Before someone you love gets a tattoo, ask them to consider this report from the Federal Drug Administration (FDA) issued on August 22, 2012.

The Food and Drug Administration (FDA) is particularly concerned about a family of bacteria called nontuberculous Mycobacteria (NTM) that has been found in a recent outbreak of illnesses linked to contaminated tattoo inks.

M. chelonae, one of several disease-causing NTM species, can cause lung disease, joint infection, eye problems and other organ infections. These infections can be difficult to diagnose and can require treatment lasting six months or more.

Some of these contaminated tattoo inks have caused serious infections in at least four states in late 2011 and early 2012. FDA is reaching out to tattoo artists, ink and pigment manufacturers, public health officials, health care professionals, and consumers to warn them of the potential for infection.

FDA also warns that tattoo inks, and the pigments used to color them, can become contaminated by other bacteria, mold and fungi.

To raise awareness and make diagnoses more accurate, FDA strongly encourages reporting of tattoo-associated complications to its MedWatch program, says Linda Katz, M.D., M.P.H., director of FDA’s Office of Cosmetics and Colors.

“Getting the word out to tattoo artists is particularly critical. Even when they diligently follow hygienic practices, they may not know that an ink itself may be contaminated. Contamination is not always visible in the inks,” Katz says.

FDA’s goal is to encourage these artists to take certain precautions in their practice and to urge potentially infected clients to seek medical care. “Reporting an infection to FDA and the artist is important. Once the problem is reported, FDA can investigate, and the artist can take steps to prevent others from being infected,” says epidemiologist Katherine Hollinger, D.V.M., M.P.H., from the Office of Cosmetics and Colors.

A Challenging Investigation

Tattoo inks are subject to FDA regulation. FDA investigates and intervenes when a serious safety issue arises.  And that’s what happened here.

FDA’s CORE (Coordinated Outbreak Response and Evaluation) Network initiated and coordinated the investigation with state and local health departments and laboratories, the Centers for Disease Control and Prevention (CDC), and FDA investigators working in numerous district offices.

The investigation began in January 2012 when FDA, through its MedWatch reporting program, learned about seven people in Monroe County, New York who had NTM infections. They’d all gotten tattoos from the same artist, who used the same brand of ink on all of them. The infections occurred on the newly acquired tattoos, with red bumps appearing soon after the tattoo had healed.

FDA later became aware of 12 more people with an NTM infection who were also clients of this same tattoo artist. The same brand of ink was also used on them. Of these 19 people, 14 were confirmed to have the same type of NTM infection. An NTM sample from a sealed container of the same type of ink used to tattoo the affected individuals was a perfect match to the NTM linked to these infections.

Meanwhile, FDA learned of outbreaks of NTM infections in other states, including but not limited to Washington, Iowa, and Colorado. The cases in these states involved different NTM species or different ink manufacturers than those in New York. While the infections in Washington, Iowa, and Colorado were not linked to the New York infections, there was a link identified between the M. chelonae infections in Washington and Iowa.

For the New York outbreak alone, FDA investigators visited the tattoo ink supplier and manufacturer. These were located as far away as California. These investigations resulted in a recall of the implicated ink.

Strategies for Controlling Risks of Infection

Tattoo artists can minimize the risk of infection by using inks that have been formulated or processed to ensure they are free from disease-causing bacteria, and avoiding the use of non-sterile water to dilute the inks or wash the skin.  Non-sterile water includes tap, bottled, filtered or distilled water.

Consumers should know that the ointments often provided by tattoo parlors are not effective against these infections. NTM infections may look similar to allergic reactions, which means they might be easily misdiagnosed and treated ineffectively.

Once an infection is diagnosed, health care providers will prescribe appropriate antibiotic treatment according to Katz. Such treatment might have uncomfortable side effects, such as nausea or gastrointestinal problems. However, without prompt and proper treatment an infection could spread beyond the tattoo or become complicated by a secondary infection.

If you suspect you may have a tattoo-related infection, FDA recommends the following:

• Contact your health care professional if you see a red rash with swelling, possibly accompanied by itching or pain in the tattooed area, usually appearing 2-3 weeks after tattooing.
• Report the problem to the tattoo artist.
• Report the problem to MedWatch, on the Web or at 1-800-332-1088; or contact FDA’s consumer complaint coordinator in your area.

Inks and pigments can be contaminated through:

• use of contaminated ingredients to make inks,
• use of manufacturing processes that introduce contaminants or allow contaminants to survive,
• use of unhygienic practices that contaminate ink bottles or mixing with contaminated colors,
• use of non-sterile water to dilute the inks,
• Using tattoo inks past their expiration date.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Pertussis (Whooping Cough) is a serious and highly contagious disease. It is on the rise again in the U.S. The following message,about Pertussis, is from the Centers for Disease Control (CDC).

Pertussis Vaccine Protection

There is high pertussis vaccine coverage for children nationwide. However, protection from the childhood vaccine decreases over time. Preteens, teens and adults need to be re-vaccinated, even if they were completely vaccinated as children.

Also, pertussis vaccines are very effective but not 100% effective [PDF – 140KB]. If pertussis is circulating in the community, there is still a chance that a fully vaccinated person can catch this very contagious disease. When you or your child develops a cold that includes a prolonged or severe cough, it may be pertussis. The best way to know is to contact your doctor.

Pertussis Symptoms

Pertussis can cause serious illness in infants, children and adults. The disease starts like the common cold, with runny nose or congestion, sneezing, and maybe mild cough or fever. But after 1–2 weeks, severe coughing can begin.

Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. Pertussis can cause violent and rapid coughing, over and over, until the air is gone from the lungs and you are forced to inhale with a loud “whooping” sound. In infants, the cough can be minimal or not even there.

Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. If your baby is having trouble breathing, take him to a hospital or doctor right away.

Disease Complications

Pertussis is most severe for babies; more than half of infants younger than 1 year of age who get the disease must be hospitalized. About 1 in 4 infants with pertussis get pneumonia (lung infection), and about two thirds will have slowed or stopped breathing. Pertussis can be deadly for 1 or 2 infants per 100 who are hospitalized. Learn how pertussis can be treated.

How Pertussis Spreads

People with pertussis usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many infants who get pertussis are infected by parents, older siblings, or other caregivers who might not even know they have the disease.

Pertussis Trends

Reported cases of pertussis vary from year to year and tend to peak every 3-5 years. In 2010, 27,550 cases of pertussis were reported in the U.S.—and many more cases go unreported. Twenty-seven deaths were reported – 25 of these deaths were in children younger than 1 year old.

Preventing Pertussis

The best way to prevent pertussis is to get vaccinated. Parents can also help protect infants by keeping them away as much as possible from anyone who has cold symptoms or is coughing.

Vaccine Recommendations

For Infants and Children: In the US, the recommended pertussis vaccine for children is called DTaP. This is a safe and effective combination vaccine that protects children against three diseases: diphtheria, tetanus, and pertussis.

For maximum protection against pertussis, children need five DTaP shots. The first three shots are given at 2, 4, and 6 months of age. The fourth shot is given at 15 through 18 months of age, and a fifth shot is given when a child enters school, at 4 through 6 years of age. If a 7-10 year old is not up-to-date with DTaP vaccines, a dose of Tdap should be given before the 11-12 year old check up.

For Preteens and Teens: Vaccine protection for pertussis, tetanus, and diphtheria can decrease with time. Preteens going to the doctor for their regular check-up at age 11 or 12 years should get a booster vaccine, called Tdap. Teens and young adults who didn’t get a booster of Tdap as a preteen should get one dose when they visit their health care provider.

For Pregnant Women: Pregnant women who have not been previously vaccinated with Tdap should get one dose of Tdap during the third trimester or late second trimester – or immediately postpartum, before leaving the hospital or birthing center. By getting Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, likely providing protection against pertussis in early life, before the baby starts getting DTaP vaccines. Tdap will also protect the mother at time of delivery, making her less likely to transmit pertussis to her infant.

For Adults: Adults 19 years of age and older who didn’t get Tdap as a preteen or teen should get one dose of Tdap. Getting vaccinated with Tdap at least two weeks before coming into close contact with an infant is especially important for families with and caregivers of new infants.

The easiest thing for adults to do is to get Tdap instead of their next regular tetanus booster—the Td shot that is recommended for adults every 10 years. The dose of Tdap can be given earlier than the 10-year mark, so it’s a good idea for adults to talk to a health care provider about what’s best for their specific situation.

Swimming is great fun, but recreational waters can be a place to pick up illnesses.

The Centers for Disease Control (CDC), in a recent press release asks that we all do our part in keeping our recreational water safe.

The CDC suggests following these healthy swimming steps to protect you, your family, and other swimmers from recreational water illnesses.

Three Steps for All Swimmers – Keep germs from causing recreational water illnesses:

• Don’t swim when you have diarrhea. You can spread germs in the water and make other people sick.
• Don’t swallow the pool water. Avoid getting water in your mouth.
• Don’t assume that pool water is germ free because the water is treated with chlorine
• Practice good hygiene. Shower with soap before swimming and wash your hands after using the toilet or changing diapers. Germs on your body end up in the water.

Three Steps for Parents of Young Kids – Keep germs out of recreational water:

• Take your kids on bathroom breaks or check diapers often. Waiting to hear “I have to go” may mean that it’s too late.
• Change diapers in a bathroom or a diaper-changing area and not at poolside. Germs can spread in and around the pool.
• Wash your child thoroughly (especially the rear end) with soap and water before swimming. Invisible amounts of fecal matter can end up in the pool.

Michele Hlavsa, CDC, states.”“You can get gastrointestinal infections, viral meningitis, ear infections – also known as swimmer’s ear – but the most common infection is diarrhea from the germs in recreational waters.” Ms. Hlavsa advises, “Don’t swallow the water, or swim with open sores.”