An emergency physician at the Richmond Hospital as well as Vancouver Coastal Health (VCH) are speaking out about the potential dangers of inhaling nitrous oxide. N2O is most commonly used in medical procedures, typically for anesthesia, analgesia, and sedation.
Nitrous oxide is becoming more commonly used by teenagers and young adults, who inhale from small canisters called “whippits” to experience a brief high, VCH said in an emailed statement.
Dr. Matthew Kwok and the VCH warn that non-medical use to the drug can be extremely dangerous. He also notes that whippits, which are used in whipped cream dispensers, can be easily accessed with no restriction on age, medical history, or intended use.
“We’re seeing patients in the emergency department with drug-induced psychosis and neurological effects who’ve inhaled nitrous oxide,” says Dr. Kwok. “People become addicted to this drug.”
A first-hand experience that Dr. Kwok has encountered involved a 20-year-old woman who was experiencing visual and auditory hallucinations. The doctor wrote about the case in a recent issue of the BC Medical Journal, saying that the female “voiced concerns about a ‘transmitting’ device in her throat.’”
“She believed that this device was making her legs weak and affecting her walking,” reads Dr. Kwok’s report. “She also heard voices from the device telling her to kill herself. She had come to the emergency department because she was worried for her safety.”
The report notes that the woman had no history of psychiatric or medical illness; however, she admitted to using nitrous oxide daily and says that she increased her dosage to approximately 100 whippits per day.
A psychiatrist, neurologist, and an addiction medicine physician agreed after an assessment that the psychosis was a result of N2O misuse. Fortunately, her symptoms resolved and she was discharged without incident.
Dr. Kwok says that when he and his team tried to report the case, they were unable to find agencies that tracked nitrous oxide overdoses in Canada.
“This is a commercially available product that can cause serious adverse health effects, yet there isn’t a proper reporting mechanism that adequately reflects the magnitude of the potential toxicity,” says Dr. Kwok. “Our research shows very few reported cases, in part because the nitrous oxide comes from a product marketed for whipping cream and an adverse report would only be accepted if the canister itself was faulty.”
Dr. Kwok is calling for restrictive access, as well as having safeguards implemented to minimize harm. He also wants to see higher awareness in both medical staff and members of the public.
“When people present at the emergency department with unexplained neurological symptoms it’s important for clinicians to consider nitrous oxide as a possible cause,” says Dr. Kwok. “It’s also important for users to know that using this product outside a supervised medical setting can cause serious health effects.”
Polio vaccine boosters offered to kids in London as virus linked to New York case detected – ABC News
Children in London are being offered polio vaccine boosters after sewage samples with the virus were found in multiple areas across the city.
The U.K. Health Security Agency announced Wednesday that all children between ages 1 and 9 across the British capital will be eligible to receive an inactivated polio vaccine booster.
“This will ensure a high level of protection from paralysis and help reduce further spread of the virus,” the agency said in a statement.
“While the majority of Londoners are protected from polio, the [National Health Service] will shortly be contacting parents of eligible children aged 1 to 9 years old to offer them a top-up dose to ensure they have maximum protection from the virus,” Jane Clegg, chief nurse for the NHS in London, added.
There are more than 1 million children between those ages who live in London as of mid-2020, the latest year for which data is available, according to the U.K. Office of National Statistics.
Between February 8 and July 5 of this year, poliovirus has been detected in 19 sewage samples across nine boroughs including at Beckton Sewage Treatment Works in London, which is the largest sewage treatment plant in the U.K.
Recently, a report indicated a polio case in New York was genetically linked to the samples found in the U.K.
Polio vaccines are part of routine immunizations for children. In the U.S., vaccinated children are not recommended to get a booster shot at this time.
According to the UKHSA, the booster program will begin in the areas where the virus has been detected and where vaccination rates are lowest before being rolled out across the city.
“The NHS in London will contact parents when it’s their child’s turn to come forward for a booster or catch-up polio dose — parents should take up the offer as soon as possible,” the agency’s statement read.
On July 21, health officials reported a case of polio was discovered in Rockland County in New York — just north of New York City — in a 20-year-old unvaccinated man.
The man contracted vaccine-derived polio, which means he was infected by someone who received the oral polio vaccine, which is no longer used in the U.S. or the U.K.
The oral vaccine uses a live weakened virus, which — in rare cases — can spread through fecal matter and infect unvaccinated individuals. Comparatively, the injectable polio vaccine, uses an inactivated virus.
As of Aug. 5, 11 samples were genetically linked to the Rockland County patient including six samples collected in June and July from Rockland County and five samples collected in July from nearby Orange County, health department data shows.
However, health officials have said the majority of the population is not at risk for polio because most were vaccinated as part of their regular childhood immunizations, but that it’s important for those who are unvaccinated to get their shots.
The New York State Health Department told ABC News its focus would be on ensuring immunizations.
“Our current focus is to ensure unvaccinated New Yorkers and children get immunized against polio and that they are up to date with their polio immunization schedule,” the department said.
The Centers for Disease Control and Prevention is the organization in the U.S. that makes vaccine recommendations, but has not suggested any such move to add a fifth dose of polio vaccine to the current vaccine schedule underway.
The CDC did not immediately respond to a request for comment from ABC News.
The agency recently told ABC News the U.S. health agency is deploying a team to New York to investigate the case in Rockland County. The team will also administer vaccines in the county.
“These efforts include ongoing testing of wastewater samples to monitor for poliovirus and deploying a small team to New York to assist on the ground with the investigation and vaccination efforts,” the agency said in a statement.
Monkeypox: Manitoba's top doctor gives vaccine update | CTV News – CTV News Winnipeg
Manitoba will be offering more vaccination appointments for monkeypox.
A news release from the province Thursday confirmed that additional appointments will be available “soon,” but no dates were listed.
Appointments can be made online or by calling Health Links-Info Santé at 204-788-8200 or toll-free at 1-888-315-9257.
Manitoba recently expanded eligibility for the monkeypox vaccine, but on Monday, tweeted all appointments were booked.
To date, no monkeypox cases have been found in Manitoba.
Dr. Brent Roussin, Manitoba’s chief provincial public health officer, said the province has a “scarce resource” of the monkeypox vaccine.
“It has to be stored properly, and it’s scarce because there are outbreaks happening in other jurisdictions,” he said. “We want to do whatever we can to avoid any wastage.”
While infections have primarily been reported in the gay, bisexual, and other men who have sex with men (gbMSM) population, Roussin said it is important to avoid stigmatizing populations.
“There is a balance between risk communication and doing whatever we can to avoid stigmatizing those populations,” he said.
Roussin added the province will be releasing data on total monkeypox vaccines administered next week.
Canada to start testing some wastewater for polio 'as soon as possible' – CBC News
After new reports of polio cases abroad, and virus samples in the wastewater of several other developed countries, Canada intends to start testing wastewater from a number of cities “as soon as possible,” CBC News has learned.
The Public Health Agency of Canada (PHAC) already works to monitor polio activity around the world, a spokesperson said in an email response to CBC News questions.
Currently, PHAC’s National Microbiology Laboratory in Winnipeg does have the diagnostic tools available to test samples for poliovirus. Any suspected positive Canadian samples of poliovirus will be sent to that lab for further laboratory analysis and confirmation, with results shared with the respective local health authorities “so appropriate public health measures can be taken if necessary.”
According to the statement, PHAC has been communicating with national and international partners who are experts in this field to finalize a wastewater testing strategy. It will be testing wastewater samples that were collected earlier this year from “key high-risk municipalities” to determine if polio was present prior to the reported international cases.
PHAC will also be sending samples to the U.S. Centers for Disease Control and Prevention for additional confirmation.
“However, it is important to acknowledge that accurately testing wastewater for poliovirus is a developing science,” the statement continued. “For example, wastewater detections can be affected by extreme precipitation events, such as flooding in a community.”
Reports of polio in U.S., U.K., Israel
On Wednesday, British health authorities announced they will offer a polio booster dose to children aged one to nine in London, after finding evidence the virus has been spreading in multiple regions of the capital.
The agency said it was working closely with health authorities in the U.S. and Israel, as well as the World Health Organization, to investigate the links between polio viruses detected in those two countries.
In July, Israel announced a recent outbreak of polio infections appeared to be under control, after multiple people became infected, including a Jerusalem girl who was paralyzed and now requires rehabilitation, according to the Jerusalem Post.
More recently, in the state of New York, one unvaccinated young adult suffered paralysis after a polio infection in Rockland County — an area known for low vaccination rates — which marked the first case reported in the U.S. in nearly a decade.
Outbreaks also remain common in Afghanistan, Pakistan, and parts of Africa — areas of the world where vaccination efforts have not yet eradicated the virus.
Polio can often be asymptomatic, but in some cases, the viral infection can lead to paralysis or death.
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