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.

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.”

womenshealth.gov, a project of  the U.S. Department of Health and Human Services Office on Women’s Health, recently published the following tips written by Health Day News.

Tips on What Can Cause Muscle Cramps

The American Academy of Orthopaedic Surgeons says although the exact causes of muscle cramps aren’t known, the following conditions are thought to increase your risk:

• Having tight muscles that haven’t been stretched.
• Having poorly conditioned muscles that become easily fatigued.
• Overusing your muscles.
• Exerting yourself in extreme heat.
• Being dehydrated.
• Having low levels of essential minerals and salt, including potassium.

Tips on Avoiding Hurting Yourself While Gardening

The American Council on Exercise suggests how to garden without hurting yourself:

• Use correct posture and form.
• Warm up before you garden with a 10-minute walk.
• Make sure all of your movements are smooth and steady.
• Keep your abdominal muscles taut.
• Lift with your legs (never your back).
• Don’t twist your back while digging.
• Breathe regularly. Exhale when you lift, and inhale as you lower a heavy load.

In a recent newsletter from Beth Israel Hospital, NYC, Elizabeth Palillo, PharmD, Clinical Pharmacy Manager stresses that at least once a year we need to go through our medicine cabinets and do the following:

• Throw out expired products.
• Discard prescription medications we don’t use anymore.
• If the cold and flu season is over, throw that medicine out. The cough medicine bottle is probably contaminated because someone drank right from the bottle.
• Throw out last year’s sunscreen as sunscreen degrades after being exposed to heat.
• Restock first aid products.

Ms. Palillo offers the following advice about storing and disposing of medicine:

• Find another place than the bathroom to store medicine as there is too much heat and steam in this room on a regular basis. Better places are: nightstands, a kitchen cabinet or a desk.
• Take care disposing of your medicines. Dump pills and liquids in a tin can that can be sealed, such as a coffee can and mix with something non-edible such as kitty litter or powdered detergent. Duct tape the lid to the can and dispose of in the garbage.

• Be environmentally friendly and don’t flush medicine down the toilet. Exceptions to the no-flush rule are narcotics and painkillers. The reason for suggesting flushing these medications is there is potential for them to be found in the trash and abused.

When you are on prescription medications, traveling can be a challenge if you need to go through security checkpoints.

Should you choose to put your prescription medications in the luggage that you check in at the airport or cruise terminal, you run the risk of being separated from needed medications due to lost luggage.

Delayed delivery of your luggage can sometimes happen on cruise ships due to the sheer volume of luggage to be delivered to ship’s cabins.

The U.S. Centers for Disease Control and Prevention (CDC) suggests these precautions for air, ship and any distance travel where being without your prescription medications, for any length of time would be a health risk

• Pack your medications in a carry-on (carry with you) bag, so they don’t get lost.
• Bring a list and keep it in your carry with you bag of your prescriptions, including brand and generic names.
• Have a letter, on your doctor’s letterhead, with his or her  prescription for any controlled substance or medication that needs to be injected
• Be sure that a family member or friend, at home, has an extra copy of your prescription medications.

• If you are going to be traveling internationally, check beforehand with the American Embassy or Consulate to ensure that your medications are allowed in the country you will be visiting.