AZ DOC:Lightning strikes twice: Botulism at Eyman again.

SOS from AZ prisons, CDC! I can't believe there's more botulism at Eyman The last time this happened was July 2012, and the AZ DOC's claim it was from prison hooch was an outright lie. Those men got sick from something they ate this summer, and three of the four were left to suffer with it for a week without medical attention before being taken to the hospital - check out this post here. That's twice now since Wexford took over that there's been a botulism outbreak.

So before anyone else buys the latest DOC report that their prisoners are just up to no good again, let's look at the other possible reasons for this kind of exceptionally rare outbreak to have occurred twice in the same prison in just a few months period of time (mind you - there were only 110 cases of botulism poisoning in the entire US in 2010 - only 9 of which were food-borne). Even if this batch of botulism really came from an alcoholic beverage cooked up in a cell and not a can of beef stew or something smuggled out of the chow hall, I'd be looking at what they're selling in the canteen theses days, boys. Something those guys are eating in that prison just isn't right.

"SOS from Arizona's other death row..."

 Phoenix, AZ (June 2012) 

 The Arizona Department of Corrections is already facing a class action suit, Parsons v Ryan, for gross medical neglect of its prisoners and the abuse of solitary confinement for managing the mentally ill. For their part, Wexford Health Sources has been outright accused of criminal misconduct in their management of AZ state prisoner health care since wining the contract in July 2012. If the CDC doesn't really look into things this time, who can the public trust to do so?

 

--------------from Food Poisoning Bulletin----------- 

Prison Hooch Sends 7 Inmates To ICU with Botulism

Food Poisoning Bulletin
November 26, 2012
By Carla Gillespie
 
Prison hooch, or homemade alcohol,  is the likely source of a botulism outbreak at an Arizona prison that sent seven inmates to intensive care. The seven inmates, all from Special Management Unit 1 of the Arizona State Prison Complex Eyman in Florence, were hospitalized over the weekend.

Botulism is not spread through person-to-person contact. Although it can develop in contaminated wounds or through IV drug use, it most often develops after eating or drinking food that is tainted with the toxin. Botulism poisoning  must be treated with a course of special anti-toxin, the stockpile of which is controlled by the Centers for Disease Control and Prevention (CDC).

Health officials in Pinal County, where the prison is located, suspect that the inmates became ill after drinking  hooch made from fermented fruit. After discussions with county health officials, the CDC made a preliminary confirmation of botulism and released the anti-toxin. Samples of the hooch were collected and sent to the CDC lab for testing.

Five of the inmates became seriously ill on Saturday and two more fell ill on Sunday. All seven are in intensive care. Symptoms of botulism poisoning, which can be fatal, include: muscle weakness, difficulty speaking, chewing, swallowing and breathing; and paralysis.

County, state and federal authorities are working on the investigation into the outbreak. This is the second time in four months that such and incident has occurred at the prison. In August, four inmates contracted botulism from prison hooch.

Dear Director Ryan: Community standards for treating Hep C.

More unanswered correspondence with Director Ryan about Hep C. For all I know he's just sending me to his Spam Box now. The only way I can be relatively sure he sees this is by posting it or hand-delivering it - and I don't want them to trespass me down there if I show up too much.

Besides, this has useful info for everyone. Check out the links to the professional standards. Keep in mind when they were written, too.

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Arizona Prison Watch	Fri, Aug 20, 2010 at 10:15 AM
To: cryan kklausner
For all my criticism of them (which still stands), at least the CDC has easily-accessible information on the basics. Robertson stopped evaluating the extent of Davon's liver disease - and possible co-morbid conditions - when he should have kept going. He still needs the genotyping done to make sure he doesn't have more than one strain of HCV, and to determine the likelihood that he'll even respond to treatment. And in light of the increased risk for disorders like diabetes (and his weight loss and fatigue), his glucose should be monitored more regularly to determine what his ranges are. Davon should also be treated like a human being, not a veterinary specimen - no one seems to really be trying to educate him on his medical condition or lab results, or even ask him about his fatigue, weight loss, headaches, etc. despite hearing concerns from Julie multiple times a week. ------------------------------- CDC HCV FAQs: Testing and Diagnosis Who should be tested for HCV infection? HCV testing is recommended for anyone at increased risk for HCV infection, including: Persons who have ever injected illegal drugs, including those who injected only once many years ago Recipients of clotting factor concentrates made before 1987 Recipients of blood transfusions or solid organ transplants before July 1992 Patients who have ever received long-term hemodialysis treatment Persons with known exposures to HCV, such as healthcare workers after needlesticks involving HCV-positive blood recipients of blood or organs from a donor who later tested HCV-positive All persons with HIV infection Patients with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests) Children born to HCV-positive mothers (to avoid detecting maternal antibody, these children should not be tested before age 18 months) What blood tests are used to detect HCV infection? Several blood tests are performed to test for HCV infection, including: Screening tests for antibody to HCV (anti-HCV) enzyme immunoassay (EIA) enhanced chemiluminescence immunoassay (CIA) Recombinant immunoblot assay (RIBA) Qualitative tests to detect presence or absence of virus (HCV RNA polymerase chain reaction [PCR]) Quantitative tests to detect amount (titer) of virus (HCV RNA PCR) How do I interpret the different tests for HCV infection? A table on the interpretation of HCV test results is available at http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_graph.pdf [PDF - 1 page]. Is an algorithm for HCV diagnosis available? A flow chart on HCV infection testing for diagnosis is available at http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_flow.pdf [PDF - 1 page]. What is the next step after a confirmed positive anti-HCV test? The level of ALT (alanine aminotransferase, a liver enzyme) in the blood should be measured. An elevated ALT indicates inflammation of the liver. The patient should be checked further for chronic liver disease and possible treatment. The evaluation should be performed by a healthcare professional familiar with chronic Hepatitis C. Can a patient have a normal liver enzyme (e.g., ALT) level and still have chronic Hepatitis C? Yes. It is common for patients with chronic Hepatitis C to have liver enzyme levels that go up and down, with periodic returns to normal or near normal levels. Liver enzyme levels can remain normal for over a year despite chronic liver disease. Management and Treatment What should be done for a patient with confirmed HCV infection? HCV-positive persons should be evaluated (by referral or consultation, if appropriate) for presence of chronic liver disease, including assessment of liver function tests, evaluation for severity of liver disease and possible treatment, and determination of the need for Hepatitis A and Hepatitis B vaccination. When might a specialist be consulted in the management of HCV-infected persons? Any physician who manages a person with Hepatitis C should be knowledgeable and current on all aspects of the care of a person with Hepatitis C; this can include some internal medicine and family practice physicians as well as specialists such as infectious disease physicians, gastroenterologists, or hepatologists. What is the treatment for chronic Hepatitis C? Combination therapy with pegylated interferon and ribavirin is the treatment of choice, resulting in sustained virologic response (defined as undetectable HCV RNA in the patient's blood 24 weeks after the end of treatment) rates of 40%–80% (up to 50% for patients infected with genotype 1, the most common genotype found in the United States, and up to 80% for patients infected with genotypes 2 or 3). Combination therapy using interferon and ribavirin is FDA-approved for use in children ages 3–17 years. Treatment success rates are now being improved with the addition of polymerase and protease inhibitors to standard pegylated interferon/ribavirin combination therapy. How many different genotypes of HCV exist? At least six distinct HCV genotypes (genotypes 1–6) and more than 50 subtypes have been identified. Genotype 1 is the most common HCV genotype in the United States. Is it necessary to do viral genotyping when managing a person with chronic Hepatitis C? Yes. Because there are at least six known genotypes and more than 50 subtypes of HCV, genotype information is helpful in defining the epidemiology of Hepatitis C and in making recommendations regarding treatment. Knowing the genotype can help predict the likelihood of treatment response and, in many cases, determine the duration of treatment. Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin When using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended. Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection. Can superinfection with more than one genotype of HCV occur? Superinfection is possible if risk behaviors (e.g., injection drug use) for HCV infection continue, but it is believed to be very uncommon. Does chronic Hepatitis C affect only the liver? A small percentage of persons with chronic HCV infection develop medical conditions due to Hepatitis C that are not limited to the liver. These conditions are thought to be attributable to the body's immune response to HCV infection. Such conditions can include Diabetes mellitus, which occurs three times more frequently in HCV-infected persons Glomerulonephritis, a type of kidney disease caused by inflammation of the kidney Essential mixed cryoglobulinemia, a condition involving the presence of abnormal proteins in the blood Porphyria cutanea tarda, an abnormality in heme production that causes skin fragility and blistering Non-Hodgkins lymphoma, which might occur somewhat more frequently in HCV-infected persons Where can I find more information about management and treatment of patients with chronic Hepatitis C? The American Association for the Study of Liver Diseases: AASLD Practice Guideline: Diagnosis, Management, and Treatment of Hepatitis C . The National Institute of Diabetes and Digestive and Kidney Diseases: Chronic Hepatitis C Current Disease Management. -- Arizona Prison Watch http://arizonaprisonwatch.blogspot.com A community resource for monitoring, navigating, surviving, and dismantling the prison industrial complex in Arizona. “The degree of civilization in a society can be judged by entering its prisons.” - Fyodor Dostoyevsky (1821-1881)