News from the districts - Downeast

The Downeast Public Health Council identified three primary priorities and one secondary priority for their three-year district public health improvement plan. The council then funded incubator-style proposals to offer smaller amounts of funding to meet specific objectives and outcomes, allowing many district partners to develop pilot projects.

The council funded seventeen projects from February-June 2017. Two of these focused on an assessment of physical activity work in each county and then developing a pilot project. In Washington County, the project was initiating more bicycle mobility and having access to bicycles and safety equipment as well as learning how to maintain a bicycle.

In Hancock County, the project mapped walking trails and neighborhood walks, imprinted them on postcards, and provided smart phone capability in connecting people to these walking sites.

The council also provided a stipend for a Hanley Leadership undergraduate intern to work with district partners on developing a lung cancer outreach campaign.

Early start to flu season in Maine

The flu has officially arrived in Maine for the 2017-2018 season. U.S. CDC recommends a yearly flu vaccine as the first and most important step in protecting against flu viruses. Vaccine for the 2017-2018 flu season has been updated to better match circulating flu viruses.

Disease Surveillance and Reporting

Maine CDC is hosting a “Start of the 2017-18 Influenza Season” conference call at 1:00 p.m. Thursday, September 28. The intent of this call is to provide updates for the season, outline resources available, and remind facilities of the requirements for the flu season. This call is particularly relevant for: infection practitioners, providers, laboratorians, employee health, emergency preparedness, hospital administration, and long term care facilities. Talking points will be distributed after the call, as well as questions and information highlighted on the call.

Lines may be limited, so if multiple people from one location intend to call in, please call in together.

Call in number:  877-455-0244 Code:  6681820529#

For up-to-date information and recommendations on influenza for health professionals, go to http://www.cdc.gov/flu/professionals

For influenza surveillance information in Maine, go to www.maineflu.gov.

2017-2018 Vaccine Information for Providers

Children younger than eight who have never received flu vaccine will need a booster dose no less than 28 days after the first dose of flu vaccine.

Vaccine is open for ordering. Limited supplies of multi-dose vials are available. If interested in ordering multi-dose vials, please call vaccine management at 287-3347.

Influenza vaccine ordered for the 2017/2018 season IS subject to replacement for preventable wastage.

Children under the age of 19 only are eligible for vaccine through the Maine Immunization Program. Repeated fraudulent administration of this public vaccine to individuals 19 years and older will result in a referral to CMS for fraud investigation.

Under Maine statute, all doses of public vaccine administered must be recorded in the Immunization Registry within five working days.

Ordering guidelines:

• 2017 Provider Agreement must be active
• Temperatures and inventory reconciliation must be up to date
• Order only a supply anticipated to be utilized in the next six-week time period

VFC eligibility screening is mandatory for every child and every vaccine. Eligibility screening must be documented in the ImmPact registry.

• Under 19 years of age
• Medicaid
• Uninsured
• American Indian/Alaska Native

Privately insured children do receive public vaccine; however, they must be documented as Not VFC Eligible in ImmPact.

Knowledge, understanding, and support can save lives

From September 10-16, Maine joins the rest of the United States and the international community in recognizing World Suicide Prevention Week.  World Suicide Prevention Week is an opportunity to learn about the role that all of us can play in preventing suicide and commit to supporting the mental health of our family, friends, and communities.

In 2015, 235 Mainers died by suicide, making suicide was the second-leading cause of death for Maine youth and young adults between the ages of 15-34. Every suicide death or suicide attempt has a ripple effect that stretches far beyond the individual and their family, affecting schools, workplaces, and entire communities. Few of us remain untouched.

But there is good news: suicide is preventable. This year’s theme for World Suicide Prevention Week is “Take a minute, save a life,” reminding us that even small actions can have a big impact on the lives of those who may be struggling. If you suspect someone you know may be at risk of suicide, follow these steps:

1. Show you care by listening carefully and without judgment.
2. Ask them if they are thinking about suicide. Be direct and empathetic. (Asking about suicide does not increase the risk of suicide.)
3. Stay with them (or have another caring person stay with them) while you locate help.
4. Call the Maine Crisis Hotline (1-888-568-1112) or the National Suicide Prevention Lifeline (1-800-273-8255).
5. If the person is at immediate risk of harming themselves, call 911.

If you would like to learn more about how you can help prevent suicide in your community or workplace, we invite you to attend one of the many training sessions offered in partnership with the Maine Suicide Prevention Program.  For more information, please contact Sheila Nelson at 207-287-3856 or sheila.nelson@maine.gov, or visit the Maine Suicide Prevention Program training website: http://www.namimaine.org/?page=TrainingCalendar.

Preparedness in the Downeast district

The Downeast District continues to build strong relationships with our emergency preparedness partners through active participation in tabletop exercises.

Bar Harbor Airport held a full-scale airplane in the water scenario with the district liaison working in the Emergency Operation Center (EOC) for the event.

Castine conducted a table top exercise around a hurricane-type event that caused road closures to the peninsula and subsequent damage and contamination to the local drinking water infrastructure. Maine CDC staff provided consultation on boil order procedures and drinking water protocols for home owners and food establishments.

Although not as high a public health concern, both Gouldsboro and Bucksport reviewed their emergency operations plans around dammed waterways and then conducted table top exercises around high precipitation events, causing breaching and damage to the dams and potential flooding impacts on residences, roads, and infrastructure.

All in all, these were great opportunities for regional public health and public safety working with local communities to better prepare for potential realistic emergencies. 

Disasters don’t plan ahead. You can.

September is National Preparedness Month. Maine CDC’s Public Health Emergency and Response (PHEP) team provides oversight and coordination of all public health and medical response and recovery resources that are required to reduce and/or prevent loss of life from an infectious disease outbreak, a natural disaster, or an act of terrorism. This is accomplished by activating and staffing the Public Health Emergency Operations Center, which is the central nervous system for all response and recovery activities being conducted by public health and healthcare responders.

In between public health emergencies, the PHEP program is busy preparing for the next emergency by updating emergency operations plans based on lessons learned, facilitating the identification and prioritization of public health threats, facilitating incident management training, developing and facilitating response exercises among with partners statewide, managing response equipment and supply caches, rotating and distributing medical countermeasures, testing emergency communications equipment, and recruiting medical volunteers.

In the past year, the Maine Responds coordinator has recruited 564 medical volunteers, bringing our total number of deployable volunteers to more than 900 individuals. PHEP has developed six new Medical Reserve Corps Units; there is now one in each of the eight public health districts. The Maine Health Alert Network has the highest enrollment numbers (n=15,000) since implementing the HAN system in 2007. PHEP also increased operational ability to safely transport highly infectious disease patients to specialized healthcare facilities to receive appropriate and specialized care. 

Maine Cancer Registry Recognized

Maine CDC's cancer registry has again been recognized as a Registry of Excellence by U.S. CDC's National Program of Cancer Registries (NPCR) for its high quality data for cancer prevention and control activities.

The North American Association of Central Cancer Registries has recognized Maine's cancer registry for meeting its Gold Standard on quality, completeness and timeliness of data every year since 2004.

Study Shows Effects of Heat on Health, Prompts Changes to Local Advisories

A new study of heat and health shows that hospital emergency department visits and deaths from all causes in Maine, New Hampshire, and Rhode Island increased significantly, by 7.5 and 5.1 percent respectively, on days when the heat index reached 95 degrees as compared to days with a maximum heat index of 75 degrees.

Based on the study findings, the National Weather Service (NWS) Northeast Region forecast offices will now issue heat advisories when the heat index is forecast to reach 95 degrees on two or more consecutive days or 100 degrees for any amount of time. The previous NWS regional threshold was a maximum daily heat index of 100.

In Maine, the results of the study and the NWS policy change are driving public health officials to develop local heat response plans. In 2015, Cumberland County was the first area in Maine to develop a comprehensive plan to identify what state and local officials will do during different hot weather scenarios. In addition, Maine CDC will begin issuing health warnings for the public at the lower threshold adopted by the NWS.

The study, “Heat-related morbidity and mortality in New England: Evidence for local policy,” was published in the journal Environmental Research and led by Gregory Wellenius of the Brown University School of Public Health, and co-authored by Andrew Smith and Rebecca Lincoln of the Maine CDC, along with colleagues from the state public health agencies in New Hampshire and Rhode Island.

For More Information:

• Information about preventing and recognizing heat illness: http://www.maine.gov/dhhs/mecdc/environmental-health/heat/index.html
• Data about heat illness in Maine: http://data.mainepublichealth.gov/tracking 

Change to Rulemaking Notification

Maine CDC has a new way to communicate about agency rulemaking with its updated Maine CDC Rules webpage.

Interested parties may sign up to receive updates on specific topics:  

• Disease Management (includes health data and reporting, disease detection and prevention programs, mortality review, etc.)
• Environmental/Public Health (includes radon, tanning facilities, child lead poisoning prevention, public water systems and health, environmental testing laboratory, etc.)
• Healthcare Access/Sustainability (includes Certificate of Need, designating underserved areas,  free care guidelines, etc.) 
• Infectious Diseases (includes immunizations, epidemiology, notifiable diseases, etc.)
• Licensing, Certification and Professional Standards (includes licensed medical facilities, services and professionals, health inspections, licensed body artists, child care licensing, eating and lodging places, campgrounds, medical marijuana, tobacco licensing, etc.)
• Maternal Health and Family and Children (includes child/newborn screening and testing, children with special needs, WIC, out-of-home investigations for reports of child abuse and neglect, etc.)
• Vital Records (includes birth, death, marriage, data release, etc.) 

To subscribe to these and more topics, visit our subscription page. 

Poster Contest Winners Selected

 

Congratulations to the 2017 Lyme Disease Awareness Month poster contest winners. Winning entries are posted at www.maine.gov/lyme

The winners from Maine CDC’s 8th annual Lyme Disease Awareness Month poster contest were:

• Lylah Shanz, 1st grade, Stratton School
• Allison Hanscom, 3rd grade, Miles Lane School
• Jayvin Saint Louis, 4/5 grade, Spruce Mountain Elementary School
• Emily Seavey, 6th grade, Lyman Middle School

2017 Honorable mentions:

• Kenzi Jo Richards, 4/5 grade, Spruce Mountain Elementary School
• Noah Koenig, 7th grade, Stratton School

Winning entries are posted at www.maine.gov/lyme

News from the Districts - Penquis

The Bangor International Airport conducted its tri-annual airport disaster drill on May 16. The Federal Aviation Administration requires airports across the country to conduct full-scale disaster exercises once every three years. The exercise is usually designed around a mass causality scenario. The Northeastern Maine Regional Healthcare Coalition, 26 health care and behavioral health partners, participated in the drill as well as Maine CDC’s District Public Health Liaisons and the director of Disaster Behavioral Health. Maine CDC staff was assigned in different roles including as observers, evaluators, and debriefing throughout the exercise.

One of the elements of the exercise involved moving behavioral health patients from emergency departments to behavioral health care facilities. This involved new health care partners in the behavioral health care sector that have not participated in a drill of this scale in the past. The long term care and home health partners tested new plans to assist with decompressing hospitals during time of medical surge.

The participants in the exercise then attended a ‘Hot Wash’ that illustrated strengths and weaknesses that were observed by the evaluators. There were many lessons learned and captured to assist in future development of disaster plans.

Syphilis cases on the rise in U.S. and Maine

U.S. CDC has launched a new campaign - Syphilis Strikes Back - to raise awareness about recent increases in the number and rate of syphilis cases. In 2015, the United States experienced the highest number and rate of reported primary and secondary syphilis cases in more than 20 years.

Forty-nine cases of primary, secondary, and early latent syphilis were reported to Maine CDC in 2015, which represents a significant increase over the five-year median of 19 cases.  

In 2015, the statewide syphilis rate was 3.7 per 100,000. Rates were highest in Somerset and Cumberland counties, with rates of 11.7 per 100,000 and 9 per 100,000 respectively.

Of the reported cases, 61 percent were diagnosed in southern Maine (26 cases in Cumberland County, four cases in York County) and 22 percent of cases were diagnosed in central Maine (Kennebec and Somerset counties).

Most of the cases (76 percent) were among 25 – 54-year-olds. Since 2011, the proportion of syphilis cases in people age 40 and older has been increasing steadily from 30 percent in 2011 to 47 percent in 2015.

The majority of syphilis cases identified as male (41 cases or 82 percent). The number of early syphilis cases among females rose from one reported case in 2011 to nine reported cases in 2015. 

The predominant mode of transmission associated with reported syphilis cases was male-to-male sexual contact (32 cases or 65 percent).

There were 48 cases of syphilis reported to Maine CDC in 2016, but analyses of the 2016 data are not yet complete.

For more information about syphilis, visit https://www.cdc.gov/std/sam/2017syphilis.htm

News from the districts - Midcoast

The Midcoast Public Health District serves Waldo, Lincoln, Knox, and Sagadahoc counties. The population is as diverse as its geography, which includes farmland, coastal villages, urban centers, and year-round island communities.

The Midcoast District Coordinating Council has developed a District Public Health Improvement Plan (DPHIP) and identified priority areas of focus: lead exposure in one- and two-year-olds, improving youth and adult mental health, and fighting obesity and the impact of chronic disease by increasing public use of existing low or no cost physical activity resources.  Over the last several months, Council members have volunteered innumerable hours developing goals, objectives, and strategies to best address these priorities.

Volunteerism is also a key element as the Midcoast District launches its Medical Reserve Corps (MRC) Unit in collaboration with Maine Responds.  MRC unit members are medical and non-medical volunteers who may be called upon in times of a public health emergency for staffing alternate medical care sites, providing vaccinations, or distributing medications at a Point of Dispensing (POD). We look forward to developing the Midcoast MRC Unit in support of public health emergency preparedness in our District.

Nutrition is an important part of public health

During National Nutrition Month, we recognize the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which is funded by the USDA Food and Nutrition Services. WIC provides checks for supplemental foods, health care and social service referrals, breastfeeding promotion and support and nutrition education to low-income and nutritionally at risk, pregnant, post-partum and breastfeeding women, and to infants and children up to age five.

Studies have shown the WIC Program has a positive impact in the following health outcomes:

• Reducing premature births 
• Reducing low and very low birth-weight babies 
• Reducing fetal and infant deaths 
• Reducing the incidence of low-iron anemia 
• Increasing access to prenatal care earlier in pregnancy 
• Increasing pregnant women’s consumption of key nutrients such as iron, protein, calcium, and Vitamins A and C 
• Increasing immunization rates 
• Improving diet quality 
• Increasing access to regular health care 

In Maine, WIC local agency clinic services are contracted statewide in each of the eight public health districts. Clinic services include: program eligibility, income verification, nutrition assessment and education, breast feeding education, hemoglobin screening, anthropometrics, referrals, and checks for healthy foods.

The average monthly participation in Maine is approximately 20,000. The projected cost of food per participant for federal fiscal year 2016 is $59.45 per month. More than three-quarters of women who accessed the program in federal fiscal year 2016 initiated breastfeeding, with more than one-third breastfeeding longer than three months and more than one-quarter breastfeeding longer than six months. More than 16 percent of WIC children ages two through five who had been overweight are now at a healthy weight.

Maine CDC Coordinator Highlights the Importance of Radon Action Month

January is National Radon Action Month. Bob Stilwell, primary radon contact for the State of Maine since November 1990, answered some questions about radon and the health risks associated with it. 

Why is radon an important public health issue?

Radon is a proven human carcinogen, recognized by the U.S. EPA and U.S. Surgeon General as the number two cause of lung cancer overall and the leading cause of lung cancer in nonsmokers. The World Health Organization and International Atomic Energy Agency recognize radon as a serious radiation hazard that causes lung cancer and are taking steps to assist member nations in developing policies and programs to reduce radon exposure.

What are the most important things you do in your role as State Radon Coordinator?

1. Provide technical assistance and training to the radon industry in Maine, so the services they provide are durable and effective at reducing radon exposure to Maine residents.

2. Apply for and manage Federal grants every year that allow the radon effort in Maine to continue. All Maine state radon work has been funded by federal grants since 1990.

What do you wish everybody knew about radon?

I wish everyone knew that the “action level” of 4 picoCuries per liter (pCi/l) for radon is not a “safe” or “acceptable” level. The action level for radon was set in the 1970s based on the ability of technology at that time to reduce radon levels in buildings.  At that time, technology could reduce radon to below 4 pCi/l in any building. If radon were treated like all other proven human carcinogens, with the “action” level set based on cancer risk instead of on 1970s mitigation technology, the “action” level would be less than one pCi/l.

For more information about radon, visit http://www.maine.gov/dhhs/mecdc/environmental-health/rad/radon/hp-radon.htm

News from the districts - Central

An important role of the Central District Coordinating Council (DCC) - and all DCCs - is to develop and implement a district public health improvement plan. District public health improvement plans have three purposes: (1) improve health of district residents, (2) improve the district public health system, and (3) inform the State Health Improvement Plan.

The Central DCC has worked this fall to review data and choose priorities for the 2016-19 plan and asked the hospitals and health systems in the district to present their newly-chosen strategic priorities to see where we can work together.

Priorities selected for 2016-19 are substance use/mental health, adverse childhood experiences, obesity, and oral health.  We are currently forming workgroups for each of these priority areas to review the evidence base for district improvement action and recommend strategies that will make a difference in the health of district residents.

Contact Paula Thomson at paula.thomson@maine.gov with questions or for more information.

January is National Birth Defects Prevention Month

Birth defects affect one in every 33 babies born in the United States and are a leading cause of infant mortality. Babies who survive and live with birth defects are at an increased risk for developing many lifelong physical, cognitive, and social challenges. 

Although not all birth defects can be prevented, all women who could become pregnant or are pregnant can lower their risk of having babies with birth defects by following some basic health guidelines throughout their reproductive years, such as:

• Do not eat raw or runny eggs or raw sprouts.
• Avoid unpasteurized (raw) milk and cheese and other foods made from them.
• Talk to your health care provider about what you can do to prevent infections like Zika virus.
• Make sure that you are up-to-date with vaccinations before getting pregnant.
• Talk to your health care provider about vaccinations that you should receive during pregnancy.
• Stay away from wild or pet rodents, live poultry, lizards and turtles, and do not clean cat litter boxes while pregnant.
• When mosquitoes and ticks are active, wear long-sleeved shirts and long pants when outside.
• Use Environmental Protection Agency-registered insect repellents.
• Wash your hands often with soap and water.

The United States Public Health Service recommends that all women of childbearing age consume 400 micrograms (400mcg or .4mg) of folic acid daily to prevent up to 50-70 percent of neural tube defects, such as spina bifida and anencephaly.

For more information, visit http://www.maine.gov/dhhs/mecdc/population-health/mch/cshn/birth-defects/index.html

Know the Risk Factors and Signs of Diabetes

Maine CDC has estimated that 7.8 percent of the adult population in Maine is living with pre-diabetes and 9.5 percent is living with diabetes. November is Diabetes Awareness Month, which serves as a reminder to everyone about the risk factors and cautions related to pre-diabetes and diabetes.

What is Pre-diabetes?

Pre-diabetes is when a person’s blood glucose (blood sugar) levels are higher than normal, but are not high enough to be diagnosed as diabetes. One in three adults in the U.S. has pre-diabetes and most of them don’t know it. Some of the risk factors for developing pre-diabetes are: adults who are over the age of 45, adults who are not physically active and adults with high blood pressure. Without making lifestyle changes, 15-30 percent will develop type 2 diabetes within 5 years. Making some simple lifestyle changes, including: eating healthier, losing weight and being more active make it possible to prevent or delay pre-diabetes from progressing into type 2 diabetes.

For more information visit the Maine National Diabetes Prevention Program information portal at: www.ReThinkDiabetes.org or speak to your doctor to see if you are at risk of pre-diabetes.

What is Diabetes?

Diabetes is a disease that causes high levels of glucose in the blood because insulin is not functioning correctly in the body.

• Type 1 diabetes is usually diagnosed in youth and young adults. The cause is unknown and cannot be prevented, but it can be managed through insulin therapy and living a healthy lifestyle.
• Type 2 diabetes accounts for 90-95 percent of all diagnosed cases of diabetes. Type 2 diabetes can be controlled with healthy eating and exercise. 

Steps to Encourage Diabetes Management

1. Managing diabetes is not easy, but it can be done with proper education and support. Take small steps to stay healthy. You don’t have to make big lifestyle changes all at once. Set realistic goals on what’s important to you.
2. Early self-management education and support is important to prevent diabetes-related health problems.  When blood glucose is not in control, it can lead to serious complications.  
3. Managing diabetes is a team effort. Diabetes can be overwhelming. Having a network of support from family, friends and your health care team, can help you stay on track.

To find a Diabetes Self-Management Training program in Maine to help support you in your self-management planning visit:

http://www.maine.gov/dhhs/mecdc/population-health/dcp/educationprogram.htm

For More Information

• http://www.cdc.gov/
• http://www.diabetes.org/
• http://rethinkdiabetes.org/
• https://www.niddk.nih.gov/

News from the Districts - Western

The Western District Coordinating Council recently brought together district partners from a variety of sectors (law enforcement, legislature, health care, community providers, etc.) to share ideas and solutions to address this growing opioid problem.

One of the highlights of this forum was a back to work program that has been implemented in Oxford County. A significant part of the Western Maine Addiction Recovery Initiative is Project Save ME, where people who are in active substance use can go to any police department in Oxford County and ask for help.

Many aspects of Project Save ME have contributed to its success, including trained recovery coaches, area social service agencies and a partnership with C.N. Brown. Early on, C.N. Brown noticed that substance use disorder was affecting their business and employees and decided to be a part of the solution. Those who enter into Project Save ME and get into recovery have the potential to be an employee of C. N. Brown. Individuals who have reached six months of recovery and received a letter of recommendation from their counseling can get help with getting a job at a local Big Apple store.

The liaison between the Western Maine Addiction Recovery Initiative and C. N. Brown has talked about how positive the partnership has been and a willingness to reach out to other businesses to bring more potential employment options to Project Save ME. The Western DCC is looking forward to extending the project to the other two counties in the district as well.

Changes to Maine's Childhood Lead Poisoning Law

In September, Maine CDC began implementing changes to Maine’s law that requires lead hazard inspections in the homes of children with lead poisoning. The amendments changed the State’s definition of lead poisoning to a blood lead level of five micrograms per deciliter (5 ug/dL) or higher for children younger than age six, which is also U.S. CDC’s definition of an elevated blood lead level.

With the changes, Maine CDC expects to inspect about 500 rental units for lead hazards each year—a five-fold increase in the number of units over previous years. These inspections, along with a primary prevention strategy underway in Maine communities with the highest burdens of lead poisoning, make up Maine CDC’s efforts to eradicate childhood lead poisoning.

What can you do to prevent lead poisoning?

• Public Health Professionals: Learn about lead poisoning in your community on the Maine Tracking Network. Work with municipalities to address lead hazards in rental properties through code enforcement or outreach to property owners. Promote screening and home lead dust testing among parents.
• Providers: Make sure your practice is following Maine CDC’s screening and confirmation testing guidelines – Maine CDC initiates an inspection of a child’s home environment for venous blood lead test results of 5 ug/dL or higher.
• Property Owners: Regularly maintain painted surfaces in properties built before 1978 – find out more.
• Parents: Talk to your child’s doctor about a blood lead test and find out if you have lead dust in your home with a free kit from the Maine CDC – order online at maine.gov/healthyhomes.

FYI: October 23-29 is National Lead Poisoning Prevention Week – see our webpage for resources you can use to promote lead poisoning prevention.

News from the Districts - Cumberland

Whether it’s about levels of lead in drinking water at Yarmouth schools or concerns about well water levels on Long Island, Local Health Officers in Cumberland Public Health District are fielding questions about water quality and safety in their communities. Cumberland County was also recently included in the areas in Maine affected by drought, according to assessments of the State Drought Task Force.

Maine CDC and the Cumberland County Emergency Management Agency partnered to organize an information and outreach session on water issues for Local Health Officers on Tuesday. David Braley, Senior Environmental Hydrogeologist with the Maine CDC Drinking Water Program, and Mike Koza from the Portland Water District, presented.

The event was the first in a series of information and networking meetings aimed at strengthening relationships and support between Maine CDC, Cumberland Emergency Management Agency and Local Health Officers in Cumberland, many of whom are volunteers.