{"id":10285,"date":"2025-03-01T14:03:25","date_gmt":"2025-03-01T19:03:25","guid":{"rendered":"https:\/\/www-test.dhss.delaware.gov\/dph\/dhan313\/"},"modified":"2025-03-02T00:51:55","modified_gmt":"2025-03-02T05:51:55","slug":"dhan313","status":"publish","type":"page","link":"https:\/\/www-test.dhss.delaware.gov\/dph\/php\/alerts\/dhan313\/","title":{"rendered":"php\/alerts\/dhan313 ~  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\/dhan313.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\"]-->313 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->October 9, 2013 9:51 am <!--[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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CDC recommends increased vigilance by public health agencies, emergency\n\n\n  departments, and healthcare providers for patients who develop acute hepatitis or liver failure following use of a weight loss or muscle\n\n\n  building nutritional supplement. CDC requests that state health departments report such occurrences to the CDC. CDC also recommends that,\n\n\n  as part of a comprehensive evaluation, clinicians evaluating patients with acute hepatitis should ask about consumption of dietary\n\n\n  supplements.<\/em>\n\n\n<\/p>\n\n\n<h4>\n\n\n  Background:\n\n\n<\/h4>\n\n\n<p>\n\n\n  On September 9, 2013, the Hawaii Department of Health (DOH) was notified of seven patients with severe acute hepatitis and sudden liver\n\n\n  failure of unknown cause. The patients were previously healthy and sought medical care from May through September 2013. Clinicians\n\n\n  reported that the seven patients had all used OxyELITE Pro, a dietary supplement marketed for weight loss and muscle gain, prior to\n\n\n  illness onset.\n\n\n<\/p>\n\n\n<p>\n\n\n  The investigation is ongoing and the data presented are preliminary. Thus far, clinicians have reported 45 patients to the Hawaii DOH in\n\n\n  response to a public health alert. Of those, 29 patients, including the original seven, were confirmed to have acute hepatitis after\n\n\n  using a nutritional supplement for weight loss or muscle building. The median age of\u00a0 the 29 patients is 33 years; 14 (48%) are\n\n\n  male. The date of the first reported laboratory test was used as a proxy for illness onset and ranged from May 10 through October 3,\n\n\n  2013. The most commonly reported symptoms included loss of appetite, light-colored stools, dark urine, and jaundice. Median laboratory\n\n\n  values reported at the peak of illness were the following:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>aspartate aminotransferase (AST) 1,128 IU\/L;\n\n\n  <\/li>\n\n\n  <li>alanine transaminase (ALT) 1,793 IU\/L;\n\n\n  <\/li>\n\n\n  <li>alkaline phosphatase 150 IU\/L; and\n\n\n  <\/li>\n\n\n  <li>total bilirubin 12.6 mg\/dL.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  Ten patients had liver biopsy data available at the time of this report. Seven had histology consistent with hepatitis from drug\/toxic\n\n\n  injury, with findings including hepatocellular necrosis and cholestasis. Three patients had liver biopsy findings of acute hepatitis\n\n\n  associated with other etiologies such as autoimmune hepatitis. Eleven (38%) patients were hospitalized, with a median duration of seven\n\n\n  days. One patient died, and two patients received liver transplants. Two remain hospitalized, and all other hospitalized patients have\n\n\n  been discharged.\n\n\n<\/p>\n\n\n<p>\n\n\n  Of the 29 identified patients, 24 (83%) reported using OxyELITE Pro during the 60 days prior to illness onset. There was no other dietary\n\n\n  supplement or medication use reported in common by more than two patients.\n\n\n<\/p>\n\n\n<p>\n\n\n  National case finding efforts have identified several individuals from states outside Hawaii with reported OxyELITE Pro or other weight\n\n\n  loss or muscle building dietary supplement use prior to the development of acute hepatitis of unknown cause. CDC, in collaboration with\n\n\n  state health departments, is collecting additional clinical and epidemiologic information from these individuals to determine if this\n\n\n  outbreak is national in scope.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Case definition:\n\n\n<\/h4>\n\n\n<p>\n\n\n  An individual with acute-onset hepatitis of unknown etiology that developed symptoms on or after April 1, 2013 following use of a\n\n\n  non-prescription weight loss or muscle building dietary supplement during the 60 days prior to illness onset.\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>With acute-onset hepatitis of unknown etiology defined as having BOTH:\n\n\n    <ul>\n\n\n      <li>ALT <span style=\"text-decoration: underline\">><\/span> 4 times the upper limit of normal\n\n\n      <\/li>\n\n\n      <li>Total bilirubin <span style=\"text-decoration: underline\">><\/span> 2 times the upper limit of normal\n\n\n      <\/li>\n\n\n    <\/ul>\n\n\n  <\/li>\n\n\n  <li>AND\n\n\n  <\/li>\n\n\n  <li>negative workup for infectious or other explicative etiologies for hepatitis. Workup for other potential etiologies should include:\n\n\n    <ul>\n\n\n      <li>Hepatic imaging (i.e., ultrasound\/doppler, CT scan, MRI) not consistent with alternative, explicative etiologies\n\n\n      <\/li>\n\n\n      <li>Negative viral hepatitis panel\n\n\n      <\/li>\n\n\n      <li>No pre-existing diagnosis of chronic liver disease (e.g., autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing\n\n\n      cholangitis, Wilson\u2019s disease, hemochromatosis)\n\n\n      <\/li>\n\n\n      <li>No recent hypotensive shock or septic episodes\n\n\n      <\/li>\n\n\n      <li>No history of alcoholism documented in medical records\n\n\n      <\/li>\n\n\n    <\/ul>\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h4>\n\n\n  Recommendations:\n\n\n<\/h4>\n\n\n<ul>\n\n\n  <li>Clinicians evaluating patients with acute hepatitis should ask about consumption of dietary supplements as part of a comprehensive\n\n\n  evaluation.\n\n\n  <\/li>\n\n\n  <li>Clinicians should report patients meeting the case definition to the Division of Public Health, Office of Epidemiology at (302)\n\n\n  744-1033 and to the US Food and Drug Administration\u2019s MedWatch program online at <a href=\"https:\/\/www.accessdata.fda.gov\/scripts\/medwatch\/\">https:\/\/www.accessdata.fda.gov\/scripts\/medwatch\/<\/a> or by phone at 1-888-INFO-FDA.\n\n\n  <\/li>\n\n\n  <li>People who use dietary supplements for weight loss or muscle gain should do so with caution and under a medical provider\u2019s\n\n\n  close supervision.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h4>\n\n\n  For more information:\n\n\n<\/h4>\n\n\n<p>\n\n\n  State public health agencies should contact CDC at (866) 933-5295 if they identify patients who meet the case definition.\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><!--[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 #313 October 9, 2013 9:51 am 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-10285","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10285","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=10285"}],"version-history":[{"count":1,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10285\/revisions"}],"predecessor-version":[{"id":11461,"href":"https:\/\/www-test.dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10285\/revisions\/11461"}],"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=10285"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}