{"id":10283,"date":"2025-03-01T14:03:25","date_gmt":"2025-03-01T19:03:25","guid":{"rendered":"https:\/\/www-test.dhss.delaware.gov\/dph\/dhan311\/"},"modified":"2025-03-02T00:51:55","modified_gmt":"2025-03-02T05:51:55","slug":"dhan311","status":"publish","type":"page","link":"https:\/\/www-test.dhss.delaware.gov\/dph\/php\/alerts\/dhan311\/","title":{"rendered":"php\/alerts\/dhan311 ~  Division of Public Health &#8212; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan311.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->311 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->August 23, 2013 3:36 pm <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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These infections include primary amebic meningoencephalitis (PAM) caused by\n\n\n  <em>Naegleria fowleri<\/em>* and granulomatous amebic encephalitis caused by <em>Balamuthia mandrillaris<\/em> <sup>\u2020<\/sup> and\n\n\n  <em>Acanthamoeba<\/em> species.<sup>\u00a7<\/sup>\u00a0 Although several drugs have in vitro activity against FLA, mortality from these\n\n\n  infections remains greater than 90% despite treatment with combinations of drugs.\n\n\n<\/p>\n\n\n<p>\n\n\n  Miltefosine is a drug used to treat leishmaniasis and also has shown in vitro activity against FLA (<em>1<\/em>), but as an\n\n\n  investigational drug, it has not been readily available in the United States. With CDC assistance, however, miltefosine has been\n\n\n  administered in combination with other drugs since 2009 for FLA infections as single-patient emergency use with permission from the Food\n\n\n  and Drug Administration. Although the number of <em>B. mandrillaris<\/em> and <em>Acanthamoeba<\/em> species infections treated with a\n\n\n  miltefosine-containing regimen is small, it appears that a miltefosine-containing treatment regimen does offer a survival advantage for\n\n\n  these usually fatal infections (<em>2<\/em>). Miltefosine has not been used successfully to treat a <em>Naegleria<\/em> infection, but the\n\n\n  length of time it has taken to import miltefosine from abroad has made timely treatment of fulminant <em>Naegleria<\/em> infections with\n\n\n  miltefosine difficult.\n\n\n<\/p>\n\n\n<p>\n\n\n  CDC now has an expanded access IND protocol in effect with the Food and Drug Administration to make miltefosine available directly from\n\n\n  CDC for treatment of FLA in the United States. The expanded access IND use of miltefosine for treatment of FLA is partly supported by 26\n\n\n  case reports of FLA infection from around the world during the period of 2008\u20132012 in which miltefosine was part of the treatment\n\n\n  regimen (Unpublished data, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic\n\n\n  Infectious Diseases, CDC, 2013). Miltefosine is generally well-tolerated, with gastrointestinal symptoms as the most commonly reported\n\n\n  adverse effects.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Recommendation\n\n\n<\/h4>\n\n\n<p>\n\n\n  Clinicians who suspect they have a patient with FLA infection who could benefit from treatment with miltefosine should contact CDC to\n\n\n  consult with an FLA expert. See the <strong>For More Information<\/strong> section below for information on contacting a CDC FLA expert.\n\n\n<\/p>\n\n\n<h4>\n\n\n  For More Information\n\n\n<\/h4>\n\n\n<ul>\n\n\n  <li>For diagnostic assistance, specimen collection guidance, specimen shipping instructions, treatment recommendations, and information\n\n\n  on obtaining miltefosine from CDC, clinicians should contact the CDC Emergency Operations Center at 770-488-7100 to request to speak to\n\n\n  an FLA expert.\n\n\n  <\/li>\n\n\n  <li>For more information on diagnostic assistance specimen collection guidance and specimen shipping instructions, see <a href=\"http:\/\/www.cdc.gov\/parasites\/naegleria\/diagnosis-hcp.html\">http:\/\/www.cdc.gov\/parasites\/naegleria\/diagnosis-hcp.html<\/a>.\n\n\n  <\/li>\n\n\n  <li>For <em>Naegleria fowleri<\/em> treatment recommendations, see <a href=\"http:\/\/www.cdc.gov\/parasites\/naegleria\/treatment-hcp.html\">http:\/\/www.cdc.gov\/parasites\/naegleria\/treatment-hcp.html<\/a>.\n\n\n  <\/li>\n\n\n  <li>For the <em>MMWR<\/em> Notice to Readers on this topic, see <a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6233a4.htm?s_cid=mm6233a4_w\">http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6233a4.htm?s_cid=mm6233a4_w<\/a>.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h4>\n\n\n  References\n\n\n<\/h4>\n\n\n<ol>\n\n\n  <li>Schuster FL, Guglielmo BJ, Visvesvara GS. In-vitro activity of miltefosine and voriconazole on clinical isolates of free-living\n\n\n  amebas: <em>Balamuthia mandrillaris<\/em>, <em>Acanthamoeba<\/em> spp., and <em>Naegleria fowleri<\/em>. J Eukaryot Microbiol\n\n\n  2006;53:121\u20136.\n\n\n  <\/li>\n\n\n  <li>Cope JR, Roy SL, Yoder JS, Beach MJ. Improved treatment of granulomatous amebic encephalitis and other infections caused by\n\n\n  <em>Balamuthia mandrillaris<\/em> and <em>Acanthamoeba<\/em> species [Poster]. Presented at CSTE Annual Conference, Pasadena, CA, June\n\n\n  9\u201313, 2013. Available at <a href=\"http:\/\/www.cste2.org\/confpresentations\/uploadedfiles\/cste%202013%20miltefosine%20Poster%20final.pdf\">http:\/\/www.cste2.org\/confpresentations\/uploadedfiles\/cste%202013%20miltefosine%20Poster%20final.pdf<\/a>.\n\n\n  <\/li>\n\n\n<\/ol>\n\n\n<h4>\n\n\n  Endnotes\n\n\n<\/h4>\n\n\n<p>\n\n\n  * Additional information available at <a href=\"http:\/\/www.cdc.gov\/parasites\/naegleria\">http:\/\/www.cdc.gov\/parasites\/naegleria<\/a>.\n\n\n<\/p>\n\n\n<p>\n\n\n  <sup>\u2020<\/sup> Additional information available at <a href=\"http:\/\/www.cdc.gov\/parasites\/balamuthia\">http:\/\/\n\n\n  www.cdc.gov\/parasites\/balamuthia<\/a>.\n\n\n<\/p>\n\n\n<p>\n\n\n  <sup>\u00a7<\/sup> Additional information available at <a href=\"http:\/\/www.cdc.gov\/parasites\/acanthamoeba\">http:\/\/www.cdc.gov\/parasites\/acanthamoeba<\/a>.\n\n\n<\/p>\n\n\n<p class=\"text-center\">\n\n\n  <em>The Centers for Disease Control and Prevention (CDC) protects people\u2019s health and safety by preventing and controlling diseases\n\n\n  and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through\n\n\n  strong partnerships with local, national, and international organizations.<\/em>\n\n\n<\/p>\n\n\n<p>\n\n\n  ************************************\n\n\n<\/p>\n\n\n<p>\n\n\n  You are receiving this email because you are a registered member of the Delaware Health Alert Network. If you are not a member and would\n\n\n  like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a>\n\n\n<\/p><br>\n\n\n<br>\n\n\n<p class=\"smalltext\"><a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\"><img loading=\"lazy\" decoding=\"async\" alt=\"Download Adobe Acrobat Reader\" height=\"21\" src=\"\/wp-content\/uploads\/dhss\/img\/getacro60.gif\" width=\"60\"><\/a> Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader.  A free copy of Adobe Acrobat Reader can be downloaded directly from <a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\">Adobe <\/a>. If you are using an assistive technology unable to read Adobe PDF, please either view the corresponding text only version (if available) or visit Adobe&#8217;s <a href=\"http:\/\/access.adobe.com\">Accessibility Tools page<\/a>.<\/p>\n\n\n\n<!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #311 August 23, 2013 3:36 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10283","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10283","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10283"}],"version-history":[{"count":1,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10283\/revisions"}],"predecessor-version":[{"id":11459,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10283\/revisions\/11459"}],"up":[{"embeddable":true,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10283"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}