Synopsis for March 12, 2004

The MMWR is embargoed until Thursday, 12 PM EST.

1. Use of Carbon Monoxide Alarms to Prevent Poisonings During a Power Outage ― North Carolina, December 2002
2. Mycobacterium chelonae Infections Associated with Face Lifts — New Jersey, 2002-2003
3. Silicosis in Dental Laboratory Technicians ― Five States, 1994-2000
4. Azithromycin Treatment Failures in Syphilis Infections ― San Francisco, California, 2002-2003

Synopsis for March 12, 2004

Use of Carbon Monoxide Alarms to Prevent Poisonings During a Power Outage ― North Carolina, December 2002

Severe CO poisoning and death can be prevented by equipping homes with inexpensive battery-operated CO detectors and educating the public, particularly non-English speakers, about the appropriate use of alternate heat and energy sources during power outages.

During a 9-day power outage in Mecklenburg County, NC (Charlotte and surrounding townships) in December 2002, an ice storm caused 79 percent of country households to lose power and 124 people were poisoned by carbon monoxide (CO). Of those poisoned, 25 victims were severely poisoned and one woman died. Most poisoning cases were caused by people who used charcoal or propane grills or electrical generators inside a home or garage. Language and cultural barriers put non-English speaking minorities at particular risk.

Severe CO poisoning is less likely to occur in homes equipped with battery-operated CO alarms. In this event, one out of every five people exposed to toxic levels of CO without a functioning CO alarm was severely poisoned. In homes with a functioning alarm, all but one out of 31 victims exposed to CO escaped with no or mild symptoms.

Mycobacterium chelonae Infections Associated with Face Lifts — New Jersey, 2002-2003

Surgeons should use only sterile, single-use, tissue-marking agents during procedures that require aseptic technique.

Mycobacterium chelonae is a rapidly growing mycobacterium that can cause difficult-to-treat skin infections. This report describes an investigation of a cluster of M. chelonae infections occurring among patients who had face lifts. The vehicle responsible for this cluster was contaminated methylene blue, which was used on multiple occasions as a tissue-marking agent. The findings of this investigation suggest that: 1) unsterile methylene blue can be a reservoir for M. chelonae and, therefore, should not be used in procedures that require aseptic technique; 2) clinicians should consider M. chelonae when evaluating surgical-site infections; and 3) when practical alternatives exist, multiuse supplies should be avoided in clinical practice.

Silicosis in Dental Laboratory Technicians ― Five States, 1994-2000

Silicosis, a preventable debilitating lung disease that occurs in occupations where there is exposure to silica dust, has been identified in dental laboratory technicians.

Silicosis is a debilitating and sometimes fatal occupational lung disease caused by inhaling respirable crystalline silica dust. Although crystalline silica exposure and silicosis have historically been associated with work in mining, quarrying, sandblasting, masonry, founding, and ceramics, materials and processes used in dental laboratories also pose a threat of silicosis to dental technicians. During 1994–2000, occupational disease surveillance programs in five states (MA, MI, OH, NJ, NY) identified nine confirmed cases of silicosis among persons with a history of working in dental laboratories. A report issued jointly by theses states describes three of these confirmed cases of silicosis, and underscores the need for employers to institute appropriate industrial hygiene control methods that reduce exposure of dental laboratory technicians to crystalline silica.

Azithromycin Treatment Failures in Syphilis Infections ― San Francisco, California, 2002-2003

Penicillin remains the recommended drug for treating syphilis infection.

Syphilis cases have been increasing in the United States since 2000 and is at epidemic levels among men who have sex with men, of particular concern is San Francisco, which, in 2002, had one of the highest rates of primary and secondary syphilis in the country. To facilitate treatment of early syphilis certain disease-control programs administered azithromycin, an oral treatment alternative to the recommended drug (injected penicillin). Several San Francisco patients with syphilis did not respond to treatment with azithromycin.

These treatment failures indicate that some syphilis infections may not respond adequately to azithromycin. As organisms such as Treponema pallidum (the bacterium which causes syphilis) evolve and become resistant to current antibiotics, we need to pursue multiple routes for preventing STDs. These must include behavioral changes among at-risk populations, development of new antibiotics, and vaccines against infection. Clinicians and public health officials should also remain vigilant about closely following patients who are treated with new therapies.

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