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Cluster of Non-Travel Associated Burkholderia pseudomallei Cases Linked to Contaminated Room Spray
MDHHS-Bureau of Laboratories
Burkholderia pseudomallei, a tier one select agent and the causative agent of melioidosis (also known as Whitmore’s Disease), is known as the “great mimicker”. Clinical presentation is often misdiagnosed as tuberculosis or pneumonia due to wide ranging symptoms. Cases within the United States are rare and typically associated with travel to endemic areas of the world (southeast Asia, northern Australia, Indian subcontinent, southern China, Hong Kong, and Taiwan).1 Non-travel associated cases, such as the recent cluster of four cases, are extremely rare. The cluster of cases spanned March to July of 2021 and included four states: Texas, Georgia, Kansas, and Minnesota.
Transmission mainly occurs through direct contact with contaminated soil and water through cuts or abrasions, inhalation of contaminated soil dust, or ingestion of contaminated water. Human to human and animal to human transmission is extremely rare. Incubation can range from 1-21 days with only 5% of cases being activated after latent infection. Activations can happen many years after initial infection with one case of reactivation occurring 62 years after the initial exposure.2
To investigate the recent four state cluster whole genome sequencing was performed. Genetic analysis indicated that all 4 cases were related, and the cluster was eventually linked to Better Homes & Gardens Aromatherapy Room Spray Lavender & Chamomile scent with gemstones.
The product was manufactured in India and sold through Walmart from February to October 21, 2021, when the recall took effect. An additional five scents were also removed as an abundance of caution. B. pseudomallei isolated from the contaminated room spray was found to match the isolates from all four cases.3 To date, no additional cases have been identified. |
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While rare, this incident emphasizes the global nature of both travel and product importation and importance of being vigilant for select agents. Sentinel Laboratories play a crucial role to recognize, rule-out, or refer utilizing the Sentinel Laboratory Procedures.4 It is important to rule-out select agents prior to loading onto commercial identification systems to prevent potential laboratory exposures. Automated systems may fail to correctly identify B. pseudomallei and may mis-identify as B. thailandensis, B. cepacia, and other members of the Burkholderia genera, Chromobacterium violaceum, Ochorobactrum anthropic, and possibly Pseudomonas spp., Acinetobacter spp., and Aeromonas spp., B. cepacia can closely mimic B. pseudomallei. The ASM sentinel guidelines recommend confirming identification of B. cepacia particularly if recovered from blood or tissue from a non-cystic fibrosis patient. The most notable characteristic to assess is amoxicillin clavulanate resistance. B. cepacia will be resistant while 99% of B. pseudomallei isolates are susceptible.
For more information on select agents, or to schedule a Biothreat Agent training contact the Bioterrorism Training Coordinator, Jason Wholehan wholehanj@michigan.gov
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Service Animals in Emergencies
Alice Frame, MA - MDHHS Disabilities Health Unit Coordinator
What is a service animal?
First and foremost, a service animal is not the same as a pet. A service animal is trained to do work or perform a service to benefit an individual with a disability. These animals are protected by the Americans with Disabilities Act (ADA) to help individuals with disabilities or medical conditions.
Where are service animals allowed?
Individuals should be allowed to bring their service animals to any area of public or private businesses and facilities where people are allowed if the animal is housebroken and under the user’s control. This can be done with a harness or leash, or through voice and/or signal commands. If a service animal is not under control, he is no longer protected by the ADA guidelines.
What does this mean for emergencies?
When at all possible, a service animal should be allowed to remain with the handler. Emergencies are stressful for everyone but can be even more so for an individual with a disability when separated from a service animal. Response staff cannot ask to see medical documentation or service animal certification, but can ask these two questions:
- Is the dog a service animal needed for a disability?
- What work is the dog trained to perform?
Ambulances: If space permits, a service animal should be allowed to accompany an individual with a disability in an ambulance. However, if there is limited space in the ambulance or the animal is behaving in a way that prevents responders from working on the patient, the staff should make arrangements to transport him separately to the same location as his owner. This can be done through local police, a secondary emergency responder or other entity. Ideally, animal and user would arrive as close to the same time as possible. On arrival, the service animal should be returned back to their owner.
Hospitals and treatment centers: As a general rule, service animals must be allowed in any areas where public and patients are allowed. These areas include patient rooms, clinics, exam rooms, cafeterias and lounge spaces. However, it is appropriate to exclude service animals from areas that must remain sterile, such as operating rooms and burn units. Many hospitals and treatment centers have established service animal protocols.
Sheltering: Service animals must be allowed in any shelter or location being used for emergency sheltering. An individual with a disability cannot be separated from everyone else or moved to a separate shelter just because they have a service animal.
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Cold-related Illness & Carbon Monoxide Resources
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With extreme cold temperatures there can be an increase in cold-related illness (CRI) and carbon monoxide poisoning emergency department visits. The risk for carbon monoxide poisoning increases during cold weather because people may use dangerous methods to heat their homes.
Here are some links to resources and information that will be helpful in responding to cold-related illnesses:
MDHHS Cold Health and Safety and Carbon Monoxide Resources:
National Mental Health Resources:
- 24/7 Disaster Distress Helpline at 800-985-5990
- 24/7 National Suicide Prevention Lifeline at 800-273-8255.
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CDCs Public Health Emergency Law Virtual Training
CDC offers free, online Public Health Emergency Law (PHEL) training about management of public health emergencies and how to effectively use legal authorities. PHEL consists of three competency-based units and covers legal issues to consider before, during, and after public health emergencies. (Each unit takes about 40 minutes.) The training prepares state, tribal, local, and territorial practitioners to make better informed legal decisions related to emergency preparedness and response activities in their jurisdictions.
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The Guardian of Public Health is a monthly newsletter from the Bureau of EMS, Trauma and Preparedness (BETP) within the Michigan Department of Health and Human Services (MDHHS). The Guardian aims to provide readers with relevant content on topics that affect the public health of Michigan's citizens and communities.
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This publication was supported by Cooperative Agreement number 1NU90TP922062-01-00, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Bureau of EMS, Trauma & Preparedness | 1001 Terminal Rd, Lansing, MI 48906 | 517-335-8150
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