Public Health Update 2/25/10

Maine CDC/DHHS Public Health Update
February 25, 2010

Travel-related Disease Conditions
Maine CDC has investigated multiple cases of travel-related illness since January. During school vacation weeks in February and April, Maine residents may travel to warmer climates, which put them at risk for mosquito-borne diseases. See this health alert for information about travel-related disease conditions: http://bit.ly/ddYiJT

In addition, these two US CDC sites provide advice for relief workers, including travel guidance specific to workers traveling to Haiti: http://wwwnc.cdc.gov/travel/content/relief-workers.aspx and http://emergency.cdc.gov/disasters/earthquakes/responders.asp

US CDC Recommends Universal Annual Flu Vaccination
CDC’s Advisory Committee on Immunization Practices (ACIP) voted Feb. 24 to expand the recommendation for annual influenza vaccination to include all people aged 6 months and older, beginning in the 2010-2011 flu season. The new recommendation seeks to remove barriers to influenza immunization and signals the importance of preventing influenza across the entire population. For more information, see: http://www.cdc.gov/media/pressrel/2010/r100224.htm

The US Food and Drug Administration (FDA) and World Health Organization (WHO) have both recommended that the 2010-2011 seasonal flu vaccine include the 2009 pandemic H1N1 flu strain, along with a type A H3N2 and a type B strain. This inclusion of the 2009 pandemic strain of H1N1 will eliminate the need for two separate flu vaccines next fall. These recommendations typically guide vaccine manufacturers in preparing each season’s flu vaccines.

Please note that protection from the 2009 H1N1 flu vaccine lasts through the whole 2009-2010 season. Children younger than 10 are the only people recommended to receive two doses of H1N1 vaccine this season.

Influenza Activity in Maine and the US
H1N1 activity continues in Maine as well as across the U.S., but in more diminished levels than in November and December. Since the last update, there has been one outbreak of influenza-like illness in a long-term care facility and two hospitalizations due to H1N1 - one in adult older than 64, and an intensive care unit admission of a toddler. Maine’s weekly influenza surveillance reports can be found here: http://bit.ly/b6dCfZ

Virtually all of those hospitalized the past 2 months have not been vaccinated. Almost all are considered high-risk, yet were also not started on antiviral medicines within 48 hours of symptom onset. It is especially important for health care providers to offer vaccine to patients who are now in high risk groups that were not earlier in the season, such as women who are recently pregnant, people who are now caring for infants younger than six months-old, and infants who are now older than six months.

With more than 900,000 doses of H1N1 vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated against H1N1 flu. This includes seniors (http://bit.ly/9Py6xX), recently pregnant women (http://bit.ly/76KrZb), new parents and caregivers of infants younger than six months (http://bit.ly/5eckZK), and parents of children older than six months (http://bit.ly/7lrdRH). Children ages nine and younger need a second dose of vaccine about a month after the first dose for full immunity.

Vaccine clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.


Group A Strep Update
Maine CDC has now received 16 reports of cases of invasive Group A Streptococcal (GAS) infections since January, an increase of 3 cases since the last update.

Cases have been confirmed in Androscoggin, Cumberland, Hancock, Kennebec, Oxford, Penobscot, Somerset, and York counties in people ages 6 through 90. Nine of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), an increase of two since the last update. Five people with STSS have died.

Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year.

There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in this Maine CDC health advisory http://bit.ly/bswpU2 or this US CDC site: http://bit.ly/cP0vIl.

RSV
Several anecdotal reports indicate possible high rates of Respiratory Syncytial virus (RSV), and the percentage of positive samples tested for RSV at two reference laboratories in Maine is higher than last year at this time. RSV is not a reportable disease in Maine, so exact numbers and rates are not available.

RSV is a contagious viral disease that can lead to serious health problems—especially for young children and older adults. There is no vaccine to prevent RSV. However, there are simple ways you can protect your child or yourself from getting sick during RSV season.

People with cold-like symptoms should cover their coughs and sneezes, wash hands frequently, avoid sharing cups and utensils, and refrain from kissing. Cleaning contaminated surfaces (such as doorknobs) may help stop the spread of viruses.

Symptoms of RSV infection are similar to other respiratory infections. A person with an RSV might cough, sneeze, and have a runny nose, fever, and decrease in appetite. Wheezing may also occur. In very young infants, irritability, decreased activity, and breathing difficulties may be the only symptoms of infection. Most otherwise healthy infants infected with RSV do not need to be hospitalized.

For more information about RSV, see this US CDC web site: http://bit.ly/9mPfDi

County Health Rankings
The University of Wisconsin, with funding from the Robert Wood Johnson Foundation, issued a report titled County Health Rankings, Mobilizing Action Toward Community Health on Feb. 17. Rankings were completed in all 50 states, including Maine. Counties were ranked within states only, with no comparison between states.

The county health rankings and data are available at http://www.countyhealthrankings.org/.

The report helps identify factors that influence health in each county, including health outcomes and health factors. All counties in Maine, regardless of their ranking, have both strengths to celebrate and challenges to address.

For years, public health data have shown that many counties in Maine with lower incomes and educational attainment are less healthy. Such disparities continue to be reflected in these rankings. However, the report also shows significant variation. For instance, some counties with similar socioeconomic profiles have very different rankings for other health factors and for health outcomes, suggesting that a complex array of factors influence the health of our communities.
Maine is already working on addressing our health challenges. It is also important to note that Maine is one of the healthiest states in the nation. The 2009 America’s Health Rankings report released by the United Health Foundation ranked Maine 9th in overall health.

Several years ago, public health stakeholders worked to form a new statewide public health system that addresses health issues across the state and in every community. We continue working to strengthen this system, which includes Healthy Maine Partnerships, Maine CDC District Public Health Units, municipal health departments, local health officers, and District Coordinating Councils.

We hope the data in this report are another motivating factor for Maine people to improve their own health, as well as to become involved with the public health system to improve the overall health of their communities.

One such new resource is the Keep ME Well website, a tool produced by Maine’s public health system that individuals can use to find out how to improve health, stay well and find low cost healthcare services. The site can be accessed at http://www.keepmewell.org/.

Maine CDC has recently posted an updated compilation of comprehensive health indicators for each of Maine’s 8 public health districts, most with state and national comparisons. They can be found at: http://www.maine.gov/dhhs/boh/health_indicator_comparison.htm.

Updates from Federal Partners
• US CDC issued this Q&A about H1N1 and seasonal flu and Hispanic communities: http://www.cdc.gov/h1n1flu/qa_hispanic.htm
• This MMWR describes an outbreak of H1N1 flu on a Peruvian Navy ship in June-July 2009: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5906a3.htm?s_cid=mm5906a3_e%0d%0a
• As of Feb. 17, business associates of HIPAA covered entities must comply with, and are subject to penalties for violations of, the HIPAA Security Rule (http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/index.html).
• New requirements for notifying individuals when their protected health information is breached went into effect Feb. 22. For more information: http://bit.ly/93PXS4

How to Stay Updated
• Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”) http://www.facebook.com/pages/Augusta-ME/Maine-CDC/135584761549
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
• For clinical consultation and outbreak management guidance call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
• For general questions:
o call 2-1-1 from 8 a.m. to 8 p.m. seven days per week

Public Health Update 2/12/10

Maine CDC/DHHS Public Health Update
February 12, 2010

Influenza Activity in Maine and the US
H1N1 activity continues in Maine as well as across the U.S. but in diminished levels than in November and December. There was one outbreak of influenza like illness in a Hancock County K-12 school last week. Nationally and in Maine, virtually all of the influenza viruses identified are the 2009 pandemic strain of influenza A. More information can be obtained at: http://www.cdc.gov/flu/weekly/index.htm#whomap.

Influenza Vaccine
Sanofi Pasteur has shortened the expiration period of all of its 2009 H1N1 influenza vaccine in pre-filled syringes; all lots should now be administered by February 15, 2010 regardless of the expiration imprinted on the package. There are no safety concerns with the recalled lots of 2009 H1N1 vaccine and no re-administration of the vaccine is required. For more information, see this US CDC Q&A: http://www.cdc.gov/h1n1flu/vaccination/qa_recall.htm?s_cid=tw_flu104. Maine health care providers who have received this vaccine have been contacted directly by Maine CDC’s Immunization Program staff.

With more than 900,000 doses of H1N1 vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated against H1N1 flu. Clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Parents are reminded to ensure that children younger than 10 years-old get both doses of 2009 H1N1 vaccine. The recommended interval between the first and second dose is 28 days.

Even those not at high-risk for complications from influenza should consider vaccine, because either they themselves can suffer complications or can infect those who are at higher risk for complications. Health care providers who treat people at high risk for complications from influenza (such as those with underlying conditions, pregnant women, young children, and those older than 64) are urged to vaccinate those patients and to treat with antiviral medicines at the onset of symptoms.

Disposing of and Reporting Unused/Expired Vaccine
Health care providers who have sufficient supplies and no longer need vaccine that is being shipped to them should contact their local vaccine coordinator to arrange for redistribution. Unused or expired H1N1 vaccines may not be returned to the distributor. If vaccine cannot be redistributed prior to expiration, the health care provider is responsible for disposing of the vaccine appropriately.

For information on hazardous waste disposal in Maine, see the Biomedical Waste Management Rules (06-096 CMR 900): http://www.maine.gov/sos/cec/rules/06/096/096c900.doc and 38 MRSA Chapter 13, Waste Management: http://www.mainelegislature.org/legis/statutes/38/title38ch13sec0.html

Discarded vaccine needs to be reported to Maine CDC. Providers Please discard the expired vaccine doses as providers do with their other expired medicines and ask them to report the doses discarded on the same weekly reporting form used for vaccine administration (http://www.maine.gov/dhhs/boh/maineflu/schools/documents/Aggregate-H1N1-weekly-reporting_V3.pdf) – please note any discarded doses in the space between the two “Total” cells at the lower right corner of the form with a mark of “Expired (and discarded) doses.”

Group A Strep Update
Maine CDC has now received 13 reports of cases of invasive Group A Streptococcal (GAS) infections since January in Maine. Cases have been confirmed in Androscoggin, Cumberland, Hancock, Kennebec, Oxford, Penobscot, and York counties in people ages 6 through 90. Seven of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year.

There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in this Maine CDC health advisory http://bit.ly/bswpU2 or this US CDC site: http://bit.ly/cP0vIl.

Earthquakes and Public Health
The American Public Health Association has developed a web page with links to information about relief efforts in Haiti, which includes resources for people who are interested in volunteering: http://www.apha.org/programs/globalhealth/issues/

There are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones, such as Haiti, to assist in recovery efforts. These two US CDC sites provide advice for relief workers, including travel guidance specific to workers traveling to Haiti: http://wwwnc.cdc.gov/travel/content/relief-workers.aspx and http://emergency.cdc.gov/disasters/earthquakes/responders.asp

Updates from Federal Partners
US CDC issued an abbreviated Pandemic Influenza Plan template for primary care provider offices, which will allow providers to rapidly (within 1-5 days) develop a pandemic influenza plan: http://www2c.cdc.gov/podcasts/download.asp?af=h&f=761031

Maine Animal Rabies Fourth Quarter Update
Maine CDC provides a quarterly update on animal rabies to veterinarians and other animal health professionals, which may be used to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine. Read the update here: http://www.maine.gov/tools/whatsnew/attach.php?id=91596&an=2

To read the full update, click here: http://bit.ly/bhbbuw

Flu Vaccine Available at Basketball State Championships

Flu clinics will be held at the Maine Principal’s Association high school basketball tournament in Augusta. Clinics will be held February 16th,17th, and 18th. H1N1 (swine flu) and seasonal flu vaccine will be offered at the clinics.

“Now that plenty of vaccine is available we strongly recommend everyone get vaccinated,’’ said Dr. Dora Anne Mills, Director of the Maine CDC. “Although the H1N1 disease surge is on the decline, this virus is expected to circulate for months, if not years, to come. Now is an excellent time to get vaccinated, especially given the amount of vaccine available,” said Dr. Mills.

The clinics will be held:

Feb 17 & 18th
9 AM- 4 PM (Seasonal flu and H1N1)


Feb 16th, 17th & 18th
5:30- 7 PM (H1N1 only)


Augusta Civic Center - Penobscot Room
76 Community Drive, Augusta, Maine

People interested in receiving a vaccine should bring their insurance cards; however, the clinics are free for the uninsured.

These clinics are being provided by Public Health Nursing and Concentra.

For more information about flu, please visit: http://www.maineflu.gov or call 2-1-1 from 8 a.m. to 8 p.m.

Maine Public Health Update 2/4/10

Maine CDC/DHHS Public Health Update
February 4, 2010

Dr. Stephen Sears is our new State Epidemiologist
We at Maine CDC are extremely pleased to announce the arrival of Dr. Stephen Sears as our new State Epidemiologist. A well-known infectious disease physician with a master degree in public health, Dr. Sears is from Maine and comes to us after a career that involves hospital administration (MaineGeneral and Mercy Hospitals) as well as infectious disease and public health work. More information can be found at: http://www.maine.gov/tools/whatsnew/index.php?topic=DHS+Press+Releases&id=90686&v=cdc_article.

Influenza Activity in Maine and the US
There has been another death due to H1N1, bringing the total to 19 reported since August. This death occurred in an adult in the 25-49 age group in southern Maine. All deaths related to H1N1 in Maine have occurred among people with underlying health conditions. A total of 11 people in Maine have been hospitalized the past month with H1N1, including 4 children. Of these hospitalizations, 4 included an admission to an intensive care unit, including 1 child and 2 young adults. Only 1 of the 11 had been vaccinated at least a few days prior to illness and only 2 had received early antiviral medicines.

Nationally, influenza activity is reported to be sporadic in most states, with no states reporting widespread activity. Almost all of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception. More information can be obtained at: http://www.cdc.gov/flu/weekly/index.htm#whomap.

With over 900,000 doses of vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated with the H1N1 pandemic strain of influenza. Even those not at high-risk for complications from influenza should consider vaccine because either they can suffer complications or can become infect those who are at higher risk for complications.

Health care providers who treat people at high risk for complications from influenza (such as those with underlying conditions, pregnant women, young children, and those older than 64) are urged to vaccinate those patients and to treat with antiviral medicines at the onset of symptoms.

Vaccine can still be found in a number of public clinics, including many that are offering it for free. These can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Group A Strep Update
Maine CDC has now received 11 reports of cases of invasive Group A Streptococcal (GAS) infections seen in January in Maine. Four of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year. There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in last week’s health advisory at: www.mainepublichealth.gov or at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm.

Earthquakes and Public Health
There are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones such as Haiti to assist in recovery efforts. The US CDC’s earthquake website has helpful information for those who may be involved with the Haiti relief efforts or who are interested in improving their preparations here at home. http://www.bt.cdc.gov/disasters/earthquakes/

Feb. 7 is National Black HIV/AIDS Awareness Day. This article from the Black AIDS Institute describes the HIV/AIDS infrastructure in Haiti after the earthquake: http://www.blackaids.org/ShowArticle.aspx?articletype=SITEFEATURE&articleid=770&pagenumber=1. For more information on HIV/AIDS in Maine, become a fan of Maine CDC’s HIV, STD, and Viral Hepatitis program on Facebook: http://www.facebook.com/pages/Augusta-ME/Maine-HIV-STD-and-Viral-Hepatitis-Program/91975685100

Updates from Federal Partners
US CDC updated this Q&A about the 2009-2010 flu season: http://www.cdc.gov/flu/about/season/current-season.htm
This MMWR discusses H1N1 outbreaks in long term care facilities. There have been 11 such outbreaks in Maine, including one described in this report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5903a3.htm?s_cid=mm5903a3_e%0d%0a
A non-safety, voluntary recall of some .5 mL Sanofi Pasteur pre-filled syringe doses of H1N1 vaccine has been announced. US CDC answers common questions about the recall here: http://www.cdc.gov/h1n1flu/vaccination/qa_recall.htm Maine health care providers with this vaccine are being notified.

Check Out Our Partners on Facebook
Maine CDC: http://bit.ly/cBNhXp
Maine HIV, STD, Viral Hepatitis Program: http://bit.ly/aphqWA Maine WIC Nutrition Program: http://bit.ly/bDFndk
Portland Public Health: http://bit.ly/5bh6wj


Read the full update at : http://bit.ly/9UkoA3