scholarly journals P025 Clinical pearl; treating infant botulism on a paediatric intensive care unit (PICU)

2019 ◽  
Vol 104 (7) ◽  
pp. e2.29-e2
Author(s):  
Caroline Dalton
Keyword(s):  
Public Health ◽  
Medicinal Product ◽  
Prevention Program ◽  
Communicable Disease ◽  
Lessons Learned ◽  
List Type ◽  
California Department ◽  
Out Of Hours ◽  
Treatment And Prevention ◽  
Infant Botulism

ProblemA call was received out of hours by the specialist PICU pharmacist (SP). A five month old baby with rapidly spreading paralysis of unknown cause had been admitted to the unit. A toxin had been extracted from the stool culture and tested on mice. Within hours all mice had died, confirming a positive result for Botulism toxin. The SP was asked to obtain an urgent supply of Human Botulism Anti-Toxin however the only worldwide manufacturer/supplier, the Infant Botulism Treatment and Prevention Program (IBTPP), is based in California.1 BabyBIG, Botulism Immune Globulin Intravenous (Human) (BIG-IV), is an orphan drug that consists of human-derived anti-botulism toxin antibodies that is approved by the U.S. Food and Drug Administration for the treatment of infant botulism types A and B in patients <1 year old.Pharmacist contributionsDay 1: After confirmation with PHE (Public Health England) that the use of their heptavalent horse botulisum anti-toxin would be inappropriate, it was suggested that a supply should be obtained from the USA. SP phoned the IBTPP on call consultant and discussed need for an urgent supply.Consequently SP ensured the appropriate provision and recording of required information and the seamless transition of relevant paperwork.Day 2: SP liaised with the Clinical Director for Children’s Services, the PHE consultant on call and the Trust Silver on call manager to authorise large out of hours drug expenditure. Prompt authorised signature of contract between the above parties was arranged by SP via email. SP contacted the MHRA duty officer on call to obtain an import permit authorisation letter (Notification of Intent to Import an Unlicensed Medicinal Product) to allow for this unlicensed import of a human medicinal product from outside the EEA, re-affirming this was of urgent clinical need.Trust Chief Pharmacist was alerted to the situation by SP, and access to the to the Trust import/specials licence required by the MHRA was granted to the SP to finalise the MHRA import licence. A courier from California was organised by SP liaising with the on call IBTPP consultant, ensuring all paperwork was accurately completed. Dosing, administration and reconstitution advice was given by SP to PICU medical and nursing staff via email. SP immediately confirmed receipt via phone and provided clarification of this when required. SP remained contactable throughout the weekend to resolve any queries the staff had with regards to BabyBIG.Day 3: The SP attempted contact with border control at Heathrow airport to ensure a timely transition through customs and liaised with the courier in the UK to ensure rapid delivery once BabyBIG had been cleared. Allowing sufficient transit time from Heathrow, the SP then called to confirm receipt of BabyBIG on PICU.Outcome and lessons learnedBabyBIG obtained and patient treated successfully, avoiding potential for serious complications and dramatically reducing PICU and overall inpatient stay. A cost analysis done by SP confirmed treatment with BabyBIG reduced overall Trust spend on this admission by half; accounting for average expected PICU stay for infant botulism cases(∼6 weeks) versus this patient’s stay (∼1.5 weeks).ReferencesDivision of Communicable Disease Control, California Department of Public Health. Infant Botulism Treatment and Prevention Program [online] California Department of Public Health, 2010. (accessed 02 Aug 2018) Available from: http://www.infantbotulism.org/general/babybig.phpSave

Public Health Control Measures in Response to Global Pandemics and Drug Resistance

2015 ◽  
Vol 43 (S2) ◽  
pp. 49-56
Author(s):  
Polly J. Price
Keyword(s):  
Public Health ◽  
Communicable Disease ◽  
International Health ◽  
Control Measures ◽  
World Health ◽  
Legal Authority ◽  
List Type ◽  
Resistant Disease ◽  
Global Pandemic ◽  
Health Organization

These teaching materials explore the specific powers of governments to implement control measures in response to communicable disease, in two different contexts:The first context concerns global pandemic diseases. Relevant legal authority includes international law, World Health Organization governance and the International Health Regulations, and regulatory authority of nations.The second context is centered on U.S. law and concerns control measures for drug-resistant disease, using tuberculosis as an example. In both contexts, international and domestic, the point is to understand legal authority to address public health emergencies.

scholarly journals P005 Diphtheria treatment

2019 ◽  
Vol 104 (7) ◽  
pp. e2.7-e2
Author(s):  
Claire Hannah
Keyword(s):  
Public Health ◽  
Qt Interval ◽  
Kidney Injury ◽  
Test Dose ◽  
Left Ventricular ◽  
Lessons Learned ◽  
List Type ◽  
Staff Members ◽  
Diphtheria Antitoxin ◽  
Corynebacterium Diphtheria

BackgroundDiphtheria is a life threatening but vaccine preventable disease. 5 cases were identified by Public Health England (PHE) in 2017.1 Respiratory diphtheria is characterised by a pseudomembrane which obstructs the airways. Corynebacterium diphtheria produces an exotoxin that causes local tissue necrosis, myocarditis, polyneuropathy, paralysis, respiratory failure and death.Clinical caseA 4 year old boy was admitted via A&E with suspected croup requiring intubation and ventilation on intensive care unit (ICU). Throat swabs confirmed diphtheria diagnosis, PHE was contacted and diphtheria antitoxin was obtained. The patient received two subcutaneous doses of diphtheria-antitoxin. He developed myocarditis, Acute Kidney Injury (AKI), impaired left ventricular function and polyneuropathy. He was treated with 14 days intravenous vancomycin and clindamycin following multiple antibiotic changes.Pharmacy contributionAnti-toxin: Diphtheria anti- toxin was obtained and advice was provided regarding an appropriate dose and route of administration. Ward staff were reluctant to give a subcutaneous infusion. A pharmacist provided reassurance that this was the only way to treat the infection and a subcutaneous cannula was inserted. He was given 0.2 ml subcutaneously as a test dose followed by the remaining 40,000 units. His second dose was given as a test dose of 0.2 ml followed by 60,000 units between two sites due to multi-organ involvement. Chemoprophylaxis: The patient’s family and 34 staff members required prophylactic antibiotics. They received azithromycin 500 mg once daily for 3 days. Staff members had throat swabs and were to remain off work until these swabs were negative which resulted in the Trust cancelling elective operations and admissions. Pharmacy confirmed azithromycin was safe for 34 adult patients and checked for interactions with currently prescribed medicines and advised appropriately.Critical careCreatinine doubled and the pharmacist reviewed drugs to account for renal impairment. The pharmacist highlighted that clarithromycin can prolong QT interval. An echocardiogram revealed the patient had prolonged QT interval and clarithromycin was switched to an alternative after discussion with the microbiologist.Vancomycin therapeutic levels were reached on day 5. The dose remained unchanged for the remainder of the course and levels taken every 3 days were appropriate. The pharmacist prepared a weaning plan for morphine and clonidine. The pharmacist advised reducing dexamethasone and stopping when no longer required due to raised blood glucose measurements.Lessons learnedHow to obtain and administer diphtheria antitoxin. What chemoprophylaxis to provide to family and staff, the difficulties of supplying this to so many adults in a children’s hospital and the pressure the hospital faced having 34 staff members excluded for 48 hours while cultures were taken The importance of personal protective equipment to protect staff and other patients Monitoring parameters: vancomycin levels, renal function, cardiac function, blood sugars Importance of encouraging parents to have their children vaccinated with all the primary immunisations to protect their children and othersReferencePublic health England: Diphtheria in England 2017. Accessed via: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/711453/hpr1818_dphthr17.pdf

US State-Level Legislative Responses to the Ebola Outbreak, 2014-2015

2016 ◽  
Vol 10 (4) ◽  
pp. 649-653
Author(s):  
Lainie Rutkow ◽  
Alexandra Jabs
Keyword(s):  
Public Health ◽  
Task Force ◽  
Communicable Disease ◽  
State Level ◽  
Hemorrhagic Fever ◽  
Lessons Learned ◽  
Electronic Data Collection ◽  
The Face ◽  
Collection Form ◽  
Definition Of

AbstractObjectiveWe sought to systematically identify and analyze state-level legislative responses to Ebola from April 2014 through June 2015.MethodsUsing standardized search terms, we searched the LexisNexis State Capital database to identify bills or resolutions that explicitly mentioned Ebola or viral hemorrhagic fever in all 50 US states and Washington, DC, from April 2014 through June 2015. Information was abstracted from relevant bills or resolutions by using an electronic data collection form. Abstracted information was analyzed to identify themes and patterns.ResultsOur search processes returned 273 bills and resolutions; 17 met our inclusion criterion. These 17 bills and resolutions were introduced in 11 states. The primary goals of these materials concerned the following: protecting or acknowledging public health and health care workers (n=4), revising the definition of “communicable disease” (n=3), financial considerations (n=5), establishing a task force (n=2), and updating or creating facilities (n=3). Six bills were enacted and 4 resolutions were adopted.ConclusionApproximately 20% of the states introduced bills or resolutions concerning the Ebola outbreak. These bills and resolutions highlight important practice considerations, including protections for those who assist in treating Ebola and revision of laws in the face of emerging infectious disease threats. Policy-makers and emergency planners would benefit from incorporating lessons learned from states’ Ebola responses into their preparedness activities. (Disaster Med Public Health Preparedness. 2016;10:649–653)

scholarly journals O5 Treatment of infantile botulism with botulism immune globulin (BabyBIG)

2019 ◽  
Vol 104 (7) ◽  
pp. e2.45-e2
Author(s):  
Nigel Gooding ◽  
Riaz Kayani ◽  
Lynne Whitehead
Keyword(s):  
Intensive Care ◽  
Respiratory Distress ◽  
Immune Globulin ◽  
Case Series ◽  
Intravenous Sedation ◽  
Public Health Department ◽  
List Type ◽  
Local Hospital ◽  
Out Of Hours ◽  
Infant Botulism

BackgroundA 7 month old male infant was admitted to their local hospital with poor feeding, reduced urine output, cough and respiratory distress. Worsening respiratory distress and apnoea required ventilation and transfer to a tertiary paediatric intensive care unit, with a presumed diagnosis of respiratory sepsis. Following 1 day of intensive care, intravenous sedation was discontinued with a view to extubation. After 48 hours sedation hold, the patient still had no spontaneous movements and unreactive pupils. Following further review, stool samples were sent to the Health Protection Agency (HPA) for botulism testing. Although initial tests (culture) were negative, a mouse bioassay test was subsequently reported as positive for botulism toxin. HPA and the California Public Health Department (CDPH) confirmed that treatment with botulism immune globulin (BabyBIG) was indicated. How does BabyBIG work: BabyBIG consists of human-derived anti-botulism-toxin antibodies and is approved in the U.S. for treatment of infant botulism types A and B. BabyBIG immediately neutralises circulating neurotoxin and allows motor nerve regeneration to begin. Complete recovery can take several months.1 2 Supply of BabyBIG: Diagnosis of botulism was made out of hours at a weekend, requiring BabyBIG to be obtained directly from CDPH. Pharmacy contacted the Medicines and Healthcare Regulatory Authority (MHRA) on-call service to authorise UK importation of Baby BIG. Pharmacy worked closely with the clinical team and MHRA to ensure that relevant paperwork required by CDPH was completed. Cost of Baby BIG is $43,000 USD and required the Trust Medical Director to authorise funding. CDPH authorised release of Baby BIG, which was received in the Trust 48 hours later. Administration of BabyBIG: Pharmacy prepared an IV monograph document to assist preparation and administration of BabyBIG, which is presented as 100 mg vials for reconstitution with 2 ml water for injection. BabyBIG is administered as a single dose of 50 mg/kg, infused at an initial rate of 25 mg/kg/hour for 15 minutes which, if tolerated, is increased to 50 mg/kg/hour for the remainder of the infusion. The infusion is administered via an 18 µm filter.Patient outcomeWithin 24 hours of administration, there was some movement in the patient’s upper limbs and some triggering of the ventilator. By day 12 post-administration pupils were more reactive and there were some antigravity movements. By Day 15 there were signs of facial movement and improved grip strength. A tracheostomy was performed to facilitate weaning form the ventilator. By Day 67 the infant was off the ventilator and on Day 93 was discharged to their local hospital.SummaryPharmacy played a significant role, ensuring correct processes were followed for BabyBIG to be ordered out of hours, liaising with international partners, organising international transit, ensuring import documentation was available, providing important drug information to ensure the drug was prescribed and administered correctly, and answering parent’s questions about the medication. In this case, BabyBIG provided a highly effective treatment for infant botulism.ReferencesPayne JR, Khouri JM, Jewell NP, et al. Efficacy of Human Botulism Immune Globulin for the Treatment of Infant Botulism: The First 12 Years Post License. J Pediatr 2018;193:172–177.Ramroop S, Williams B. Infant botulism and botulism immune globulin in the UK: a case series of four infants. Arch Dis Child 2012;97:459–460

scholarly journals California’s Prisoner Protections for Family and Community Health Act

2020 ◽  
Vol 135 (1_suppl) ◽  
pp. 50S-56S
Author(s):  
Kimberley D. Lucas ◽  
Joseph Bick ◽  
Janet C. Mohle-Boetani
Keyword(s):  
Public Health ◽  
Transmitted Disease ◽  
Lessons Learned ◽  
California Department ◽  
Prison Staff ◽  
Sexually Transmitted ◽  
Correctional Health ◽  
Staff Members ◽  
Incarcerated Men ◽  
Condom Access

In 2014, California passed Assembly Bill 966, which required condom access for persons incarcerated in all 35 California state prisons (33 men’s and 2 women’s prisons). The California Correctional Health Care Services and the Sexually Transmitted Disease Control Branch and the Office of AIDS of the California Department of Public Health collaborated in a prison administration–led multidisciplinary implementation workgroup. Our workgroup, representing public health, correctional health, legal and legislative affairs, labor relations, and prison staff members, participated in 4 planning meetings during May–September 2015. We surveyed prison staff members and incarcerated men to identify and address potential challenges; conceptualized a tamper-resistant condom dispenser; developed educational materials, frequently asked questions for staff members, and fact sheets for the public; and conducted forums for custody and medical staff members at each prison. Key lessons learned included the need for high-level custody support, engagement of labor unions early in the decision-making process, and flexibility within defined parameters for sites to determine best practices given their unique institutional population, culture, and physical layout. Condom access was initiated at 4 prisons in July 2015 and expanded incrementally to the remaining 29 men’s prisons through July 2016. A total of 243 563 condoms were accessed in the men’s prisons, for an average of 354 condoms per 1000 population per month. The start-up dispenser cost was $69 825 (735 dispensers at $95 each). We estimated an annual condom cost of $0.60 per person. Although staff members and incarcerated men expressed concern that this legislation would condone sex and provide repositories for contraband, no serious adverse incidents involving condoms were reported. California demonstrated that condom access is a safe, low-cost intervention with high uptake for a large correctional system and provided a replicable implementation model for other states. Prison condom programs have the potential to decrease transmission of sexually transmitted infections (STIs) among incarcerated persons and their communities, which are often disproportionately affected by STIs, HIV, and other chronic diseases.

scholarly journals Critical concepts for COVID-19 Mass Vaccination Site Operations

2021 ◽  
pp. 1-24
Author(s):  
Scott A. Goldberg ◽  
David Callaway ◽  
Daniel Resnick-Ault ◽  
Sujal Mandavia ◽  
Rodrigo Martinez ◽  
...  
Keyword(s):  
Public Health ◽  
Inventory Management ◽  
Communicable Disease ◽  
Vaccination Campaign ◽  
Herd Immunity ◽  
The United States ◽  
Mass Vaccination ◽  
Lessons Learned ◽  
Vaccination Site ◽  
The Impact

Abstract Mass vaccination campaigns have been used effectively to limit the impact of communicable disease on public health. However, the scale of the COVID19 vaccination campaign is unprecedented. Mass vaccination sites consolidate resources and experience into a single entity and are essential to achieving community (“herd”) immunity rapidly, efficiently, and equitably. Healthcare systems, local and regional public health entities, emergency medical services, and private organizations can rapidly come together to solve problems and achieve success. As medical directors at several mass vaccination site across the United States, we describe key mass vaccination site concepts including site selection, operational models, patient flow, inventory management, staffing, technology, reporting, medical oversight, communication, and equity. Lessons learned from experience operating a diverse group of mass vaccination sites will help to inform not only sites operating during the current pandemic but may serve as a blueprint for future outbreaks of highly infectious communicable disease.

scholarly journals Experiences and Lessons Learned from COVID-19 Pandemic Management in South Korea and the V4 Countries

2021 ◽  
Vol 6 (4) ◽  
pp. 201
Author(s):  
Gergő Túri ◽  
Attila Virág
Keyword(s):  
Public Health ◽  
South Korea ◽  
Health System ◽  
Public Health System ◽  
Communicable Disease ◽  
Lessons Learned ◽  
Health Policies ◽  
Contact Tracing ◽  
Economic Damage ◽  
Public Health Policies

In the first year and a half of the COVID-19 pandemic, South Korea suffered significantly less social and economic damage than the V4 countries (Czech Republic, Hungary, Poland, and Slovakia) despite less stringent restrictive measures. In order to explore the causes of the phenomenon, we examined the public health policies and pandemic management of South Korea and the V4 countries and the social and economic outcomes of the measures. We identified the key factors that contributed to successful public health policies and pandemic management in South Korea by reviewing the international literature. Based on the analysis results, South Korea successfully managed the COVID-19 pandemic thanks to the appropriate combination of non-pharmaceutical measures and its advanced public health system. An important lesson for the V4 countries is that successful pandemic management requires a well-functioning surveillance system, a comprehensive testing strategy, an innovative contact tracing system, transparent government communication, and a coordinated public health system. In addition, to develop pandemic management capabilities and capacities in the V4 countries, continuous training of public health human resources, support for knowledge exchange, encouragement of research on communicable disease management, and collaboration with for-profit and non-governmental organizations are recommended.

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