2011 County Health Rankings

Hancock County has the healthiest residents in Maine and Oxford County remains the least healthy county in the state, according to the second annual County Health Rankings, released today by the University of Wisconsin Population Health Institute with funding from the Robert Wood Johnson Foundation. According to the Rankings, residents of Oxford County are more likely to die a premature death than those in Hancock County.

Rankings were completed in all 50 states, including Maine. Counties were ranked within states only, with no comparison between states. Full Maine rankings are available at: http://www.countyhealthrankings.org/maine/downloads-and-links

The report helps identify factors that influence health in each county. 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 health factors and outcomes, suggesting that a complex array of factors influences the health of our communities.

Although some of our counties have better health outcomes than others, it is important to note that overall Maine is one of the healthiest states in the nation. Maine ranked as the 8th healthiest state in the country for 2010 by the United Health Foundation’s America’s Health Rankings. Maine also ranks 4th overall for child health in a new Commonwealth Fund state-by-state scorecard. These positive state rankings reflect a concerted effort to address health challenges through collaboration of a variety of public health stakeholders at the local, regional and state levels.

Maine’s public health system is charged with using a variety of data sources, including rankings such as these, to improve the health of all communities in Maine. Significant health improvement planning efforts are underway at the local, district, and state levels.

The University of Wisconsin also provided District Rankings this year to coincide with the 8 geographic public health districts in the state. In the District Rankings, Cumberland is the healthiest district and Aroostook is least healthy

Influenza Update

There were four new outbreaks of influenza in the week ending March 19, compared with nine the previous week. There has been one pediatric influenza-associated death reported from York in a vaccinated child. Flu continues to be widespread in Maine.

Vaccination is still recommended for those who have not been vaccinated this season. One flu vaccine is protective for the entire flu season, and a second dose is not recommended for adults, even if they were vaccinated early in the fall.

Two doses of flu vaccine are only recommended for young children who have never been vaccinated before. Children younger than 9 who have never had a seasonal flu vaccine should receive two doses, spaced at least 4 weeks apart.

Weekly updates on flu activity are available

• For Maine
  
• For the US
  
• For the world
  

World Water Day

World Water Day is held every year on March 22 to highlight the importance of the availability of clean freshwater and the key role that water plays around the world.

This year’s theme is “Water for Cities: Responding to the Urban Challenge,” designed to bring awareness to the rapid growth of the world’s population in urban areas and the increasing demand for clean freshwater.

In Maine, we are fortunate to have abundant, clean, and safe drinking water. However, in many parts of the world, access to safe, clean water is scarce. According to UNICEF estimates, over 884 million people lack access to safe drinking water worldwide.

If you have a private well, make sure you know your well is safe. Test your water. For more information on testing your well, visit http://wellwater.maine.gov.

For information on public water systems in Maine, visit the Maine CDC Drinking Water Program.

Natural Disasters and Public Health

There are many public health concerns as a result of natural disasters, such as the recent earthquakes and tsunami. The US CDC’s natural disasters website has helpful information for those who may be involved with relief efforts or who are interested in improving their preparations here at home.

Radiation concerns

Maine CDC's Radiation Control Program is following events in Japan closely. Several federal agencies with expertise in radiation control are closely monitoring the problems occurring at the nuclear power plant in Japan including the Nuclear Regulatory Commission, Environmental Protection Agency, Department of Energy, and the Department of Homeland Security Federal Emergency Management Agency.

While no radiation from Japan has been detected in the United States, and it is presently unlikely that any will be, we will continue to closely monitor the situation as it continues to unfold. There are three separate air sampler stations located in Orono, Augusta, and Portland that monitor ambient air regularly. These samplers would detect any unusual levels of radiation in the air. Further updates will be forthcoming.

Maine CDC's Radiation Control Program has posted frequently asked questions about Japan and radiation and information about Potassium Iodide.

UPDATE: A web site with various federal resources and information has been established at http://www.usa.gov/Japan2011.shtml

National Women and Girls HIV/AIDS Awareness Day

Tomorrow is National Women and Girls HIV/AIDS Awareness Day, which is coordinated by the national Office on Women's Health. Women make up a quarter of all new HIV infections in Maine. Every 35 minutes, a woman tests positive for HIV in the US. In 2010, 20% of people accessing HIV medical case management in Maine were women.

Women have unique issues and special challenges that make it harder for them to prevent HIV or take care of themselves if they have HIV:

• Women's bodies are different. A woman is twice as likely as a man to get HIV infection during vaginal sex (because the lining of the vagina provides a large area of potential exposure to HIV-infected semen). Some diseases or disorders unique to women make HIV more serious.
• Women can give HIV to their babies. Women who have HIV can give it to their babies during pregnancy, delivery, or breast-feeding.
• Women may lack control in relationships: they may be scared to refuse sex or insist that their partner use a condom, or can’t talk to their partner about abstinence, faithfulness, or using condoms.
• Women may not know if their partner is doing things that put him (and therefore her) at risk for HIV.
• Women may not earn much money, which makes it hard for them to pay doctors or even get a ride to their doctor appointments. In extreme instances, some women even end up trading sex for money or drugs.
• Women may be caregivers for others and not feel they have the time to take care of themselves or are unable to find someone to take care of their loved ones when they want to access services. Women may not earn much money, which makes it hard for them to pay doctors or even get a ride to their doctor appointments. In extreme instances, some women even end up trading sex for money or drugs.

What can providers do?

• Emphasize and make HIV testing a routine part of health care. Integrate HIV testing into reproductive health care and other key services.
• Reach out and educate, especially among young women and women of color. Many women want more information and are most likely to get it from doctors, other women with HIV/AIDS, the Internet, television, and radio.
• Decrease mother-to-child transmission by testing, educating, and treating.
• Prevent new infections by working with HIV-infected partners.
• Improve access to care and support services for women, as well as support women’s roles as caregivers and mothers.

HIV test sites in Maine

Pertussis Update

Since January 1, 2011, there have been 28 cases of pertussis (whooping cough) reported to Maine CDC. Cases have been reported in Cumberland, Hancock, Kennebec, Oxford, Penobscot, Piscataquis, Somerset and Waldo counties. Cases range in age from 1 month to 57 years.

Coughing fits due to pertussis infection can last for up to 10 weeks or more; sometimes known as the “100-day cough.” Pertussis can cause serious illness in infants, children, and adults and can even be life-threatening, especially in infants. More than half of infants less than 1 year of age who get pertussis must be hospitalized.

The most effective way to prevent pertussis is through vaccination with DTaP for infants and children and with Tdap for pre-teens, teens and adults — protection from the childhood vaccine fades over time. Pertussis is generally treated with antibiotics, which are used to control the symptoms and to prevent infected people from spreading the disease.

The December 20, 2010, Health Alert on pertussis is available at: http://www.maine.gov/tools/whatsnew/attach.php?id=173192&an=2

For more information about pertussis, visit: http://www.maine.gov/dhhs/boh/ddc/epi/vaccine/pertussis.shtml

Tdap Vaccination Strategies

Representatives from the Association for Professionals in Infection Control and Epidemiology, US CDC, the National Foundation for Infectious Diseases, and the Society for Healthcare Epidemiology of America co-authored a report titled Tdap Vaccination Strategies for Adolescents and Adults, Including Health Care Personnel, which is available at http://www.jointcommission.org/tdap/

The report is intended to help health care organizations of all types (hospitals, long term care facilities, ambulatory settings, home health organizations, etc.) improve Tdap vaccination rates.

The report notes that some important changes to the previously published ACIP recommendations were approved at the October 2010 ACIP meeting:

1. For adults ages 65 years and older, a single dose of Tdap vaccine may be given in place of a tetanus and diphtheria toxoids (Td) vaccine in persons who have not received Tdap.
2. Adults ages 65 years and older who have or anticipate having close contact with an infant age less than 12 months should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission of pertussis to infants age less than 12 months.
3. Tdap can be administered regardless of the interval since the last tetanus- or diphtheria-containing vaccine.
4. Children ages 7 through 10 years who are not fully immunized against pertussis and for whom no contraindication to pertussis vaccines exists should receive a single dose of Tdap to provide protection against pertussis. If additional doses of tetanus and diphtheria toxoid–containing vaccines are needed, then children ages 7 through 10 years should be vaccinated according to catch-up guidance.

PCR Diagnosing of Pertussis – Best Practices

US CDC has issued a Health Alert on the best practices for health care professionals related to the use of polymerase chain reaction (PCR) for diagnosing pertussis in light of the continuing resurgence of pertussis and the likelihood that health care professionals will see more patients with suspected pertussis.

• For guidance in distinguishing signs and symptoms of pertussis from those of other conditions, see http://www.cdc.gov/pertussis/clinical/features.html
• For more information on diagnostic testing, see http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html
• For information on specimen collection, see http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html
• For the entire guidance on PCR best practices in diagnosing pertussis, see http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html

Influenza Update 3/3/11

Surveillance

Flu is widespread in Maine. In the week ending Feb. 19, there were 12 new outbreaks – 10 in long term care facilities, 1 in a K-12 school, and 1 in an institution.

Weekly updates on flu activity are available

• For Maine: http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml
• For the US: http://www.cdc.gov/flu/weekly/summary.htm
• For the world: http://www.cdc.gov/flu/international/activity.htm

The January 31 Health Alert on influenza is available at: http://www.maine.gov/tools/whatsnew/attach.php?id=191687&an=2

Vaccination

Some people have expressed concern about needing a second flu vaccine if they were vaccinated early in the fall. One flu vaccine is protective for the entire flu season and a second dose is not recommended for adults.

An MMWR from August 2010 notes that “additional vaccine doses during the same season do not increase the antibody response” and that the “frequency of breakthrough infections is not known to be higher among those who were vaccinated early in the season.”

Two doses of flu vaccine are only recommended for young children who have never been vaccinated before. Children younger than 9 who have never had a seasonal flu vaccine should receive two doses, spaced at least 4 weeks apart.

It is not too late to be vaccinated against the flu this season. To obtain flu vaccine, contact your health care provider, or look up clinics at www.flu.gov or www.211maine.org