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The Spring of Spice: Alabama Department of Public Health (ADPH) Conducts Outbreak Investigation in April and May

Posted By Arrol Sheehan, Mary McIntyre, Melissa Morrison, Cassie Brailer, and Kelly Stevens, Friday, September 18, 2015
Updated: Friday, September 18, 2015

Upon learning that there was a rapid rise in emergency room visits, hospitalizations and poison center calls related to use of synthetic cannabinoids, the ADPH Epidemiology Division (EPI) of the Bureau of Communicable Diseases responded quickly to protect the health of the public.

A Health Alert Network (HAN) notification was issued and health care providers statewide were asked to consider exposure to synthetic cannabinoids, also known as Spice, as a diagnosis for patients presenting with the following symptoms: rapid heart rate, nausea and vomiting, agitation, confusion, lethargy, hallucinations, paranoia, kidney and respiratory problems.

ADPH also actively engaged the media to inform the public. Dr. Mary G. McIntyre, State Epidemiologist, emphatically cautioned the public, "Responses to these chemicals can be unpredictable and deadly. People have experienced coma, kidney failure, and heart attacks just to mention some of the effects experienced by users. Please do not take the risk. Do not use these products."

EPI field surveillance staff contacted hospitals on a weekly basis to monitor the numbers of emergency room visits and hospitalizations; reports were provided by 82 of the 99 Alabama hospitals. During the surveillance period of April 15 to May 28, 1,046 emergency room visits and 259 hospitalizations were reported; however, those are likely underestimates. Five deaths were reported, with ages of the deceased ranging from the 20s through the 40s.

Additionally, a review of Alabama Emergency Medical Services Information System (EMSIS) data identified 693 emergency calls for spice-related exposure in April and May, compared to only 105 for January through March. The demographics of the 693 patients are as follows: 572 (83%) were male, 497 (72%) were black or African American, 179 (26%) were white, 9 (1.3%) were American Indian or Alaska Native and 12 (2%) were Hispanic. The patient ages ranged from 9 to 67 years with a mean of 31 and median of 27.

In July, the staff gathered for a videoconference to review the outbreak and share lessons learned. Future plans include collaboration between EPI and the Office of Emergency Medical Services to incorporate EMSIS data into surveillance activities so that similar events will be identified sooner. ADPH plans to reach out to providers through the Medical Association of the State of Alabama (MASA) to further raise awareness of signs and symptoms and to educate providers on recommendations for management.

This article was adapted from the article of the same name written by Arrol Sheehan, MA, and published in Alabama’s Health, August 2015, Volume 48, Number 3, a Publication of the Alabama Department of Public Health. This article was written by Arrol Sheehan, M.A., Public Information Manager; Mary G. McIntyre, M.D., M.P.H., State Epidemiologist and ASHO for Disease Control & Prevention; Melissa Morrison, M.P.H., Commander, US Public Health Service; Cassie Brailer, B.S., Public Health Associate; and Kelly Stevens, M.S., Director, Epidemiology Division. Join the CSTE Marijuana Subcommittee for discussion, publications, and resources surrounding related risk issues.

 
Acknowledgements
The Spice team includes the following Central Office staff and the FSS from each area:
EPI Kelly Stevens, MS Epidemiology Division Director
EPI Cassie Brailer, BA Public Health Associate
EPI Shirley Offutt, RN, BSN Surveillance Nurse Manager
EPI Sherri Davidson, MPH Epidemiologist Supervisor
DCP Mary G. McIntyre, MD, MPH State EPI
CEFO Melissa Morrison, MPH Commander, US Public Health Service
EMS MisChele White, BSBA, MPA EMS Data Program Administrator
PHA1 Kathy Linzey, RN, BSN Surveillance Nurse Coordinator
PHA2 Theresa Tucker, RN, BSN Surveillance Nurse Coordinator
PHA2 Toni Richie, RN, BSN Surveillance Nurse Coordinator
PHA3 Jenny Parker-Long, RN, BSN Surveillance Nurse Coordinator
PHA4 Stephanie Millsap, MPH Epidemiologist Jefferson CHD
PHA4 Bridgette Kennedy, MPH Epidemiologist Jefferson CHD
PHA5 Michelle Marlow, RN, BSN Surveillance Nurse Coordinator
PHA6 Kelly Haywood, RN, BSN Surveillance Nurse Coordinator
PHA7 Tina Norwood, RN, BSN Surveillance Nurse Coordinator
PHA8 Patti Stadlberger, RN, BSN Surveillance Nurse Coordinator
PHA9 Kelly Singleton, RN, BSN Surveillance Nurse Coordinator
PHA10 Catherine Person, RN, BSN Surveillance Nurse Coordinator
PHA11 Becky Dixon, RN, BSN Surveillance Nurse Mobile CHD
PHA11 Cheryl Lahrs, RN, BSN Surveillance Nurse Mobile CHD

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