INVESTIGATION OF ELEVATED LEAD LEVELS: APPLESAUCE POUCHES - Updated 11/7/23

Do not eat, sell, or serve multiple brands of apple cinnamon fruit pouches. FDA’s investigation is ongoing. For detailed information from Wanabana on specific batch/units that are being recalled see press release: IPress-release-Wanabana-Apple-Cinnamon-Fruit-Puree-Recall-Oct-29-2023.pdf

SALMONELLA OUTBREAK - Updated 10/27/23

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are collecting different types of data to investigate a multistate outbreak of Salmonella Thompson infections.  Epidemiologic and traceback data show that onions processed at Gills Onions may be contaminated with Salmonella and may be making people sick.

https://www.cdc.gov/salmonella/thompson-10-23/details.html

SALMONELLA OUTBREAK - Updated 7/26/23

16 people sick in CT, MA, NJ & NY after eating ground beef. Investigators are working to identify the source of the ground beef. More info: https://www.cdc.gov/salmonella/saintpaul-07-23/index.html

Department of Public Health Advises Consumers of Potential 

Listeria Monocytogenes Contamination from Recalled 
 Cricket Creek Farm Cheeses

Updated June 6, 2023

Chang Farm of Whately, MA has Recalled Mung Bean Sprouts due to Possible Presence of 

Listeria monocytogenes 

Contamination

Updated May 10, 2023

Listeria outbreak: How to protect yourself from the deadly foodborne bacteria.

Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears

Current Update – March 21. 2023

As of March 14, 2023, CDC, in partnership with state and local health departments, identified 68 patients in 16 states (CA, CO, CT, FL, IL, NC, NJ, NM, NY, NV, PA, SD, TX, UT, WA, WI) with VIM-GES-CRPA, a rare strain of extensively drug-resistant P. aeruginosa. Thirty-seven patients were linked to four healthcare facility clusters. Three people have died and there have been 8 reports of vision loss and 4 reports of enucleation (surgical removal of eyeball). Dates of specimen collection were from May 2022 to February 2023. Isolates have been identified from clinical cultures of sputum or bronchial wash (15), cornea (17), urine (10), other nonsterile sources (4), and blood (2), and from rectal swabs (26) collected for surveillance; some patients had specimens collected from more than one anatomic site. 

For more information visit CDC Outbreak and Patient Notifications

Influenza

What is influenza?

Influenza (flu) is a disease of the body's respiratory system, which includes the nose, throat, and lungs. Flu is caused by a virus and it can be serious. Every year in the U.S. seasonal flu causes thousands of hospital admissions and deaths. Getting an annual flu vaccine is the best protection.    

The current severity of Influenza in MA is LOW for the week of 4/23/23 to 4/29/2323

What is listeriosis?

Listeriosis is an infection caused by bacteria called Listeria monocytogenes. The infection is most dangerous for pregnant women, newborns, older adults, and adults with weakened immune systems.

Who gets listeriosis?

Anyone can get listeriosis. However, the following people have a higher risk of serious illness:

• Pregnant women 
• Unborn babies and newborns
• People with cancer, diabetes, kidney or liver disease
• People with HIV infection
• People who take steroid medications or are on chemotherapy
• Older adults

Healthy adults and children occasionally get infected with Listeria, but they are usually not seriously ill.

How is listeriosis spread?

People usually get listeriosis by eating food containing Listeria bacteria. Veterinarians, farmers, and others who work with animals may become infected through direct contact with infected animals. Babies can be born with listeriosis if their mothers eat food containing Listeria during their pregnancy.

How does Listeria get into food?

Listeria monocytogenes is found in soil and water. Vegetables and fruits, such as whole melons, can become contaminated from the soil or from manure used as fertilizer. Animals can carry Listeria without appearing ill, and can contaminate other foods such as meats and dairy products. Listeria has been found in many raw foods, such as uncooked meats and vegetables, as well as in processed foods that become contaminated during or after processing, such as soft cheeses, cold cuts, smoked fish products, and ready-to-eat products such as crabmeat and chicken. Unpasteurized (raw) milk or foods made from unpasteurized milk may contain Listeria.

What are the symptoms of listeriosis?

A person with listeriosis usually has fever, muscle aches, and sometimes gastrointestinal symptoms such as nausea or diarrhea. Many people develop only mild symptoms. If infection spreads to the nervous system, symptoms such as headache, stiff neck, confusion, loss of balance, or convulsions can occur. Infected pregnant women may have mild, flu-like symptoms; but infection during pregnancy can lead to premature delivery, infection of the newborn, or even stillbirth.

How is listeriosis treated?

Listeriosis can be treated with antibiotics. When infection occurs during pregnancy, antibiotics can often prevent infection of the fetus or newborn. Babies with listeriosis can be given the same antibiotics as adults.

How can listeriosis be prevented?

The following measures can be taken to reduce a person’s chance of getting sick with listeriosis:

• Thoroughly cook all raw meats.
• Wash raw vegetables before eating.
• Scrub the surface of melons, such as canteloupes, watermelon, or honeydew, before cutting and wash hands with warm water and soap for 20 seconds before and after handling.
• Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods.
• Wash hands, knives, and cutting boards with soap and water after handling uncooked meats.
• Avoid raw (unpasteurized) milk or foods made from raw milk.
• Always thaw ready-to-eat frozen food in the refrigerator or microwave, not on a counter.
• Before eating, thoroughly reheat leftover food until steaming hot.

People at higher risk for listeriosis, such as pregnant women and persons with weakened immune systems, should also do the following:

• Avoid soft cheeses such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese unless the label says “MADE WITH PASTEURIZED MILK”. (Hard cheeses, processed cheeses, cream cheese, cottage cheese, or yogurt need not be avoided.)
• Avoid hot dogs, deli meats, or fermented or dry sausages unless they are heated until steaming hot just before serving.

Wash hands after handling hot dog and deli meats, and clean all utensils and food preparation surfaces in contact with these food items.

MPOX (Formerly Monkeypox)

Mpox is a rare disease that can make you sick, including a rash, which may look like pimples or blisters, often with an earlier flu-like illness. Mpox can spread to anyone through close, personal, often skin-to-skin contact. Anyone who has been in close contact with someone who has Mpox is at risk, but early data suggest that gay, bisexual, and other men who have sex with men make up a high number of cases. 

UPDATE 5/15/23 PRESS RELEASE POTENTIAL RISK FOR NEW MPOX CASES

Potential Risk for New Mpox Cases

Distributed via the CDC Health Alert Network
May 15, 2023, 9:00 AM ET
CDCHAN-00490

Summary
In the United States, cases of mpox (formerly monkeypox) have declined since peaking in August 2022, but the outbreak is not over. The Centers for Disease Control and Prevention (CDC) continues to receive reports of cases that reflect ongoing community transmission in the United States and internationally. This week, CDC and local partners are investigating a cluster of mpox cases in the Chicago area. From April 17 to May 5, 2023, a total of 12 confirmed and one probable case of mpox were reported to the Chicago Department of Public Health. All cases were among symptomatic men. None of the patients have been hospitalized. Nine (69%) of 13 cases were among men who had received 2 JYNNEOS vaccine doses. Confirmed cases were in 9 (69%) non-Hispanic White men, 2 (15%) non-Hispanic Black men, and 2 (15%) Asian men. The median age was 34 years (range 24–46 years). Travel history was available for 9 cases; 4 recently traveled (New York City, New Orleans, and Mexico).

Although vaccine-induced immunity is not complete, vaccination continues to be one of the most important prevention measures. CDC expects new cases among previously vaccinated people to occur, but people who have completed their two-dose JYNNEOS vaccine series may experience less severe symptoms than those who have not.

Spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events. The purpose of this Health Alert Network (HAN) Health Update is to inform clinicians and public health agencies about the potential for new clusters or outbreaks of mpox cases and to provide resources on clinical evaluation, treatment, vaccination, and testing.

Background
 A global outbreak of mpox began in May 2022. Previous outbreaks in places where mpox is not endemic were mostly related to international travel; however, this outbreak spread rapidly across much of the world through person-to-person contact, disproportionately affecting gay and bisexual men, other men who have sex with men (MSM), and transgender people. Most patients with mpox have mild disease, although some, particularly those with advanced or untreated HIV infection, may experience more severe outcomes.

As of May 10, a total of 30,395 cases have been reported in the United States. This outbreak had a peak of about 460 cases per day in August 2022, and gradually declined, likely because of a combination of temporary changes in sexual behavior, vaccination, and infection-induced immunity[1,2]. However, CDC continues to receive reports of new cases and clusters in the United States and internationally.

Although approximately 1.2 million JYNNEOS mpox vaccine doses have been administered in the United States since the beginning of the outbreak, only 23% of the estimated population at risk for mpox has been fully vaccinated. Vaccine coverage varies widely among jurisdictions. The projected risk of a resurgent mpox outbreak is greater than 35% in most jurisdictions in the United States without additional vaccination or adapting sexual behavior to prevent the spread of mpox [3]. Resurgent outbreaks in these communities could be as large or larger than in 2022.

To help prevent a renewed outbreak during the spring and summer months, CDC is urging clinicians to be on alert for new cases of mpox and to encourage vaccination for people at risk. If mpox is suspected, test even if the patient was previously vaccinated or had mpox. Clinicians should also refamiliarize themselves with mpox symptoms, specimen collection, laboratory testing procedures, and treatment options.

Recommendations for Clinicians Evaluating and Treating Patients
 Conduct a thorough patient history to assess possible mpox exposures or epidemiologic risk factors. Mpox is usually transmitted through close, sustained physical contact and has been almost exclusively associated with sexual contact in the current global outbreak. It is important to take a detailed sexual history for any patient with suspected mpox.

Perform a complete physical examination, including a thorough skin and mucosal (e.g., oral, genital, anal) examination. Doing so can detect lesions of which the patient may be unaware.

Consider mpox when determining the cause of a diffuse or localized rash, including in patients who were previously infected with mpox or vaccinated against mpox. Differential diagnoses include herpes simplex virus (HSV) infection, syphilis, herpes zoster (shingles), disseminated varicella-zoster virus infection (chickenpox), molluscum contagiosum, scabies, lymphogranuloma venereum, allergic skin rashes, and drug eruptions. Specimens should be obtained from lesions (including those inside the mouth, anus, or vagina), if accessible, and tested for mpox and other sexually transmitted infections (STI), including HIV, as indicated. The diagnosis of an STI does not exclude mpox, as a concurrent infection may be present.

Patients with mpox benefit from supportive care and pain control. Mpox can commonly cause severe pain and can affect anatomic sites, including the anus, genitals, and oropharynx, which can lead to other complications. Assess pain in all patients with mpox virus infection and recognize that substantial pain may exist from mucosal lesions not evident on physical exam. Topical and systemic strategies should be used to manage pain. Pain management strategies should be tailored to the needs and context of an individual patient.

Tecovirimat is considered first-line among options that have not been approved by the U.S. Food and Drug Administration to treat eligible patients with mpox. If a clinician intends to prescribe oral tecovirimat, consider seeking access through enrollment in the AIDS Clinical Trials Group (ACTG) Study of Tecovirimat for Human Monkeypox Virus (STOMP) so that the trial can determine efficacy of this drug. This trial includes a placebo-controlled, randomized arm, and an open-label option for individuals with severe disease or those who decline randomization. Remote enrollment is available. For patients not eligible for the STOMP trial or who decline to participate, stockpiled oral tecovirimat is available upon request for mpox patients who meet treatment eligibility (e.g., have severe disease or are at increased risk for severe disease) under CDC’s Expanded Access Investigational New Drug (IND) protocol. More information about evaluating and treating patients can be found on the CDC mpox Clinical Guidance web pages.

Clinicians should notify their state or local health departments of any suspected or confirmed mpox cases (via 24-hour Epi On Call contact list).

Recommendations for Vaccinating Patients
 JYNNEOS vaccine can be given as post-exposure prophylaxis (PEP) both to people with known or presumed exposure to the mpox virus. Vaccine can also be given to people with certain risk factors and recent experiences that may make them more likely to have been exposed to mpox. As PEP, vaccine should be given as soon as possible, ideally within 4 days of exposure; however, administration 4 to 14 days after exposure may still provide some protection against mpox. People who are vaccinated should continue to avoid close, skin-to-skin contact with someone who has mpox. JYNNEOS involves 2 vaccine doses given 28 days apart; peak immunity is expected 14 days after the second dose [4].

Previous studies have suggested that JYNNEOS vaccination is protective against mpox. When combined with other prevention measures, vaccination prior to exposure and PEP vaccination strategies might help control outbreaks by reducing transmission of the mpox virus, preventing disease, or reducing disease severity and hospitalization. Duration of immunity after one or two doses of JYNNEOS is unknown.

Currently, CDC does not recommend routine immunization against mpox for the general public. Mpox vaccination should be offered to people with high potential for exposure to mpox:

• People who had known or suspected exposure to someone with mpox.
• People who had a sex partner in the past 2 weeks who was diagnosed with mpox.
• Gay, bisexual, and other MSM, and transgender or nonbinary people (including adolescents who fall into any of these categories) who, in the past 6 months, have had
  1. A new diagnosis of one or more sexually transmitted diseases (e.g., chlamydia, gonorrhea, syphilis).
  2. More than one sex partner.
• People who have had any of the following in the past 6 months
  1. Sex at a commercial sex venue.
  2. Sex in association with a large public event in a geographic area where mpox transmission is occurring.
  3. Sex in exchange for money or other items.
• People who are sex partners of people with the above risks.
• People who anticipate experiencing any of the above scenarios.
• People with HIV infection or other causes of immunosuppression who have had recent or anticipate potential mpox exposure.
• People who work in settings where they may be exposed to mpox.
  1. People who work with orthopoxviruses in a laboratory.

Extensive risk assessment should not be conducted in people who request vaccination to avoid the barriers created by the stigma experienced by many who could benefit from vaccination. People in the community at risk (e.g., gay, bisexual, or other MSM; transgender or nonbinary people) asking for vaccination is adequate attestation to individual risk of mpox exposure. People who previously received only one JYNNEOS vaccine dose should receive a second dose as soon as possible.

For More Information

• Clinical Quick Reference
• Vaccination Basics for Healthcare Professionals
• Case Definitions for Use in the 2022 Mpox Response
• Clinical Recognition
• Clinical Considerations for Treatment and Prophylaxis of Mpox Infection in People Who are Immunocompromised
• Treatment Information for Healthcare Professionals

References

1. Endo, A. et al. Heavy-tailed sexual contact networks and monkeypox epidemiology in the global outbreak. Science. 2022 Oct 7; 378 (6615):90-94. https://doi.org/10.1126/science.add4507
2.  Clay, P.A., et al. Modelling the impact of vaccination and behavior change on mpox transmission in Washington D.C. medRxiv (Preprint), 2023 Feb 14. Available at: https://doi.org/10.1101/2023.02.10.23285772
3. CDC. Risk assessment of mpox resurgence and vaccination considerations. 2023 Apr 4. Available at: https://www.cdc.gov/poxvirus/mpox/response/2022/risk-assessment-of-resurgence.html
4. Rao, A., et al. Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:734-742. https://dx.doi.org/10.15585/mmwr.mm7122e1

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.

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REGIONAL RESPONSE TO THE CURRENT MPOX SITUATON (2022)

In a regional response to Mpox, the towns of Easton, Foxboro, Mansfield, Norton, Plainville and Sharon takes seriously any potential threat to the health of the public. We are communicating and coordinating with our local health care partners including Sturdy Memorial and the Massachusetts Department of Public Health, as well as following CDC’s advice on the matter.

Here are a number of resources including Sturdy Memorial’s page on Mpox. https://www.sturdymemorial.org/advice/monkeypox/ 

If you have any Mpox symptoms, and especially if you have a rash, it is best to avoid prolonged physical contact with anyone until you are well. IF YOU ARE SICK, STAY IN AND CONTACT YOUR HEALTH CARE PROVIDER.

For up-to-date information: 

MA Department of Public Health: Mpox | Mass.gov

Center for Disease Control: Mpox | Poxvirus | CDC  

Information about Mpox

Noroviruses (Norwalk-like Viruses)

What are Noroviruses (Nowalk-like Viruses)?

Norwalk virus, Norwalk-like viruses (NLV) or noroviruses are a group of viruses (germs) that cause diarrheal illnesses. These viruses are named after the original strain that caused an outbreak in Norwalk, Ohio. They are also sometimes referred to as small, round-structured viruses (SRSV) or caliciviruses. 

What are the symptoms of NLV infection?

The symptoms of NLV infection include nausea, vomiting, diarrhea, and abdominal cramps. Other symptoms can include headache, fever, and chills, and muscle aches. These symptoms usually begin 1-2 days after exposure to the virus and will last about 1-2 days in most people, with no long-term effects. 

https://www.cdc.gov/norovirus/

Respiratory Syncytial Virus Infection (RSV)

What are RSV?

Respiratory Syncytial Virus Infection, or RSV, is a common respiratory virus that usually causes mild, cold-like symptom. Most people recover in a week or tow, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection in the lungs) in children younger than 1 year of age in the United States.

What are the symptoms of RSV?

People infected with RSC usually show symptoms within4 to 6 days after getting infected.

Symptoms of RSV infection usually include: 

• Runny Nose
• Decrease in appetite
• Coughing
• Sneezing
• Fever
• Wheezing

Care

Most RSV infections go away on their own in a week or two.

Take steps to relieve symptoms:

• Manage fever and pain
• Drink enough fluids
• Talk to your healthcare provider before giving your child nonprescription medicines. Some medicine contain ingredients that are not good for children.
• Additional Information

CDC Respiratory Syncytial Virus Infection

MA Press Release 11/01/22