CONTEXT: In March 2015, the Virginia Department of Health (VDH) was alerted by the Virginia Poison Center of a 6- @entity1 cluster treated for severe clinical presentations after using heroin. @entity1 ' symptoms were atypical for @entity4521 use, and concern existed that @entity1 were exposed to heroin that had been adulterated with or replaced by another substance. OBJECTIVE: To understand the extent and characterization of the outbreak and implement response measures to prevent further cases. The purpose of this report is to highlight the collaborative nature of a public health investigation among a diverse group of stakeholders. DESIGN: Active surveillance and retrospective case finding. SETTING: Richmond metro area community and hospitals. @entity1 : Regional @entity4968 centers, the Division of Consolidated Laboratory Services, the Department of Behavioral Health and Developmental Services, community partners, local law enforcement, and multiple VDH divisions. INTERVENTION: Outbreak investigation, communication to public health professionals, clinicians, and the community, and liaising with the local law enforcement. MAIN OUTCOME MEASURES: Outbreak control. RESULTS: Laboratory confirmation of @entity16959 in clinical specimens implicated it as the heroin adulterant. Thirteen @entity1 met clinical and epidemiologic criteria for exposure to @entity16959 -adulterated heroin. All @entity1 were associated with a localized area within Richmond, and @entity1 interviews elucidated heroin supplier information. VDH collaborated with local law enforcement agents who investigated and arrested the supplier, leading to cessation of the outbreak. CONCLUSION: This outbreak highlights the value of policies and practices that support an integrated outbreak response among public health practitioners, @entity4968 center staff, laboratorians, clinicians, law enforcement agents, community groups, and other agencies. Collaboration enabled implementation of effective control measures-including those outside the purview of the health department-and should be standard practice in future outbreaks involving illicit substances.

Collaborative Public Health Investigation of XXXX -Adulterated Heroin Outbreak-Richmond, Virginia, March-April 2015.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient', 'PARTICIPANTS'] @entity4521 :: ('MESH:D003932', 'Chemical') :: ['heroin'] @entity4968 :: ('MESH:D011041', 'Disease') :: ['poison'] @entity16959 :: ('MESH:D002976', 'Chemical') :: ['clenbuterol']
@entity16959 :: (MESH:D002976,Chemical) :: ['Clenbuterol']
