outbreak

microdosing-candy-linked-illnesses-double;-possible-recall-in-“discussions”

Microdosing candy-linked illnesses double; possible recall in “discussions”

CDC, chocolate, cones, diamond shruumz, fda, gummies, intubation, microdosing, outbreak, psychedelic, recall, Science, seizures / /

No recall —

Of the 26 cases identified so far, 25 sought medical care and 16 were hospitalized.

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Microdosing candy-linked illnesses double; possible recall in “discussions”

Cases of illnesses linked to microdosing candies have more than doubled, with reports of seizures and the need for intubation, mechanical ventilation, and intensive care stays. But, there remains no recall of the products—microdosing chocolates, gummies, and candy cones by Diamond Shruumz—linked to the severe and life-threatening illnesses. In the latest update from the Food and Drug Administration late Tuesday, the agency said that it “has been in contact with the firm about a possible voluntary recall, but these discussions are still ongoing.”

In the update, the FDA reported 26 cases across 16 states, up from 12 cases in eight states last week. Of the 26 reported cases, 25 sought medical care and 16 were hospitalized. No deaths have been reported.

Last week, the Centers for Disease Control and Prevention released a health alert about the candies. The agency noted that as of June 11, the people sickened after eating Diamond Shruumz candies presented to health care providers with a host of severe symptoms. Those include: central nervous system depression with sedation, seizures, muscle rigidity, clonus (abnormal reflex responses), tremor, abnormal heart rate (bradycardia or tachycardia), abnormal blood pressure (hypotension or hypertension), gastrointestinal effects (nausea, vomiting, or abdominal pain), skin flushing, diaphoresis (excessive sweating), and metabolic acidosis with increased anion gap (an acid-based disorder linked to poisonings).

At the time of the CDC alert, 10 patients had been hospitalized, and “several required intubation, mechanical ventilation, and admission to an intensive care unit,” the agency reported.

It remains unclear what ingredient in the candies could be causing the poisonings. The FDA reports that it has worked with state partners to collect multiple samples of Diamond Shruumz products so they can be analyzed for potential toxic components. That analysis is still ongoing, the agency said.

Diamond Shruumz has not responded to multiple requests for comment from Ars.

Untold toxic ingredients

Diamond Shruumz does not list the ingredients of its products on its website. They are sold as “microdosing” candies, a term that typically suggests a small amount of a psychedelic compound is present. The company describes its chocolates, gummies, and cones as “trippy,” “psychedelic,” and “hallucinogenic,” and also claims they contain a “primo proprietary blend of nootropic and functional mushrooms.” But, it’s unclear what, if any, psychoactive compound is present in the candies.

The CDC notes that products like these “might contain undisclosed ingredients, including illicit substances, other adulterants, or potentially harmful contaminants that are not approved for use in food.”

Diamond Shruumz posted documents on its website from third-party laboratories claiming to indicate that the candies do not contain the most notable mushroom-derived psychedelic compound, psilocybin. The reports also indicate that some of the products do not contain cannabinoids or compounds from the hallucinogenic Amanita muscaria mushroom. Additionally, the company said in a blog post that its products contain a blend of Lion’s mane, Reishi, and Chaga mushrooms, but these are all non-hallucinogenic mushrooms used in herbal and traditional medicines and supplements.

In recent decades, hundreds of new synthetic psychoactive substances have hit the market in such products, including many new phenethylamines and tryptamines, which are chemically related to LSD and psilocybin. Some experts and members of the psychedelic community have speculated that Diamond Shruumz products could potentially contain one of the more popular tryptamines, 4-AcO-DMT, often pronounced  “4-akko-DMT,” and also known as 4- acetoxy-N,N-dimethyltryptamine, O-acetylpsilocin, or psilacetin. According to a qualitative 2020 study, users describe 4-AcO-DMT as producing effects similar to psilocybin, but without some of the unpleasant side effects noted with natural mushrooms, such as nausea. Animal experiments have confirmed that 4-AcO-DMT appears to produce psilocybin-like effects.

Still, it’s unclear if such ingredients could explain the symptoms seen in the current outbreak. Though clinical data on 4-AcO-DMT is scant, it has not been linked to such severe symptoms. On the other hand, some novel synthetic compounds, such as Dox and NBOMe, often misrepresented as LSD, are considered dangerous. For instance, NBOMe compounds (N-methoxybenzyl, also called N-bombs or 251), first discovered in 2003, have been linked to overdoses and deaths. In the scientific literature, they’ve been linked to “unpleasant hallucinations, panic, agitation, hypertension, seizures, acute psychosis, and/or excited delirium that can result in cardiac arrest,” according to the 2020 study.

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More seizures, intubation from microdose candies: 12 sickened, 10 hospitalized

CDC, chocolates, diamond shruumz, fda, health, microdose, mushrooms, outbreak, poison, psychelics, Science / /

Potent microdoses —

FDA updates alert after the latest case fell ill on June 9.

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Diamond Shruumz's

Enlarge / Diamond Shruumz’s “extremely potent” infused cones in “sprinkles” flavor.

More people have reported severe poisonings in an ongoing outbreak marked by people seizing and needing to be intubated after consuming microdose candies made by Diamond Shruumz, the Food and Drug Administration reported Tuesday.

There are now at least 12 reported cases across eight states. All 12 people were ill enough to seek medical care, and 10 needed to be hospitalized. The symptoms reported so far include seizures, central nervous system depression (loss of consciousness, confusion, sleepiness), agitation, abnormal heart rates, hyper/hypotension, nausea, and vomiting, the FDA reported.

In Tuesday’s update, the FDA also expanded the products linked to the illnesses. In addition to all flavors of Diamond Shruumz’s Microdosing Chocolate Bars, the agency’s warning now covers all flavors of the brand’s Infused Cones and Micro Dose and Macro Dose Gummies.

According to the FDA, the most recent case fell ill on June 9. On June 7, the FDA issued its initial warning on Diamond Shruumz’s chocolates, reporting that eight people had been sickened in four states, with six people hospitalized. The agency advised the public not to sell, serve, buy, or consume the chocolates and instead discard them.

The candies are available nationwide. They are sold online—where they remain available for purchase as of Tuesday evening—and can also be found in various retail locations throughout the US, including smoke/vape shops and retailers that sell hemp-derived products.

The current tally of cases includes one from Alabama, four from Arizona, two from Indiana, one from Kentucky, one from Missouri, one from Nevada, one from Pennsylvania, and one from South Carolina.

Diamond Schruumz has not responded to multiple requests for comment from Ars. The New York Times also reported that the company was unresponsive.

It remains unclear what exactly is in the candies and what could cause such severe toxicity. The company does not provide ingredient lists for its products on its website. The term “microdosing” typically suggests a small amount of psychedelic compound is present, and Diamond Shruumz markets its products as “trippy,” “psychedelic,” and “hallucinogenic.” But lab reports posted on Diamond Shruumz’s website indicate that its candies do not contain the notable mushroom-derived psychedelic compound, psilocybin.

The company only says that its candies contain a “primo proprietary blend of nootropic and functional mushrooms.” Nootropics are compounds said to affect cognition, though supplement makers have used the term dubiously in marketing.

In an April 2023 blog, Diamond Shruumz said its chocolate bars contain a blend of Lion’s mane, Reishi, and Chaga mushrooms, which are all non-hallucinogenic mushrooms used in herbal and traditional medicines and supplements. “Lion’s mane is a natural nootropic that can enhance cognitive function, while Reishi is an adaptogen that helps the body adapt to stress and boosts the immune system,” the company claimed. “Finally, Chaga is rich in antioxidants and can help reduce inflammation in the body.”

The FDA, along with America’s Poison Centers and the Centers for Disease Control and Prevention, is still investigating the cases and working to determine the cause. In a response to an inquiry from Ars, the FDA declined to comment on whether it is in contact with the company and if it is recommending a voluntary recall.

6/12/2024 3: 50pm ET: This story was updated to include the response from the FDA. 

More seizures, intubation from microdose candies: 12 sickened, 10 hospitalized Read More »

people-are-seizing,-being-intubated-after-eating-microdose-chocolates

People are seizing, being intubated after eating microdose chocolates

CDC, chocolate, fda, health, illnesses, microdosing, outbreak, outbreak investigation, poison control centers, Science, toxin / /

Yikes —

“Extreme caution” urged as at least 8 people in 4 states sickened, 6 hospitalized.

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A Diamond Shruumz chocolate bar, which come in a variety of flavors.

Enlarge / A Diamond Shruumz chocolate bar, which come in a variety of flavors.

Various federal and state health officials are sounding the alarm on Diamond Shruumz-brand Microdosing Chocolate Bars. The candy, said to be infused with mushrooms, has been linked to severe illnesses, including seizures, loss of consciousness, confusion, sleepiness, agitation, abnormal heart rates, hyper/hypotension, nausea, and vomiting, according to an outbreak alert released by the Food and Drug Administration on Friday.

So far, eight people across four states have been sickened—four in Arizona, two in Indiana, one in Nevada, and one in Pennsylvania, the FDA reported. Of the eight, six have been hospitalized.

“We are urging the public to use extreme caution due to the very serious effects of these products,” Maureen Roland, director of the Banner Poison and Drug Information Center in Phoenix, said in a press release earlier this week.

Steve Dudley, director of the Arizona Poison and Drug Information Center, added that there’s “clearly something toxic occurring” with the chocolates. “We’ve seen the same phenomenon of people eating the chocolate bar then seizing, losing consciousness, and having to be intubated.” Dudley noted that the state is aware of additional cases beyond the eight reported Friday by the FDA. Those cases were reported from Nebraska and Utah.

It’s not entirely clear what is in the chocolates or what could be causing the illnesses. The FDA said it was working with the Centers for Disease Control and Prevention as well as America’s Poison Centers to “determine the cause of these illnesses and is considering the appropriate next steps.”

On its website, Diamond Shruumz says that its chocolate bars contain a “primo proprietary blend of nootropic and functional mushrooms.” The website also contains reports of laboratory analyses on their products, some of which indicate the absence of select known fungal toxins and compounds such as the hallucinogen psilocybin and cannabinoids.

Diamond Shruumz did not immediately respond to Ars’ request for comment.

The chocolate bars are still available for sale online but the FDA said that consumers should not eat, sell, or serve them. Any bars already purchased should be discarded. Likewise, retailers should not sell or distribute them. The FDA noted that, in addition to being available online, the bars are also sold in various retail locations nationwide, including smoke/vape shops and retailers that sell hemp-derived products.

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After mice drink raw H5N1 milk, bird flu virus riddles their organs

avian influenza, bird flu, CDC, cows, dairy cows, fda, flu, H5N1, Infectious disease, Mice, milk, outbreak, raw milk, Science, USDA, virus / /

Deadly dairy —

No, really, drinking raw milk during the H5N1 outbreak is a bad idea.

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Fresh raw milk being poured into a container on a dairy farm on July 29, 2023, in De Lutte, Netherlands.

Enlarge / Fresh raw milk being poured into a container on a dairy farm on July 29, 2023, in De Lutte, Netherlands.

Despite the delusions of the raw milk crowd, drinking unpasteurized milk brimming with infectious avian H5N1 influenza virus is a very bad idea, according to freshly squeezed data published Friday in the New England Journal of Medicine.

Researchers at the University of Wisconsin-Madison squirted raw H5N1-containing milk from infected cows into the throats of anesthetized laboratory mice, finding that the virus caused systemic infections after the mice were observed swallowing the dose. The illnesses began quickly, with symptoms of lethargy and ruffled fur starting on day 1. On day 4, the animals were euthanized to prevent extended suffering. Subsequent analysis found that the mice had high levels of H5N1 bird flu virus in their respiratory tracts, as well their hearts, kidneys, spleens, livers, mammary glands, and brains.

“Collectively, our data indicate that HPAI [Highly Pathogenic Avian Influenza] A(H5N1) virus in untreated milk can infect susceptible animals that consume it,” the researchers concluded. The researchers also found that raw milk containing H5N1 can remain infectious for weeks when stored at refrigerator temperatures.

Bird flu has not historically been considered a foodborne pathogen, but prior to the unexpected outbreak of H5N1 in US dairy cows discovered in March, it had never been found at high levels in a food product like milk before. While experts have stepped up warnings against drinking raw milk amid the outbreak, the mouse experiment offers some of the first data on the risks of H5N1 from drinking unpasteurized dairy.

Before the mouse data, numerous reports have noted carnivores falling ill with H5N1 after eating infected wild birds. And a study from March in the journal Emerging Infectious Diseases reported that over half of the 24 or so cats on an H5N1-infected dairy farm in Texas died after drinking raw milk from the sick cows. Before their deaths, the cats displayed distressing neurological symptoms, and studies found the virus had invaded their lungs, brains, hearts, and eyes.

While the data cannot definitely determine if humans who drink H5N1-contaminated raw milk will suffer the same fate as the mice and cats, it highlights the very real risk. Still, raw milk enthusiasts have disregarded the concerns. PBS NewsHour reported last week that since March 25, when the H5N1 outbreak in US dairy cows was announced, weekly sales of raw cow’s milk have ticked up 21 percent, to as much as 65 percent compared with the same periods a year ago, according to data shared by market research firm NielsenIQ. Moreover, the founder of California-based Raw Milk Institute, Mark McAfee, told the Los Angeles Times this month that his customers baselessly believe drinking H5N1 will give them immunity to the deadly pathogen.

In normal times, the Centers for Disease Control and Prevention and the Food and Drug Administration strongly discourage drinking raw milk. Without pasteurization, it can easily be contaminated with a wide variety of pathogens, including Campylobacter, Cryptosporidium, E. coli, Listeria, Brucella, and Salmonella.

Fortunately, for the bulk of Americans who heed germ theory, pasteurization appears completely effective at deactivating the virus in milk, according to thorough testing by the FDA. Pasteurized milk is considered safe during the outbreak. The US Department of Agriculture, meanwhile, reports finding no H5N1 in retail beef so far and, in laboratory experiments, beef patties purposefully inoculated with H5N1 had no viable virus in them after the patties were cooked to 145°F (medium) or 160°F (well done).

To date, the USDA has reported that H5N1 has infected at least 58 dairy herds in nine states.

After mice drink raw H5N1 milk, bird flu virus riddles their organs Read More »

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Mixup of drinking and irrigation water sparks dangerous outbreak in children

CDC, children, E. coli, hemolytic uremic syndrome, irrigation water, outbreak, Science, Shiga toxin–producing Escherichia coli (STEC) O157:H7, Utah / /

fearsome faucets —

Of 13 children sickened, 7 hospitalized and 2 had life-threatening complications.

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A child cools off under a water sprinkler.

Enlarge / A child cools off under a water sprinkler.

In 1989, a city in Utah upgraded its drinking water system, putting in a whole new system and repurposing the old one to supply cheap untreated water for irrigating lawns and putting out fires. That meant that the treated water suitable for drinking flowed from new spigots, while untreated water gushed from the old ones. Decades went by with no apparent confusion; residents seemed clear on the two different water sources. But, according to an investigation report published recently by state and county health officials, that local knowledge got diluted as new residents moved into the area. And last summer, the confusion over the conduits led to an outbreak of life-threatening illnesses among children.

In July and August of 2023, state and local health officials identified 13 children infected with Shiga toxin-producing Escherichia coli (STEC) O157:H7. The children ranged in age from 1 to 15, with a median age of 4. Children are generally at high risk of severe infections with this pathogen, along with older people and those with compromised immune systems. Of the 13 infected children, seven were hospitalized and two developed hemolytic uremic syndrome, a life-threatening complication that can lead to kidney failure.

Preliminary genetic analyses of STEC O157:H7 from two of the children suggested that the children’s infections were linked to a common source. So, health officials quickly developed a questionnaire to narrow down the potential source. It soon became clear that the irrigation water—aka untreated, pressurized, municipal irrigation water (UPMIW)—was a commonality among the children. Twelve of 13 infected children reported exposure to it in some form: Two said they drank it; five played with UPMIW hoses; three used the water for inflatable water toys; two used it for a water table; and one ran through sprinklers. None reported eating fruits or vegetables from home (noncommercial) gardens irrigated with the UPMIW.

The report on the investigation, published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, did not name the city in Utah. But press releases from a county health department identified the affected city as Lehi, about 30 minutes south of Salt Lake City.

Further genetic testing of STEC O157:H7 isolates linked all of the children’s infections together, as well as to water from five of nine UPMIW exposure sites and samples from the reservoir where the irrigation water is sourced. Microbial source tracking indicated that the contamination could have come from the feces of birds or ruminants.

The county health department and the city put out press releases and informational mailers. They warned residents about the risks of UPMIW, telling them not to drink it or let children play in it. “Do not use irrigation water for bounce houses, pools, slip-n-slides, or any other recreational activities. It is common for children to swallow or get water in their mouths while playing.”

The notices also said that the CDC recommended against watering lawns with the water, though the county advised residents to merely “use caution” when allowing children to play on grass irrigated with UPMIW. “Keep an eye on them,” the advisers warned, and try to prevent them from putting their hands or anything from the lawn in their mouths. “E. coli is hardy and can stick.”

This is not the first time that irrigation water has been linked to outbreaks. In 2010 and 2015, two other Utah cities reported campylobacteriosis outbreaks linked to cross-connections between UPMIW and drinking water lines.

The researchers say such outbreaks can be avoided by efforts to prevent contamination in irrigation water, such as treating water, cleaning reservoirs, and covering them. And, of course, clearly labeling irrigation water and keeping residents informed about its dangers are key to preventing infections.

Mixup of drinking and irrigation water sparks dangerous outbreak in children Read More »

we-still-don’t-understand-how-one-human-apparently-got-bird-flu-from-a-cow

We still don’t understand how one human apparently got bird flu from a cow

bird flu, cattle, CDC, cows, genetic surveillance, H5N1, human case, Infectious disease, mutations, outbreak, pandemic, Science, USDA, viral sequences, viruses / /
Holstein dairy cows in a freestall barn.

Enlarge / Holstein dairy cows in a freestall barn.

The US Department of Agriculture this week posted an unpublished version of its genetic analysis into the spillover and spread of bird flu into US dairy cattle, offering the most complete look yet at the data state and federal investigators have amassed in the unexpected and worrisome outbreak—and what it might mean.

The preprint analysis provides several significant insights into the outbreak—from when it may have actually started, just how much transmission we’re missing, stunning unknowns about the only human infection linked to the outbreak, and how much the virus continues to evolve in cows. The information is critical as flu experts fear the outbreak is heightening the ever-present risk that this wily flu virus will evolve to spread among humans and spark a pandemic.

But, the information hasn’t been easy to come by. Since March 25—when the USDA confirmed for the first time that a herd of US dairy cows had contracted the highly pathogenic avian influenza H5N1 virus—the agency has garnered international criticism for not sharing data quickly or completely. On April 21, the agency dumped over 200 genetic sequences into public databases amid pressure from outside experts. However, many of those sequences lack descriptive metadata, which normally contains basic and key bits of information, like when and where the viral sample was taken. Outside experts don’t have that crucial information, making independent analyses frustratingly limited. Thus, the new USDA analysis—which presumably includes that data—offers the best yet glimpse of the complete information on the outbreak.

Undetected spread

One of the big takeaways is that USDA researchers think the spillover of bird flu from wild birds to cattle began late last year, likely in December. Thus, the virus likely circulated undetected in dairy cows for around four months before the USDA’s March 25 confirmation of an infection in a Texas herd.

This timeline conclusion largely aligns with what outside experts previously gleaned from the limited publicly available data. So, it may not surprise those following the outbreak, but it is worrisome. Months of undetected spread raise significant concerns about the country’s ability to identify and swiftly respond to emerging infectious disease outbreaks—and whether public health responses have moved past the missteps seen in the early stages of the COVID-19 pandemic.

But another big finding from the preprint is how many gaps still exist in our current understanding of the outbreak. To date, the USDA has identified 36 herds in nine states that have been infected with H5N1. The good news from the genetic analysis is that the USDA can draw lines connecting most of them. USDA researchers reported that “direct movement of cattle based upon production practices” seems to explain how H5N1 hopped from the Texas panhandle region—where the initial spillover is thought to have occurred—to nine other states, some as far-flung as North Carolina, Michigan, and Idaho.

Bayes factors for inferred movement between different discrete traits of H5N1 clade 2.3.4.4b viruses demonstrating the frequency of movement.

Enlarge / Bayes factors for inferred movement between different discrete traits of H5N1 clade 2.3.4.4b viruses demonstrating the frequency of movement.

Putative transmission pathways of HPAI H5N1 clade 2.3.4.4b genotype B3.13 supported by epidemiological links, animal movements, and genomic analysis.

Enlarge / Putative transmission pathways of HPAI H5N1 clade 2.3.4.4b genotype B3.13 supported by epidemiological links, animal movements, and genomic analysis.

Putative transmission pathways of HPAI H5N1 clade 2.3.4.4b genotype B3.13 supported by epidemiological links, animal movements, and genomic analysis. [/ars_img]The bad news is that those lines connecting the herds aren’t solid. There are gaps in which the genetic data suggests unidentified transmission occurred, maybe in unsampled cows, maybe in other animals entirely. The genetic data is clear that once this strain of bird flu—H5N1 clade 2.3.4.4 genotype B3.13 —hopped into cattle, it could readily spread to other mammals. The genetic data links viruses from cattle moving many times into other animals: There were five cattle-to-poultry jumps, one cattle-to-raccoon transmission, two events where the virus moved from cattle to domestic cats, and three times when the virus from cattle spilled back into wild birds.

“We cannot exclude the possibility that this genotype is circulating in unsampled locations and hosts as the existing analysis suggests that data are missing and undersurveillance may obscure transmission inferred using phylogenetic methods,” the USDA researchers wrote in their preprint.

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Alarming superbug from deadly eyedrop outbreak has spread to dogs

antibiotics, CDC, drug resistance, eyedrop, EzriCare, fda, infectious diseases, outbreak, Pseudomonas aeruginosa, Science / /

gone to the dogs —

It’s unclear how the dogs became infected with the same strain in the eyedrops.

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A dog gets examined by veterinary technicians in Texas.

Enlarge / A dog gets examined by veterinary technicians in Texas.

Two separately owned dogs in New Jersey tested positive last year for a dreaded, extensively drug resistant bacterial strain spread in the US by contaminated artificial eye drops manufactured in India. Those drops caused a deadly multi-state outbreak in humans over many months last year, with at least 81 people ultimately infected across 18 states. Fourteen people lost their vision, an additional four had eyeballs surgically removed, and four people died.

The preliminary data on the dogs—presented recently at a conference of disease detectives hosted by the Centers for Disease Control and Prevention—highlights that now that the deadly outbreak strain has been introduced around the US, it has the potential to lurk in unexpected places, spread its drug resistance to fellow bacteria, and cause new infections in people and animals who may have never used the drops.

The two dogs in New Jersey were not known to have received the drops linked to the outbreak: EzriCare Artificial Tears and two additional products made by the same manufacturer, which were recalled in February 2023. Such over-the-counter products are sometimes used in animals as well as people. But the dogs’ separate owners said they didn’t recall using the drops either. They also didn’t report any exposures in health care settings or recent international travel that could explain the infections. One of the dogs did, at one point, receive eye drops, but they were not an outbreak-associated brand. The only connection between the two dogs was that they were both treated at the same veterinary hospital, which didn’t stock the outbreak-associated eyedrops.

The dogs’ infections were caught between March and June 2023 when clinicians at the veterinary hospital were working to address a chronic cough in one of the dogs and a stubborn ear infection in the other, according to CBS News, which was present for the CDC’s conference of its Epidemic Intelligence Service in Atlanta. The ear and lung swabs were sent to an academic veterinary laboratory in Pennsylvania, where a microbiologist noticed that bacteria from both swabs had uncommon drug-resistance features. The microbiologist then uploaded genetic sequences of the bacterial strains to a national database, where they caught the attention of the CDC and state health authorities.

The genetic sequences uploaded were of the carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) strain—and they were highly similar to the bacterial strain identified in the deadly eyedrop outbreak. These bacteria are extensively resistant to antibiotics, resisting even last-line drugs, and can silently colonize animals and humans for months or years. An investigation ensued.

Infection gaps

Emma Price, the CDC epidemic intelligence service officer who presented the investigation’s findings at the conference, suggested it was fortunate they were able to make the connection. “Because [the academic veterinary laboratory] had a grant and a veterinary microbiologist works there, he did his great due diligence and uploaded the results. That’s how we got the notification, because the strain matched the outbreak strain,” Price told CBS News.

However, the disease detectives were ultimately unable to identify exactly how the two dogs became infected. “Shared exposures included treatment in the veterinary hospital’s surgical preparation and recovery areas for both canines and ophthalmology department visits by either the affected canine or another animal in the same household,” Price and colleagues wrote in their findings. But all of the sampling done of the veterinary hospital where the dogs were treated turned up negative for the eyedrop outbreak strain.

In the process of the investigation, the epidemiologists also conducted an infection control assessment of the veterinary hospital, finding a variety of “gaps.” These included problems with hand hygiene practices, personal protective equipment use—including use of gloves—and equipment and environmental cleaning and disinfection at the hospital. Price noted that these problems are not uncommon and that there is a general lack of emphasis on infection control in veterinary settings.

Though Price and her colleagues were unable to identify the direct route of infection, they suspect the dogs were likely infected either by exposure to a contaminated product or secondary transmission at the veterinary hospital.

Both dogs have since made full recoveries, but because CRPA strains can silently colonize many body sites on both humans and animals, it’s possible that the bacteria still linger on the dogs or on the other pets and people in their households. Price warned the owners of possible future transmission and recommended they flag this risk to their health care providers. She also noted the potential for the bacteria to spread from dog to dog. It would be ideal to “keep the dogs away from other dogs in the future, which we understand is a difficult thing to do,” she said.

Alarming superbug from deadly eyedrop outbreak has spread to dogs Read More »

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Three women contract HIV from dirty “vampire facials” at unlicensed spa

CDC, health, HIV, Infectious disease, outbreak, outbreak investigation, platelet-rich plasma, Science, spa, vampire facials / /

Yikes —

Five patients with links to the spa had viral genetic sequences that closely matched.

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Drops of the blood going onto an HIV quick test.

Enlarge / Drops of the blood going onto an HIV quick test.

Trendy, unproven “vampire facials” performed at an unlicensed spa in New Mexico left at least three women with HIV infections. This marks the first time that cosmetic procedures have been associated with an HIV outbreak, according to a detailed report of the outbreak investigation published today.

Ars reported on the cluster last year when state health officials announced they were still identifying cases linked to the spa despite it being shut down in September 2018. But today’s investigation report offers more insight into the unprecedented outbreak, which linked five people with HIV infections to the spa and spurred investigators to contact and test nearly 200 other spa clients. The report appears in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The investigation began when a woman between the ages of 40 and 50 turned up positive on a rapid HIV test taken while she was traveling abroad in the summer of 2018. She had a stage 1 acute infection. It was a result that was as dumbfounding as it was likely distressing. The woman had no clear risk factors for acquiring the infection: no injection drug use, no blood transfusions, and her current and only recent sexual partner tested negative. But, she did report getting a vampire facial in the spring of 2018 at a spa in Albuquerque called VIP Spa.

“Vampire facial” is the common name for a platelet-rich plasma microneedling procedure. In this treatment, a patient’s blood is drawn, spun down to separate out plasma from blood cells, and the platelet-rich plasma is then injected into the face with microneedles. It’s claimed—with little evidence—that it can rejuvenate and improve the look of skin, and got notable promotions from celebrities, including Gwyneth Paltrow and Kim Kardashian.

The woman’s case led investigators to VIP Spa, which was unlicensed, had no appointment scheduling system, and did not store client contact information. In an inspection in the fall of 2018, health investigators found shocking conditions: unwrapped syringes in drawers and counters, unlabeled tubes of blood sitting out on a kitchen counter, more unlabeled blood and medical injectables alongside food in a kitchen fridge, and disposable equipment—electric desiccator tips—that were reused. The facility also did not have an autoclave—a pressurized oven—for sterilizing equipment.

A novel and challenging investigation

The spa was quickly shut down, and the owner Maria de Lourdes Ramos De Ruiz, 62, was charged with practicing medicine without a license. In 2022, she pleaded guilty to five counts and is serving a three-and-a-half-year prison sentence.

A second spa client, another woman between the ages of 40 and 50, tested positive for HIV in a screen in the fall of 2018 and received a diagnosis in early 2019. She has received a vampire facial in the summer of 2018. Her HIV infection was also at stage 1. Investigators scrambled to track down dozens of other clients, who mostly spoke Spanish as their first language. The next two identified cases weren’t diagnosed until the fall of 2021.

The two cases diagnosed in 2021 were sexual partners: a woman who received three vampire facials in the spring and summer of 2018 from the spa and her male partner. Both had a stage 3 HIV infection, which is when the infection has developed into Acquired Immunodeficiency Syndrome (AIDS). The severity of the infections suggested the two had been infected prior to the woman’s 2018 spa treatments. Health officials uncovered that the woman had tested positive in an HIV screen in 2016, though she did not report being notified of the result.

The health officials reopened their outbreak investigation in 2023 and found a fifth case that was diagnosed in the spring of 2023, which was also in a woman aged 40 to 50 who had received a vampire facial in the summer of 2018. She had a stage 3 infection and was hospitalized with an AIDS-defining illness.

Viral genetic sequencing from the five cases shows that the infections are all closely related. But, given the extent of the unsanitary and contaminated conditions at the facility, investigators were unable to determine precisely how the infections spread in the spa. In all, 198 spa clients were tested for HIV between 2018 and 2023, the investigators report.

“Incomplete spa client records posed a substantial challenge during this investigation, necessitating a large-scale outreach approach to identify potential cases,” the authors acknowledge. However, the investigation’s finding “underscores the importance of determining possible novel sources of HIV transmission among persons with no known HIV risk factors.”

Three women contract HIV from dirty “vampire facials” at unlicensed spa Read More »

concern-grows-as-bird-flu-spreads-further-in-us-cows:-32-herds-in-8-states

Concern grows as bird flu spreads further in US cows: 32 herds in 8 states

avian influenza, bird flu, CDC, cows, dairy cows, fda, H5N1, herds, infection, milk, outbreak, Science, USDA, virus / /

Rapidly evolving —

Experts say the US is not sharing as much data on the outbreak as it should.

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Greylag geese sit on a field and rest while a cow passes by in the background.

Enlarge / Greylag geese sit on a field and rest while a cow passes by in the background.

Researchers around the world are growing more uneasy with the spread of highly pathogenic avian influenza (H5N1) in US dairy cows as the virus continues to make its way into new herds and states. Several experts say the US is not sharing enough information from the federal investigation into the unexpected and growing outbreak, including genetic information from isolated viruses.

To date, the US Department of Agriculture has tallied 32 affected herds in eight states: Idaho, Kansas, Michigan, New Mexico, North Carolina, Ohio, South Dakota, and Texas. In some cases, the movement of cattle between herds can explain the spread of the virus. But the USDA has not publicly clarified if all the herds are linked in a single outbreak chain or if there is evidence that the virus has spilled over to cows multiple times. Early infections in Texas were linked to dead wild birds (pigeons, blackbirds, and grackles) found on dairy farms. But the USDA reportedly indicated to Stat News that the infections do not appear to be all linked to the Texas cases.

Spread of the virus via cattle movements indicates that there is cow-to-cow transmission occurring, the USDA said. But it’s unclear how the virus is spreading between cows. Given that even the most symptomatic cows show few respiratory symptoms, the USDA speculates that the most likely way it is spreading is via contaminated milking equipment.

Adding to the uncertainty of the virus’s spread, The New York Times on Friday reported that the one herd found infected with H5N1 in North Carolina showed no symptoms of the virus. This raises the possibility that the virus could be silently spreading in unknown numbers of other asymptomatic herds and states. In its most recent FAQ document, the USDA encouraged testing for H5N1 if herds show clinical symptoms, such as lethargy, fever, low milk production, and loose stools. But the Times noted that the agency has begun reimbursing farms for testing asymptomatic cows.

Meanwhile, the USDA also reported that it has evidence that H5N1 from dairy farms has spread back into birds in nearby poultry farms, but how this is happening is also unknown.

Data gaps

All the uncertainty and widespread transmission raises concern about how the virus is evolving to infect mammals and whether it is heading for humans. Last week, the chief scientist for the World Health Organization, Jeremy Farrar, told reporters in Geneva that the spread of the virus in US dairy cows is an “enormous concern,” according to CNN.  “The great concern, of course, is that in doing so and infecting ducks and chickens—but now increasingly mammals—that that virus now evolves and develops the ability to infect humans. And then critically, the ability to go from human-to-human transmission.”

In particular, experts are wary that the dairy cow outbreaks could spill over to nearby pig farms as it’s doing with nearby poultry farms. Pigs can be infected with both bird flu viruses and human flu viruses, making them potential melting pots for new recombinant flu strains.

So far, the USDA says that genetic sequences of H5N1 viruses infecting cows has not revealed any mutations that “would make it more transmissible to humans and between people.” But last Thursday, Stat reported that international experts have faulted the USDA for not sharing more genetic data from its investigation, among other information. Until this weekend, the agency had only shared a few genetic sequences in an international database of viral genome sequences (GISAID).

“A country with capacity like the United States should be able to generate this information within days,” Marion Koopmans, head of the department of viroscience at Erasmus Medical Center in the Dutch city of Rotterdam told Stat last week. “I would expect very fast, very transparent updates, and it’s somewhat amazing not to see that happening.”

On Sunday, facing mounting criticism, the USDA announced the release of 239 genetic sequences to GISAID. It noted it is also adding raw data to a US federal database “in the interest of public transparency and ensuring the scientific community has access to this information as quickly as possible.” The agency said it will continue to make such data available on a rolling basis.

Dr. Rosemary Sifford, the USDA’s chief veterinarian, told the Times, “Please recall that we’ve been engaged in this for less than a month. We are working very hard to generate more information,” she said.

Overall, the USDA and the US Centers for Disease Control and Prevention continue to consider the risk to the public to be low. Farmworkers and others who have direct contact with infected animals are encouraged to take precautions, however.

While deadly to birds, H5N1 in cows is relatively mild, rarely if ever causing deaths. Milk from sick animals contains high levels of virus, but it is being destroyed. Even if some infected milk makes its way into the milk supply, the Food and Drug Administration is confident that the virus would be killed in the pasteurization process. “Pasteurization has continually proven to inactivate bacteria and viruses, like influenza, in milk,” the agency said in an FAQ Friday. Some experts have called for data confirming this, though.

Concern grows as bird flu spreads further in US cows: 32 herds in 8 states Read More »

bogus-botox-poisoning-outbreak-spreads-to-9-states,-cdc-says

Bogus Botox poisoning outbreak spreads to 9 states, CDC says

botox, botulism, CDC, health, injection, outbreak, Science / /

botched shots —

All of the case have been in women, nine of whom were hospitalized.

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A package of counterfeit Botox.

A package of counterfeit Botox.

At least 19 women across nine US states appear to have been poisoned by bogus injections of Botox, the Centers for Disease Control and Prevention reported late Monday.

Nine of the 19 cases—47 percent—were hospitalized and four—21 percent—were treated with botulinum anti-toxin. The CDC’s alert and outbreak investigation follows reports in recent days of botulism-like illnesses linked to shady injections in Tennessee, where officials reported four cases, and Illinois, where there were two. The CDC now reports that the list of affected states also includes: Colorado, Florida, Kentucky, Nebraska, New Jersey, New York, and Washington.

In a separate alert Tuesday, the Food and Drug Administration said that “unsafe, counterfeit” versions of Botox had been found in several states, and the toxic fakes were administered by unlicensed or untrained people and/or in non-medical or unlicensed settings, such as homes or spas. The counterfeit products appeared to have come from an unlicensed source, generally raising the risks that they’re “misbranded, adulterated, counterfeit, contaminated, improperly stored and transported, ineffective and/or unsafe,” the FDA said.

The CDC and the FDA listed the various symptoms that followed injections of the counterfeit Botox, which include: blurred or double vision, drooping eyelids, difficulty swallowing, dry mouth, slurred speech, constipation, incontinence, shortness of breath or difficulty breathing, weakness, and difficulty lifting one’s head. “These symptoms are similar to those seen when botulinum toxin spreads to other parts of the body,” the FDA wrote. Anyone experiencing those symptoms after an injection should go to the emergency room or contact a health care professional.

Botox is a regulated drug containing purified, controlled doses of botulinum toxin, a neurotoxin made by Clostridium bacteria that causes muscle paralysis by blocking a neurotransmitter. It’s often injected into the face to reduce the appearance of wrinkles. The CDC reported that all 19 cases identified so far are in women between the ages of 25 and 59. Eighteen of the 19 specifically reported getting the injections for cosmetic purposes.

But harmful exposure to the toxin—such as from an infection, eating contaminated foods, or use of counterfeit Botox—can cause botulism or at least botulism-like illnesses. In severe cases, botulism can progress to descending, symmetric muscle weakness, full muscle paralysis, and can sometimes be fatal. The CDC reported that some of the people in the outbreak were hospitalized and treated with anti-toxin out of concern that the toxin had spread beyond the injection site. However, the agency noted that five people were specifically tested for botulism, and all tested negative.

In an email to Ars late last week, the CDC recommended that anyone interested in a Botox injection do so using “an FDA-approved product, administered by licensed providers and in licensed settings.” The agency added in its alert Monday: ” If in doubt, don’t get the injection.”

The FDA, meanwhile, provided detailed information on how to ensure your shot of Botox is the real thing. FDA-approved Botox is made by AbbVie, and authentic Botox products come in unit doses of 50, 100, and 200. The outside of the box should say “BOTOX® COSMETIC / onabotulinumtoxinA / for Injection” or “OnabotulinumtoxinA / BOTOX® / for injection,” and it should list the manufacturer as either “Allergan Aesthetics / An AbbVie Company” or “abbvie.” The active ingredient should be listed as “OnabotulinumtoxinA” on the box.

In contrast, some of the counterfeit versions the FDA has tracked down so far were sold in 150-unit doses (not made by AbbVie), only appear to have “Allergan” on the box (not the full manufacturer name), and the active ingredient is displayed as “Botulinum Toxin Type A” instead of  “OnabotulinumtoxinA.” The counterfeit versions also have had non-English language text on the outside of the box and displayed a lot number of C3709C3. Any one of these features is a sign that the product is counterfeit. Images of the counterfeit products from the FDA are below.

Bogus Botox poisoning outbreak spreads to 9 states, CDC says Read More »

deadly-morel-mushroom-outbreak-highlights-big-gaps-in-fungi-knowledge

Deadly morel mushroom outbreak highlights big gaps in fungi knowledge

CDC, fda, food poisoning, fungi, health, montana, morel mushrooms, outbreak, Science, sushi, toxin / /

This fungi’s not fun, guys —

Prized morels are unpredictably and puzzlingly deadly, outbreak report shows.

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Mature morel mushrooms in a greenhouse at an agriculture garden in Zhenbeibu Town of Xixia District of Yinchuan, northwest China's Ningxia Hui Autonomous Region.

Enlarge / Mature morel mushrooms in a greenhouse at an agriculture garden in Zhenbeibu Town of Xixia District of Yinchuan, northwest China’s Ningxia Hui Autonomous Region.

True morel mushrooms are widely considered a prized delicacy, often pricey and surely safe to eat. But these spongey, earthy forest gems have a mysterious dark side—one that, on occasion, can turn deadly, highlighting just how little we know about morels and fungi generally.

On Thursday, Montana health officials published an outbreak analysis of poisonings linked to the honeycombed fungi in March and April of last year. The outbreak sickened 51 people who ate at the same restaurant, sending four to the emergency department. Three were hospitalized and two died. Though the health officials didn’t name the restaurant in their report, state and local health departments at the time identified it as Dave’s Sushi in Bozeman. The report is published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The outbreak coincided with the sushi restaurant introducing a new item: a “special sushi roll” that contained salmon and morel mushrooms. The morels were a new menu ingredient for Dave’s. They were served two ways: On April 8, the morels were served partially cooked, with a hot, boiled sauce poured over the raw mushrooms and left to marinate for 75 minutes; and on April 17, they were served uncooked and cold-marinated.

The mystery poison worked fast. Symptoms began, on average, about an hour after eating at the restaurant. And it was brutal. “Vomiting and diarrhea were reportedly profuse,” the health officials wrote, “and hospitalized patients had clinical evidence of dehydration. The two patients who died had chronic underlying medical conditions that might have affected their ability to tolerate massive fluid loss.”

Of the 51 sickened, 46 were restaurant patrons and five were employees. Among them, 45 (88 percent) recalled eating morels. While that’s a high percentage for such an outbreak investigation, certainly enough to make the morels the prime suspect, the health officials went further. With support from the CDC, they set up a matched case-control study, having people complete a detailed questionnaire with demographic information, food items they ate at the restaurant, and symptoms.

Mysterious poison

Forty-one of the poisoned people filled out the questionnaire, as did 22 control patrons who ate at the restaurant but did not report subsequent illness. The analysis indicated that the odds of recalling eating the special sushi roll were nearly 16 times higher among the poisoned patrons than among the controls. The odds of reporting any morel consumption were nearly 11 times higher than controls.

The detailed consumption data also allowed the health officials to model a dose response, which suggested that with each additional piece of the special roll a person recalled eating, their odds of sickness increased nearly threefold compared with people who reported eating none. Those who ate four or more pieces of the roll had odds nearly 22.5 times higher. A small analysis focusing on the five employees sickened, which was not included in the published study but was noted by the Food and Drug Administration, echoed the dose-response finding, indicating that sickness was linked with larger amounts of morel consumption.

When the officials broke down the analysis by people who ate at the restaurant on April 17, when the morels were served uncooked, and those who ate at the restaurant on April 8, when the mushrooms were slightly cooked, the cooking method seemed to matter. People who ate the uncooked rather than the slightly cooked mushrooms had much higher odds of sickness.

This all strongly points to the morels being responsible. At the time, the state and local health officials engaged the FDA, as well as the CDC, to help tackle the outbreak investigation. But the FDA reported that “samples of morel mushrooms collected from the restaurant were screened for pesticides, heavy metals, toxins, and pathogens. No significant findings were identified.” In addition, the state and local health officials noted that DNA sequencing identified the morels used by the restaurant as Morchella sextelata, a species of true morel. This rules out the possibility that the mushrooms were look-alike morels, called “false morels,” which are known to contain a toxin called gyromitrin.

The health officials and the FDA tracked down the distributor of the mushrooms, finding they were cultivated and imported fresh from China. Records indicated that 12 other locations in California also received batches of the mushrooms. Six of those facilities responded to inquiries from the California health department and the FDA, and all six reported no illnesses. They also all reported cooking the morels or at least thoroughly heating them.

Deadly morel mushroom outbreak highlights big gaps in fungi knowledge Read More »

gastrointestinal-disease-explodes-in-ala.-elementary-school;-773-kids-out

Gastrointestinal disease explodes in Ala. elementary school; 773 kids out

Alabama, elementary school, gastrointestinal, health, Infectious disease, Norovirus, outbreak, school, Science, students / /

no, no, no —

Highly contagious norovirus is the leading suspect; four other area schools affected.

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An electron micrograph of norovirus.

Enlarge / An electron micrograph of norovirus.

Officials in Alabama have shut down an elementary school for the rest of the week and are conducting a deep clean after 773 of the school’s 974 students were absent Wednesday amid an explosive outbreak of gastrointestinal illness.

Local media reported that only 29 students were absent from Fairhope West Elementary School on Tuesday. However, the situation escalated quickly on Wednesday as word spread of a stomach bug going around the Gulf Coast school. A spokesperson for the county school district told AL.com that 773 students and 50 staff were absent Wednesday. It’s unclear how many of the absences were due to sickness or precaution.

Health officials are now investigating the cause of the gastrointestinal outbreak, collecting specimens for testing. So far, officials are working under the assumption that it is norovirus, a highly infectious gastrointestinal bug that can survive hand sanitizer and transmit easily from surfaces, food, and water. The symptoms of the unidentified illness align with norovirus: vomiting, diarrhea, abdominal cramps, and nausea.

On Wednesday, Baldwin County Schools Superintendent Eddie Tyler sent a message to parents saying that the county had decided to shut the school down for the rest of the week. “Due to the amount of staff and students who are absent, the number who are experiencing symptoms, and in an effort to help contain the contagion, we unfortunately need to shut the building down,” Tyler wrote. “While out, we will be conducting a deep cleaning of the school so when students return next week, it will be sanitized to the fullest extent.”

But local outlet WKRG reported Thursday that the outbreak has already spread beyond Fairhope West. On Thursday, 1,231 students from four other area schools were also absent, including 721 students at Fairhope East Elementary School, 136 at a third elementary school, 170 at a middle school, and 204 at a high school. These are in addition to the 974 students at Fairhope West who are out of school while it is shut down.

Norovirus activity is high across the country, with the northeastern region seeing the largest surge, according to surveillance by the Centers for Disease Control and Prevention. The agency notes that outbreaks are commonly linked to health care settings, restaurants or catered events, cruise ships, as well as schools and childcare centers. “Close quarters, shared spaces, and high-touch surfaces make it easy for norovirus to spread in schools,” the CDC points out.

In 2022, the COVID-19 pandemic flipped the script on standard norovirus outbreaks. People who were hoping to avoid close contact and share indoor air with strangers headed to the great outdoors, which led to a large outbreak of norovirus in the Grand Canyon.

Gastrointestinal disease explodes in Ala. elementary school; 773 kids out Read More »