STUDY OBJECTIVES: In April 2015, a multistate outbreak of illness linked to synthetic cannabinoid (SC) use was unprecedented in magnitude and severity. We identified Mississippi cases in near-real time, collected information on cases to characterize the outbreak, and identified the causative SC. METHODS: A case was defined as any patient of a Mississippi healthcare facility who was suspected of SC use and presenting with >/=2 of the following symptoms: sweating, severe agitation, or psychosis during April 2-May 3, 2015. Clinicians reported cases to the Mississippi Poison Control Center (MPCC). We used MPCC data to identify cases at the University of Mississippi Medical Center (UMMC) to characterize in further detail, including demographics and clinical findings. Biologic samples were tested for known and unknown SCs by liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF/MS). RESULTS: Clinicians reported 721 cases (11 deaths) statewide; 119 (17%) were UMMC patients with detailed data for further analysis. Twelve (10%) were admitted to an intensive care unit and 2 (2%) died. Aggression (32%), hypertension (33%), and tachycardia (42%) were common. SCs were identified in serum from 39/56 patients (70%); 33/39 patients (85%) tested positive for MAB-CHMINACA (N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)-1H-indazole-3-carb oxamide) or its metabolites. Compared to all patients tested for SCs, those positive for MAB-CHMINACA were more likely to have altered mental status on examination (OR = 3.3, p = .05). CONCLUSION: SC use can cause severe health effects. MAB-CHMINACA was the most commonly detected SC in this outbreak. As new SCs are created, new strategies to optimize surveillance and patient care are needed to address this evolving public health threat.

The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for 7 days (aPR 2.4, 95% CI 1.1-5.2) and experienced low water pressure for 7 days (aPR 3.6, 95% CI 1.4-9.0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts.

OBJECTIVES: We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011. METHODS: We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone survey of 98 injured cases along with 200 uninjured controls. RESULTS: Most (n = 1,111, 79.5%) injuries treated were non-life threatening (Injury Severity Score ≤15). Severe injuries often affected head (72.9%) and chest regions (86.4%). Mobile home residents showed the highest odds of injury (OR, 6.98; 95% CI: 2.10-23.20). No severe injuries occurred in tornado shelters. Within permanent homes, the odds of injury were decreased for basements (OR, 0.13; 95% CI: 0.04-0.40), bathrooms (OR, 0.22; 95% CI: 0.06-0.78), hallways (OR, 0.31; 95% CI: 0.11-0.90) and closets (OR, 0.25; 95% CI: 0.07-0.80). Exposure to warnings via the Internet (aOR, 0.20; 95% CI: 0.09-0.49), television (aOR, 0.45; 95% CI: 0.24-0.83), and sirens (aOR, 0.50; 95% CI: 0.30-0.85) decreased the odds of injury, and residents frequently exposed to tornado sirens had lower odds of injury. The prevalence of PTSD in respondents was 22.1% and screening positive for PTSD symptoms was associated with tornado-related loss events. CONCLUSIONS: Primary prevention, particularly improved shelter access, and media warnings, seem essential to prevent severe tornado-injury. Small rooms such as bathrooms may provide some protection within permanent homes when no underground shelter is available.