This message is from the Louisiana Department of Health Emergency Operations Center (LDH EOC)  regarding 

Severe Vibrio vulnificus Infections in the United States Associated with Warming Coastal Waters Notice from the CDC, modified to include Louisiana-specific information.

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to:

are bacteria that cause an estimated 80,000 illnesses each year in the United States. About a dozen species of 

 causes the most infections in the United States, accounting for about 40% of reported cases of vibriosis, followed by 

 , which accounts for about 20%. Most people with 

 infection have diarrhea. Some people might also have stomach cramping, nausea, vomiting, fever, and chills. One species,

 , is known to cause life-threatening infections. About 150–200 

 infections are reported to CDC each year and about one in five people with this infection die—sometimes within 1–2 days of becoming ill.

naturally live in coastal waters, including salt water and brackish water, which is a mixture of salt water and fresh water. Most people get infected with 

 by eating raw or undercooked shellfish, particularly oysters. Some people get infected when an open wound is exposed to salt water or brackish water containing 

[1]. People can also get infected if an open wound comes in contact with raw or undercooked seafood. Open wounds include those from a recent surgery, piercing, tattoo, and other cuts or scrapes—including those acquired during aquatic activity. Extreme weather events, such as coastal floods, hurricanes, and storm surges, can force coastal waters into inland areas, putting people that are exposed to these waters—especially evacuees who are older or have underlying health conditions—at increased risk for 

wound infections. This effect was observed in Florida after Hurricane Ian in 2022 [2].

 is primarily transmitted through open-wound contact with salt water or brackish water, but occasionally (in approximately 10% of cases) the bacteria also can infect people if they eat raw or undercooked shellfish. Person-to-person transmission has not been reported. People at higher risk for wound infection include those with underlying health conditions such as liver disease, diabetes, and immunocompromising conditions [3]. 

wound infections have a short incubation period and are characterized by necrotizing skin and soft tissue infection

 , with or without hemorrhagic bullae. Many people with 

 wound infection require intensive care or surgical tissue removal.

bacteria thrive in warmer waters—especially during the summer months (May to October) and in low-salt marine environments like estuaries

infections have been most commonly reported by Gulf Coast states. However, 

 infections in the Eastern United States increased eightfold from 1988–2018, and the northern geographic range of infections has increased 48 km per year [4]. During July–August 2023, the United States has experienced above-average coastal sea surface temperatures and widespread heat waves [5]. During the same period, several East Coast states, including 

 infections. Many of these infections were acquired after an open wound was exposed to coastal waters in those states. Some of these infections were associated with consumption of raw or undercooked seafood or had unclear etiology.

At this time, Louisiana has not seen an increase in reported cases of 

 have been reported year-to-date during 2023 in Louisiana. An average of 13 cases were reported each year during the previous 5 years.

Amid increasing water temperatures and extreme weather events (e.g., heat waves, flooding, and severe storms) associated with climate change [6], 

 infection should exercise caution when engaging in coastal water activities 

Prompt treatment is crucial to reduce mortality from severe 

Recommendations for Healthcare Professionals

This guidance pertains to managing severe 

Taking the following steps can help keep you safe:

Learn more about how you can help protect yourself from 

The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

Severe Vibrio vulnificus Infections in the United States Associated with Warming Coastal Waters

New Orleans, LA 8/30/2023 – Today, Louisiana State Board of Medical Examiners announced it has been recognized as a Wellbeing First Champion for 2023 by ALL IN: Wellbeing First for Healthcare. As a Wellbeing First Champion, LSBME has verified that licensure/renewal applications are free from intrusive and stigmatizing language around mental health care and treatment. This means that health workers at LSBME can seek the needed care without fear of losing their license.

WellBeing First for Healthcare Champion

This message is from the Office of Public Health Immunization Program regarding Heat Poisoning.  Contact OPH with any comments or concerns. 

Heat poisoning, also known as heat-related illness or heat exhaustion, is a serious condition that occurs when the body overheats due to prolonged exposure to high temperatures. This can happen when the body's ability to regulate its internal temperature is compromised. Click 

 for the full OPH Immunization Update Issue 121.

What is heat poisoning?

What is heat poisoning

recommendations on the use of respiratory syncytial virus (RSV) monoclonal antibodies to protect infants from illnesses caused by RSV. 

Advisory Committee on Immunization Practices (ACIP), the Centers for Disease Control and Prevention (CDC)

 is recommending the use of a new immunization, nirsevimab, to help protect all infants under 8 months and some older babies from severe illnesses caused by RSV.

Nirsevimab, trade name BeyfortusTM, is a long-acting monoclonal antibody product, which has been shown to reduce the risk of both hospitalizations and healthcare visits for RSV in infants by about 80 percent.

Nirsevimab, which was approved last month by the U.S. Food and Drug Administration (FDA), is administered as an injection and provides infants and toddlers with antibodies to protect against severe RSV illness. It provides critical protection during a baby’s first RSV season, when they’re most at risk for severe illness.

RSV is one of the most common causes of childhood respiratory illness and results in annual outbreaks of respiratory illnesses in all age groups. It is the leading cause of hospitalizations for infants and older babies.

According to CDC, nirsevimab is expected to be available this fall for RSV season. There are many factors affecting the implementation rollout of this new medication that are currently being addressed at the national level, before it begins arriving to local hospitals and doctors’ offices. Once implementation hurdles are cleared, AstraZeneca and Sanofi have indicated they are prepared to meet public demand and make nirsevimab available to providers.

Expectant parents and parents of infants under the age of 8 months, as well as those with older babies, should talk with their healthcare providers to request this added layer of protection against RSV this season and inquire when they expect have supply on hand.

optimal timing for nirsevimab administration is shortly before the season

 , nirsevimab may be given at any time during the RSV season for age-eligible infants and children who have not yet received a dose.

Nirsevimab should be administered within one week of birth

. Administration can be during the birth hospitalization or in the outpatient setting. Infants with prolonged birth hospitalizations due to prematurity or other causes should receive nirsevimab shortly before or promptly after discharge.

In most regions of the United States and other areas with similar climates, RSV season typically starts during the fall and peaks in the winter. Tropical climates may have seasonality that differs from most of the continental United States or is unpredictable. Providers in these jurisdictions should consult state, local or territorial guidance on timing of nirsevimab administration. Within Louisiana, reports of RSV and other viral respiratory disease activity can be found 

children who have received nirsevimab should not receive palivizumab for the same RSV season

Coadministration with routine childhood vaccines

Children aged 8–19 months who should receive nirsevimab when entering their second RSV season because of increased risk of severe disease, include:

ACIP voted to include nirsevimab in the Vaccines for Children program, which provides recommended vaccines and immunizations at no cost to about half of the nation’s children.

CDC is currently working to make nirsevimab available through the Vaccines for Children program. Healthcare providers will be a key partner in CDC’s outreach efforts. Additional clinical guidance and healthcare provider education material will be provided by CDC in the coming months.

CDC recommends the use of a new monoclonal antibody to protect infants and children from Respiratory Syncytial Virus

Any questions or objections regarding the below should be addressed to the office of public health within LDH.

This message is from the Louisiana Health Alert Network (LA HAN) regarding - 

CDC makes recommendations on the use of Respiratory Syncytial Virus vaccines in older adults. 

Following a review by their Advisory Committee on Immunization Practices (ACIP), the Centers for Disease Control and Prevention (CDC)

is recommending the use of a single dose of recently approved vaccines by GSK and Pfizer for respiratory syncytial virus (RSV).

The vaccines have been shown to prevent RSV lower respiratory tract disease (LRTD) for use in adults aged ≥60 years. For both the GSK and Pfizer vaccines, a single RSV dose demonstrated efficacy in preventing symptomatic RSV-associated LRTD among adults aged ≥60 years. CDC actions follow an earlier approval of these vaccines by the U.S. Food and Drug Administration (FDA).

This HAN provides clinical guidance for the use of RSV vaccines in adults aged ≥60 years. 

RSV vaccines have demonstrated efficacy in preventing RSV-associated lower respiratory tract disease and have the potential to prevent substantial morbidity and mortality among older adults.

In the U.S., RSV causes seasonal epidemics of respiratory illness. Each season, RSV causes substantial morbidity and mortality in older adults, including lower respiratory tract disease (LRTD), hospitalization, and death. Most adult RSV disease cases occur among older adults with an estimated 60,000 – 160,000 hospitalizations and 6,000–10,000 deaths annually among adults aged ≥65 years.

CDC recommends that adults 60 and older may receive an RSV vaccine, using shared clinical decision-making.

Unlike routine and risk-based vaccine recommendations, recommendations based on shared clinical decision-making do not target all persons in a particular age group or an identifiable risk group. The decision to vaccinate a patient should be based on a discussion between the health care provider and the patient, guided by the patient’s risk for disease and their characteristics, values and preferences, the provider’s clinical discretion and the characteristics of the vaccine.

Providers and patients should consider the patient’s risk for severe RSV-associated disease. Epidemiologic evidence indicates that persons aged ≥60 years who are at highest risk for severe RSV disease and who might be most likely to benefit from vaccination include:

• Patients with chronic medical conditions such as lung diseases, including chronic obstructive pulmonary disease and asthma.

• Patients with cardiovascular diseases such as congestive heart failure and coronary artery disease.

• Those with moderate or severe immune compromise (either attributable to a medical condition or receipt of immunosuppressive medications or treatment).

• People with diabetes mellitus; neurologic or neuromuscular conditions; kidney disorders, liver disorders, and hematologic disorders.

• People who are frail; of advanced age; and/or have other underlying conditions or factors that the provider determines might increase the risk for severe RSV-associated respiratory disease.

• Adults aged ≥60 years who are residents of nursing homes and other long-term care facilities.

As single dose of the RSV vaccine is currently recommended; evidence does not exist at this time to determine the need for revaccination.

Optimally, vaccination should occur before the onset of the RSV season; however, typical RSV seasonality was disrupted by the COVID-19 pandemic and has not returned to pre-pandemic patterns. For the 2023–24 season, clinicians should offer RSV vaccination to adults aged ≥60 years using shared clinical decision-making as early as vaccine supply becomes available and should continue to offer vaccination to eligible adults who remain unvaccinated.

Co-administration of RSV vaccines with other adult vaccines during the same visit is acceptable.

As with all vaccines, RSV vaccination should be delayed for people experiencing moderate or severe acute illness with or without fever.

RSV vaccines are contraindicated for and should not be administered to those with a history of severe allergic reaction, such as anaphylaxis, to any component of the vaccine.

CDC makes recommendations on the use of Respiratory Syncytial Virus vaccines in older adults

As you know, we periodically warn our licensees about fraudulent attempts by criminals.  Most recently one of our physicians received a fraudulent fax and phone call purportedly from the LSBME.  The person pretended to be an investigator, gave a badge number, told the physician that his license was in danger of being suspended, and that he was going to be arrested for drug trafficking and money laundering.  He was also told he could get a lawyer or use this person for his defense.  

This is only one of a variety of stories that are told to physicians and others to extort money in one way or another. Many medical boards are reporting similar stories in their newsletters and alerts to their licensees.

Just to reiterate, anyone subject to an investigation by the LSBME is informed of this by mail, and there are certain procedures that are followed in every investigation.  Second, while the LSBME does sometimes levy a fine on a licensee for one reason or another AFTER an investigation finds that a person has violated a rule, we would never ask you to send the LSBME money as part of an investigation. And finally, when anyone asks you to do something and not tell anyone, you know there is something wrong.

Unfortunately, these scammers are frequently very convincing, and very clever.  If you ever receive any communication claiming to be from the Board pertaining to a potential action against your license, call our main number and ask to speak specifically to the person who the letter is from, or to an investigator.  If you ever receive a phone call from someone allegedly calling you from our main number, call us back directly to that number, (504) 568-6820 and ask to speak to the person who called you.  In general, if you are ever worried about a possible scam related to this agency, please contact 

Scam Alert

If you have any questions or comments regarding the below information, please contact LDH/OPH Well-Ahead Louisiana at 

Authorized under Act 167 of the 2022 Regular Legislative Session, LAC 48:V.Chapter 133, this office has created the 

Louisiana Physician Loan Repayment Program

Physicians serving in federally designated Health Professional Shortage Areas (HPSA) across the state may be eligible for the Louisiana Physician Loan Repayment Program. This program repays governmental or commercial educational loans in exchange for serving in underserved facilities.  This loan repayment program offers primary care MD’s and DO’s the opportunity to have their student loans repaid in exchange for practicing in underserved communities.

Physicians can receive up to $30,000 annually for a five-year commitment (totaling up to $150,000). Participants who complete their original five-year commitment in compliance, remain in an eligible site in a HPSA, and still have educational loans to repay may be able to extend their commitment with a two-year renewal to receive $15,000 annually.

Physicians (allopathic or osteopathic) listed below are eligible to receive a Physician Loan Repayment Program award (to include those in the final year of their residency):

*Application submission does not guarantee funding. Additional qualification are required.

 (June 30, 2023, | Issue 117) from LA Immunization

Immunization Updates 6 30 2023

Immunization Update 6 30 2023

Locally Acquired Malaria Cases Identified in the United States .

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to share information and notify clinicians, public health authorities, and the public about—

CDC is collaborating with two U.S. state health departments with ongoing investigations of locally acquired mosquito-transmitted 

 malaria cases. There is no evidence to suggest the cases in the two states (Florida and Texas) are related. In 

, four cases within close geographic proximity have been identified, and active surveillance for additional cases is ongoing. Mosquito surveillance and control measures have been implemented in the affected area. In 

, one case has been identified, and surveillance for additional cases, as well as mosquito surveillance and control, are ongoing. All patients have received treatment and are improving. Locally acquired mosquito-borne malaria has not occurred in the United States since 2003 when eight cases of locally acquired 

malaria were identified in Palm Beach County, FL (1). Despite these cases, the risk of locally acquired malaria remains extremely low in the United States. However, 

 mosquito vectors, found throughout many regions of the country, are capable of transmitting malaria if they feed on a malaria-infected person (2). The risk is higher in areas where local climatic conditions allow the 

 mosquito to survive during most of or the entire year and where travelers from malaria-endemic areas are found. In addition to routinely considering malaria as a cause of febrile illness among patients with a history of international travel to 

, clinicians should consider a malaria diagnosis in any person with a fever of unknown origin regardless of their travel history. Clinicians practicing in areas of the United States where locally acquired malaria cases have occurred should follow guidance from their state and local health departments. Prompt diagnosis and treatment of people with malaria can prevent progression to severe disease or death and limit ongoing transmission to local 

 to prevent malaria and other mosquito-borne illnesses.

No locally acquired malaria cases have been identified in Louisiana at this time. However, competent mosquito vectors are present in the state, creating the potential for local transmission.

 is a serious and potentially fatal disease transmitted through the bite of an infective female anopheline mosquito. Though rare, malaria can also be transmitted congenitally from mother to fetus or to the neonate at birth, through blood transfusion or organ transplantation, or through unsafe needle-sharing practices. Malaria is caused by any of five species of protozoan parasite of the genus 

 . Worldwide, more than 240 million cases of malaria occur each year (95% in Africa). Almost all cases of malaria in the United States are imported and occur in people traveling from 

, many from sub-Saharan Africa and South Asia. Before the COVID-19 pandemic, approximately 2,000 cases of mostly travel-related malaria were diagnosed in the United States each year; approximately 300 people experienced severe disease (most 

), and 5 to 10 people with malaria died yearly (3). Most imported cases of malaria in the United States are diagnosed during summer and early fall. In 2023, CDC expects summer international travel among U.S. residents will be increasing to pre-COVID-19 pandemic levels (4).

Clinical manifestations of malaria are non-specific and include fever, chills, headache, myalgias, and fatigue. Nausea, vomiting, and diarrhea may also occur. For most people, symptoms begin 10 days to 4 weeks after infection, although a person may feel ill as early as 7 days or as late as 1 year after infection. If not treated promptly, malaria may progress to severe disease, a life-threatening stage, in which mental status changes, seizures, renal failure, acute respiratory distress syndrome, and coma may occur. Malaria in pregnant people is associated with high risks of both maternal and perinatal morbidity and mortality. 

 infections can cause rapidly progressive severe illness or death, while the other species, including 

 , are less likely to cause severe disease. Laboratory abnormalities can include anemia, thrombocytopenia, hyperbilirubinemia, and elevated transaminases, varying from normal or mildly altered in uncomplicated disease to very abnormal in severe disease. 

 can remain dormant in the liver and such infections require additional treatment; failure to treat the dormant hepatic stages may result in chronic infection, causing relapsing episodes. Relapses may occur after months or even years without symptoms.

. Patients suspected of having malaria should be urgently evaluated in a facility that is able to provide rapid diagnosis and treatment, within 24 hours of presentation

 . Order microscopic examination of thin and thick blood smears, and a rapid diagnostic test (RDT) if available, to diagnose malaria as soon as possible. Artemether-lumefantrine (Coartem®) is the preferred option, if readily available, for the initial treatment of uncomplicated 

or unknown species of malaria acquired in areas of chloroquine resistance. Atovaquone-proguanil (Malarone®) is another recommended option. 

 infections acquired from regions other than Papua New Guinea or Indonesia should initially be treated with chloroquine (or hydroxychloroquine). IV artesunate is the only drug available for treating severe malaria in the United States. Artesunate for InjectionTM, manufactured by Amivas, is approved by the U.S. Food and Drug Administration (FDA) and is commercially available. Hospitals should have a plan for rapidly diagnosing and treating malaria within 24 hours of presentation. Additional information on diagnosing and treating malaria, including details of treating the dormant liver stages, is available on the 

Recommendations for Hospitals and Laboratories

Malaria Prevention, Diagnosis, and Treatment

Locally Acquired Malaria Cases Identified in the United States

the Locally Acquired Malaria Cases Identified in the United States

The Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA) recently announced a nationwide shortage of penicillin G benzathine (Bicillin L-A) which is a first-line recommended treatment for syphilis. The Louisiana Department of Health (LDH) is aware of in-state providers experiencing challenges obtaining Bicillin L-A and is working closely with federal partners to monitor and mitigate the impacts of this shortage to the extent possible.

What should providers do during the Bicillin L-A shortage?

See the CDC Bicillin Shortage Announcement for additional clinical information: 

https://www.cdc.gov/std/treatment-guidelines/syphilis.htm

What should providers do if they experience shortages of Bicillin L-A?

 Luetkemeyer, A. F., et al. (2023). Post-exposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections, 

 Venkatesan, P. (2022). Doxycycline PEP for prevention of STIs. 

Penicillin G Benzathine (Bicillin L-A®) Shortage

, pursuant to LSA-R.S. 42:19(A), that the Louisiana State Board of Medical Examiners (the "Board"), within the Louisiana Department of Health, State of Louisiana, shall convene a Regular Call meeting of the Respiratory Therapy Advisory Committee starting at 9:00 a.m., Monday, June 12, 2023, at the offices of the Board, 630 Camp Street, New Orleans, Louisiana. 

Pursuant to La. R.S. 42:17.3 and Act 408 of the 2022 Regular Session, the Respiratory Therapy Advisory Committee will participate via live-streaming video and teleconference for the public session and via non-streaming video and teleconference during the executive session.

Committees” and then “Respiratory Therapy” where a Youtube link to

the meeting will be posted at the appointed time of the meeting.

Individuals who wish to make a public comment before or during the meeting, may do so by

Public comments comprised of videos and/or audio content must be limited to no more than 3 minutes length and the email size must be less than 10 megabytes.

Both requirements must be met, or the content will be refused by our system. All comments received prior to or during the meeting will be identified and acknowledged during the meeting and maintained in the meeting 

Members of the public may give verbal comment on any agenda item when the matter comes up for discussion.

“ZOOM LINK REQUEST” to request a link to the videoconference, identifying themselves by name and relevant affiliation, if any, and the agenda item about which they wish to make verbal comment. 

The committee will make reasonable efforts to accommodate requests made while the meeting is in progress but cannot guarantee

to limit or prohibit participation in order to maintain orderly conduct of the meeting in accordance with La. R.S. 

Note: Regular Meeting held and noticed pursuant to La. Rev. Stat. §42:17A(1), (2), (4), (5) and (10), R.S. 42:17.3 and Act 408 of the 2022 Regular Session. Further, agenda items may be taken out of order and/or in executive session pursuant to R.S 42:17A. La. R.S. 42:17A states “A public body may hold an executive session pursuant to La. 

for one or more of the following reasons: (1) Discussion of the character, professional competence, or physical or mental health of a person, provided that such person is notified in writing at least twenty-four hours, exclusive of Saturdays, Sundays, and legal holidays, before the scheduled time contained in the notice of the meeting at which such executive session is to take place and that such person may require that such discussion be held at an open meeting.….In cases of extraordinary emergency, written notice to such person shall not be required; however, the public body shall give such notice as it deems appropriate and circumstances permit; (2) Strategy sessions or negotiations with respect to collective bargaining, prospective litigation after formal written demand, or litigation when an open meeting would have a detrimental effect on the bargaining or litigating position of the public body;….(4) Investigative proceedings regarding allegations of misconduct; (5) Cases of extraordinary emergency, which shall be limited to natural disaster, threat of epidemic, civil disturbances, suppression of insurrections, the repelling of invasions, or other matters of similar magnitude; and,….(10) Or any other matters now provided for or as may be provided for by the legislature.”

Respiratory Therapy Advisory Committee Meeting

 pursuant to LSA-R.S. 42:19(A), that the Louisiana State Board of Medical Examiners (the "Board"), within the Louisiana Department of Health, State of Louisiana, shall convene a Regular Call meeting of the Occupational Therapy Advisory Committee starting at 10:00 a.m., Friday, June 9, 2023, at the offices of the Board, 630 Camp Street, New Orleans, Louisiana. Pursuant to La. R.S. 42:17.3 and Act 408 of the 2022 Regular Session, the Occupational Therapy Advisory Committee will participate via live-streaming video and teleconference for the public session and via non-streaming video and teleconference during the executive session.

To view the meeting via YouTube, please go to the website at 

, and from the home page, click on “Advisory Committees” and then “Occupational Therapy” where a YouTube link to the meeting will be posted at the appointed time of the meeting.

Individuals who wish to make a public comment before or during the meeting, may do so by emailing: 

. Public comments comprised of videos and/or audio content must be limited to no more than 3 minutes length and the email size must be less than 10 megabytes. Both requirements must be met, or the content will be refused by our system. All comments received prior to or during the meeting will be identified and acknowledged during the meeting and maintained in the meeting minutes.

Members of the public may give verbal comment on any agenda item when the matter comes up for discussion. Individuals wishing to make verbal comment must email 

 with the subject line “ZOOM LINK REQUEST” to request a link to the videoconference, identifying themselves by name and relevant affiliation, if any, and the agenda item about which they wish to make verbal comment. This request should be made as far in advance of the meeting as possible so that the request can be processed. The committee will make reasonable efforts to accommodate requests made while the meeting is in progress but cannot guarantee that such requests can be honored. The committee reserves the right to limit or prohibit participation in order to maintain orderly conduct of the meeting in accordance with La. R.S. 42:17(C).

The agenda of such meeting shall be as annexed hereto.

Note: Regular Meeting held and noticed pursuant to La. Rev. Stat. §42:17A(1), (2), (4), (5) and (10), R.S. 42:17.3 and Act 408 of the 2022 Regular Session. Further, agenda items may be taken out of order and/or in executive session pursuant to R.S 42:17A. La. R.S. 42:17A states “A public body may hold an executive session pursuant to La. R.S. 42:16 for one or more of the following reasons: (1) Discussion of the character, professional competence, or physical or mental health of a person, provided that such person is notified in writing at least twenty-four hours, exclusive of Saturdays, Sundays, and legal holidays, before the scheduled time contained in the notice of the meeting at which such executive session is to take place and that such person may require that such discussion be held at an open meeting.….In cases of extraordinary emergency, written notice to such person shall not be required; however, the public body shall give such notice as it deems appropriate and circumstances permit; (2) Strategy sessions or negotiations with respect to collective bargaining, prospective litigation after formal written demand, or litigation when an open meeting would have a detrimental effect on the bargaining or litigating position of the public body;….(4) Investigative proceedings regarding allegations of misconduct; (5) Cases of extraordinary emergency, which shall be limited to natural disaster, threat of epidemic, civil disturbances, suppression of insurrections, the repelling of invasions, or other matters of similar magnitude; and,….(10) Or any other matters now provided for or as may be provided for by the legislature.”

LOUISIANA STATE BOARD OF MEDICAL EXAMINERS

Occupational Therapy Advisory Committee Meeting

IMMUNIZATION Update

Emerging Threat of Xylazine in Combination with Fentanyl

Louisiana Department of Health Reporting the Emerging Threat of Xylazine in Combination with Fentanyl

The Louisiana Opioid Surveillance Initiative (LOSI) is tracking an increase in the number of drug overdose deaths involving 

Xylazine is a non-opioid, central nervous system depressant that can cause drowsiness, amnesia, slowed breathing, reduced heart rate, and dangerously low blood pressure.

  Also known as “tranq” or “tranq dope,” it is a veterinary tranquilizer that is 

 approved for human use. Nationally, xylazine has been reported as an adulterant in the illicit drug supply and has been detected in an increasing number of overdose deaths.

Xylazine or drugs that contain xylazine can be injected, snorted, swallowed, or inhaled.

 Xylazine is most often found mixed with heroin and fentanyl.

 Stimulants such as methamphetamine and cocaine have also been combined with xylazine.

 Because xylazine is often found in combination with other sedating drugs like opioids, there is an increased risk for overdose or death. Often people who are exposed to xylazine are unaware that it is in their drug supply when they are ingesting it. Unfortunately, opioid antagonists like naloxone are ineffective in reversing the sedative effects of xylazine, increasing its lethality. However, as mentioned above, xylazine is often times used in combination with opioids and therefore using naloxone can still be of benefit in those cases.

LOSI collects data on fatal drug overdoses from coroners, drug seizures, and toxicology testing results. LOSI analyzed fatal overdoses deaths in Louisiana occurring from 2018 to 2022. Xylazine-involved deaths are defined as deaths with xylazine included in the primary or secondary cause of death. 

Xylazine was involved in 39 overdose deaths in 2021, an 86% increase from 2020. 

Xylazine as a contributor to overdose deaths is likely under-reported due to non-specific causes of death used in the death records database, such as “multi-drug toxicity” or “cardiac arrest due to polysubstance abuse.”

In 2019, LOSI began providing comprehensive toxicology testing for coroners through the Overdose Data to Action grant funds. In 2021, 4% of all post-mortem toxicology tests were positive for xylazine. This represents an increase greater than 300% from 2019, when 0.9% of test were positive for xylazine. Post-mortem toxicology results for 2022 are still outstanding so these data are preliminary.

Designation as an emerging national drug threat

On April 12, 2023, the White House Office of National Drug Control Policy (ONCDP) officially designated fentanyl adulterated or associated with xylazine as an emerging threat to the United States. This designation was made because xylazine combined with fentanyl is being sold illicitly and is associated with significant and rapidly worsening negative health consequences, including fatal overdoses and severe health outcomes. 

Injection use of xylazine has been associated with severe, necrotic skin ulcerations and other skin complications. These ulcerations may develop at the site of injection or in areas of the body away from the site of injection. 

 These wounds can be severe and are distinctly different from other soft-tissue infections, such as cellulitis and abscesses often associated with injection drug use.

Because xylazine is a such a potent sedative, people who use xylazine may become unconscious for long periods of time and fall asleep in certain positions that may compromise their airway or put them at increased risk for pressure ulcers, compartment syndrome  

  The sedative effects of xylazine also puts individuals at increased risk for physical harm, sexual assault, and robberies.

Repeated exposure to xylazine may result in dependence. Withdrawal symptoms such as agitation and severe anxiety may occur when the usual doses of the drug are decreased or discontinued.

Once ingested, xylazine has a rapid onset and can last 8 hours or longer depending on the dose.

   Initially, people become sleepy, their heart rate and blood pressure will decrease. With high doses, people may become comatose with small pupils and hypothermia. Breathing may decrease or even stop. These signs and symptoms looks very similar to an opioid overdose.

The symptoms of xylazine use and opioid use are similar, making it difficult to differentiate whether an individual has used one or both substances. 

If an overdose from a xylazine-containing drug occurs, administer naloxone.

because xylazine is often combined with fentanyl

. Naloxone will not reverse the effects of xylazine, but it will reverse the effects of fentanyl and other opioids that have been mixed with xylazine. The person may remain unresponsive if xylazine is involved. After naloxone is administered, call for help and seek assistance from emergency medical personnel.  

Provide rescue breathing, oxygen administration, and airway management if able and equipped. 

Inform emergency medical personnel of the possibility of a xylazine-involved overdose.

Health care professionals should consider potential xylazine exposure when patients appear to have an opioid overdose with small pupils, not breathing well, unresponsive, without responding to naloxone and have a very low heart rate (30-40 beats per minute) and low blood pressure. In these situations, health care professionals should provide supportive measures, secure the airway, and support breathing. Atropine or low dose epinephrine can be administered to improve the heart rate and blood pressure; blood pressure may be increased using fluids or a pressor, such as norepinephrine (Levophed), if needed. 

  Healthcare providers can consider screening for xylazine using appropriate tests if available; note that xylazine is currently not tested for in the common drugs of abuse panels. Additionally, health care professionals who see patients with severe, necrotic skin ulcerations should consider repeated xylazine exposure as part of the differential diagnosis. Finally, health care professionals caring for patients with opioid use disorder (OUD) should monitor patients for withdrawal symptoms not managed by traditional OUD treatments, as this may indicate xylazine withdrawal. 

Reducing the Harm for People Who Use Drugs

The illicit drug supply is unpredictable and there is not prevalent, readily available technology to test drugs for xylazine. It is safer to use when other people are present. People who feel safe and trust each other can use together, but take turns using in order to prevent simultaneous overdoses.

In case of an overdose, administer naloxone, give rescue breaths or CPR if trained and indicated, call 911 and monitor until breathing resumes. When exposed to xylazine, a person may remain sedated even after naloxone is administered and breathing has resumed.

Use sterile syringes and clean the site with an alcohol swab before every injection to prevent wound, ulcers, abscesses, and infections. Monitor site and seek medical attention in case of abscess and skin ulcers.

Contact a local harm reduction program or syringe services program for advice on safer use, safe use supplies, fentanyl test strips, naloxone, and/or assistance with abscesses or wound care. Note that fentanyl test strips only test for the presence of fentanyl; they do not test for the presence of xylazine.

Considering the increasingly dangerous illicit drug supply, LDH strongly recommends that individuals using drugs, their friends, and their families should have naloxone readily available.

Naloxone, commonly purchased as Narcan nasal spray, is life-saving medicine that can reverse an overdose by restoring normal breathing to a person experiencing opioid-induced respiratory depression. Naloxone is not harmful to anyone not overdosing. The Louisiana Department of Health has issued the 

, providing every individual in Louisiana with a prescription for the overdose reversal medication, which is available for purchase through most pharmacies and is covered by Louisiana Medicaid plans. Pharmacies will also provide information on how and when to administer this medicine. Naloxone is expected to be available as a fully over the counter medication in the coming months.

It is important for everyone to recognize the signs of an opioid overdose. These include:

Call 911 if any of these signs or symptoms of an opioid overdose are observed.

In Louisiana, “Good Samaritan Laws” provide legal protections to those who in good faith call for help or render assistance to an overdose victim (revised statute 14:403.10).

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