Category: Uncategorized

Tried any kratom? Now wouldn't be a good time to do so.

If you are like me, you're not familiar with kratom. I actually heard about it almost 2 years ago, in a CDC blurb about poisonings and overdoses with the substance. Now, however, it's associated with a new public health danger, salmonellosis due to S. Javiana, S. Okatie, and S. Thompson serotypes. CDC first publicized the outbreak last month, with illness onset as early as October 2017. Now, however, the outbreak is expanding to a total of 87 people in 35 states. The most recent states added including Maryland and West Virginia. Take a look at the current case count map.

Kratom's other name is Mitrabyna speciosa, a cousin of the coffee plant. It appears to be used as both a "natural" remedy as well as for recreational purposes for its opioid- and stimulant-like effects. If you happen to uncover any cases of salmonellosis, be sure to ask about kratom exposure. Also, at this time there is no common source supplier of the tainted kratom, so CDC is advising to avoid all use of this compound. (Not that anyone should be using it anyway!)

Influenza-like illness continues to drop nationally, as seen from the latest CDC data for the week ending March 3:

At Children's National we don't collect data in that manner, but our viral detection results for the week ending March 11 show a clear shift in influenza strains, now showing a predominance of influenza B. At our institution flu B is now about twice as common as flu A, which was the predominant strain earlier in the season. RSV is still hanging around from 2017, now at least as common as flu A detections.

In past years, this shift to influenza B has been typical for late in the flu season. However, we still have plenty of flu in the air, not too late to recommend influenza immunization for any children who missed it earlier in the year.

I don't know about you, but the news coverage of this year's flu season seems to me to be a bit over the top. Certainly we are having a busy flu season, but it helps to compare to prior years to put into perspective. I haven't heard a news report that's done that so far.

Things seemed to really take off in early January, both in our area and around the country. The CDC flu web site is the best resource we have, but it does lag behind by about a week, so the most recent data we have today are for the week ending January 13. Mortality data lag even farther behind.

As you can see, the pattern for overall pneumonia and influenza mortality so far is similar to prior years, just too early to determine where this year will fall in terms of severity of illness:

For the country as a whole, the outpatient influenza-like illness surveillance so far is similar to the 2012-13 and 2014-15 seasons:

In Maryland so far this year, a little above 70% of isolates tested have been influenza AH3N2, the strain that likely will have the lowest vaccine efficacy (CDC has not released efficacy estimates yet, it's a bit early). A little under 20% of strains are the AH1N1 2009 strain, and about 9% are influenza B strains. Oseltamivir (Tamiflu) resistance has been detected in 2 of 168 samples of AH1N1 but in none of 587 AH3N2 and 209 influenza B strains so far this season.

Remember, it's not too late to immunize children for influenza. We likely will be dealing with a significant amount of flu for several weeks. Immunity develops about 2 weeks following immunization.

A few days ago I happened to have some national news broadcast on the TV and was surprised to hear a representative from Consumer Reports advising all to avoid consuming romaine lettuce due to a risk for E. coli O157 contamination, which as you know can result in hemolytic-uremic syndrome. As of January 10, 24 people in the US have been reported with E. coli O157:H7 infections with onset from November 15 through December 12. CDC has information on 18 individuals so far, with 9 hospitalizations (including 1 death), and 2 cases of HUS. Cases have been reported from 15 states, all across the country, but unclear yet whether they are all related. Three cases have been reported in Maryland.

I was surprised by the Consumer Reports advice because I've been following this outbreak in Canada and the US for a number of weeks, both from CDC updates that I receive regularly, as well as my subscription to 1 of those nerdy ID listservs. Yesterday the CDC posted an update that I think is the best summary of circumstances to date and stating that we should not "...avoid any particular food given the short shelf life of leafy greens and because a specific type of leafy greens has not been identified." The short shelf life is in reference to the fact that the last reported case in the outbreak had onset December 12, and if it was related to romaine lettuce or other leafy greens they are probably long gone from the grocery shelves. Confounding all this are delays in reporting, probably aggravated by the holiday season. In the meantime, Canadian public health authorities declared their outbreak, which they were able to link to contaminated romaine lettuce, ended as of January 10.

Consumer Reports also posted an update yesterday, perhaps in response to the CDC, reaffirming their advice for everyone to avoid consuming romaine lettuce. They also noted criticism of CDC and FDA by some members of Congress.

I subscribe to Consumer Reports magazine, but it may not shock you to know that I'm sticking with CDC advice and have continued to consume romaine lettuce. I always wash it well, but of course that can't remove all traces of E. coli.