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To the Editor: We report a case of Cryptococcus gattii infection in a 12-year-old neutered male cat in Alaska. The cat traveled to Anchorage, Alaska (61 [degrees]N) from San Diego [...]

The article presents a reports on the impact of the increased use of synthetic cannabinoids (SCs) in Anchorage, Alaska between 2015 to 2016. The article further discusses the discovery made by Alaska Division of Public Health's Section of Epidemiology of a rise in the number of patients who had reacted adversely to use of SCs in the hospital emergency departments in Anchorage, which resulted in a public health investigation.

Abstract: Zoonotic parasites are important causes of endemic and emerging human disease in northern North America and Greenland (the North), where prevalence of some parasites is higher than in the general North American population. The North today is in transition, facing increased resource extraction, globalisation of trade and travel, and rapid and accelerating environmental change. This comprehensive review addresses the diversity, distribution, ecology, epidemiology, and significance of nine zoonotic parasites in animal and human populations in the North. Based on a qualitative risk assessment with criteria heavily weighted for human health, these zoonotic parasites are ranked, in the order of decreasing importance, as follows: Echinococcus multilocularis, Toxoplasma gondii, Trichinella and Giardia, Echinococcus granulosus/canadensis and Cryptosporidium, Toxocara, anisakid nematodes, and diphyllobothriid cestodes. Recent and future trends in the importance of these parasites for human health in the North are explored. For example, the incidence of human exposure to endemic helminth zoonoses (e.g. Diphyllobothrium, Trichinella, and Echinococcus) appears to be declining, while water-borne protozoans such as Giardia, Cryptosporidium, and Toxoplasma may be emerging causes of human disease in a warming North. Parasites that undergo temperature-dependent development in the environment (such as Toxoplasma, ascarid and anisakid nematodes, and diphyllobothriid cestodes) will likely undergo accelerated development in endemic areas and temperate-adapted strains/species will move north, resulting in faunal shifts. Food-borne pathogens (e.g. Trichinella, Toxoplasma, anisakid nematodes, and diphyllobothriid cestodes) may be increasingly important as animal products are exported from the North and tourists, workers, and domestic animals enter the North. Finally, key needs are identified to better assess and mitigate risks associated with zoonotic parasites, including enhanced surveillance in animals and people, detection methods, and delivery and evaluation of veterinary and public health services. [Copyright &y& Elsevier]

Background. Foodborne botulism resulting from consumption of uncooked aquatic game foods has been an endemic hazard among Alaska Native populations for centuries. Our review was conducted to help target botulism prevention and response activities. Methods. Records of Alaska botulism investigations for the period 1947-2007 were reviewed. We used the Centers for Disease Control and Prevention case definitions for foodborne botulism and linear regression to evaluate incidence trends and χ2 or Fisher's Exact tests to evaluate categorical data. Results. A total of 317 patients (61% of whom were female) and 159 outbreaks were reported. Overall mean annual incidence was 6.9 cases per 100,000 Alaska Native persons; mean incidence was lower in 2000 (5.7 cases per 100,000 Alaska Native persons) than in any period since 1965-1969 (0.8 cases per 100,000 Alaska Native persons). Age-specific incidence was highest (26.6 cases per 100,000 Alaska Native persons) among persons aged ⩾60 years. The overall case-fatality rate was 8.2%, and the case-fatality rate was ⩽4.0% since 1980. Misdiagnosis was associated with a higher case-fatality rate and delayed antitoxin administration. Conclusions. Foodborne botulism remains a public health problem in Alaska. Incidence might be decreasing, but it remains >800 times the overall US rate (0.0068 cases per 100,000 persons). Prevention messages should highlight the additional risk to female individuals and older persons. Early diagnosis is critical for timely access to antitoxin and supportive care. [ABSTRACT FROM AUTHOR]

In July 2015, personnel in the Alaska Division of Public Health's Section of Epidemiology became aware of an increase in the number of patients being treated in Anchorage hospital emergency departments for adverse reactions associated with use of synthetic cannabinoids (SCs). SCs are a chemically diverse class of designer drugs that bind to the same cannabinoid receptors as tetrahydrocannabinol, the main psychoactive component of cannabis. A public health investigation was initiated to describe clinical outcomes, characterize the outbreak, and identify SC chemicals circulating in Anchorage. During July 15, 2015-March 15, 2016, a total of 1,351 ambulance transports to Anchorage emergency departments for adverse SC reactions were identified. A review of charts obtained from two Anchorage hospitals determined that among 167 emergency department visits for adverse SC reactions during July 15-September 30, 2015, 11 (6.6%) involved a patient who required endotracheal intubation, 17 (10.2%) involved a patient who was admitted to the intensive care unit, and 66 (39.5%) involved a patient classified as being homeless. Testing of 25 product and paraphernalia samples collected from patients at one hospital identified 11 different SC chemicals. Educational outreach campaigns focused on the considerable health risks of using SCs need to complement judicial and law enforcement actions to reduce SC use.