Post by jj on Aug 1, 2008 11:16:38 GMT -5
Georgia Health Department Presentation
www.slideshare.net/guest4adeaa/ge....nt-presentation
Slide Show Transcript
Slide 1: UNIDENTIFIED DERMATOSIS SYNDROME (UDS) (a.k.a., Morgellons Disease) SURVEILLANCE DATABASE 09/17/07 1
Slide 2: Jane M. Perry, MPH, Director Chemical Hazards Program Environmental Health and Injury Prevention Branch Georgia Division of Public Health 2 Peachtree St., 13th Floor Atlanta, GA 30303-3141 Phone: 404.657.6534 Fax: 404.657.6533 e-mail: jmperry@dhr.state.ga.us 09/17/07 2
Slide 3: PRESENTATION FORMAT • Definitions • Project history • Goals • Hypothesis • Survey • Results • Conclusions • Treatments • Next Steps 09/17/07 3
Slide 4: CHEMICAL HAZARDS PROGRAM The Chemical Hazards Program was established in 1994 through a cooperative agreement with the Agency for Toxic Substances and Disease Registry (ATSDR) The mission of the Chemical Hazards Program is to protect the health and promote the quality of life of Georgians through the prevention of exposure to hazardous substances in the environment. 09/17/07 4
Slide 5: “MORGELLONS DISEASE” Individuals report disturbing symptoms of seeing and feeling crawling, stinging and biting organisms on and in their skin. These organisms are described as fiber-like or black specks, and are accompanied by skin lesions. Sufferers also report chronic joint pain, disabling fatigue, cognitive difficulties, mental confusion, memory loss, behavioral effects, and mood disorders. 09/17/07 5
Slide 6: DELUSION OF PARASITOSIS • An unshakable false belief that live organisms are present in the skin. --Obermeyer, 1961 • Delusion of parasitosis usually involves young adults who are typically marginal in their socio-economic status where substance abuse is frequently associated, and older adults where drug abuse is usually not associated. • They will frequently bring in bits of skin, lint, and other “specimens” to try to prove the existence of these alleged parasites. This behavior is so characteristic that it has been referred to as the “matchbox sign”. • The delusion may be shared by a significant other. --Koo & Lee, 2001, p, 286 09/17/07 6
Slide 7: RULED OUT • Drug use • Dementia • Professional pest control • Parasites—bed bugs, scabies, fleas, lice, mites, etc. • History of psychosis diagnosed undiagnosed 09/17/07 7
Slide 8: HEADLINES $32 Million Verdict in Mold Case Court TV Forensic Files Morgellons Has Plenty of Skeptics Good Morning America Disease Baffles Patients and Doctors Popular Mechanics 09/17/07 8
Slide 9: HEADLINES (cont.) Doctors Make Progress with Mysterious Disease Fox TV (San Francisco) CDC Probes Bizarre Morgellons Condition The Associated Press Online Campaign Sparks Interest in New Disease National Public Radio 09/17/07 9
Slide 10: HEADLINES (cont.) Itching for Answers to a Mystery Condition TIME Magazine Making Your Skin Crawl CBS (Atlanta) ABC Primetime: Medical Mysteries ABC News 09/17/07 10
Slide 11: ABC PRIMETIME: Medical Mysteries August 9, 2006 “Recent research by Randy S. Wymore, Ph.D., assistant professor of pharmacology and physiology, OSU, and a forensic scientist at the Tulsa Police Department has ruled out textile origin of fibers from patients by demonstrating that the fibers do not match any of the 100,000 textile and similar fibers in the FBI database.” SIGN UP SHEET FOR A COPY 09/17/07 11
Slide 12: Skin lesions on the legs Typical photo of fibers Source: www.thenmo.org/images.htm Source: www.morgellonUSAs.org Electron microscope image Fibers show fluourescence Source: www.morgellons.org Source: www.morgellons.org 09/17/07 12
Slide 13: PROJECT HISTORY Dawson County case – Bottled water plant – Soil sample results – Saliva test results Lamar County case – Corporate employed Roofer – Wife has it, too Spalding County case – Whole family involved – Complaints of fungus – Family moved across the street 09/17/07 13
Slide 14: PROJECT HISTORY (Cont.) • Delusory Parasitosis article, Epi Rpt. 12/04 • NUSPA survey data • Morgellons Research Foundation (New Morgellons Order) – Possibly millions of cases worldwide – Over 10,000 registered from all 50 states – About 70 cases registered in GA – GA representative contact interaction • Am J Clinical Dermatol 2006 • “Unidentified Dermatosis Syndrome” 09/17/07 14
Slide 15: GOALS 1. Discourage those with UDS from using toxic chemicals to relieve symptoms. 2. Encourage CDC and other state agencies to investigate these reports. 3. Establish a UDS communication network in Georgia. 4. Identify treatments that offer symptom relief and share this information via the network. 5. Test hypothesis. 09/17/07 15
Slide 16: Abstract Residents throughout Georgia have reported fiber-like and/or black specks crawling on/in their skin, and a related set of symptoms including visible sores and disabling fatigue. In response, CHP developed the Unidentified Dermatosis Syndrome (UDS) Surveillance Database. It is intended to build and maintain self-reported symptom surveillance capacity. In addition, data will be analyzed to determine if smptoms may be caused by exposure to trichothecene (T-2 toxins) in soil. 09/17/07 16
Slide 17: HYPOTHESIS CHP will examine whether: 3. parasites or other organisms may be causing the symptoms; 2. individuals may share hypersensitivity to mycotoxins (i.e., T-2 toxins) produced by certain fungi/molds present in soil causing specific neurotoxic effects. 09/17/07 17
Slide 18: T-2 TOXIN Trichothecene (T-2) mycotoxin • Produced by certain fungi and molds • One of the most potent of all naturally occurring toxins • Classified, and has been used as a biological weapon Source Fungi/Mold • Fusarium, Aspergillus, Penicillium, and Stachybotrus • Present in soils throughout Georgia • dependent on substrates, pH, nutrient levels, moisture, and temperature Symptoms from Exposure Skin irritation, severe itching, sores and shedding of the skin, sense distortion, lack of muscle coordination, teratogenic immunosuppressive effects, nose and throat pain, neurological and psychiatric effects… 09/17/07 18
Slide 19: SYMPTOM SURVEY April 1– October 30, 2006 – Administered by phone – Pilot survey (10) – Survey (25) – 54 questions – Recommendations – Referrals – Request for follow up contact 09/17/07 19
Slide 20: CASE DEFINITION • String-like “parasites” or black specs in the skin, urine, or on the body* • Crawling sensations in the skin or body* • Sores/itching • Fatigue • Confusion • Memory loss • Hair Loss • Dizziness * If not checked, symptoms do not meet our criteria. 09/17/07 20
Slide 21: CASE RECRUITMENT Memo – District/county EH program managers – County PH clinics – PH nursing managers – Epi On-call – CDC, other state Health Departments – Morgellons Research Foundation – Georgia Veterinary Medical Association – Activist websites – Others 09/17/07 21
Slide 22: SURVEY QUESTIONS Demographics Home environment – Address for GIS mapping – Length of residency – Mold and fungus inside, outside – Flora, soil conditions Outdoor activities – Gardening – Change in activities 09/17/07 22
Slide 23: SURVEY QUESTIONS (cont.) Symptoms – When, where began – Onset event – Description – Others in household, pets – Seasonal, other changes – Exacerbation triggers 09/17/07 23
Slide 24: SURVEY QUESTIONS (cont.) Medical history – Allergies – Lyme disease, ticks – Tests, results – Medications Doctor visits – Number of visits – Medical specialties Treatments/symptom relief 09/17/07 24
Slide 25: COMMUNICATION NETWORK Recommendations (Interviewers Protocol): • DO NOT attempt to treat symptoms with pesticides, household chemicals, or other products not intended for those uses. • DO try over the counter allergy medicines such as Claritin to relieve your symptoms. Use only as directed. • DO contact your doctor or veterinarian for prescription strength allergy medicines for yourself, your loved ones, and your pets. • DO network with other individuals and organizations where members have similar symptoms. There are websites where you can contact others who suffer symptoms similar to yours. By listing these websites below, the GDPH is not endorsing any specific organization or diagnosis or philosophy. For more information about symptoms, visit: www.morgellons.org www.skinparasites.com www.dpref.com www.unknownskindisease.com www.morgellons-research.org/morgellons www.cherokeechas.com 09/17/07 25
Slide 26: DRAFT RESULTS Significant majority middle age white, non-Hispanic men and women living in north half of GA symptoms < 3 years (but as far back as 20 years) do not report mold in the home discontinued outdoor activity visit doctor(s) and/or specialist(s) Dermatology, Infectious Disease, GI, Internal Medicine, Neurology, Urology, Ophthalmology, Allergy, Rheumatology self medicate bleach, ammonia, inspect spray, dog flea dip, gasoline, kerosene, WD40, Windex, Lysol 09/17/07 26
Slide 27: DRAFT RESULTS (cont.) Insignificant majority or about equal females / males have / don’t have outdoor hobbies precipitating event 09/17/07 27
Slide 28: DRAFT RESULTS (cont.) Population The 10 county Atlanta metropolitan area has 53% of the population of Georgia North, central, and south Georgia account for the remaining 48%. North Georgia and the Atlanta area together account for 66% of Georgia’s population 09/17/07 28
Slide 29: 09/17/07 29
Slide 30: DRAFT RESULTS (cont.) 09/17/07 30
Slide 31: 23% 9% 12% 20% 09/17/07 31
Slide 32: CONCLUSIONS 1. Most of the case reports came from north Georgia and indicate contact with upturned soils. 3. There are associations supporting the hypothesis, but these associations are weak and not significant. 5. While significant trends cannot be defined from this descriptive survey, this survey documents the experiences of those who report these symptoms-- including potentially hazardous methods used to alleviate symptoms. 09/17/07 32
Slide 33: EFFECTIVE TREATMENTS • Add vinegar to shampoo • Complete body shave • Avoid antibacterial soaps • Dry body with paper towels • Encase bedding in vinyl covers • Wash all fabrics with bleach or, for colors, soak in vinegar. • If no children in household, set hot water heater to 155 degrees • Replace all carpets with linoleum or tile or vacuum daily • Keep pets outdoors 09/17/07 33
Slide 34: NEXT STEPS • Continue analyses • Publish paper • Sampling – Environmental – Biological – Pets • CDC investigation 09/17/07 34
www.slideshare.net/guest4adeaa/ge....nt-presentation
Slide Show Transcript
Slide 1: UNIDENTIFIED DERMATOSIS SYNDROME (UDS) (a.k.a., Morgellons Disease) SURVEILLANCE DATABASE 09/17/07 1
Slide 2: Jane M. Perry, MPH, Director Chemical Hazards Program Environmental Health and Injury Prevention Branch Georgia Division of Public Health 2 Peachtree St., 13th Floor Atlanta, GA 30303-3141 Phone: 404.657.6534 Fax: 404.657.6533 e-mail: jmperry@dhr.state.ga.us 09/17/07 2
Slide 3: PRESENTATION FORMAT • Definitions • Project history • Goals • Hypothesis • Survey • Results • Conclusions • Treatments • Next Steps 09/17/07 3
Slide 4: CHEMICAL HAZARDS PROGRAM The Chemical Hazards Program was established in 1994 through a cooperative agreement with the Agency for Toxic Substances and Disease Registry (ATSDR) The mission of the Chemical Hazards Program is to protect the health and promote the quality of life of Georgians through the prevention of exposure to hazardous substances in the environment. 09/17/07 4
Slide 5: “MORGELLONS DISEASE” Individuals report disturbing symptoms of seeing and feeling crawling, stinging and biting organisms on and in their skin. These organisms are described as fiber-like or black specks, and are accompanied by skin lesions. Sufferers also report chronic joint pain, disabling fatigue, cognitive difficulties, mental confusion, memory loss, behavioral effects, and mood disorders. 09/17/07 5
Slide 6: DELUSION OF PARASITOSIS • An unshakable false belief that live organisms are present in the skin. --Obermeyer, 1961 • Delusion of parasitosis usually involves young adults who are typically marginal in their socio-economic status where substance abuse is frequently associated, and older adults where drug abuse is usually not associated. • They will frequently bring in bits of skin, lint, and other “specimens” to try to prove the existence of these alleged parasites. This behavior is so characteristic that it has been referred to as the “matchbox sign”. • The delusion may be shared by a significant other. --Koo & Lee, 2001, p, 286 09/17/07 6
Slide 7: RULED OUT • Drug use • Dementia • Professional pest control • Parasites—bed bugs, scabies, fleas, lice, mites, etc. • History of psychosis diagnosed undiagnosed 09/17/07 7
Slide 8: HEADLINES $32 Million Verdict in Mold Case Court TV Forensic Files Morgellons Has Plenty of Skeptics Good Morning America Disease Baffles Patients and Doctors Popular Mechanics 09/17/07 8
Slide 9: HEADLINES (cont.) Doctors Make Progress with Mysterious Disease Fox TV (San Francisco) CDC Probes Bizarre Morgellons Condition The Associated Press Online Campaign Sparks Interest in New Disease National Public Radio 09/17/07 9
Slide 10: HEADLINES (cont.) Itching for Answers to a Mystery Condition TIME Magazine Making Your Skin Crawl CBS (Atlanta) ABC Primetime: Medical Mysteries ABC News 09/17/07 10
Slide 11: ABC PRIMETIME: Medical Mysteries August 9, 2006 “Recent research by Randy S. Wymore, Ph.D., assistant professor of pharmacology and physiology, OSU, and a forensic scientist at the Tulsa Police Department has ruled out textile origin of fibers from patients by demonstrating that the fibers do not match any of the 100,000 textile and similar fibers in the FBI database.” SIGN UP SHEET FOR A COPY 09/17/07 11
Slide 12: Skin lesions on the legs Typical photo of fibers Source: www.thenmo.org/images.htm Source: www.morgellonUSAs.org Electron microscope image Fibers show fluourescence Source: www.morgellons.org Source: www.morgellons.org 09/17/07 12
Slide 13: PROJECT HISTORY Dawson County case – Bottled water plant – Soil sample results – Saliva test results Lamar County case – Corporate employed Roofer – Wife has it, too Spalding County case – Whole family involved – Complaints of fungus – Family moved across the street 09/17/07 13
Slide 14: PROJECT HISTORY (Cont.) • Delusory Parasitosis article, Epi Rpt. 12/04 • NUSPA survey data • Morgellons Research Foundation (New Morgellons Order) – Possibly millions of cases worldwide – Over 10,000 registered from all 50 states – About 70 cases registered in GA – GA representative contact interaction • Am J Clinical Dermatol 2006 • “Unidentified Dermatosis Syndrome” 09/17/07 14
Slide 15: GOALS 1. Discourage those with UDS from using toxic chemicals to relieve symptoms. 2. Encourage CDC and other state agencies to investigate these reports. 3. Establish a UDS communication network in Georgia. 4. Identify treatments that offer symptom relief and share this information via the network. 5. Test hypothesis. 09/17/07 15
Slide 16: Abstract Residents throughout Georgia have reported fiber-like and/or black specks crawling on/in their skin, and a related set of symptoms including visible sores and disabling fatigue. In response, CHP developed the Unidentified Dermatosis Syndrome (UDS) Surveillance Database. It is intended to build and maintain self-reported symptom surveillance capacity. In addition, data will be analyzed to determine if smptoms may be caused by exposure to trichothecene (T-2 toxins) in soil. 09/17/07 16
Slide 17: HYPOTHESIS CHP will examine whether: 3. parasites or other organisms may be causing the symptoms; 2. individuals may share hypersensitivity to mycotoxins (i.e., T-2 toxins) produced by certain fungi/molds present in soil causing specific neurotoxic effects. 09/17/07 17
Slide 18: T-2 TOXIN Trichothecene (T-2) mycotoxin • Produced by certain fungi and molds • One of the most potent of all naturally occurring toxins • Classified, and has been used as a biological weapon Source Fungi/Mold • Fusarium, Aspergillus, Penicillium, and Stachybotrus • Present in soils throughout Georgia • dependent on substrates, pH, nutrient levels, moisture, and temperature Symptoms from Exposure Skin irritation, severe itching, sores and shedding of the skin, sense distortion, lack of muscle coordination, teratogenic immunosuppressive effects, nose and throat pain, neurological and psychiatric effects… 09/17/07 18
Slide 19: SYMPTOM SURVEY April 1– October 30, 2006 – Administered by phone – Pilot survey (10) – Survey (25) – 54 questions – Recommendations – Referrals – Request for follow up contact 09/17/07 19
Slide 20: CASE DEFINITION • String-like “parasites” or black specs in the skin, urine, or on the body* • Crawling sensations in the skin or body* • Sores/itching • Fatigue • Confusion • Memory loss • Hair Loss • Dizziness * If not checked, symptoms do not meet our criteria. 09/17/07 20
Slide 21: CASE RECRUITMENT Memo – District/county EH program managers – County PH clinics – PH nursing managers – Epi On-call – CDC, other state Health Departments – Morgellons Research Foundation – Georgia Veterinary Medical Association – Activist websites – Others 09/17/07 21
Slide 22: SURVEY QUESTIONS Demographics Home environment – Address for GIS mapping – Length of residency – Mold and fungus inside, outside – Flora, soil conditions Outdoor activities – Gardening – Change in activities 09/17/07 22
Slide 23: SURVEY QUESTIONS (cont.) Symptoms – When, where began – Onset event – Description – Others in household, pets – Seasonal, other changes – Exacerbation triggers 09/17/07 23
Slide 24: SURVEY QUESTIONS (cont.) Medical history – Allergies – Lyme disease, ticks – Tests, results – Medications Doctor visits – Number of visits – Medical specialties Treatments/symptom relief 09/17/07 24
Slide 25: COMMUNICATION NETWORK Recommendations (Interviewers Protocol): • DO NOT attempt to treat symptoms with pesticides, household chemicals, or other products not intended for those uses. • DO try over the counter allergy medicines such as Claritin to relieve your symptoms. Use only as directed. • DO contact your doctor or veterinarian for prescription strength allergy medicines for yourself, your loved ones, and your pets. • DO network with other individuals and organizations where members have similar symptoms. There are websites where you can contact others who suffer symptoms similar to yours. By listing these websites below, the GDPH is not endorsing any specific organization or diagnosis or philosophy. For more information about symptoms, visit: www.morgellons.org www.skinparasites.com www.dpref.com www.unknownskindisease.com www.morgellons-research.org/morgellons www.cherokeechas.com 09/17/07 25
Slide 26: DRAFT RESULTS Significant majority middle age white, non-Hispanic men and women living in north half of GA symptoms < 3 years (but as far back as 20 years) do not report mold in the home discontinued outdoor activity visit doctor(s) and/or specialist(s) Dermatology, Infectious Disease, GI, Internal Medicine, Neurology, Urology, Ophthalmology, Allergy, Rheumatology self medicate bleach, ammonia, inspect spray, dog flea dip, gasoline, kerosene, WD40, Windex, Lysol 09/17/07 26
Slide 27: DRAFT RESULTS (cont.) Insignificant majority or about equal females / males have / don’t have outdoor hobbies precipitating event 09/17/07 27
Slide 28: DRAFT RESULTS (cont.) Population The 10 county Atlanta metropolitan area has 53% of the population of Georgia North, central, and south Georgia account for the remaining 48%. North Georgia and the Atlanta area together account for 66% of Georgia’s population 09/17/07 28
Slide 29: 09/17/07 29
Slide 30: DRAFT RESULTS (cont.) 09/17/07 30
Slide 31: 23% 9% 12% 20% 09/17/07 31
Slide 32: CONCLUSIONS 1. Most of the case reports came from north Georgia and indicate contact with upturned soils. 3. There are associations supporting the hypothesis, but these associations are weak and not significant. 5. While significant trends cannot be defined from this descriptive survey, this survey documents the experiences of those who report these symptoms-- including potentially hazardous methods used to alleviate symptoms. 09/17/07 32
Slide 33: EFFECTIVE TREATMENTS • Add vinegar to shampoo • Complete body shave • Avoid antibacterial soaps • Dry body with paper towels • Encase bedding in vinyl covers • Wash all fabrics with bleach or, for colors, soak in vinegar. • If no children in household, set hot water heater to 155 degrees • Replace all carpets with linoleum or tile or vacuum daily • Keep pets outdoors 09/17/07 33
Slide 34: NEXT STEPS • Continue analyses • Publish paper • Sampling – Environmental – Biological – Pets • CDC investigation 09/17/07 34