take additional steps to remove the prescription status of naloxone—the overdose-reversing drug—to make it more available over the counter. “As the overdose epidemic has worsened, given the FDA’s clear guidance there is no moral, medical, or safety-related reason for these life-saving overdose reversal agents to remain locked under prescription regulations,” the AMA wrote (PDF) the Office of National Drug Control Policy (ONDCP). If not for naloxone, tens of thousands of additional Americans likely would have died from overdoses. The AMA greatly appreciates ONDCP has made increasing access to naloxone a high priority and recommended steps that would make it more widely available to harm-reduction organizations and individuals regardless of their insurance status. The letter notes that naloxone manufacturers are dragging their feet on making it more available over the counter. TO CONTINUE: https://www.ama-assn.org/health-care-advocacy/advocacy-update/feb-18-2022-national-advocacy-update?utm_source=SFMC&utm_medium=email&utm_term=2182022&utm_content=22-9997_Advocacy_Update_021822&utm_campaign=Advocacy_Email_Newsletter_AdvocacyUpdate&utm_uid=15829237&utm_effort=#ama-urges-administration-to-save-lives-by-moving-naloxone-from-behind-the-counter (New York, NY, February 14, 2022) – A new, interactive, online memorial was launched today by the public health organization Vital Strategies to honor those who have lost their lives to a drug overdose—more than one million in the past two decades in the U.S.—far surpassing car crashes and firearm fatalities combined. Inspired by the AIDS quilt, the digital mosaic allows anyone to commemorate a loved one lost to overdose, and calls for urgent action in their name.
The memorial’s launch is accompanied by the largest-ever national advertising campaign promoting harm reduction to raise awareness about common-sense ways to save lives, such as distributing the opioid overdose reversal drug naloxone to people who use drugs and their loved ones. Following the national launch, Vital Strategies will share the campaign in some of the states hardest-hit by the overdose crisis, including using technology that will allow the memorial to be projected onto buildings. “The AIDS quilt turned grief into demand for change, forcing the country to confront the mounting HIV/AIDS epidemic with the urgency it required. With overdose deaths topping 100,000 a year, we are beyond the moment of reckoning with our failure to address drug use as a health issue,” said Dr. Daliah Heller, Vice President of Drug Use Initiatives at Vital Strategies. “We hope the overdose memorial offers an opportunity for those touched by this tragedy to share their stories and join in the call to support the public health solution to the overdose crisis: harm reduction.” The campaign is funded by Bloomberg Philanthropies as part of their initiative to tackle the overdose epidemic in the United States. “At Bloomberg Philanthropies, we believe in promoting evidence-based interventions to ensure longer, better lives for the greatest number of people—harm reduction does just that,” said Dr. Kelly Henning, who leads the public health program at Bloomberg Philanthropies. “The rising number of overdose deaths is devastating communities around the U.S. so it’s urgent that public health solutions such as harm reduction interventions are widely supported and implemented. Too often underfunded, such community-led, evidence-driven interventions like naloxone distribution and syringe service programs are critical and must receive increased support to help save lives.” Every 5-and-a-half minutes someone dies from a drug overdose in the U.S. More than 100,000 people died in the past year alone—the highest number on record. Many of these tragedies could have been prevented if harm reduction measures were in place and at scale. Although the Biden Administration began funding harm reduction last year, most federal- and state-directed overdose prevention efforts do not focus on these proven, life-saving measures. The goal of this public awareness initiative is to build support for harm reduction measures such as: fentanyl test strips and other drug checking tools so that people can test for harmful additives in drugs; sterile syringes and other safer drug use supplies to stop the spread of HIV and Hepatitis C; naloxone in community hands to reverse fatal overdoses; methadone and buprenorphine access for those struggling with opioid dependence; and overdose prevention centers, such as those recently opened in New York. TO CONTINUE: https://www.vitalstrategies.org/largest-ever-harm-reduction-ad-campaign-to-run-in-conjunction-with-memorial-to-generate-support-for-solutions-to-growing-crisis-including-full-page-new-york-times-ad-and-tv-spots/?fbclid=IwAR1HLUEoN23-qyz0hIogsa8Qkzn1ZZbK-GPgUNBMnlO2exw_B85RQI9qIYc After New York City successfully opened the nations’s first legally operating overdose prevention centers, it’s time to open more of them across the state.
By ANNETTE GAUDINO, BRIANNA NORTON, CLIFTON GARMON FEBRUARY 9, 2022 NYN Media Usually, an A grade would be seen as a measure of a job well done. However, when it comes to progress toward hepatitis elimination, New York is only now getting back on track. The Empire State has work to do in order to regain our status as national leaders in this effort. As evaluated by Hep ElimiNATION, a joint project of the O’Neill Institute for National and Global Health Law at Georgetown University Law Center, the National Viral Hepatitis Roundtable, and the Center for Health Law and Policy Innovation at Harvard Law School, New York’s A grade comes with caveats, specifically a lack of dedicated, sufficient funding for proactive case finding, linkage to care and harm reduction services for New Yorkers living with and at risk of developing viral hepatitis. Hepatitis C is one of the deadliest infectious diseases in the United States, killing more annually than all other infectious diseases combined, except COVID-19. Around 3.5 million people in the country suffer from chronic infection, including over 100,000 living in New York State. They are disproportionately poor, people of color, people who have been incarcerated and people who use drugs. Hepatitis C has been fully curable for nearly a decade, but far too many patients still face obstacles accessing lifesaving treatment: achieving just outcomes for them demands a multi-pronged approach. The New York Hepatitis C Elimination Task Force has identified several such areas for policy improvement, outlining potential action steps within each. We need to broadly implement proven strategies to prevent hepatitis C (HCV) infection before it happens, including expanded access to syringe service program, peer outreach to people who inject drugs and people experiencing homelessness, and prevention and treatment measures within correctional facilities. Next, we must strengthen our testing and care infrastructure serving those already infected, through interventions such as ensuring pregnant people are screened for HCV during each pregnancy, testing and treatment in non-traditional healthcare settings, and enforcement of recent policy changes that removed prior authorization requirements for HCV medication among Medicaid patients. Finally, we must better serve all the needs of those most vulnerable to viral hepatitis through initiatives to address social determinants of health including unstable housing and employment. TO CONTINUE READING: https://www.nynmedia.com/content/opinion-new-york-state-ready-statewide-injection-sites MedicalXpress Breaking News-and-Events|February 7, 2022 MDLinx
A recent study has found that so-called "drug checking" programs have unexpected benefits, allowing public health programs to reach and work with people who use drugs who would otherwise not access services such as HIV testing. Drug checking refers to analyzing illegal drugs, or prescription drugs not acquired from a pharmacy, that people have used or are about to use. There are various technologies available for drug checking, but the ultimate goal is to reduce overdoses and other health risks associated with an increasingly contaminated illicit drug supply. "We already knew that using fentanyl test strips reduces overdoses in the United States—these are used to identify whether fentanyl is present in other drugs," says Jennifer Carroll, an assistant professor of anthropology at North Carolina State University and first author of a paper on the study. "We also knew that drug checking with advanced technologies, such as spectrometers, has been very effective at preventing drug overdoses in other countries, such as Canada and the United Kingdom. TO CONTINUE READING:https://www.mdlinx.com/news/study-finds-unexpected-benefits-of-drug-checking-programs/1qpzigBobDP1s5JjD0mbQ0?show_order=8&article_t A wave of diagnostics ushered in by Covid could help revive flagging efforts to eliminate the disease. By Ted Alcorn Feb. 4, 2022 NY TIMES
The day after Christmas, when Kellie Trent was scheduled to pick up medication to cure her hepatitis C, it seemed like a little miracle. She was expected at the Pioneer Family Practice in western Washington State, seven months after screening positive for the blood-borne infection at a clinic that dispenses medication to treat her heroin addiction. All that time, as she underwent more tests and waited for results while in and out of residential drug treatment, addressing her hepatitis C remained out of reach. On the eve of her December appointment, her physician, Dr. Lucinda Grande, grew concerned when a storm brought four inches of snow to the region, snarling the roads. But in the end, Ms. Trent did not show up because she landed in jail for a few days, arrested after missing court appearances for sentencing on a misdemeanor assault charge, according to court records. Dr. Grande stowed away the first half of the unused prescription — a four-week course of pills priced at $13,000. “She has had a bumpy road,” Dr. Grande said. Ms. Trent is among an estimated 2.4 million Americans with hepatitis C, which killed more than 14,000 in 2019, the most recent data available, despite the availability of drugs offering a relatively straightforward cure. The U.S. government set a target of largely vanquishing the disease by 2030, but data from the Centers for Disease Control and Prevention show the number of treated patients has been falling and is less than half the rate necessary to meet that goal. TO CONTINUE READING:https://www.nytimes.com/2022/02/04/health/hepatitis-c-test.html |
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