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During March-July 2018, the Illinois Department of Public Health responded to an acute outbreak of severe coagulopathy among patients with recent synthetic cannabinoid use. Toxicological testing indicated that cases were exposed to brodifacoum, a long-acting anticoagulant rodenticide. A total of 174 confirmed and probable cases, including 5 deaths, were linked to this outbreak. On the basis of the experience of responding to this complex outbreak, we recommend several steps for consideration to improve health department preparation for acute outbreaks involving illicit substances including strengthening communication between public health and law enforcement agencies, reviewing legal authority to investigate noninfectious acute disease outbreaks, continuing strong partnerships with state poison control centers, partnering with substance abuse and mental health agencies to provide services to patients, and determining health department ability to rapidly enter into public-private partnership agreements.

Objectives: There is no pesticide related illness (PRI) surveillance program in Illinois. This study examines the quality of state-based data sources for their ability to inform public health surveillance on PRI., Methods: We estimated the counts of PRI by probabilistic data linkage of hospital discharge, emergency department, and poison center databases from 2010 to 2015. We characterized identified PRI cases., Results: We identified 3867 unique cases of PRI and 6269 asymptomatic pesticide exposures. Out of the 3867 PRI cases, there were 1319 emergency department visits and 321 hospitalizations. We identified 13 deaths and 1640 major or moderate effects from PRI. Over half of ingestion related exposures occurred in children aged 0 to 4 years. Workers' compensation and Emergency Medical Service data were unusable., Conclusion: An effective public health surveillance on PRI requires reliable state data sources and cost-effective methods of assembling data from multiple sources.

Competing Interests: No conflicts of interest were reported.

Objectives: We sought to describe the demographics and trends of Coricidin product abuse in children in Illinois and to calculate an approximate total charge to the health-care system., Methods: In this retrospective database review, we identified 652 cases of intentional exposure to Coricidin products among children < 18 years old in the Illinois Poison Center database from 2001 to 2006. Demographic, historical, clinical, and outcome data were recorded., Results: The mean (standard deviation) age was 15.7 (1.58) years. A significant increase in exposures occurred during the study period which showed a cyclic nature with peaks in the fall months. Of the patients with disposition data available, 28.6% were admitted to a critical care unit, 15.2% to a noncritical care hospital unit, 6.3% were admitted for inpatient psychiatric care, and 46.4% were evaluated in the emergency department and discharged home. Moderate or major outcomes were reported in 42.7% of cases in which data were available. No deaths were reported. The total approximate hospital charge was $2,119,881.90 or $353,313.65/year., Conclusions: Intentional abuse of Coricidin products reported to the poison center occurred primarily among adolescents and was often associated with significant short-term clinical effects and a clear financial burden to the health-care system., Scientific Significance: This investigation demonstrates that Coricidin product abuse continues to be a problem particularly among adolescents. Parents and clinicians need to continue to be aware of these substances as drugs of abuse and curbing sales to adolescents should be considered.