As of Thursday afternoon, the NC Division of Public Health (DPH) reported that it was investigating 28 cases related to the E. coli outbreak. Twelve cases have been confirmed, and sixteen cases are under investigation.

Here is the latest list of counties and cases reported:

Wake               13

Sampson           6

Cleveland           1

Durham              2

Johnston             1

Lenoir                  1

Orange                2

Wilson                 2

Four of the confirmed cases involve children who have been hospitalized with hemolytic uremic syndrome (HUS). Health officials say the outbreak appears to be linked to people who attended the State Fair in mid-October.

On Monday, State Epidemiologist Megan Davies, MD, explained that investigators are using an exhaustive interview process to help pinpoint the source of the E. coli O157. This includes further interviews involving confirmed or suspected cases, and interviews with more than seventy randomly chosen people who attended the fair but did not become ill. By using a control group, officials hope to find some commonality that may provide additional clues as to the source, but Davies cautioned that it’s possible they may not learn what the specific exposure was.

The investigation is expected to be completed by early next week. DPH officials have been working closely with the Agriculture Department and local health departments. Updates on the investigation are being posted daily by 4:00 pm at: http://epi.publichealth.nc.gov/gcdc/ecoli.html.

State law requires that all suspected shiga toxin-producing E. coli infections and HUS cases be reported within 24 hours to the local health department or by contacting the epidemiologist on call at 919-733-3419. Suspected cases do not require laboratory confirmation to be reported.

North Carolina’s infant mortality rate declined sharply in 2010, reaching its lowest level in state history. The rate, seven deaths for 1,000 live births, represents an 11.4 percent drop from the state’s 2009 rate of 7.9 deaths.  The largest decline in infant mortality in 2010 was among African American infants, a reduction of 19.6 percent from 2009. State Health Director Jeffrey Engel, MD, noted that many factors, including public health programs that focus on providing accessible, high quality medical care and promoting healthy lifestyles for women of childbearing age, contributed to the improvement. This year’s report also noted a 46 percent reduction in reported cases of Sudden Infant Death Syndrome (SIDS), down from 98 deaths in 2009 to 53 in 2010. View the full report at http://www.schs.state.nc.us/SCHS/deaths/ims/2010/.

On Monday afternoon, NC public health officials updated their investigation into an E. coli outbreak that appears to be linked to people who attended the N.C. State Fair in Raleigh earlier this month. A total of 24 cases have been reported, with nine confirmed and 15 under investigation. The total is down slightly from Friday (26) as officials made adjustments following further reviews.

As of 3:00pm Monday, here are the cases and counties reported:

                11                          Wake County

                  7                          Sampson County

                  2                          Wilson County

                   1 each                Cleveland, Durham, Johnston and Warren counties

Of the 24 cases reported, five remain hospitalized, with four of the patients children who are suffering from hemolytic uremic syndrome (HUS), a type of kidney disease associated with E. coli O157.

All nine of the confirmed cases attended the State Fair, according to State Epidemiologist Megan Davies, MD. No new cases were reported over the weekend, as the first incubation period (10 days) ends this week. Dr. Davies says officials typically wait two incubation periods before determining whether an E. Coli O157 outbreak has ended.

Officials are using an exhaustive interview process involving patients and a control group to help pinpoint the source of the outbreak. Dr. Davies said this includes further interviews with the confirmed and suspected cases, and interviews with more than seventy people who attended the fair but did not become ill. The process is designed to find some commonality to lead investigators to the source, but Dr. Davis cautioned that it’s possible they will not learn what the specific exposure was.

People in the control group were selected randomly from about 2,000 fairgoers who had provided emails when purchasing tickets. State Health Director Jeffrey Engel, MD, said media reports had helped the investigation by making people aware of the outbreak and making it easier for investigators to obtain information.

Dr. Davies say she expected the investigation to be completed by early next week. Working closely with the Division of Public Health are officials from the state Agriculture Department and local health departments.

Updates on the investigation are being posted daily by 4:00 pm at http://epi.publichealth.nc.gov/gcdc/ecoli.html.

State law requires that all suspected shiga toxin-producing E. coli infections and HUS cases be reported within 24 hours to the local health department. Physicians may call their local health department or the epidemiologist on call at 919-733-3419 to report suspected cases, which do not require laboratory confirmation to be reported.

NC Division of Public Health (DPH) officials are investigating a cluster of E. coli O157 infections and hemolytic uremic syndrome (HUS) cases that have been identified during the past two weeks, according to a memo sent to physicians and other health care providers on October 25, 2011, by State Epidemiologist Megan Davies, MD. Investigations continue to determine the source of infection.

State health officials reported today that they were investigating 26 cases of E. coli, with 10 confirmed cases and 16 cases still being evaluated. Of the 26 cases under investigation, 13 are adults (18 years old or older) and 13 are children (under 18).    Five people remain hospitalized: four children and one adult.  Current patient interview information shows that 23 of the 26 persons involved in the investigation report having attended the State Fair, and cases have been reported from Durham, Wake, Johnston, Franklin, Cleveland, Orange, Wilson and Sampson counties.

Updated information on case numbers in the investigation will be posted daily by 4 p.m., beginning on Friday 10/28, at http://epi.publichealth.nc.gov/gcdc/ecoli.html

Dr. Davies issued the memo to make physicians and other providers aware of the outbreak and to encourage reporting of suspected E. coli O157 infections among patients seen in their practices. The memo also cites recent literature on nephroprotection to prevent hemolytic uremic syndrome in susceptible individuals (Ake JA et al. Relative Nephroprotection During Escherichia coli O157:H7 Infections: Association with Intravenous Volume Expansion. Pediatrics. 2006;115:e673-680).

Read the memo here.

The memo covers clinical, laboratory and public health issues and reminds providers that early recognition and IV hydration may help prevent renal failure. By law, all suspected shiga toxin-producing E. coli infections and HUS cases must be reported within 24 hours to the local health department. Dr. Davies reminds providers that they should report suspected cases and not wait for laboratory confirmation.

To report suspected cases, contact your local health department or contact the epidemiologist on call at 919-733-3419.

The North Carolina Division of Public Health (DPH) reports no influenza activity for the week ending 10-15-11. The CDC reports influenza activity is currently low in the Northern Hemisphere, with Australia reporting that its flu season appears to have peaked and is decreasing.

Physicians and practices can go find more information about flu activity in North Carolina at: http://www.flu.nc.gov/flu/.

As the 2011-2012 flu season gets underway, the Hanover-Pender County Medical Society (NHPCMS) is urging area health care professionals to be immunized against influenza. The call comes in a letter that was drafted after Paul Kamitsuka, MD, an infectious disease physician, expressed concerns about the lack of influenza immunization among staff in long-term care centers in the area. The letter was jointly signed by NHPCMS President Philip M. Brown, Jr., MD, and New Hanover County Health Department Director David E. Rice, MPH, MA. It was sent to area health care professionals, agencies, schools and others with direct person-to-person contact with a patient, student or client. Read the letter here.

The 2011-2012 influenza season officially began on October 2, 2011. The NC Department of Public Health (DPH) reports that influenza activity has been low, with no positive specimens identified by the State Laboratory of Public Health as of October 8, 2011. Hospital-based Public Health Epidemiologists (PHEs) also reported no positive influenza results for the week ending October 8, 2011.

DPH and the Communicable Disease Branch urge physicians and other professional health care workers to receive influenza immunizations to minimize the impact and spread of influenza this season.

Campbell University announced this week that it will add a new Master of Science in Public Health Degree that will start next fall. In a prepared statement, the University said the program will address the shortage of public health professionals and focus on rural health disparities.

The degree will be offered through Campbell’s College of Pharmacy and Health Sciences. The school will start accepting applications for the two-year program in November, with classes beginning in August 2012.

The Health Resources and Services Administration (HRSA) recently released $32 million to 904 community health centers nationwide, as part of an initiative to enhance the quality and coordination of health care services through the patient-centered medical home.

Eighteen community health centers in North Carolina are among the recipients, each receiving $35,000 made available by the Affordable Care Act. The grants provide supplemental funding to  help health centers achieve recognition as patient-centered medical homes, through care planning, support for team-based models of service delivery, and system upgrades.

North Carolina grantees include:

Roanoke Chowan Community Health Center, Inc.              Ahoskie

Medical Resource Center for Randolph County, Inc.          Asheboro

Western NC Community Health Services, Inc.                    Asheville

Piedmont Health Services, Inc.                                            Carrboro

The C.W. Williams Community Health Center, Inc.             Charlotte

Lincoln Community Health Center, Inc.                                Durham

Stedman-Wade Health Services, Inc.                                   Fayetteville

Gaston Family Health Services, Inc.                                     Gastonia

Blue Ridge Community Health Services                               Hendersonville

First Choice Community Health Centers                              Mamers

Tri-County Community Health                                              Newton Grove

Robeson Health Care Corporation                                        Pembroke

Wake Health Services, Inc.                                                   Raleigh

Rural Health Group, Inc.                                                       Roanoke Rapids

Greene County Health Care Incorporated                            Snow Hill

Metropolitan Community Health Services, Inc.                    Washington

New Hanover CHC                                                                Wilmington

Carolina Family Health Centers, Inc.                                    Wilson

North Carolina has been awarded a $7.4 million Community Transformation Grant by the US Department of Health and Human Services (HHS). The grants are used to support planning and implementation of state and community projects to reduce chronic diseases, such as diabetes, heart disease, stroke and cancer.

“The cost of managing chronic diseases in North Carolina is $6 billion and rising – and that only accounts for the three risk factors of tobacco use, physical inactivity and poor nutrition,” State Health Director Jeffrey P. Engel, MD, said. “This investment in prevention will help control costs, but more importantly, will save lives, reduce disability and improve the quality of life for millions of North Carolinians.”

The Community Transformation Grants focus on three priority areas: tobacco-free living; active living and healthy eating; and evidence-based quality clinical and other preventive services, specifically prevention and control of high blood pressure and high cholesterol.

In North Carolina, the Division of Public Health will work with agencies, organizations and local coalitions to:

• Build upon recent success with second-hand smoke exposure in public places;
• Make communities more walkable and bikeable through land-use and transportation policy;
• Make public places such as schools more accessible for physical activity, through joint-use agreements that allow people to walk on a school track after school hours; and
• Increase access and affordability of healthy foods in convenience stores, farmers markets and farm stands, with an emphasis on expanding access in low-income communities.

Click here to learn more about Community Transformation Grants.

The Centers for Disease Control and Prevention recommends a yearly flu vaccination as the first and most important step in protecting against flu viruses. Remind your patients that annual vaccination is recommended for optimal protection. Medicare pays for the flu vaccine and its administration for seniors and other Medicare beneficiaries with no co-pay or deductible. Take advantage of each office visit and start protecting your patients as soon as your 2011-2012 seasonal flu vaccine arrives. And don’t forget to immunize yourself and your staff.  Get the Flu Vaccination – Not the Flu.

Remember – Influenza vaccine plus its administration are covered under Part B benefits. Note that influenza vaccine is NOT a Part D-covered drug. For information about Medicare’s coverage of the influenza vaccine and its administration, as well as related educational resources for healthcare professionals and their staff, visit http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp.

As the 2011-2012 flu season approaches, the NC Division of Public Health (DPH) is offering some facts that physicians may wish to share with staff and patients:

• The 2011-2012 trivalent season flu vaccine will include pandemic 2009 H1N1 virus. That’s the same virus used in the 2009 H1N1 monovalet vaccine.
• The CDC recommends universal flu vaccination. Everyone six months of age and older should receive a flu vaccine.
• Health care personnel are particularly encouraged to receive flu vaccine, not only to protect themselves from the disease, but also to help prevent transmission of the flu to patients, co-workers, family members and others.

A higher dose formulation of an inactivated seasonal influenza vaccine (Fluzone High-Dose) for use in people age 65 years and older is available. Fluzone High-Dose contains four times the amount of influenza antigen compared to other inactivated seasonal influenza vaccines. The Advisory Committee on Immunization Practices (ACIP) has not expressed a preference for Fluzone High-Dose or any other licensed inactivated influenza vaccine for use in people age 65 and older.

Please, this flu season: protect yourself, protect your patients, protect your family–Get your flu vaccine.

As we have done with past severe weather-related events, the NCMS is prepared to implement its emergency/disaster plan in the event Hurricane Irene disrupts and damages physician practices or other health care delivery facilities in eastern North Carolina. We are partnering with the Old North State Medical Society (ONSMS) in order to enhance our communication wtih physicians across our state. We want to thank ONSMS President Edward Treadwell, MD, and Executive Director Thea Monet for making this possible.

On Thursday, Governor Perdue declared a state of emergency and President Obama approved federal aid to assist state and local responses to the storm. Forecasts at midday Friday indicated that the center of Irene was expected to make landfall in the vicinity of Cape Lookout around 9:00 am Saturday. Advisories showed Irene had weakened to a Category 2 hurricane, with maximum sustained winds of 105 miles per hour. Forecasters did not expect the storm to strengthen before making landfall. High wind warnings were issued for eastern North Carolina for Saturday, effective from 6:00 am to midnight. Heavy rains capable of producing flash floods were expected, beginning Friday afternoon and continuing through Saturday.

State emergency officials reported that storm shelters were opened in North Hampton, Wilson, Halifax, Nash, Wilson and Johnston Counties. Wake County was on stand-by to open an evacuation shelter, should the shelters in the eastern counties exceed 50 percent capacity. Mandatory evacuations were ordered in several coastal communities.

As many NCMS and ONSMS members will recall from Hurricane Floyd, high winds and floods can quickly displace physicians and their practices. Should you experience an extended storm-related disruption, or you become aware of a physician who has had such an experience, please contact Mike Edwards at the NCMS, medwards@ncmedsoc.org or 919-833-3836, ext. 112.

The NCMS emergency/disaster plan includes:

•  Serving as a key contact point to assist physicians affected by the storm
  • Call: 800-722-1350 or 919-833-3836
• Communication of important information to physicians in private practice and component medical societies in storm-affected areas
• Coordinating and communicating requests for volunteers, equipment, donations and other needs
• Serving as a liaison with the Division of Public Health, State Emergency Management and other agencies in communicating advisories, alerts, updates and other storm-related information important to physicians and component medical societies
• Creating online resources including phone numbers and other information to help physicians during the post-storm recovery

NCMS is prepared to utilize a variety of communication tools to reach physicians, including our Doctor to Doctor blog, NCMS Webpage, Twitter, Facebook, email, fax and phone calls. As past experience has demonstrated, power outages can affect locally available communication, so we will try to provide information using several sources and encourage physicians to periodically check the NCMS website, http://www.ncmedsoc.org/, for updates and other information.

Here are some helpful links for storm-related events:

CDC Hurricane Information for Health Care Professionals: www.bt.cdc.gov/disasters/hurricanes/hcp.asp

American Red Cross Information on Disaster and Emergency Preparedness:

Getting Assistance: http://www.redcross.org/portal/site/en/menuitem.d8aaecf214c576bf971e4cfe43181aa0/?vgnextoid=6cde1a53f1c37110VgnVCM1000003481a10aRCRD&vgnextfmt=default

Preparedness Information:  http://www.redcross.org/portal/site/en/menuitem.d8aaecf214c576bf971e4cfe43181aa0/?vgnextoid=46de1a53f1c37110VgnVCM1000003481a10aRCRD&vgnextfmt=default

NC Division of Emergency Management: http://www.nccrimecontrol.org/Index2.cfm?a=000003,000010

NC Department of Public Health (DHHS): http://publichealth.nc.gov/

NC State Government Hurricane Information: http://www.ncgov.com/NCHurricane.aspx

Hurricane and Health Safety (NC DHHS): http://www.ncdhhs.gov/hurricanes/

Please feel free to share this information with your physician colleagues and staff and know that we are here to help you. 

Robert Seligson, EVP, CEO, NCMS, rseligson@ncmedsoc.org.

Cancer survivors, 16-39 years of age who were diagnosed at age 21 or younger, now have a special resource where they can ask questions about medical or psychological issues facing adolescent/young adult survivors of cancer. The Adolescent and Young Adult Cancer Survivor Hotline officially opened August 16 and also is available to family members or friends (18 years or older) of cancer survivors, and to health care providers.

There are two ways to access the Hotline:

(1) Page 800-604-8215, 9:00 am – 4:00 pm, Monday-Friday

Leave a phone number and a provider in the Childhood Cancer Survivorship clinics at UNC-Chapel Hill, UNC-Asheville, or Wake Forest University will call you back within 30 minutes.

(2) Email  survivingcancer@med.unc.edu

Leave an email address and a provider will be back in touch within 24 hours on weekdays.

The Hotline is funded by a grant from the Rally Foundation for Childhood Cancer Research ( http://www.rallyfoundation.org/ ). You can learn more at http://unclineberger.org/yesican/.

Click here to download a flyer that can be given to patients or posted in your office.

The North Carolina Division of Public Health (DPH) has informed the NCMS that it has updated information in memos that were originally sent to physicians and other providers in 2009 about DPH surveillance of vector borne diseases. The memos are available on the NCMS website, http://www.ncmedsoc.org/. DPH updates information about these diseases yearly.  NCMS wishes to thank State Public Health Veterinarian Carl Williams, DVM, DACVPM, for this update.

Read the latest information about Diagnosis and Surveillance for Tick Borne Rickettsial dieases (TBRD) and Arboviral diseases.

Click here to read the latest information on Diagnosis and Surveillance for Lyme Disease.

A video is now available on VaccineShop.com® to help physicians and other providers learn more about the Fluzone Intradermal vaccine microinjection system, the clinical profile, and how to administer Fluzone Intradermal vaccine.  The vaccine is licensed for use in patients 18 to 64 and is available for the upcoming flu season.

Vaccine manufacturer sanofi pasteur is offering an unbranded Flashcard that explains the clinical rationale for Fluzone High Dose, for people over 65 years of age. The company reports that it has already started shipping the vaccine and is tracking ahead of schedule for all flu dose shipping.

Click here to read the 2011 Fluzone High-Dose Newsletter.