Healthcare providers should be aware that out of an abundance of caution HEALTH continues to follow up with patients exposed to contaminated methylprednisolone acetate (MPA1) from the New England Compounding Center (NECC) in Framingham, Mass. Any concerns over lingering infections may result in referrals to area healthcare providers. For the latest CDC updates and clinical guidance related to this outbreak, visit http://emergency.cdc.gov/HAN/han00338.asp.

Shortages of isoniazid (INH), a cornerstone drug for treating tuberculosis disease (TB) and latent Mycobacterium tuberculosisinfection (LTBI), are continuing. This notice gives an update on the shortages and expands general guidance about how to adjust practices in response to the shortages from that outlined in CDC's December 21, 2012, Morbidity and Mortality Weekly Report (MMWR) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6150a4.htm ). It also outlines national plans for restoring INH supplies and lists published guidance that could assist in making treatment decisions when INH is unavailable.

The Rhode Island State Health Laboratory (RISHL) instituted a new HIV screening test two years ago which is called the Abbott HIV Ab/Ag Combo test. This test is capable of detecting HIV infections earlier than the previous generation Abbott test utilized at the RISHL, giving us the capacity to detect acute infections. This notice serves to provide additional guidance on interpreting results.

The Rhode Island Department of Health (HEALTH) has confirmed two cases of pertussis in Coventry involving two Grade 6 students at the Alan Shawn Feinstein Middle School. We are working with the schools and families to identify and recommend prophylaxis for close contacts and high-risk individuals. At this time public health nurses are directing these contacts to see a pediatrician, family physician, or nurse practitioner to ensure prophylaxis. Parents of students at the school are being advised by email and/or letter to be vigilant for cough illness, and this notice might prompt calls to area healthcare providers.

New information from diagnostic imaging of patients exposed to contaminated methylprednisolone acetate (MPA1) from the New England Compounding Center (NECC) in Framingham, Mass., demonstrates the need for assertive clinical evaluation of these patients for the possibility of an unrecognized, localized spinal or paraspinal infection. This Health Alert Network (HAN) notice provides updated guidance and information about the ongoing multistate outbreak of fungal infections. Click on the link above.

Distributed via Health Alert Network, November 20, 2012, 15:00 ET (3:00 PM ET), CDC HAN-00335-2012-11-20-ADV-N: The Centers for Disease Control and Prevention (CDC) continues to work closely with state public health departments on a multistate investigation of fungal meningitis and other infections among patients who received a methylprednisolone acetate (MPA) injection prepared by the New England Compounding Center (NECC) in Framingham, Mass. This HAN notice provides updated information on the following: (1) epidural abscess and other clinical syndromes being diagnosed in exposed patients, and (2) diagnostic and treatment recommendations for clinicians.

The Rhode Island Department of Health (HEALTH) has confirmed three cases of pertussis in North Providence: one case in Grade 7 and one case in Grade 6 at Birchwood Middle School, and one case involving a Grade 5 student at Marieville Elementary School.

Distributed via Health Alert Network; October 23, 2012, 22:00 ET (10:00 PM ET); CDCHAN-00330-2012-10-23-UPD-N. As part of its ongoing investigation of the multistate outbreak of fungal infections, the Centers for Disease Control and Prevention (CDC) continues to assess and revise interim guidance to clinicians involved in the management of patients who received injections with contaminated steroid products distributed by the New England Compounding Center (NECC).

Since mid-September, four pertussis cases have been confirmed in Pawtucket among students in grades 2, 3, and 6 at the Henry J. Winters Elementary School (Grades K-6). Public health nurses are actively case managing close child and adult contacts from the school, home, and community, and are directing those potential exposures to their pediatricians or primary care providers to receive prophylaxis. Additionally, a clinic is scheduled for the Henry J. Winters School students, their families, faculty, and staff to take place Friday. Oct. 26, from 2 to 7 P.M. at the school.

CDC Health Alert Network (HAN) Health Advisory Summary: The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to work closely with state public health departments on a multistate investigation of fungal meningitis and joint infections among patients who received a methylprednisolone acetate injection prepared by the New England Compounding Center (NECC) in Framingham, Mass. Some of these patients who received epidural injections also suffered strokes that may have resulted from their infection. This HAN notice provides updated information on the following: Status of the investigation; FDA issuance of a MedWatch Safety Alert on October 15 advising clinicians to follow-up with patients who received an injectable NECC product, including any ophthalmic drug that is injectable or used in conjunction with eye surgery, and a cardioplegic solution purchased from or produced by NECC after May 21, 2012; Recommendations for clinicians; Case definition.

The Centers for Disease Control and Prevention (CDC), working with the Clinician Outreach and Communication Activity (COCA) CDC Emergency Communication System, is inviting clinicians to join a special COCA Conference Call from 2 to 3 p.m. Tuesday afternoon, for CDC subject matter experts to discuss the multistate fungal meningitis outbreak investigation and share important guidance for clinicians. To view the record call materials please visit the call webpage at http://emergency.cdc.gov/coca/calls/2012/callinfo_101612.asp If you have questions or trouble accessing this COCA Call/Webinar, please e-mail coca@cdc.gov.

The Centers for Disease Control and Prevention has updated its website to include "Frequently Asked Questions For Patients: Multistate Meningitis Outbreak Investigation" in response to the ongoing nationwide investigation of fungal meningitis among patients who received an epidural steroid injection. The fact sheet is available to view and print in English and Spanish.