{"id":10387,"date":"2025-03-01T14:07:51","date_gmt":"2025-03-01T19:07:51","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan411\/"},"modified":"2025-03-02T00:54:35","modified_gmt":"2025-03-02T05:54:35","slug":"dhan411","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan411\/","title":{"rendered":"php\/alerts\/dhan411 ~  Division of Public Health  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n\n\n  <br>\n\n\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n\n    <!-- BEGIN readspeaker div -->\n\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\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\/dhan411.html\" title=\"Listen to this page using ReadSpeaker\">\n\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n\n      <\/a>\n\n\n    <\/div>\n\n\n    <!-- END readspeaker div -->\n\n\n\n\n\n    \n\n\n    <header class=\"pull-left\">\n\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->411 <!--[END]--> <\/h1>\n\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->August 30, 2019 12:52 pm <!--[END]--> <\/h2>\n\n\n    <\/header>\n\n\n  <\/div><br>\n\n\n \n\n\n  <div class=\"container\">\n\n\n    <div class=\"row\">\n\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n\n          <div class=\"panel sectionmenu_panel\">\n\n\n            <div class=\"panel-heading\">\n\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\n            <\/div>\n\n\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\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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They are known by many different names and come in many shapes, sizes \n\n\n\n\n\n\nand device types. Devices may be referred to as &#8220;e-cigs,&#8221; &#8220;vapes,&#8221; &#8220;e-hookahs,&#8221; &#8220;vape pens,&#8221; &#8220;mods,&#8221; tanks, \n\n\n\n\n\n\nor electronic nicotine delivery systems (ENDS). Some e-cigarette devices resemble other tobacco products such \n\n\n\n\n\n\nas cigarettes; some resemble ordinary household items such as USB flash drives, pens, and flashlights; and \n\n\n\n\n\n\nothers have unique shapes. Use of e-cigarettes is sometimes referred to as &#8220;vaping&#8221; or &#8220;juuling.&#8221; E-cigarettes \n\n\n\n\n\n\nused for dabbing are sometimes called &#8220;dab&#8221; pens.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>E-cigarettes can contain harmful or potentially harmful substances, including nicotine, heavy metals (e.g., lead), \n\n\n\n\n\n\nvolatile organic compounds, and cancer-causing chemicals. Additionally, some e-cigarette products are used to \n\n\n\n\n\n\ndeliver illicit substances; may be acquired from unknown or unauthorized (i.e., &#8220;street&#8221;) sources; and may be \n\n\n\n\n\n\nmodified for uses that could increase their potential for harm to the user. For example, some e-cigarette pods \n\n\n\n\n\n\nor cartridges marketed for single use can be refilled with illicit or unknown substances. In addition, some \n\n\n\n\n\n\ne-cigarette products are used for &#8220;dripping&#8221; or &#8220;dabbing.&#8221; Dripping involves dropping e-cigarette liquid directly \n\n\n\n\n\n\nonto the hot coils of an e-cigarette which can result in high concentrations of compounds (e.g., tetrahydrocannabinol \n\n\n\n\n\n\n[THC] and cannabinoid compounds). Dabbing involves superheating substances such as &#8220;budder&#8221;, butane hash oil (BHO), \n\n\n\n\n\n\nand &#8220;710&#8221; that contain high concentrations of THC and other plant compounds (e.g., cannabidiol [CBD]).<\/p>\n\n\n\n\n\n\n \n\n\n\n\n\n\n<p>Youth, young adults, pregnant women, as well as adults who do not currently use tobacco products should not \n\n\n\n\n\n\nuse e-cigarettes. E-cigarettes containing nicotine have the potential to help some individual adult smokers \n\n\n\n\n\n\nreduce their use of and transition away from cigarettes. However, e-cigarettes are not currently approved by \n\n\n\n\n\n\nthe Food and Drug Administration (FDA) as a quit smoking aid, and the available science is inconclusive on \n\n\n\n\n\n\nwhether e-cigarettes are effective for quitting smoking.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h2>Outbreak Background<\/h2>\n\n\n\n\n\n\n<p>As of August 27, 2019, 215 possible cases have been reported from 25 states and additional reports of \n\n\n\n\n\n\npulmonary illness are under investigation. One patient (in Illinois) with a history of recent e-cigarette \n\n\n\n\n\n\nuse was hospitalized on July 29, 2019 with severe pulmonary disease and died on August 20, 2019. Although \n\n\n\n\n\n\nthe etiology of e-cigarette-associated pulmonary disease is undetermined, epidemiologic investigations in \n\n\n\n\n\n\naffected states are ongoing to better characterize the exposures, demographic, clinical, and laboratory \n\n\n\n\n\n\nfeatures and behaviors of patients. All patients have reported using e-cigarette products. The exact number \n\n\n\n\n\n\nis currently unknown, but many patients have reported using e-cigarettes containing cannabinoid products \n\n\n\n\n\n\nsuch as THC or CBD.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>Based on reports from several states, patients have experienced respiratory symptoms (cough, shortness of \n\n\n\n\n\n\nbreath, or chest pain), and some have also experienced gastrointestinal symptoms (nausea, vomiting, or diarrhea) \n\n\n\n\n\n\nor non-specific constitutional symptoms (fatigue, fever, or weight loss). Symptoms typically develop over a period \n\n\n\n\n\n\nof days but sometimes can manifest over several weeks. Gastrointestinal symptoms sometimes preceded respiratory \n\n\n\n\n\n\nsymptoms. Fever, tachycardia, and elevated white blood cell count have been reported in the absence of an identifiable \n\n\n\n\n\n\ninfectious disease. Many patients have sought initial care in ambulatory settings, some with several visits, before \n\n\n\n\n\n\nhospital admission.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>Radiologic findings have varied and are not present in all patients upon initial presentation. Bilateral pulmonary \n\n\n\n\n\n\ninfiltrates and diffuse ground-glass opacities have been reported. Many patients required supplemental oxygen, some \n\n\n\n\n\n\nrequired assisted ventilation and oxygenation, and some were intubated. Some patients have been treated with corticosteroids \n\n\n\n\n\n\nwith demonstrated improvement. Antimicrobial therapy alone has not consistently been associated with clinical improvement. \n\n\n\n\n\n\nAssessment for infectious etiologies has been completed in many patients without an identified infectious cause. Several \n\n\n\n\n\n\npatients from one state have been diagnosed with lipoid pneumonia based on clinical presentation and detection of lipids \n\n\n\n\n\n\nwithin bronchoalveolar lavage samples stained specifically to detect oil.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>All patients have reported using e-cigarette products and the symptom onset has ranged from a few days to several \n\n\n\n\n\n\nweeks after e-cigarette use. Within two states, recent inhalation of cannabinoid products, THC or cannabidiol, have \n\n\n\n\n\n\nbeen reported in many of the patients. To date, no single substance or e-cigarette product has been consistently \n\n\n\n\n\n\nassociated with illness. CDC is working closely with state health departments to facilitate collecting product specimens \n\n\n\n\n\n\nfor testing at the U.S. FDA Forensic Chemistry Center.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h2>Recommendations for Clinicians<\/h2>\n\n\n\n\n\n\n<ol>\n\n\n\n\n\n\n<li>Report cases of severe pulmonary disease of unclear etiology and a history of e-cigarette product use within the past \n\n\n\n\n\n\n90 days to your state or local health department. Reporting of cases may help CDC and state health departments determine \n\n\n\n\n\n\nthe cause or causes of these pulmonary illnesses.<\/li>\n\n\n\n\n\n\n<li>Clinicians should report cases of significant respiratory illness of unclear etiology and a history of vaping to the \n\n\n\n\n\n\n<strong>Delaware Division of Public Health, Bureau of Epidemiology (24\/7) at 1-888-295-5156<\/strong>.<\/li>\n\n\n\n\n\n\n<li>Ask all patients who report e-cigarette product use within the last 90 days about signs and symptoms of pulmonary illness.<\/li>\n\n\n\n\n\n\n<li>If e-cigarette product use is suspected as a possible etiology of a patient&#038;rsquo&#8217;s severe pulmonary disease, obtain detailed history regarding:\n\n\n\n\n\n\n<ul>\n\n\n\n\n\n\n<li>Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids \n\n\n\n\n\n\n[e.g., K2 or spice], hash oil, Dank vapes), flavors, or other substances<\/li>\n\n\n\n\n\n\n<li>Substance source(s): commercially available liquids (i.e., bottles, cartridges, or pods), homemade liquids, and re-use \n\n\n\n\n\n\nof old cartridges or pods with homemade or commercially bought liquids<\/li>\n\n\n\n\n\n\n<li>Device(s) used: manufacturer; brand name; product name; model; serial number of the product, device, or e-liquid; if the \n\n\n\n\n\n\ndevice can be customized by the user; and any product modifications by the user (e.g., exposure of the atomizer or heating coil)<\/li>\n\n\n\n\n\n\n<li>Where the product(s) were purchased<\/li>\n\n\n\n\n\n\n<li>Method of substance use: aerosolization, dabbing, or dripping<\/li>\n\n\n\n\n\n\n<li>Other potential cases: sharing e-cigarette products (devices, liquids, refill pods, or cartridges) with others<\/li>\n\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n<\/li><li>Determine if any remaining product, including devices and liquids, are available for testing. Testing can be coordinated \n\n\n\n\n\n\nwith the local or state health departments.<\/li><li>Consider all possible causes of illness in patients reporting respiratory and gastrointestinal symptoms and of e-cigarette \n\n\n\n\n\n\nproduct use. Evaluate and treat for other possible causes of illness (e.g., infectious, rheumatologic, neoplastic) as clinically \n\n\n\n\n\n\nindicated. Consider consultation with specialists (pulmonary, infectious disease, critical care, medical toxicology) as appropriate.<\/li><li>Clinical improvement of patients with severe pulmonary disease associated with e-cigarette use has been reported with the use \n\n\n\n\n\n\nof corticosteroids. The decision to use corticosteroids should be made on a case-by-case basis based on risks and benefits and the \n\n\n\n\n\n\nlikelihood of other etiologies.<\/li><li>Lipoid pneumonia associated with inhalation of lipids in aerosols generated by e-cigarettes has been reported based on the \n\n\n\n\n\n\ndetection of lipid-laden alveolar macrophages obtained by bronchoalveolar lavage (BAL) and lipid staining (e.g., oil red O). The \n\n\n\n\n\n\ndecision about whether to perform a BAL should be based on individual clinical circumstances.<\/li><li>Lung biopsies have been performed on some patients. If a lung biopsy is obtained, lipid staining may be considered during \n\n\n\n\n\n\npathologic examination, and is best performed on fresh tissue. Routine pathology tissue processing (including formalin-fixation \n\n\n\n\n\n\nand paraffin-embedding) can remove lipids. Conducting routine tissue processing and histopathologic evaluation is still important. \n\n\n\n\n\n\nConsider consultation with specialists in pulmonary medicine and pathology to help inform any evaluation plan.<\/li><li>Patients who have received treatment for severe pulmonary disease related to e-cigarette product use should undergo follow-up \n\n\n\n\n\n\nevaluation as clinically indicated to monitor pulmonary function.<\/li><\/ol>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h2>Recommendations for Public Health Officials<\/h2>\n\n\n\n\n\n\n<ol>\n\n\n\n\n\n\n<li>State public health officials should promptly notify CDC about possible cases via VapingAssocIllness@cdc.gov.<\/li>\n\n\n\n\n\n\n<li>Contact CDC at VapingAssocIllness@cdc.gov for case classification criteria, \n\n\n\n\n\n\nreporting guidelines, case investigation forms, and questions about this outbreak.<\/li>\n\n\n\n\n\n\n<li>Consider conducting case-finding activities that use existing data sources (e.g., local poison control center, coroner \n\n\n\n\n\n\nand medical examiner\u2019s office, and other applicable surveillance systems including syndromic surveillance). CDC has developed \n\n\n\n\n\n\ntwo working syndromic surveillance definitions (one version with specific symptoms and a second focused on e-cigarette product \n\n\n\n\n\n\nuse). CDC will be programming these definitions in CDC\u2019s National Syndromic Surveillance Program\u2019s BioSense\/ESSENCE platform \n\n\n\n\n\n\nfor case-finding within the platform.<\/li>\n\n\n\n\n\n\n<li>Consider asking the medical examiner or coroner\u2019s office and other pathologists to report possible cases, especially those \n\n\n\n\n\n\nwithout an alternative, likely diagnosis. If individuals are identified after death or at autopsy who showed signs of severe \n\n\n\n\n\n\npulmonary disease as described above, medical examiners and coroners are encouraged to report the cases to their local or state \n\n\n\n\n\n\nhealth department. Thorough sampling of trachea, bronchi, and lung parenchyma with collection of fresh lung tissue for staining \n\n\n\n\n\n\nof lipids (e.g., oil red O) and submission of formalin-fixed, paraffin-embedded tissues for routine histopathology are recommended. \n\n\n\n\n\n\nFor further consultation, public health officials can contact CDC\u2019s Infectious Diseases Pathology Branch at pathology@cdc.gov.<\/li>\n\n\n\n\n\n\n<li>State health department officials seeking technical assistance with an epidemiologic investigation can contact CDC at VapingAssocIllness@cdc.gov. \n\n\n\n\n\n\nState health department officials seeking technical assistance with laboratory testing can discuss with their state health department \n\n\n\n\n\n\nlaboratories or contact CDC at VapingAssocIllness@cdc.gov.<\/li>\n\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h2>Recommendations for the Public<\/h2>\n\n\n\n\n\n\n<ol>\n\n\n\n\n\n\n<li>While this investigation is ongoing, if you are concerned about these specific health risks, consider refraining from using \n\n\n\n\n\n\ne-cigarette products.<\/li>\n\n\n\n\n\n\n<li>Regardless of the ongoing investigation, anyone who uses e-cigarette products should not buy these products off the street \n\n\n\n\n\n\n(e.g., e-cigarette products with THC, other cannabinoids) and should not modify e-cigarette products or add any substances to \n\n\n\n\n\n\nthese products that are not intended by the manufacturer.<\/li>\n\n\n\n\n\n\n<li>Regardless of the ongoing investigation, e-cigarette products should not be used by youth, young adults, pregnant women, \n\n\n\n\n\n\nas well as adults who do not currently use tobacco products. If you use e-cigarette products, monitor yourself for symptoms \n\n\n\n\n\n\n(e.g., cough, shortness of breath, chest pain) and promptly seek medical attention if you have concerns about your health. \n\n\n\n\n\n\nCDC and FDA will continue to advise and alert the public as more information becomes available.<\/li>\n\n\n\n\n\n\n<li>Adult smokers who are attempting to quit should use evidence-based treatments, including counseling and FDA-approved \n\n\n\n\n\n\nmedications. If you who need help quitting tobacco products, including e-cigarettes, contact your doctor.<\/li>\n\n\n\n\n\n\n<li>If you are concerned about harmful effects from e-cigarette products, call your local poison control center at: 1-800-222-1222.<\/li>\n\n\n\n\n\n\n<li>We encourage the public to submit detailed reports of any unexpected tobacco or e-cigarette-related health or product \n\n\n\n\n\n\nissues to the FDA via the online Safety Reporting Portal: <a href=\"https:\/\/www.safetyreporting.hhs.gov\">https:\/\/www.safetyreporting.hhs.gov.<\/a><\/li>\n\n\n\n\n\n\n<\/ol>\n\n\n\n\n\n\n \n\n\n\n\n\n\n<h2>For More Information<\/h2>\n\n\n\n\n\n\n<ul>\n\n\n\n\n\n\n<li>For assistance with managing patients suspected of illness related to recreational, illicit, or other drugs, \n\n\n\n\n\n\ncall your local poison control center at: 1-800-222-1222.<\/li>\n\n\n\n\n\n\n<li>Information on electronic cigarettes and similar devices:<br>\n\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/e-cigarettes\">https:\/\/www.cdc.gov\/e-cigarettes<\/a><\/li>\n\n\n\n\n\n\n<li>CDC Press Statement:<br>\n\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/media\/releases\/2019\/s0821-cdc-fda-states-e-cigarettes.html\">https:\/\/www.cdc.gov\/media\/releases\/2019\/s0821-cdc-fda-states-e-cigarettes.html<\/a><\/li>\n\n\n\n\n\n\n<li>CDC Clinical Outreach and Communication Activity announcement:<br>\n\n\n\n\n\n\n<a href=\"https:\/\/emergency.cdc.gov\/newsletters\/coca\/081619.htm\">https:\/\/emergency.cdc.gov\/newsletters\/coca\/081619.htm<\/a><\/li>\n\n\n\n\n\n\n<li>CDC\u2019s National Syndromic Surveillance Program\u2019s BioSense\/ESSENCE:<br>\n\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/nssp\/index.html\">https:\/\/www.cdc.gov\/nssp\/index.html<\/a><\/li>\n\n\n\n\n\n\n<li>For more information, visit CDC Info:<br>\n\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/cdc-info\/index.html\">https:\/\/www.cdc.gov\/cdc-info\/index.html<\/a><\/li>\n\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<h2>References<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>Barrington-Trimis JL, Samet JM, McConnell R. Flavorings in electronic cigarettes: an unrecognized respiratory health hazard? JAMA. 2014;312(23):2493-4.<br>\n\n\n\n\n\n\n<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/1935097\">https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/1935097<\/a><\/p>\n\n\n\n\n\n\n<p>Behar RZ, Davis B, Wang Y, Bahl V, Lin S, Talbot P. Identification of toxicants in cinnamon-flavored electronic cigarette refill fluids. Toxicol In Vitro. 2014;28(2):198-208.<br>\n\n\n\n\n\n\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24516877\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24516877<\/a><\/p>\n\n\n\n\n\n\n<p>Flower M, Nandakumar L, Singh M, Wyld D, Windsor M, Fielding D. Respiratory bronchiolitis-associated interstitial lung disease secondary to electronic nicotine delivery system use confirmed with open lung biopsy. Respirol Case Rep. 2017;5(3):e00230.<br>\n\n\n\n\n\n\n<a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/rcr2.230\">https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/rcr2.230<\/a><\/p>\n\n\n\n\n\n\n<p>Gerloff J, Sundar IK, Freter R, Sekera ER, Friedman AE, Robinson R, et al. Inflammatory Response and Barrier Dysfunction by Different e-Cigarette Flavoring Chemicals Identified by Gas Chromatography-Mass Spectrometry in e-Liquids and e-Vapors on Human Lung Epithelial Cells and Fibroblasts. Appl In Vitro Toxicol. 2017;3(1):28-40.<br>\n\n\n\n\n\n\n<a href=\"https:\/\/www.liebertpub.com\/doi\/10.1089\/aivt.2016.0030\">https:\/\/www.liebertpub.com\/doi\/10.1089\/aivt.2016.0030<\/a><\/p>\n\n\n\n\n\n\n<p>He T, Oks M, Esposito M, Steinberg H, Makaryus M. &#8220;Tree-in-Bloom&#8221;: Severe Acute Lung Injury Induced by Vaping Cannabis Oil. Ann Am Thorac Soc. 2017;14(3):468-70.<br>\n\n\n\n\n\n\n<a href=\"https:\/\/www.atsjournals.org\/doi\/10.1513\/AnnalsATS.201612-974LE\">https:\/\/www.atsjournals.org\/doi\/10.1513\/AnnalsATS.201612-974LE<\/a><\/p>\n\n\n\n\n\n\n<p>Khan MS, Khateeb F, Akhtar J, Khan Z, Lal A, Kholodovych V, et al. Organizing pneumonia related to electronic cigarette use: A case report and review of literature. Clin Respir J. 2018;12(3):1295-9.<br>\n\n\n\n\n\n\n<a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/crj.12775\">https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/crj.12775<\/a><\/p>\n\n\n\n\n\n\n<p>Kosmider L, Sobczak A, Prokopowicz A, Kurek J, Zaciera M, Knysak J, et al. Cherry-flavoured electronic cigarettes expose users to the inhalation irritant, benzaldehyde. Thorax. 2016;71(4):376-7.<br>\n\n\n\n\n\n\n<a href=\"https:\/\/thorax.bmj.com\/content\/71\/4\/376\">https:\/\/thorax.bmj.com\/content\/71\/4\/376<\/a><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p class=\"text-center\">The Centers for Disease Control and Prevention (CDC) protects people&#8217;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.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>************************************<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<p>You are receiving this email because you are a registered member of the Delaware Health Alert Network.\n\n\n\n\n\n\nIf you are not a member and would like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a><\/p><!--[END]-->\n\n\n  \n\n\n        <div class=\"panel panel-danger\">\n\n\n          <div class=\"panel-heading\">    \n\n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n\n       <\/div>\n\n\n       <div class=\"panel-body\">\n\n\n      <ul>\n\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n\n            <\/ul>\n\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\n          <\/div> \n\n\n        <\/div><br>  \n\n\n\n\n\n      <\/div>\n\n\n    <\/div>\n\n\n  <\/div><!-- \/container -->\n\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #411 August 30, 2019 12:52 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-10387","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10387","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10387"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10387\/revisions"}],"predecessor-version":[{"id":11563,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10387\/revisions\/11563"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10387"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}