title: Using Syndromic Surveillance to Investigate Tattoo-Related Skin Infections in New York City.
abstract: In response to two isolated cases of Mycobacterium chelonae infections in tattoo recipients where tap water was used to dilute ink, the New York City (NYC) Department of Health and Mental Hygiene conducted an investigation using Emergency Department (ED) syndromic surveillance to assess whether an outbreak was occuring. ED visits with chief complaints containing the key word "tattoo" from November 1, 2012 to March 18, 2013 were selected for study. NYC laboratories were also contacted and asked to report skin or soft tissue cultures in tattoo recipients that were positive for non-tuberculosis mycobacterial infection (NTM). Thirty-one TREDV were identified and 14 (45%) were interviewed to determine if a NTM was the cause for the visit. One ED visit met the case definition and was referred to a dermatologist. This individual was negative for NTM. No tattoo-associated NTM cases were reported by NYC laboratories. ED syndromic surveillance was utilized to investigate a non-reportable condition for which no other data source existed. The results were reassuring that an outbreak of NTM in tattoo recipients was not occurring. In response to concerns about potential NTM infections, the department sent a letter to all licensed tattoo artists advising them not to dilute tattoo ink with tap water.
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, United States of America; New York University, New York, New York, United States of America.
authors.forename: Mollie
authors.initials: M
authors.lastname: Kotzen
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, United States of America.
authors.forename: Jessica
authors.initials: J
authors.lastname: Sell
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, United States of America.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Mathes
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, United States of America; Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Catherine
authors.initials: C
authors.lastname: Dentinger
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, United States of America.
authors.forename: Lillian
authors.initials: L
authors.lastname: Lee
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, United States of America.
authors.forename: Corinne
authors.initials: C
authors.lastname: Schiff
authors.affiliation: New York City Department of Health and Mental Hygiene, Queens, New York, United States of America.
authors.forename: Don
authors.initials: D
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D062665:Epidemiological Monitoring; D005260:Female; D005618:Fresh Water / Q000382:microbiology*; D006801:Humans; D007281:Ink; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000382:microbiology; D016926:Mycobacterium chelonae / Q000302:isolation & purification; D009519:New York City / Q000453:epidemiology; D011159:Population Surveillance; D012867:Skin / Q000382:microbiology / Q000473:pathology; D012874:Skin Diseases, Infectious / Q000453:epidemiology* / Q000382:microbiology; D011795:Surveys and Questionnaires; D013653:Tattooing / Q000009:adverse effects*; D055815:Young Adult