Minnesota Department of Health (MDH) Bug Bytes

January 29, 2004
Vol. 5: No. 1

Topics in this Issue:
1 . 2002 Gastroenteritis Outbreak Summary
2. New Postal Regulations for Mailing Clinical Samples and Workshop Announcement
3. Increase in Syphilis in Minnesota
4. CDC Recommends Restricted Use of Rifampin/Pyrazinamide for Treatment of Latent Tuberculosis Infection
5. MDH Website Redesigned

1. 2002 Gastroenteritis Outbreak Summary
The 2002 MDH Gastroenteritis Outbreak Summary is now available online at: http://www.health.state.mn.us/divs/idepc/
This annual summary includes information about foodborne, waterborne, and person-to-person outbreaks of gastroenteritis that were investigated in 2002. A total of 124 gastroenteritis outbreaks were documented that year involving at least 3,800 persons (since identified persons represent only a fraction of those actually ill). These included 46 confirmed foodborne; 16 probable foodborne; five confirmed waterborne; and 57 non-foodborne, non-waterborne gastroenteritis outbreaks. Of the 46 confirmed foodborne outbreaks, 31 (67%) were either laboratory-confirmed or epidemiologically defined as norovirus gastroenteritis. Many foodborne outbreaks of norovirus were due to ill food workers handling ready-to-eat food items (e.g., salads and sandwiches) in restaurants or catering settings. The end of 2002 saw a striking increase in the number of person-to-person outbreaks due to norovirus in settings such as schools and nursing homes. This increase in norovirus outbreaks was a trend observed throughout the country and included several high-profile outbreaks on cruise ships. For more information, contact Ellen Swanson at 612-676-5639.

2. New Postal Regulations for Mailing Clinical Samples and Workshop Announcement
New regulations governing the shipping and packaging of clinical samples by U.S. Mail went into effect January 1, 2004. These regulations require the use of certified packaging whenever clinical samples are sent in the mail. Examples of specimens affected by these regulations include stool samples collected in a foodborne illness outbreak, influenza specimens, and all organisms sent to us for surveillance purposes (e.g. EIP organisms).

The certified packaging consists of three parts: a primary specimen container, a secondary container which is pressure certified to a 95 kpa pressure differential, and a sturdy outer container. MDH has a supply of certified packaging available for those laboratories that send clinical specimens/isolates to MDH through the U.S. Mail as their only option for specimen transport. To obtain packaging please call Ruth Rutledge at 612-676-5396, or print, fill out, and fax the Supply Request Form at: http://www.health.state.mn.us/divs/phl/

There will be a packaging and shipping workshop at the MDH St. Paul Snelling Office Park Building on February 13, 8:00 a.m.-1:00 p.m. For more information go to the MLS website at: www.health.state.mn.us/mls or contact Mary Ellen Anderson at 612-676-5068.

3. Increase in Syphilis in Minnesota
Syphilis infection rates in Minnesota continue to increase. A preliminary review of Minnesota's 2003 data shows that 74 cases of early syphilis infections were reported for the first nine months compared to 60 cases for the same time frame in 2002. Of the 74 early syphilis cases in 2003, 69 (93%) are in males, including 54 cases that were reported among men who have sex with men. About one half of these were co-infected with HIV. The syphilis cases continue to be concentrated in the Twin Cities metropolitan area. CDC guidelines recommend that physicians assess the sexual risk in all their male patients and provide annual screenings for sexually active men for syphilis and other sexually transmitted diseases (STDs). The guidelines also recommend more frequent STD screenings, every 3 to 6 months, for men at highest risk. The current CDC treatment guidelines for STDs are available online at: http://www.cdc.gov/std.

4. CDC Recommends Restricted Use of Rifampin/Pyrazinamide for Treatment of Latent Tuberculosis Infection
CDC has issued revised guidelines for the use of a short-term drug regimen consisting of rifampin (RIF) and pyrazinamide (PZA) for the treatment of latent tuberculosis infection (LTBI). The 2-3 month RIF/PZA regimen, which was first introduced in 2000 as an “acceptable” alternative to regimens consisting of isoniazid (INH) or RIF alone, has been associated with an unacceptably high incidence of severe liver injury. At the time the revised guidelines were issued, CDC had received reports of 48 confirmed cases of RIF/PZA-associated severe liver injury, including 11 deaths, following the introduction of the RIF/PZA regimen.

CDC, the Infectious Diseases Society of America, and the American Thoracic Society now recommend that RIF/PZA should generally not be used to treat LTBI. A TB medical expert should be consulted before prescribing RIF/PZA for an individual patient, and very close monitoring is essential for patients on this regimen. CDC stresses that RIF and PZA should continue to be used in multi-drug regimens for the treatment of active TB disease.

The revised recommendations were published in the August 8, 2003 MMWR (at: http://www.cdc.gov/mmwr/PDF/wk/mm5231.pdf. A letter describing the rationale for the revised guidelines can be seen at: http://www.cdc.gov/nchstp/tb/dearcolleague.pdf. A fact sheet about treating LTBI is available at: http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250110.pdf. A copy of revised MDH guidelines for screening and treating LTBI, along with an LTBI medication request form, translated patient education materials, and a suggested LTBI patient monitoring flow sheet, can be found at: http://www.health.state.mn.us/tb.

CDC continues to collect reports of severe liver injury leading to hospitalization or death in persons receiving any LTBI treatment regimen. Report possible cases to the Division of TB Elimination at (404) 639-8442. Please notify the MDH TB Program at (612) 676-5414 of any reports made.

Targeted TB screening and treatment of LTBI is an important component of TB prevention and control efforts in Minnesota. MDH provides free medications for the treatment of LTBI and active TB disease. Clinicians can order medications for individual patients by calling the MDH TB Program at (612) 676-5414.

5. MDH Website Redesigned
The MDH website has been redesigned. Check it out at: http://www.health.state.mn.us.


Bug Bytes is a combined effort of the Infectious Disease Epidemiology, Prevention and Control Division and the Public Health Laboratory Division of MDH. We provide Bug Bytes as a way to say THANK YOU to the infection control professionals, laboratorians, local public health professionals, and health care providers who assist us.

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Updated Friday, November 19, 2010 at 02:16PM