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The Public Health Response to a Large Poisoning Outbreak Involving an Illicit Substance

Synthetic Cannabinoids Contaminated With a Long-Acting Anticoagulant Rodenticide, Illinois, March-July, 2018

Navon, Livia MS; Moritz, Erin PhD; Austin, Connie DVM, PhD, MPH; Wahl, Michael MD; Aks, Steven DO; Layden, Jennifer MD, PhD

Journal of Public Health Management and Practice: April 05, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHH.0000000000001002
Case Study: PDF Only

During March-July 2018, the Illinois Department of Public Health responded to an acute outbreak of severe coagulopathy among patients with recent synthetic cannabinoid use. Toxicological testing indicated that cases were exposed to brodifacoum, a long-acting anticoagulant rodenticide. A total of 174 confirmed and probable cases, including 5 deaths, were linked to this outbreak. On the basis of the experience of responding to this complex outbreak, we recommend several steps for consideration to improve health department preparation for acute outbreaks involving illicit substances including strengthening communication between public health and law enforcement agencies, reviewing legal authority to investigate noninfectious acute disease outbreaks, continuing strong partnerships with state poison control centers, partnering with substance abuse and mental health agencies to provide services to patients, and determining health department ability to rapidly enter into public-private partnership agreements.

Illinois Department of Public Health, Chicago and Springfield, Illinois (Ms Navon and Drs Moritz, Austin, and Layden); Division of State and Local Readiness, Center for Preparedness and Response (Ms Navon), and Epidemic Intelligence Service (Dr Moritz), Centers for Disease Control and Prevention, Atlanta, Georgia; Illinois Poison Center, Illinois Health and Hospital Association, Chicago, Illinois (Dr Wahl); and Cook County Health and Hospitals System, Chicago, Illinois (Dr Aks).

Correspondence: Livia Navon, MS, Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329 (

Dr Nirav Shah, Donald Kauerauf, Molly Lamb, Kelly Walblay, Judy Kauerauf, Dawn Nims, Julie Dow, and Alexandra Barger affiliated with the Illinois Department of Public Health at the time of the outbreak were key to carrying out the public health response. Staff from the following local health departments contributed to the outbreak response: Tazewell County Health Department, Peoria City/County Health Department, Cook County Department of Public Health, City of Chicago Department of Public Health, Winnebago County Health Department, Woodford County Health Department, DuPage County Health Department, Fulton County Health Department, Kankakee County Health Department, Mason County Health Department, Kane County Health Department, Madison County Health Department, Mclean County Health Department, Stephenson County Health Department, and Will County Health Department. Illinois Poison Center staff including Carol DesLauriers and the Toxikon fellows, Drs Arkady Rasin, Jason Devgun, Theresa Kim, and Maxim Dzeba, provided invaluable toxicological support and patient clinical follow-up.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

No authors report any conflicts of interest or sources of funding from nonpublic sources.

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