health

spread-of-deadly-eee-virus-explodes-5-fold-in-new-york;-one-death-reported

Spread of deadly EEE virus explodes 5-fold in New York; one death reported

Viral spread —

Normally only 2 or 3 counties have EEE-positive mosquitoes; there’s 15 this year.

An entomologist for the Louisville Metro Department of Public Health and Wellness in a swampland area on August 25, 2021 in Louisville, Kentucky collecting various mosquito species, and testing the samples for mosquito-borne diseases, such as EEE.

Enlarge / An entomologist for the Louisville Metro Department of Public Health and Wellness in a swampland area on August 25, 2021 in Louisville, Kentucky collecting various mosquito species, and testing the samples for mosquito-borne diseases, such as EEE.

New York is facing an unusual boom in mosquitoes toting the deadly eastern equine encephalitis (EEE) virus, which has already led to one rare death in the state and a declaration of an “imminent threat” by officials.

While the state’s surveillance system typically picks up EEE-positive mosquitoes in two or three counties each year, this year there have been 15 affected counties, which are scattered all across New York, State Health Commissioner James McDonald said this week.

“Eastern equine encephalitis is different this year,” McDonald said, noting the deadly nature of the infection, which has a mortality rate of between 30 and 50 percent. “Mosquitoes, once a nuisance, are now a threat,” McDonald added. “I urge all New Yorkers to prevent mosquito bites by using insect repellents, wearing long-sleeved clothing, and removing free-standing water near their homes. Fall is officially here, but mosquitoes will be around until we see multiple nights of below-freezing temperatures.”

On Monday, McDonald issued a Declaration of an Imminent Threat to Public Health for EEE, and Governor Kathy Hochul announced statewide actions to prevent infections. At the same time as the declaration, the officials reported the death of a New Yorker who developed EEE. The case, which was confirmed in Ulster County on September 20, is the state’s first EEE case since 2015.

The disease is very rare in New York. Between 1971 and 2024, there were only 12 cases of EEE reported in the state; seven cases were fatal.

Rare but deadly

EEE is generally rare in the US, with an average of only 11 cases reported per year, according to the Centers for Disease Control and Prevention. The virus lurks in wild birds and spreads to people and other animals via mosquitoes. The virus is particularly deadly in horses—as its name suggests—with mortality rates up to 90 percent. In people, most bites from a mosquito carrying the EEE virus do not lead to EEE. In fact, the CDC estimates that only about 4–5 percent of infected people develop the disease; most remain asymptomatic.

Fo those who develop EEE, the virus travels from the mosquito bite into the lymph system and spreads from there to cause a systemic infection. Initial symptoms are unspecific, including fever, headache, malaise, chills, joint pain, nausea, and vomiting. This can progress to inflammation of the brain and neurological symptoms, including altered mental state and seizures. Children under the age of 15 and adults over the age of 50 are most at risk.

The CDC estimates that about 30 percent of people who develop severe EEE die of the disease. But, with small numbers of cases over time, the reported mortality rates can vary. In Massachusetts, for instance, about 50 percent of the cases have been fatal. Among those who survive neuro-invasive disease, many are left severely disabled, and some die within a few years due to complications. There is no vaccine for EEE and no specific treatments.

Overall numbers

While New York seems to be experiencing an unusual surge of EEE-positive mosquitoes, the country as a whole is not necessarily seeing an uptick in cases. Only 10 cases from six states have been reported to the CDC this year. That count does not include the New York case, which would bring the total to 11, around the country’s average number of cases per year.

In addition to New York, the states that have reported cases are Massachusetts, Vermont, New Jersey, Rhode Island, Wisconsin, and New Hampshire. Most cases have been in the Northeast, where cases are typically reported between mid-June and early October before freezing temperatures kill off mosquito populations.

The death in New York is at least the second EEE death this year. In August, New Hampshire’s health department reported the death of an EEE case, and local media reports identified the person as a previously healthy 41-year-old man from Hampstead.

EEE gained attention last month when a small town in Massachusetts urged residents to follow an evening curfew to avoid mosquito bites.  The move came after the state announced its first EEE case this year (the state’s case count is now at four) and declared a “critical risk level” in four communities.

Between 2003 and 2023, the highest tally of cases in a year was in 2019, when states reported 38 EEE cases.

Spread of deadly EEE virus explodes 5-fold in New York; one death reported Read More »

human-cases-of-raccoon-parasite-may-be-your-best-excuse-to-buy-a-flamethrower

Human cases of raccoon parasite may be your best excuse to buy a flamethrower

kill it with fire —

The infection is very rare, but it’s definitely one you want to avoid.

Young raccoon looking out from a tree.

Enlarge / Young raccoon looking out from a tree.

If you were looking for a reason to keep a flamethrower around the house, you may have just found one.

This week, the Los Angeles County health department reported that two people were infected with a raccoon parasite that causes severe, frequently fatal, infections of the eyes, organs, and central nervous system. Those who survive are often left with severe neurological outcomes, including blindness, paralysis, loss of coordination, seizures, cognitive impairments, and brain atrophy.

The parasitic roundworm behind the infection, called Baylisascaris procyonis, spreads via eggs in raccoons feces. Adult worms live in the intestines of the masked trash scavengers, and each female worm can produce nearly 200,000 eggs per day. Once in the environment, those eggs can remain infectious for years. They can survive drying out as well as most chemical treatments and disinfectants, including bleach.

Humans get infected if they inadvertently eat soil or other material that has become contaminated with egg-laden feces. Though infections are rare—there were 29 documented cases between 1973 and 2015—younger children and people with developmental disabilities are most at risk.

For instance, an 18-month-old boy with Downs syndrome in Illinois died from the infection after he chewed and sucked on pieces of contaminated firewood bark. An autopsy later found three worm larvae per gram of his brain tissue, with a total estimated burden of 3,027 parasitic larvae, according to a 2016 report.

Burn it down

In a news release this week, the LA health department said the risk to the general public is “low” but that the two cases are “concerning because a large number of raccoons live near people, and the infection rate in raccoons is likely high. The confirmed cases of this rare infection are an important reminder for all Los Angeles County residents to take precautions to prevent the spread of disease from animals to people, also known as zoonotic disease.”

According to the Centers for Disease Control and Prevention, one of the best prevention methods for raccoon roundworms is to kill it with fire. While chemicals stand little chance of killing off infectious eggs, extreme heat destroys them instantly.

If you have raccoons around your property, you might need to employ this method. Raccoons tend to poop in communal, pungent latrines, which are often at the base of trees, on raised surfaces—such as tree stumps, woodpiles, decks, and patios—as well as in attics and garages.

If you suspect you have an outdoor raccoon latrine on your property, the CDC recommends dousing the area in boiling water or setting it ablaze. While the CDC recommends a propane torch, specifically, a personal flamethrower could also do the trick. The agency does caution that flaming a latrine site “could cause a fire, burn injury, or surface damage.”

“Before flaming any latrine site, call your local fire department for details on local regulations and safety practices,” the CDC says. “Concrete pads, bricks, and metal shovels or garden implements can be flamed without damage. Do not attempt to flame surfaces that can melt or catch fire.”

For indoor latrines, the CDC advises not to use fire. Instead, it outlines a cautious cleaning method with hot, soapy water. However, if you want, any removed feces or contaminated material can be flamed outside, if not buried or put in the trash.

Human cases of raccoon parasite may be your best excuse to buy a flamethrower Read More »

boar’s-head-will-never-make-liverwurst-again-after-outbreak-that-killed-9

Boar’s Head will never make liverwurst again after outbreak that killed 9

Insanitary —

The Jarratt, Virginia, plant is now closed indefinitely.

A recall notice is posted next to Boar's Head meats that are displayed at a Safeway store on July 31, 2024, in San Rafael, California.

Enlarge / A recall notice is posted next to Boar’s Head meats that are displayed at a Safeway store on July 31, 2024, in San Rafael, California.

The Boar’s Head deli-meat plant at the epicenter of a nationwide Listeria outbreak that killed nine people so far harbored the deadly germ in a common area of the facility deemed “low risk” for Listeria. Further, it had no written plans to prevent cross-contamination of the dangerous bacteria to other products and areas. That’s according to a federal document newly released by Boar’s Head.

On Friday, the company announced that it is indefinitely closing that Jarratt, Virginia-based plant and will never again produce liverwurst—the product that Maryland health investigators first identified as the source of the outbreak strain of Listeria monocytogenes. The finding led to the recall of more than 7 million pounds of Boar’s Head meat. The Jarratt plant, where the company’s liverwurst is made, has been shuttered since late July amid the investigation into how the outbreak occurred.

In the September 13 update, Boar’s Head explained that:

[O]ur investigation has identified the root cause of the contamination as a specific production process that only existed at the Jarratt facility and was used only for liverwurst. With this discovery, we have decided to permanently discontinue liverwurst.

While the statement seems to offer some closure on the outbreak’s source, previously released inspection reports described a facility riddled with sanitation failures. Between August 1, 2023, and August 2, 2024, the facility was cited for 69 violations, which included water leaks, mold in numerous places, algal growth, “meat buildup” caking equipment, and walls that were also crawling with flies and gnats, sightings of other insects, rancid smells, trash and debris on the floors, and even “ample amounts of blood in puddles.”

The New York Times also reported that a 2022 inspection found that the plant posed an “imminent threat” to public health and that inspectors cited “extensive rust, deli meats exposed to wet ceilings, green mold and holes in the walls.”

Cross-contamination

The document newly released by Boar’s Head is a letter dated July 31 from the US Department of Agriculture’s Food Safety and Inspection Service notifying the company that the Jarratt facility was suspended. The basis of the suspension was an inspection finding from July 24 and 25 of L. monocytogenes contaminating a pallet jack in a large room where ready-to-eat meats were processed. The room was a common area not specific to liverwurst processing and was deemed by Boar’s Head to be “low risk” for Listeria.

Meats from eight processing lines were in the room, with lines 1 through 4 on the left side and 5 through 8 on the right, handling hot dogs and other small sausages. The contaminated pallet jack was designated for production line 2, which was handling Beechwood Hams, and was used to move racks of hams from blast coolers to production lines in the processing room.

However, inspectors noted that the pallet jacks and product racks in the room weren’t kept to designated production lines, and instead, employees moved them between all of the lines and all of the blast coolers, enabling cross-contamination. And, while the equipment was moved around, people did, too. Although employees typically stuck to one production line, they would sometimes move between lines, and there were no procedures for employees to change personal protective equipment (PPE)—gloves, disposable aprons, and arm covers—when they switched. Inspectors saw them switching without changing their PPE.

“They also observed employees who freely move between all lines without directly interacting with product such as those removing garbage, removing product debris from the floors, removing condensation from overhead structures, or performing maintenance,” the USDA officials wrote.

Outbreak spread

Given that this was in a room full of meats that were supposedly ready to eat, the USDA concluded that Boar’s Head “failed to maintain sanitary conditions” and that its Listeria control program was “ineffective.”

To date, 57 people from 18 states have been sickened. All 57 were hospitalized, and nine people died. The Centers for Disease Control and Prevention reported that health officials have interviewed 44 people sickened during the outbreak, who said they ate various deli-sliced meats. Only 25 reported eating deli-sliced liverwurst.

In light of the outbreak, Boar’s Head said it is revamping its safety and quality assurances at its other facilities and hiring experienced food safety experts. “You have our promise that we will work tirelessly to regain your trust and ensure that all Boar’s Head products consistently meet the high standards that you deserve and expect. We are determined to learn from this experience and emerge stronger.”

Boar’s Head will never make liverwurst again after outbreak that killed 9 Read More »

here’s-why-you-shouldn’t-freak-out-about-lead-in-your-cinnamon

Here’s why you shouldn’t freak out about lead in your cinnamon

A rant —

For the most part, you’d have to eat a weirdly large amount to cause a problem.

Cinnamon buns.

Enlarge / Cinnamon buns.

Consumer Reports on Thursday reported the concentration of lead it found in 36 ground cinnamon products, leading to a round of startling headlines. The testing is particularly nerve-racking given that it closely follows the tragic poisoning of at least 519 US children, who were exposed to extremely high levels of lead from purposefully tainted cinnamon in applesauce snack pouches.

With that horrifying event in mind, parents are likely primed to be alarmed by any other lead findings in cinnamon. So, how concerning were the concentrations Consumer Reports found? And does one need to strictly adhere to the limits the organization recommends? By my calculations, not very and probably not. It’s really not an alarming report.

Similar to the outlet’s chocolate testing before it, the lead concentrations found in cinnamons were largely within standard ranges. In all, the report is more of a reminder that trace amounts of heavy metals are present in various common foods. And such watchdog testing can play a crucial role in keeping consumers safe, especially with underfunded and underpowered regulators.

Before I go into the data, I’ll be upfront with my conflict of interest here: I love cinnamon about as much as I love chocolate, which is to say: a lot. I can’t imagine fall or holidays without heavily cinnamoned treats. And if you believe that cinnamon isn’t a verb, you are incorrect (at least in my book). Still, my love of this tree-bark spice could certainly be shaken by my healthy aversion to neurotoxic things, especially with a small child at home gobbling up my baked goods. That’s why I dug in and did the math—and I’m happy to show my work.

Regulated concentrations

So, what did Consumer Reports (CR from here) find? The company collected three samples of each of the 36 products from grocery stores, specialty/international food shops, and online sellers. Then, they sent them off to a commercial lab for testing and reported back the average concentrations of lead in parts per million (ppm), which is equivalent to milligrams per kilogram (mg/kg).

CR judged the results by a threshold level of 1 ppm, which is the concentration at which the state of New York will issue a recall for a spice (currently, at least, they have proposed lowering it). It’s important to note that, even at the current 1 ppm threshold, New York is an outlier. As CR notes, New York is the only state to have such a threshold. The Food and Drug Administration doesn’t have a clear cut-off, but recent warnings from the agency were all regarding products that had lead concentrations of more than 2 ppm, not 1 ppm. The FDA also notes that the international food standard-setting body, Codex Alimentarius Commission, sets a limit for bark spices at 2.5 ppm. Further, the European Union set the maximum allowable lead concentration for bark spices at 2 ppm, according to regulations set in 2021 (PDF).

Despite the unusually low threshold, CR highlighted 12 products—mostly uncommon brands—that wouldn’t make it in the Big Apple. Of those, only three products were above the 2 ppm threshold that would have drawn the eyes of FDA and European Union regulators. The two brands behind the two highest readings (Paras at 3.52 ppm and EGN at 2.91 ppm) indicated to CR that they would voluntarily recall their products. The other product that came in above 2 ppm was Mimi’s Products cinnamon, with an average of 2.03 ppm. CR data shows that only one of the three samples was above 2 ppm (with readings of 1.97 ppm, 2.16 ppm, and 1.97 ppm).

That said, concentration thresholds for the purposes of regulatory recalls are one thing. Other things—likely to be far more relevant to consumers—are how much cinnamon people actually eat and what the maximum safe amount of lead is. So, what are those?

Here’s why you shouldn’t freak out about lead in your cinnamon Read More »

in-abortion-ban-states,-sterilization-spiked-after-dobbs-and-kept-climbing

In abortion ban states, sterilization spiked after Dobbs and kept climbing

Can’t blame ’em —

Sterilizations spike with abortion bans and declining access to care and contraception.

A woman holds a placard saying

Enlarge / A woman holds a placard saying “No Forced Births” as abortion rights activists gather at the Monroe County Courthouse for a protest vigil a few hours before Indianas near total abortion ban goes into effect on September 15, 2022.

The more abortion access is jeopardized, the more women turn to sterilization, according to a new report in JAMA that drew on health insurance claims of nearly 4.8 million women in the US.

In states that enacted total or near-total abortion bans following the US Supreme Court’s Dobbs decision in June 2022, the rate of sterilizations among reproductive-age women that July spiked 19 percent. A similar initial spike was seen across the nation, with states that either limited or protected access to abortions seeing a 17 percent increase.

But, after that, states with bans saw a divergent trend. The states that limited or protected abortion access saw sterilization procedures largely level off after July 2022. In contrast, states with bans continued to see increases. From July 2022 to December 2022, use of sterilization procedures increased by 3 percent each month.

The study adds to previous data finding that overturning Roe v. Wade and limiting legal access to abortion spurred reproductive-age people to seek permanent contraception. A study published in JAMA Health Forum in April, for instance, found an abrupt increase in tubal ligation and vasectomies in people aged 18 to 30 shortly after the Dobbs decision. The current study furthers the finding by assessing trends of sterilization procedures in the context of state abortion laws and policies.

The surge in sterilization is just one of the many ways reproductive healthcare in the US has been rocked or upended by the Supreme Court’s 2022 decision. In June, a study in JAMA Network Open found that states with the most restrictive abortion policies saw declines in prescriptions filled for birth control pills and emergency contraception. The finding suggests that the abortion bans and limitations have disrupted and created barriers to contraception access in restrictive states.

On Tuesday, meanwhile, the March of Dimes released a report painting a bleak picture for Americans who become pregnant. The analysis found that over half of US counties do not have a hospital that provides obstetric care. In the last two years, 1 in 25 obstetric units shut down. Further, 35 percent of counties in the US are considered maternity deserts, meaning that 1,104 counties in the US do not have a birthing facility or even a single obstetric clinician. Living in a maternity desert is associated with receiving less prenatal care and higher rates of preterm birth. Those 1,104 counties are home to 2.3 million women of reproductive age who gave birth to over 150,000 babies in 2022.

The US continues to have the highest rate of maternal deaths among any high-income country, with Black women seeing the highest death rates, according to the latest report from the Commonwealth Fund.

In abortion ban states, sterilization spiked after Dobbs and kept climbing Read More »

woman-drips-with-sweat-from-a-bite-of-food-due-to-rare-nerve-wiring-mix-up

Woman drips with sweat from a bite of food due to rare nerve-wiring mix-up

Fascinating —

After just 75 seconds of chewing, large drops of sweat ran down the woman’s face.

Woman drips with sweat from a bite of food due to rare nerve-wiring mix-up

The human body is full of marvels, some even bordering on miraculous. That includes the limited ability for nerves to regenerate after injuries, allowing people to regain some function and feeling. But that wonder can turn, well, unnerving when those regenerated wires end up in a jumble.

Such is the case for a rare neurological condition called gustatory hyperhidrosis, also known as Frey’s syndrome. In this disorder, nerves regenerate after damage to either of the large saliva glands that sit on either side of the face, just in front of the ears, called the parotid glands. But that nerve regrowth goes awry due to a quirk of anatomy that allows the nerves that control saliva production for eating to get tangled with those that control sweating for temperature control.

In this week’s issue of the New England Journal of Medicine, doctors in Taiwan report an unusual presentation of the disorder in a 76-year-old woman. She told doctors that, for two years, every time she ate, her face would begin profusely sweating. In the clinic, the doctors observed the phenomenon themselves. They watched as she took a bite of pork jerky and began chewing.

Panel A, 10 seconds after beginning chewing; Panel B, 30 seconds after; Panel C, 50 seconds after; and Panel D, 75 seconds after.

Enlarge / Panel A, 10 seconds after beginning chewing; Panel B, 30 seconds after; Panel C, 50 seconds after; and Panel D, 75 seconds after.

At the start, her face was dry and had a normal tone. But, within 30 seconds, her left cheek began to glisten with sweat and turn red from flushing. By 50 seconds, large beads of sweat coated her cheek. At 75 seconds, droplets ran down her cheek and onto her neck.

Anatomy quirk

Seven years before that doctor’s appointment, the woman had undergone surgery to remove the parotid gland on that side of her face due to the growth of a benign tumor. Gustatory hyperhidrosis is a common complication after such a removal, called a parotidectomy. Some published studies estimate that up to 96 percent of parotidectomy patients will go on to develop the disorder. But, if it does develop, it usually does so within about six to 18 months after the surgery—the time it can take for nerves to regrow. But, in the woman’s case, it appeared to develop after five years since she reported that it started only two years prior to her appointment. It’s unclear why there was such a delay.

Doctors hypothesize that gustatory hyperhidrosis develops after salivary gland injuries or surgeries because of the way nerve fibers are bundled in that part of the head. The nerves that control the salivary glands are part of the parasympathetic nervous system (PSNS). This division of the nervous system is sometimes described as controlling the relatively calm “rest and digest” bodily functions, which are controlled unconsciously as part of the autonomic nervous system that controls things like heart rate.

The PSNS is in contrast to the other part of the autonomic nervous system, called the sympathetic nervous system (SNS). The SNS controls the unconscious “fight or flight” stress responses, which include sweat glands.

Tangled fibers

While PSNS fibers that control the saliva glands and SNS fibers that control sweat glands are from different divisions, they come together on the side of the face. Specifically, they meet up in a tributary nerve called the auriculotemporal nerve. And, they don’t just feed into the same physical conduit, they also overlap in their chemical regulation. Often SNS and PSNS fibers are activated by different signaling molecules (aka neurotransmitters). But it just so happens that the nerve fibers that control sweat glands are activated by the same neurotransmitter that activates the fibers in the PSNS, including those regulating saliva glands. They’re both regulated by a neurotransmitter called acetylcholine.

When PSNS and SNS nerve fibers are damaged near the parotid salivary gland from injury or surgery, the nerves can regenerate. But, given their physical and chemical overlaps, doctors think that in gustatory hyperhidrosis, PSNS nerve fibers end up growing back abnormally, along the paths of SNS fibers. This ends up connecting the PSNS fibers to sweat glands in the skin. So, upon signals of eating, the crossed nerve fibers lead not to salivation but heat responses, including sweat production and blood vessel dilation, which explains the facial flushing.

Living with it

Thankfully, there are various treatments for people with gustatory hyperhidrosis. They include surgical reconstruction or injections of Botox (botulinum neurotoxin), which can shut down the activity of the sweat glands. Similarly, there are topical anticholinergics, which block and inhibit the activity of acetylcholine, the neurotransmitter that activates the nerve fibers activating the sweat glands. There are also topical antiperspirants that can help.

After the doctors in Taiwan diagnosed their patient with gustatory hyperhidrosis, they discussed these options with her. But she reportedly “opted to live with the symptoms.”

Woman drips with sweat from a bite of food due to rare nerve-wiring mix-up Read More »

person-in-missouri-caught-h5-bird-flu-without-animal-contact

Person in Missouri caught H5 bird flu without animal contact

Concerning —

The person recovered, and Missouri officials say risk to public is still low.

The influenza virus from an image produced with transmission electron microscopy. Viral diameter ranges from around 80 to 120 nm.

Enlarge / The influenza virus from an image produced with transmission electron microscopy. Viral diameter ranges from around 80 to 120 nm.

A person in Missouri with no reported exposure to animals was confirmed to have been infected with H5-type bird flu, the Missouri Department of Health and Senior Services (MDHSS) announced late Friday.

MDHSS reported that the person, who has underlying medical conditions, was hospitalized on August 22 and tested positive for an influenza A virus. Further testing at the state’s public health laboratory indicated that the influenza A virus was an H5-type bird flu. The Centers for Disease Control and Prevention has now confirmed that finding and is carrying out further testing to determine if it is the H5N1 strain currently causing a widespread outbreak among US dairy cows.

It remains unclear if the person’s bird flu infection was the cause of the hospitalization or if the infection was discovered incidentally. The person has since recovered and was discharged from the hospital. In its announcement, MDHSS said no other information about the patient will be released to protect the person’s privacy.

The report marks the 15th human case of an H5-type bird flu infection in the country since 2022. But, the case stands out—and is quickly generating alarm online—because the man reported no contact with animals. All 14 of the previous cases occurred in farmworkers who had contact with either dairy cows or poultry that were known to be infected with H5N1.

The finding in a person without such an exposure raises the possibility that the H5N1 virus is spreading from person to person, undetected, or is spreading via an undetected animal source.

But, while the case raises concern, some infectious disease experts are cautious not to sound the alarm without more data on the case and potential exposures.

“[U]ntil such data is collected and analyzed, my level of alarm is only mildly heightened,” Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security and founding associate director of the Center for Forecasting and Outbreak Analytics at the CDC, said online.

“I am encouraged that this case was detected through existing surveillance systems, which bodes well for our ability to identify any additional cases in the future,” she added. “Federal, state, and local health officials maintained flu surveillance through the summer months in response to the H5 situation, and that was definitely the right move.”

But Rivers, like many of her colleagues, has long worried about H5N1’s potential to jump to humans and spark a pandemic.

To date, H5N1 is known to have infected 197 herds in 14 states. Missouri has not reported infected herds, but has reported infected poultry farms.

Person in Missouri caught H5 bird flu without animal contact Read More »

adhd-med-shortages-push-dea-to-up-drug-allotment-by-23.5%

ADHD med shortages push DEA to up drug allotment by 23.5%

drug boost —

The DEA’s quota increase is for Vyvanse and its generic forms.

ADHD med shortages push DEA to up drug allotment by 23.5%

While supplies of Adderall and its generic versions are finally recovering after a yearslong shortage, the Drug Enforcement Administration is now working to curb the short supply of another drug for attention-deficit/hyperactivity disorder: Vyvanse (lisdexamfetamine) and its generic versions.

This week, the DEA said it will increase the allowed production amount of lisdexamfetamine by roughly 23.5 percent, increasing the current 26,500 kg quota by 6,236 kg, for a new total of 32,736 kg. The DEA also allowed for a corresponding increase in d-amphetamine, which is needed for production of lisdexamfetamine.

“These adjustments are necessary to ensure that the United States has an adequate and uninterrupted supply of lisdexamfetamine to meet legitimate patient needs both domestically and globally,” the DEA said.

Quotas

Just like Adderall (amphetamine/dextroamphetamine salts), Vyvanse (lisdexamfetamine) is an amphetamine-class stimulant classified by the DEA as a Schedule II drug. As such, the DEA controls its production levels to ensure demand is met while preventing excess supply that could find its way to the black market. The administration does this by setting an “aggregate production quota”—which is what the DEA adjusted for lisdexamfetamine this week—and doling out undisclosed allotments to drug manufacturers.

While various factors have contributed to the shortages of ADHD medications, some medical and industry groups have placed blame on the DEA’s quota system for underestimating demand and choking supply. For instance, the Adderall shortage began in 2022 following a labor shortage on the product’s production line at Teva, Adderall’s maker. But, while that production snag was resolved, prescription rates increased significantly, in part due to increased awareness of ADHD, broadening diagnosis criteria, and an increase in access with the rise of telehealth services, which boomed during the COVID-19 pandemic. In a report earlier this year, the American Society of Health-System Pharmacists pointed to the DEA’s quotas, saying they’re “exacerbating” shortages.

In an August 2023 joint letter, the DEA and the FDA responded to such criticism, suggesting that the quotas aren’t to blame. Rather, it’s that some manufacturers are not using up their allotment of controlled drugs.

“Based on DEA’s internal analysis of inventory, manufacturing, and sales data submitted by manufacturers of amphetamine products [which include the two ADHD drugs], manufacturers only sold approximately 70 percent of their allotted quota for the year, and there were approximately 1 billion more doses that they could have produced but did not make or ship. Data for 2023 so far show a similar trend,” the FDA and DEA wrote.

The FDA and DEA said they would work with manufacturers to ensure they would ramp up production of drugs in short supply or relinquish their remaining allotments.

Vyvanse shortage

A similarly complicated situation is seen with the current shortfall of Vyvanse and its generics. The DEA raised the quota after prodding from the Food and Drug Administration. In July, the FDA sent the DEA a letter requesting a quota increase. However, the shortage had actually begun in June 2023. At that time, Vyvanse’s maker, Takeda, said that a “manufacturing delay compounded by increased demand” had led to low inventory.

In August 2023, the FDA approved multiple generic versions of Vyvanse after Takeda’s patent exclusivity expired, raising hopes that the shortage would ease with the injection of new generics. But supply problems have persisted. In November, the Association for Accessible Medicines, which represents generic drugmakers, sent a letter to the DEA saying that generic manufacturers weren’t able to obtain enough raw material to “launch their products at full commercial scale,” because the quotas were standing in the way, according to reporting by Bloomberg.

FiercePharma reported another potential factor raised by lawmakers and industry watchers. Those onlookers took note of the timing of Takeda’s “manufacturing delays” just months before generics entered the market. With the significantly thinner profit margin of generic and off-patent drugs, there’s concern that manufacturers may de-prioritize production.

Last, the DEA flagged yet another factor in the supply chain: exports to foreign markets. While the FDA estimated a 6 percent increase in the domestic need for lisdexamfetamine between 2023 and 2024, the DEA’s export data showed a 34 percent increase in exports of lisdexamfetamine between 2022 and 2023, with expectations that exports would continue to increase this year and beyond. As such, the current 23.5 percent quota increase for lisdexamfetamine is only partly for domestic production. In fact, only a quarter of the 6,236 kg is intended for the US. Of the increased allotment, 1,558 kg is for domestic drug production, while the other 4,678 kg addresses increases in foreign demand, the DEA said.

ADHD med shortages push DEA to up drug allotment by 23.5% Read More »

parenting-nightmare:-kiss-on-the-cheek-causes-child’s-incurable-infection

Parenting nightmare: Kiss on the cheek causes child’s incurable infection

Stress of parenting —

Puzzle of child’s misdiagnosed cheek lesion solved with one look at dad

Herpes simplex virus, (HSV). Image taken with transmission electron microscopy.

Enlarge / Herpes simplex virus, (HSV). Image taken with transmission electron microscopy.

As the US Surgeon General recently highlighted, parenting is stressful. From navigating social media to facing a youth mental health crisis, challenges abound. But, for one father in Spain, even the simple, loving, everyday act of giving your child a peck on the cheek has turned to nightmare fuel.

According to a case report in the New England Journal of Medicine, the man’s 9-year-old daughter developed a fever along with a crusty, blistering lesion on her left cheek. Doctors initially diagnosed the blotch as impetigo, a bacterial infection on the skin’s surface layers that is fairly common in children. It’s often caused by Staphylococcus aureus or Streptococcus bacteria and is generally easily treated with antibiotics.

The lesion on the girl's cheek with satellite blisters noted by arrows.

Enlarge / The lesion on the girl’s cheek with satellite blisters noted by arrows.

But, after several days of treatment for impetigo, the child’s symptoms weren’t getting better. At that point, it had been seven days since the lesion erupted, and it was 3 centimeters in diameter on the side of her face. So, he took her to a dermatology clinic. There, specialists closely examined the lesion, noting the red, raised area with blisters and a “honey-crusted appearance,” which is a classic sign of impetigo. They also noted smaller “satellite” blisters around the cheek, as well as swollen lymph nodes on the left side of her neck, the same side as the lesion. All of the symptoms still lined up with impetigo. But then the specialists looked over at her dad.

The doctors took note of a crusting on her father’s lower lip, which he said had started 10 days earlier. It looked like a classic case of common cold sores, aka oral herpes. And the doctors made a connection.

Stress begets stress

Cold sores are caused by herpes simplex virus type 1 (HSV-1), a highly contagious virus that is estimated to infect 3.7 billion people under the age of 50 globally. (There’s also HSV-2, which causes genital herpes). In an initial infection, herpes viruses invade cells on the body’s surfaces, but then go into hiding in nerve cells. From there, they can occasionally reactivate and produce new lesions and infections. For HSV-1, that usually means cold sores around the mouth.

There is no cure for herpes infections; the virus will lurk in a person’s nerve cells for the rest of their lives, with the potential to spur recurring outbreaks. However, there are antiviral treatments that can ease the symptoms of outbreaks and help them clear up a little faster.

When a cold sore develops, the lesions are highly infectious. It’s often transmitted through oral-oral contact, but any direct contact or contact with contaminated saliva can spread the virus. (HSV-2 primarily spreads through sexual contact.) And, while HSV-1 lesions typically erupt around the mouth and on mucosal surfaces, they can sometimes also flare elsewhere on the skin.

The dermatologists treating the 9-year-old ran a test for HSV-1, confirming the genetic traces of the virus were present. They started the girl on an oral antiviral drug. They also noted that there was no concern for sexual abuse. The lesion cleared without scarring.

In their report on the case, they end with a note of caution for other doctors: “When HSV-1 infection manifests in children as cutaneous lesions without mucosal involvement, it may be confused with the honey-crusted appearance of impetigo.”

For parents, the lesson is to be careful not to kiss your child (or anyone else) when you have a cold sore flare up. While those viral reactivations can be sparked by many things, one notable factor will likely strike home for parents: stress.

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blood-puddles,-mold,-tainted-meat,-bugs:-boar’s-head-inspections-are-horrifying

Blood puddles, mold, tainted meat, bugs: Boar’s Head inspections are horrifying

“ample amounts of blood” —

The USDA recorded 69 violations in a year. So far, 9 people have died in the outbreak.

A recall notice is posted next to Boar's Head meats that are displayed at a Safeway store on July 31, 2024, in San Rafael, California.

Enlarge / A recall notice is posted next to Boar’s Head meats that are displayed at a Safeway store on July 31, 2024, in San Rafael, California.

Federal inspections found 69 violations—many grisly—at the Boar’s Head meat facility at the center of a deadly, nationwide Listeria outbreak that has now killed nine people, sickened and hospitalized a total of 57 across 18 states, and spurred the nationwide recall of more than 7 million pounds of meat.

The Jarratt, Virginia-based facility had repeated problems with mold, water leaks, dirty equipment and rooms, meat debris stuck on walls and equipment, various bugs, and, at one point, puddles of blood on the floor, according to inspection reports from the US Department of Agriculture’s Food Safety and Inspection Services. The reports were obtained by CBS News through a Freedom of Information Act Request. In all, the reports outline 69 violations just between the dates of August 1, 2023, and August 2, 2024.

The findings in the reports reveal the perfect conditions for the company’s meat to become contaminated with the germ behind the deadly outbreak, Listeria monocytogenes. This is a hardy germ that is ubiquitous in the environment, including in soil and water, and it spreads among people via the fecal-oral route. In healthy people, it usually only causes gastrointestinal infections. But for older people, newborns, and the immunocompromised, it can cause a life-threatening invasive infection with a fatality rate of around 17 percent. It’s also a significant danger to pregnant people, causing miscarriage, stillbirth, premature delivery, and life-threatening infections in newborns.

While it’s always lurking, L. monocytogenes especially plagues the food industry because it has the notable ability to reproduce at refrigerator temperatures—a condition that typically limits the growth of other nasty germs.

Buildup and bugs

In the Boar’s Head facility, L. monocytogenes appeared to have various opportunities to beef up its numbers. For one, the facility had a long track record of trash and meat debris in various places, which was sometimes reported alongside insect sightings. For instance, on June 10, an inspector entered the “pickle vat pump room” and noted “heavy meat buildup” on the walls, which were also crawling with flies and gnats. On the same day, an inspection of a different area found a rollup door with meat buildup on it, and a water pipe over the door leaked a steady stream of water down the wall and onto the floor. There was also a “steady line of ants” and an inventory of ladybugs, a cockroach, and a beetle of some sort.  Earlier, on March 13, an inspection of a room next to where netted hams were handled, an inspector found trash and meat protein on the floor, including “whole pork muscles.”

Going back to August 8, 2023, an inspection likewise found processing lines covered in meat particles and trash. “Heavy discolored meat buildup” was found covering a hydraulic pump, and pieces of meat and fat clung to the support braces of a catwalk. An inspection-line scale had meat pieces and trash in it—and it smelled bad. “Multiple instances of meat were found around the department on the floor. As well as standing water containing a brown mud/dirt-like substance,” the inspection read.

The facility had numerous problems with water leaks and condensation, which fits with the other numerous sightings of mold. The facility temporarily fixed water pipe leaks by wrapping the pipes in plastic. On October 26, an inspector noticed a plastic-wrapped pipe in the cure cooler. The plastic was dated August 17, and there was “orange/brown water pooled in the lowest hanging point.”

Bubbles and blood

On January 9, the inspection of a holding cooler found spots of black mold as large as a quarter throughout the room. On July 23, an inspector noticed bubbled paint on the wall around employee hand-washing sinks. The bubbles were filled with water. And under the sinks, the inspector found black mold and pink mildew.

On July 17, the inspector found “green algal growth” in a puddle of standing water in a raw holding cooler. And on July 27, an inspector noted clear liquid leaking out from a square patch on the ceiling. Behind the patch, there were two other patches that were also leaking. An employee came and wiped the liquid away with a sponge, but it returned within 10 seconds. The employee wiped it again, and the liquid again returned within 10 seconds. Meanwhile, a ceiling fan mounted close by was blowing the leaking liquid onto uncovered hams in a hallway outside the room.

To top if off, a report on February 21 found a raw cooler with “ample amounts of blood in puddles on the floor” and a “rancid smell.”

According to USDA documents, the agency has not taken enforcement actions against Boar’s Head, and there is no data available on swab testing for Listeria at the Virginia facility. The plant has been shut down since late July after health investigators found the outbreak strain of L. monocytogenes in unopened containers of Boar’s Head liverwurst.

In a statement updated on August 29, Boar’s Head said, “We are conducting an extensive investigation, working closely with the USDA and government regulatory agencies, as well as with the industry’s leading food safety experts, to determine how our liverwurst produced at our Jarratt, Virginia facility was adulterated and to prevent it from happening again… We will not resume operations at this facility until we are confident that it meets USDA regulatory standards and Boar’s Head’s highest quality and safety standards.”

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massive-nationwide-meat-linked-outbreak-kills-5-more,-now-largest-since-2011

Massive nationwide meat-linked outbreak kills 5 more, now largest since 2011

Hardy germs —

CDC implores consumers to check their fridges for the recalled meats.

Listeria monocytogenes.

Enlarge / Listeria monocytogenes.

Five more people have died in a nationwide outbreak of Listeria infections linked to contaminated Boar’s Head brand meats, the Centers for Disease Control and Prevention reported Wednesday.

To date, 57 people across 18 states have been sickened, all of whom required hospitalization. A total of eight have died. The latest tally makes this the largest listeriosis outbreak in the US since 2011, when cantaloupe processed in an unsanitary facility led to 147 Listeria infections in 28 states, causing 33 deaths, the CDC notes.

The new cases and deaths come after a massive recall of more than 7 million pounds of Boar’s Head meat products, which encompassed 71 of the company’s products. That recall was announced on July 30, which itself was an expansion of a July 26 recall of an additional 207,528 pounds of Boar’s Head products. By August 8, when the CDC last provided an update on the outbreak, the number of cases had hit 43, with 43 hospitalizations and three deaths.

In a media statement Wednesday, the CDC says the updated toll of cases and deaths is a “reminder to avoid recalled products.” The agency noted that the outbreak bacteria, Listeria monocytogenes, is a “hardy germ that can remain on surfaces, like meat slicers, and foods, even at refrigerated temperatures. It can also take up to 10 weeks for some people to have symptoms of listeriosis.” The agency recommends that people look through their fridges for any recalled Boar’s Head products, which have sell-by dates into October.

If you find any recalled meats, do not eat them, the agency warns. Throw them away or return them to the store where they were purchased for a refund. The CDC and the US Department of Agriculture also recommend that you disinfect your fridge, given the germs’ ability to linger.

L. monocytogenes is most dangerous to people who are pregnant, people age 65 years or older, and people who have weakened immune systems. In these groups, the bacteria are more likely to move beyond the gastrointestinal system to cause an invasive listeriosis infection. In older and immunocompromised people, listeriosis usually causes fever, muscle aches, and tiredness but may also cause headache, stiff neck, confusion, loss of balance, or seizures. These cases almost always require hospitalization, and 1 in 6 die. In pregnant people, listeriosis also causes fever, muscle aches, and tiredness but can also lead to miscarriage, stillbirth, premature delivery, or a life-threatening infection in their newborns.

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Tattoo ink sold on Amazon has high levels of weird and rare bacteria

Infectious ink —

The recall announcement noted that the germs “present a health concern.”

BARCELONA, SPAIN - 2021/10/02: Spanish tattoo artist Oscar Garcia works on a man, during the Expo.  Fira de Barcelona hosts the XXIV edition of the Barcelona Tattoo Expo where tattoo artists from Spain and other countries exhibit tattoos and tattoo material such as ink, needles and special machinery for tattoo work. (Photo by Ramon Costa/SOPA Images/LightRocket via Getty Images)

Enlarge / BARCELONA, SPAIN – 2021/10/02: Spanish tattoo artist Oscar Garcia works on a man, during the Expo. Fira de Barcelona hosts the XXIV edition of the Barcelona Tattoo Expo where tattoo artists from Spain and other countries exhibit tattoos and tattoo material such as ink, needles and special machinery for tattoo work. (Photo by Ramon Costa/SOPA Images/LightRocket via Getty Images)

The Food and Drug Administration has been warning for years that some tattoo inks are brimming with bacteria—a large assortment that, when injected into your skin, can cause inflammatory reactions, allergic hypersensitivity, toxic responses, and, of course, straight-up infections. And, worse yet, the labels that say the inks are sterile are not reliable.

But, a recent recall of three tattoo pigments from the same manufacturer does a good job of illustrating the FDA’s concerns. The water-based inks, all from Sierra Stain, had a bizarre array of bacteria, which were found at high levels, according to FDA testing.

One ink product—described as “Carolina Blue”—offered a microbial menagerie, with six odd species identified. They included a bacterium that often dwells in the gastrointestinal system and can inflame the mucosal lining of the intestines (Citrobacter braakii), a water-borne bacterium (Cupriavidus pauculus), and several that cause opportunistic infections (Citrobacter farmer, Achromobacter xylosoxidans, Ochrobactrum anthropi, and Pseudomonas fluorescens). These are bacteria that don’t typically go about attacking humans but will if the conditions are right, including when they find themselves inside a human with a compromised immune system.

An ink called “UV China Pink” contained an unusual soil bacterium (Curtobacterium citreum/pusillum). And an “All Purpose Black” ink puzzlingly contained Acetobacter senegalensis, a bacterium first isolated from mangos in Senegal and used for industrial vinegar production in low-income countries.

The three inks were sold nationwide through Amazon. To date, there have been no reported infections or adverse reactions linked to these inks. But the FDA notes that reactions to contaminated inks can be difficult to accurately diagnose. The infections and skin responses can look like generic rashes and allergic responses, sometimes including lesions with red papules in areas where the ink was injected, the FDA notes. However, infections from tattoo ink can leave permanent scarring.

In a study published in July in Applied and Environmental Microbiology, FDA researchers tested 75 samples of tattoo and permanent makeup inks from 14 manufacturers. Of the 75 inks, 26 (35 percent) were contaminated with a total of 34 types of bacteria, many that were possibly disease-causing. Some of the bacteria were anaerobic, meaning they don’t need oxygen to grow, suggesting they could thrive in the low-oxygen environment of skin layers. Of the 40 tattoo inks specifically, nine (22 percent) were contaminated. Among all the ink samples, 49 were labeled “sterile” and, of those, 16 (33 percent) were contaminated.

The recall announcement noted that Sierra Stain is no longer in business. While the company lists a remaining email address, it did not immediately respond to a comment request from Ars on the bacteria found in their inks.

The FDA recommends that consumers be vigilant about the quality and safety of tattoo supplies and techniques. It also encourages tattoo artists to work in professional environments that can reduce the risk of contamination.

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