Avoid carbon monoxide poisoning when opening camps this weekend

As summer approaches and Mainers start opening up their camps for the season, the Maine Center for Disease Control and Prevention warns of the dangers of carbon monoxide poisoning.

Health officials urge camp owners to make sure their propane-fueled stoves and refrigerators are working properly and vented safely when turned on for the season. Camp owners should make sure they have working carbon monoxide detectors equipped with a battery back-up located close to where people sleep. Most hardware stores or places that sell smoke detectors also carry carbon monoxide detectors.

"This is the time of year when we start to get reports of people poisoned in their camps from high levels of carbon monoxide," said state toxicologist, Dr. Andrew Smith. "Usually, blocked exhaust vents or poorly maintained gas-fueled appliances are the culprits. Unfortunately, some of the poisonings are life-threatening."

Boaters are also at risk for carbon monoxide poisoning, Smith said. Carbon monoxide is present in the exhaust of inboard and outboard motors. Gasses can build to dangerous levels in areas just behind the boat. Boaters should stay away from exhaust vent areas, like the back platform. They should not swim in these areas when the motor is on.

Carbon monoxide, or CO, is an odorless and colorless gas created by any combustion engine or device. Improper venting, maintenance, operation or placement of combustion devices can result in poisoning when CO gas builds up in enclosed spaces and in garages, barns and sheds—even if the doors and windows are open.

There are more than 100 emergency department visits each year in Maine due to carbon monoxide poisoning, Smith said.

The Me-CDC estimates that the overall number of households with detectors is increasing and that about half of owner-occupied homes now have them. Yet, in 90 percent of reported carbon monoxide poisonings, there are no carbon monoxide detectors present where the poisonings occur. Maine law requires carbon monoxide detectors to be installed in all rental units, including seasonal rentals, and new single family dwellings. Detectors are also required in existing single-family dwellings whenever there is a transfer of ownership or an addition of one or more bedrooms. The law applies to camps and seasonal homes as well.

To prevent carbon monoxide poisoning this summer:

• Make sure gas-powered appliances in your camp are working and vented properly.
• Don't use a gas-powered generator, charcoal grill, camp stove, or other gas- or charcoal-burning device inside your camp or near a window or door. Generators should be more than 15 feet from your home when running. -Don't run a car, truck, lawn mower, tractor or any other motor inside a garage, barn or shed, even if you leave the door open.
• Make sure you have a CO detector with a battery back-up in your camp near where people sleep. Check or replace the battery during your first visit.
• If your CO alarm goes off, get out right away and call 911. Get prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.

Additional Background on Carbon Monoxide Poisoning

• Carbon monoxide can starve body tissues of the oxygen they need to work. Warning signs of poisoning can be confused with illness, intoxication or motion sickness. Symptoms include headache, nausea, vomiting, dizziness, drowsiness, and confusion, but no fever. Carbon monoxide poisoning can cause coma and death.
• Each year in Maine, there are more than 100 emergency department visits and between one and five deaths due to carbon monoxide poisoning. In 90 percent of the cases, there are no carbon monoxide detectors present where the poisonings occur. For Maine CDC data on carbon monoxide poisonings visit the Maine Tracking Network: https://tracking.publichealth.maine.gov
• For information on the State law requiring carbon monoxide detectors: http://www.mainelegislature.org/legis/bills/bills_124th/chappdfs/PUBLIC162.pdf

Hantavirus Pulmonary Syndrome

Maine CDC was recently notified of the first documented case of hantavirus pulmonary syndrome (HPS) in a Maine resident. This resident had not traveled outside of Maine and was reported to have exposures known to be associated with hantavirus.

HPS was first identified in 1993 following an outbreak of unexplained severe pulmonary illness among residents of the southwestern United States. HPS is a serious and life-threatening viral disease (fatality rate approximately 30-40%) that is transmitted to humans by exposure to infected rodents. Only certain kinds of mice and rats can give people hantaviruses that cause HPS. In North America, they are the deer mouse, the white-footed mouse, the rice rat, and the cotton rat but not every mouse or rat will carry the virus.

Early symptoms of HPS include fatigue, fever, chills, and muscle aches especially in the thighs, hips, back, and shoulders. There may also be headaches, dizziness, and abdominal complaints including nausea, vomiting, and diarrhea. Four to ten days after the initial symptoms, patients experience coughing and shortness of breath as the lungs fill with fluid. There is no specific treatment or cure. Medical care is supportive in nature.

Humans become infected after breathing fresh aerosolized urine, droppings, saliva, or nesting materials of infected rodents or when these materials are directly introduced into broken skin, the nose, or the mouth. If a rodent with the virus bites someone, the virus may be spread to that person, but this is rare. HPS in the United States has not been demonstrated to be transmitted from person to person.

HPS can be prevented by:

· Keeping mice and rats out of your home.

· Cleaning up mouse and rat urine, droppings, and nesting materials with a disinfectant or a mixture of bleach and water.

· Do not sweep or vacuum up rodent urine, droppings, or nests as this will cause virus particles to go into the air where they can be breathed in.

• For more information on hantavirus, visit the Maine CDC website or the US CDC website.

• For more information on prevention of hantavirus infection and precautions for limiting household, recreational, and occupational exposures, see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5109a1.htm.

Hepatitis awareness

Hepatitis is an inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viruses that affect the liver causing illness characterized by nausea, abdominal pain, and jaundice. The most common types in the United States are hepatitis A, B, and C.

These viruses are spread from one person to another through different routes. By understanding how they are spread, you can take steps to prevent infection.

• Hepatitis A is spread by ingestion of fecal matter, even in microscopic amounts, from close person-to-person contact or ingestion of contaminated food or drinks. It can be prevented by vaccination, hand washing, drinking only clean water, cooking food thoroughly, and by practicing safe sex.

• Hepatitis B is spread by direct contact with infected blood or bodily fluids. It can be prevented by vaccination, practicing safe sex, and not sharing any items that might be contaminated with someone else’s blood such as nail clippers, tooth brushes, razors, needles or sharps, and injection drug equipment.

• Hepatitis C is spread by direct contact with infected blood. It can be prevented by not sharing any items that might be contaminated with someone else’s blood, such as nail clippers, tooth brushes, razors, needles or sharps, and injection drug equipment, and by practicing safe sex.

Vaccines are only available to protect against hepatitis A and B. Hepatitis B and C can cause long-term infection that is associated with an increased risk for chronic liver disease and liver cancer, so testing and vaccination is especially important.

US CDC has issued several recent MMWRs that discuss hepatitis, including:

• Assessing the completeness of perinatal hepatitis B virus infection reporting
• Hepatitis C virus infection among adolescents and young adults in Massachusetts

• Highlighting Hepatitis Awareness Month

The US Department of Health and Human Services has also released Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, its strategic plan to raise awareness about hepatitis and create opportunities to train health professionals to vaccinate, diagnose, treat, and ultimately save lives.

For more information: http://www.mainepublichealth.gov/hepatitis

May is National Celiac Awareness Month

One in 133 people are affected with celiac disease, an autoimmune digestive disease. For people with celiac disease, or gluten sensitive enteropathy, eating foods with gluten - a protein found in wheat, rye and barley - damages the intestinal lining. Once damaged, the intestine cannot absorb the many nutrients supplied by food. The risk of malnutrition in people who have celiac disease is high.

The symptoms some with celiac disease, or gluten sensitive enteropathy, may experience include weakness, abdominal cramping, lack of appetitite, or diarrhea. Celiac disease may be inherited or triggered by an event. The care and treatment for people with this disease is very individual and includes eating a gluten-free diet and working with a registered dietitian and physician to find the best solutions for living life to the fullest.

More and more gluten-free breads, baked goods, coatings, and other products are available in mainstream grocery stores as well as specialty stores. There are also support groups available online and at some Maine hospitals.

Some people are “gluten sensitive” but don’t have celiac disease. These individuals experience milder and more subtle symptoms and do not test positive for celiac disease. These individuals may also benefit from eating a well-balanced low gluten diet and working on a personal plan with their registered dietitian and physician to live their life to the fullest.

To learn more, contact your local hospital or go to http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ for more information.

Measles alert

In the past week, Massachusetts identified 5 new cases of measles, ranging in age from 16 months to 65 years. All confirmed and suspect cases have either unknown or undocumented history of measles vaccination. Maine clinicians are asked to increase surveillance for rash illness suggestive of measles to help with early identification of potential cases and to assist in preventing the spread of disease in Maine.

Measles is a highly contagious respiratory disease caused by a virus and is spread from person to person through the air by infectious droplets. Symptoms include fever, runny nose, cough, loss of appetite, pink eye, and a rash. The rash usually lasts 5 – 6 days, beginning at the hairline, moving to the face and upper neck, and proceeding down the body.

Diagnosis

Maine CDC requests that clinicians report suspect case of measles to 1-800-821-5821 and advising suspect patients to remain at home until test results are known to prevent exposing others to the measles virus.

Measles testing is available at Maine’s Health and Environmental Testing Laboratory (HETL). Laboratory tests for acute measles infection include viral culture, serology, and PCR. Acceptable specimens include throat swabs, NP swabs, urine, and blood (requires acute and convalescent specimens). http://www.maine.gov/dhhs/etl/micro/measles_lsis.pdf

Case Management

It takes an average of 10 – 12 days from exposure to the first symptom which is usually fever. The measles rash does not usually appear until approximately 14 days after exposure. Measles is infectious for 4 days prior to 4 days after the onset of rash. All suspect patients should be placed in a separate waiting area or a private room with negative pressure.

Control Measures

Maine CDC will work with patients, and clinicians to identify all exposed contacts and to assess individuals for evidence of immunity. Measles vaccine may prevent disease if given within 72 hours of exposure.

Vaccinate

· Children. All children >12 months of age should receive their first dose of MMR at the 12-15 month routine health care visit, and every effort should be made to identify and vaccinate children who are not up-to date. All school-aged children should have two doses of MMR vaccine.

· Adults. All adults should have acceptable proof of immunity to measles. Certain groups at high risk should have received two doses of MMR, such as international travelers, health care workers, and college students. Women are advised not to receive any live virus vaccine during pregnancy including MMR.

Please report any suspicious cases and suspect cases of measles to Maine CDC at 1-800-821-5821

Do you know the signs of stroke?

Tyra Tarbox is a 45 year old mother of four from Cumberland who suffered a significant seizure resulting in a stroke late one evening after returning home from work. Luckily, her husband was there and he took quick action, calling 911. She was rushed to the hospital, evaluated, and quickly flown to a Boston hospital for surgery.

When she awoke six days later, Tyra had no body movement and could not move her eyes to the right. She had survived not only a stroke, but also a series of complications resulting from her brain’s lack of blood. After almost a month of inpatient rehabilitation in Portland, she returned home on her husband’s birthday and is now leading a full life.

Tyra’s story is one of many stories of Mainers who have had a stroke. Unfortunately, not all the stories end so happily. Stroke is the fourth leading cause of death in Maine and the United States and is also a leading cause of serious long-term disability in adults. The Maine CDC/DHHS Cardiovascular Health Program is working with the Maine Affiliate of the American Stroke Association and other statewide partners to help more Mainers recognize the symptoms of stroke and the importance of calling 911 at the first sign of stroke.

To bring attention to National Stroke Awareness Month, Tyra Tarbox will join statewide partners working to improve stroke systems of care at the American Stroke Association Legislative Awareness Day on Tuesday, May 3, 2011, from 9:00 AM to 11:30 AM at the Maine State House in the Hall of Flags.

Early recognition of stroke symptoms is critical – time lost is brain lost. Stroke symptoms include sudden:

• Numbness or weakness in the face, arm or leg
• Slurred speech
• Blurred vision
• Dizziness or loss of balance
• Severe headache

“A patient’s survival and successful recovery are greatly increased if symptoms are recognized quickly and medical attention is given right away,” said Dr. Stephen Sears, Acting Director Maine CDC/DHHS. “Our goal is to raise awareness and empower everyone — patient and bystander — to see stroke as a medical emergency requiring an immediate call to 911. If we increase people’s ability to recognize stroke symptoms, we can positively impact patients and hopefully increase their chance of having little or no long-term physical or mental disability.”

Nearly 75% of all strokes occur in people aged 65 years and older. Risk factors such as high blood pressure, high cholesterol, smoking, lack of physical activity, poor nutrition, and a history of cardiovascular disease or diabetes also increase the possibility of stroke.

More information is available at the following websites: www.mainehearthealth.org and www.strokeassociation.org.

May Awareness Campaigns

May is a busy month for awareness campaigns. It’s National Arthritis Awareness Month, Asthma Awareness Month, Healthy Vision Month, and Hepatitis Awareness Month.

Drinking Water Week is May 1-7. Followed by Women’s Health Week, which starts on Mother’s Day (May 8).

As the weather warms up and people spend more time outside, we also run into Lyme Disease Awareness Month and Skin Cancer Awareness Month. Heat Safety Awareness Day is May 27 and Recreational Water Illness and Injury Prevention Week is May 23-29.

May is also both High Blood Pressure Education Month and Stroke Awareness Month.