Monday, April 26, 2010

Smokeless Tobacco Dangers

The Partnership for a Tobacco-free Maine (PTM) is the Maine CDC’s tobacco prevention and control program. Its mission is to reduce death and disability from tobacco use among Maine citizens by creating an environment supportive of a tobacco-free life.

Snus is a new smokeless tobacco product that can be found nationwide and is becoming more prevalent. Consumption of smokeless products has risen over the past few years as cigarette consumption has decreased.

A recent segment on 60 Minutes about snus may not have presented enough information about the harmful effects of these products, such as:

· Tobacco is tobacco. ALL tobacco is harmful. Snus is not a safe alternative to smoking. National agencies such as CDC, NCI, and NIH all recommend that any form of tobacco be avoided and discontinued.

· Maine's strong tobacco laws have been proven to discourage youth smoking and support people seeking tobacco treatment, but these new products counter our efforts. Smokers wishing to quit should be encouraged to use approved methods such as counseling, NRT, and medications.

· These products appeal especially to young people and can be a gateway to addiction. These products can be used discretely and are advertised as a way to circumvent smoke-free laws. The piece also briefly discusses the new dissolvables and how they are attractive to youth.

· Using smokeless products can, in a dual user, increase the level of addiction to nicotine. These products allow the individual who may have otherwise quit smoking to perpetuate his or her addiction to nicotine by allowing use in areas where smoking is prohibited.

· Swedish snus and U.S. snus are not the same product. They are regulated and manufactured differently. Dr. Fagerstrom discusses the Swedish form. The Swedish version contains fewer toxins than the American counterpart. Long term research on the health effects of the U.S. snus does not exist.

· Placement of advertising for new products is an issue (most signs are on convenience store entry doors below the waist high handle to become familiar and seen by children). This is not addressed in the piece.

· These are cheap products – they cost about half the price of a pack of cigarettes. Taxes on non-cigarette products have not increased at the same rate as taxes on cigarettes. Increased prices discourage initiation among youth and young adults, prompt quit attempts, and reduce consumption among current users.

· The very fact that the tobacco industry is promoting these products as a harm reduction tool should be concerning to us. Harm reduction is neither an acceptable nor ethical public health practice.

Friday, April 23, 2010

Important information on Lyme disease

A special Review Panel has unanimously agreed that no changes need be made to the 2006 Lyme disease treatment guidelines developed by the Infectious Diseases Society of America (IDSA), the nation’s pre-eminent authority on infectious diseases. These guidelines promote a short-term course of antibiotics for the treatment of Lyme disease.

IDSA’s guidelines, voluntarily used by physicians to help them decide what treatments are best and safest for patients, were the subject of an antitrust investigation about whether the guidelines’ authors had conflicts of interest and failed to consider divergent medical opinions. IDSA maintains those assertions were unfounded and voluntarily agreed to a one-time special review of the guidelines by an independent scientific Review Panel whose members were certified to be free from any conflicts of interest by an independent ombudsman.

The review panel concurred that IDSA’s guidelines, which stated that long-term antibiotic treatment is unwarranted and potentially dangerous, are medically and scientifically valid and do not need to be changed. The full report is available here.

Follow these links for more information on Lyme disease in Maine and recently signed legislation to expand Lyme disease awareness in Maine.

Update on Health Reform

The Congressional Research Service issued this 100-page report reviewing the public health, health workforce, and quality provisions in the Patient Protection and Affordable Care Act (health reform). is a comprehensive federal website on health reform, including this webpage with information on Maine. This link on the same site has information about dependent adults under age 26 being eligible for health insurance in advance of September’s start up date.

This open letter from the president and CEO of the Maine Health Access Foundation includes a summary of the health reform legislation and how it relates to Maine. It also includes links to other summaries.

Gov. Baldacci has formed a committee to work on implementing the health reforms in Maine.

Thursday, April 8, 2010

Flu Update 4/8/10

What’s New with Flu?

Flu Activity. Virtually all detected influenza activity seen across the country is with the pandemic strain of H1N1. Most states are reporting sporadic, local, or no flu activity. The full national report can be found at:

Maine’s influenza activity was coded “local” this week, mainly because of continued reports of influenza-like illness. Maine’s weekly influenza surveillance report can be found at: Maine and the U.S. continue to see virtually no seasonal influenza virus strains except for some occasional type B. Almost all the detectable influenza viruses remain the pandemic strain of H1N1 influenza.

Fall Flu Vaccine Campaign. Flu vaccine is recommended for all people for the 2010-2011 season. Although Maine CDC does not and never has provided the majority of seasonal flu vaccine in Maine, we are able to purchase sufficient seasonal flu vaccine for the 2010-2011 season for:
· all Maine children ages 6 months to 18 years-old;
· employees of schools that are providing onsite vaccine clinics on school days;
· pregnant women and their partners;
· nursing home employees and residents;
· high risk adults in limited public health settings, the scope and number of such settings determined by our vaccine supply.

The decision on which populations we plan on purchasing vaccine for is based on several factors, including: populations designated by some of the vaccine funding sources available (federal funding sources for flu vaccine for some children); populations without other easy access to vaccine (homeless shelter residents); and people who are at high risk for severe complications (pregnant women, nursing home residents). Seniors and health care workers are in high priority groups for vaccine, but generally have existing access to flu vaccine that is not dependent on state dollars.

Please note that, as in years past, the only state-supplied vaccine earmarked for health care workers is for those who work in nursing homes. However, we strongly encourage all health care personnel, including EMS, to be vaccinated.

Anyone wishing to provide state-supplied flu vaccine in the fall must be a registered Maine Immunization Program (MIP) provider; those who are not currently MIP providers must register by April 30. Vaccine order forms will be sent to all registered providers by the middle of May. More detailed instructions, including a timeline for fall flu vaccine campaign activities, are available in this Health Alert.

A conference call for those interested in providing state-supplied seasonal flu vaccine in the fall will be held from 12 noon to 1 p.m. Monday, April 12. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and to un-mute when you are actively participating.

Don’t Forget Spring Break. This US CDC web page provides information and links for travelers who want to reduce their risk of becoming sick with 2009 H1N1. With spring break coming up and large numbers of students expected to travel both domestically and internationally, vaccination of college-age students, who have been hard-hit by illness during this pandemic, continues to be recommended. Vaccine clinics can be located by calling 211 or by visiting The free clinics are in bold font.

Maine Among Top States in H1N1 Vaccine Coverage:

US CDC recently issued two reports that highlight H1N1 vaccine successes as well as opportunities to improve future vaccination rates. Maine is among the top states for vaccine coverage against H1N1 flu for all ages.

Maine’s vaccine rate for those in US CDC’s highest priority groups was tied for first place among all states at 51%, compared with the national rate of 33%. These highest priority groups include pregnant women, all people ages six months to 25 years-old, people ages 25 to 65 with chronic health conditions, and health care workers, including emergency medical services personnel.

60% of Maine’s children ages 6 months to 17 years were vaccinated, compared to 37% nationally. Maine’s childhood vaccination rate was tied for second with Vermont and Massachusetts. Rhode Island was first.

Seniors in Maine also had among the highest vaccination rates in the nation. 40% of Maine residents age 65 and older were vaccinated, which is nearly twice the national rate of 22%, and tied for first among all states.

Maine’s overall rate of vaccinating 37% of all people older than 6 months is significantly higher than the national average of 24%

We at Maine CDC are exceedingly grateful to the thousands of Mainers who worked hard to achieve such remarkable success!

Ongoing Flu Issues:

Flu activity, caused by either 2009 H1N1 or seasonal flu viruses, may rise and fall, but is expected to continue, especially in areas that did not see large surges in disease and/or did not have high vaccine rates. Testing for and reporting of cases and outbreaks to Maine CDC continue to be important strategies to track the virus’s spread.

It is still important to continue to offer the H1N1 vaccine to those at high risk for severe disease or those who are in a high priority category and who may have been missed earlier. If someone is vaccinated now, they can still receive the seasonal flu vaccine in the fall, which will contain the 2009 H1N1 strain. Those who should be focused on for ongoing H1N1 flu vaccination include:
women who are now pregnant;
infants who are now 6 months of old or older;
caregivers and household contacts of newborns and other young infants;
people 65 and older who may have been waiting for others to be vaccinated;
those with chronic diseases;
all young people ages 6 months to 25 years of age; and
all health care workers and EMS, including caregivers of people with developmental and/or physical disabilities.

In particular, US CDC strongly urges people with underlying health conditions and those over age 65 to get vaccinated against H1N1.

Vaccine supplies are plentiful and the circulating virus still closely matches the one in the pandemic vaccine. We have excellent safety data on the H1N1 vaccine.

Disposing of and Reporting Unused/Expired Vaccine
US CDC issued this Q&A on 2009 H1N1 flu vaccine with long-dated expirations. US CDC is also currently conducting a survey to determine how state laws affect the ability to ship expired vaccine for disposal. The results of this survey will help determine CDC’s centralized national system for vaccine disposal.

Discarded vaccine needs to be reported to Maine CDC. Providers should report the doses discarded on the same weekly reporting form for vaccine administration – 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.”

Health Reform

President Obama signed the Patient Protection and Affordable Care Act into law on March 23. Last week, he spoke about health reform when he visited Portland. The entire speech is available here.

This National Association of State Medicaid Directors document gives a side-by-side comparison of the different health care reform bills, while the Kaiser Family Foundation developed this summary of the final law and implementation timeline.

This Trust for America’s Health web page describes the prevention components of the final legislation.

The Association of Maternal and Child Health Programs’ Health Reform web page has a number of helpful links focused on the impact on maternal and child health programs as well as more general information.

Friday, April 2, 2010

Universal Childhood Immunization Program

LD 1408, An Act to Establish the Universal Childhood Immunization Program, has passed both chambers of the state Legislature and been signed into law by the Governor.

The program provides universal immunization coverage to children in the state by purchasing and making available to health care providers every vaccine for childhood immunization that is recommended by the US CDC’s Advisory Committee on Immunization Practices, approved by the FDA, and available under contract with US CDC.

For more information on this legislation, visit:

Thank you to the many stakeholders who worked on this bill for 4 years, and to the bill’s sponsor, Representative Connor! Updates on the bill’s implementation, including timelines, will be forthcoming.

Thursday, April 1, 2010

April is STD Awareness Month

April is STD Awareness Month. Maine CDC’s STD program conducts disease surveillance for gonorrhea, chlamydia and syphilis. Disease intervention specialists provide critical follow-up activities, including notification of disease; treatment verification for chlamydia, gonorrhea, syphilis and HIV; and partner services for all.

The HIV, STD and Viral Hepatitis Program funds STD clinics in Portland, Bangor, and Lewiston, and partners with the Family Planning Association of Maine and Planned Parenthood of Northern New England on the Infertility Prevention Project, which targets females 15-24 years-old and their partners.

Chlamydia is the most frequently reported STD in Maine, with 2,443 cases in 2009. Chlamydia disproportionately affects individuals in the 15-24 age group, and is reported in three females for every one male.

Gonorrhea typically affects a slightly older age range than Chlamydia, but during 2008 and 2009 nearly half of diagnoses occurred in the 15-24 age range, while less than a quarter were 25-29 years-old. There were 143 cases of gonorrhea reported in 2009, and 60 cases have already been reported in the first three months of 2010. We are seeing more cases among females and fewer diagnoses among men who have sex with men (MSM).

Over the past decade, annual syphilis counts have varied and until recent years had remained low, with fewer than 5 cases during most years. Cases counts peaked in 2008, with 20 cases, compared to 14 last year. Syphilis in Maine affects MSM disproportionately.

For more information about National STD Awareness month visit: or

April is Autism Awareness Month

US HHS Secretary Kathleen Sebelius issued this statement on National Autism Awareness month. This video shows the signs of autism. US CDC’s Study to Explore Early Development (SEED) is the largest collaborative scientific study to date of the risk factors of autism.

This web site discusses the purported link between vaccines and autism. For more information, see our Thimerosal fact sheet and presentation.