AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000425738.45613.12
In the News

Clinical News

Potera, Carol; Pfeifer, Gail M. MA, RN, News Director

Free Access

Outbreaks erode confidence in food and drug safety. Lethal fungus causes meningitis. The big safety story toward the end of the year involved an outbreak of noninfectious meningitis in 419 people in 19 states that had killed 30 as of November 6. The infections were traced to injections of methylprednisolone manufactured by the New England Compounding Center (NECC) and contaminated with the fungus Exserohilum rostratum. Severe cases involved basilar-artery stroke, as in the index case; milder clinical disease symptoms included headache, stiff neck, photophobia, and weakness. About 14,000 people were injected with the tainted steroid used primarily for neck and back pain.

Figure. George Cary,...
Figure. George Cary,...
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The NECC was closed and the drug vials recalled, but wider issues were revealed as a result of this outbreak. Compounding pharmacies like the NECC, for example, are exempt from Food and Drug Administration (FDA) regulations. So are many Internet sources of drugs—of the more than 10,000 Internet sites selling prescription drugs, 97% operate outside U.S. laws, according to an October 2012 report by the National Association of Boards of Pharmacy.

Contaminated tattoo inks. Although compounding pharmacies and Internet prescription drug sites may not be subject to strict oversight, tattoo inks are subject to FDA regulation. Yet outbreaks of nontuberculous Mycobacterium skin infections related to contaminated tattoo ink occurred in New York, Iowa, and Washington in 2012. These infections can look like allergic reactions and so can therefore be misdiagnosed and mistreated, according to the FDA. The agency recommends that any such infections be reported to the tattoo artist, as well as to the FDA's MedWatch reporting system at www.fda.gov/Safety/MedWatch.

Killer cantaloupes and peanuts. An outbreak of infections with Salmonella in 24 states this year was linked to a cantaloupe farm in Indiana, and contaminated peanuts from a processing plant in New Mexico that supplied peanuts to a wide variety of wholesale and retail sources were implicated in a separate outbreak. A November outbreak of Escherichia coli infections in New York was connected to spinach and spring salad mix, and lettuce and ground beef have been affected in recent years. According to the Centers for Disease Control and Prevention (CDC), Salmonella and E. coli remain important sources of human illness in the United States. Whether these outbreaks portend tougher times in U.S. food and drug safety remains to be seen as the FDA continues to implement the 2011 Food Safety Modernization Act.

Hormone replacement therapy. Reports about hormone replacement therapy (HRT) continue to cause confusion because some studies are still showing benefit. The U.S. Preventive Services Task Force (USPSTF), however, recently helped to put the studies in perspective in an updated review of the evidence, concluding that HRT doesn't prevent chronic medical conditions like heart disease and stroke but does appear to be associated with moderate harms. Read the latest USPSTF guidelines at http://bit.ly/OZ33Fg.

Veterans’ mental health. Veterans with posttraumatic stress disorder (PTSD) need prompt access to evidence-based care, says a 2012 Institute of Medicine report (http://bit.ly/PYSxyj). As many as 20% of those who served in Iraq or Afghanistan screen positive for PTSD. The IOM report identifies barriers to care, including time constraints, transportation problems, and the fear that seeking help will ruin career prospects. New technologies such as telemedicine may improve PTSD treatment but need to be evaluated.

West Nile infection increases. 2012 was the worst year ever for West Nile virus infection, which is spread by mosquitoes. As of November 6, 2012, a total of 5,054 cases, including 228 deaths, had been reported to the Centers for Disease Control and Prevention (CDC). About half involved neuroinvasive disease (such as meningitis or encephalitis). Around 80% of cases were reported in 12 states: Texas, California, Louisiana, Mississippi, Illinois, South Dakota, Michigan, Oklahoma, Nebraska, Colorado, Ohio, and Arizona. More than a third of those were in Texas. For updated figures from the CDC, go to http://1.usa.gov/6PO4J. —Carol Potera, Gail M. Pfeifer, MA, RN, news director

© 2013 Lippincott Williams & Wilkins, Inc.

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