Mosquito-borne disease

Maine CDC has confirmed the presence of Eastern Equine Encephalitis (EEE) in two mosquito pools from York County.

EEE is a virus that is transmitted through the bite of an infected mosquito. It can cause serious illness in humans; large animals, like horses; and some species of birds. Maine confirmed EEE in a flock of pheasants during 2012 and experienced unprecedented EEE activity during 2009 with multiple animals and mosquito pools testing positive for the virus.

Regionally, all of our surrounding states have also identified EEE in 2013, including mosquito pools in New Hampshire, Vermont, and Massachusetts. Two horses have tested positive for EEE in Massachusetts as well.

Maine CDC recommends the following preventative measures to protect against EEE and other mosquito-borne illnesses:

• Use an Environmental Protection Agency-approved repellent when outdoors, especially around dawn and dusk. Always follow the instructions on the product’s label;
• Wear protective clothing when outdoors, including long-sleeved shirts, pants and socks;
• Keep window and door screens down to keep mosquitoes out of the home;
• Limit time outdoors at dawn and dusk when many species of mosquitoes are most active;
• Remove containers holding water in and around the home, as water can attract mosquitoes.

Maine's Health and Environmental Laboratory (HETL) routinely performs testing for EEE and West Nile virus (WNV) in mosquitoes, large animals and humans. Maine stopped testing individual dead birds for mosquito-borne illnesses in 2006 and no longer uses them as an indicator for disease.

Maine CDC will continue to update information on mosquito-borne disease surveillance in the state every Monday from May through September at http://go.usa.gov/jt6R

Information on pesticides and repellents is available at the Maine Board of Pesticides Control website at: http://go.usa.gov/jt6F

Emerging Tick-borne Disease: Babesiosis

Babesiosis is a parasitic infection transmitted by deer ticks, the same tick that carries Lyme disease. Babesiosis is an emerging infection in Maine with 17 cases being reported between January and mid-August, compared to a total of 10 cases in 2012. Most infections occur in the summer and fall months, so the number of 2013 cases is expected to rise.

So far, cases have been reported this year in Cumberland, Knox, and York counties.

Common symptoms include: extreme fatigue, aches, fever, chills, sweating, dark urine, and possibly anemia. People with babesiosis may experience no symtpoms at all. Babesiosis is treatable, and people who are infected and do not have underlying conditions generally make a full recovery. 

If you are bitten by a tick:

• Remove the tick properly, ideally using tweezers or a tick spoon.
• Clean the area around the bite, and watch for symptoms for 30 days.
• Have your health care provider identify the tick and the engorgement level, or amount of time attached.  Tick identification is available through the Maine Medical Center Research Institute 
• Testing of the tick is not routinely recommended.

If babesiosis is suspected: Your health care provider should test you. If you have babesiosis, you should be treated with medicine for a week to 10 days.

Remember that there are other diseases carried by ticks in Maine, including anaplasmosis and Lyme disease. Symptoms of anaplasmosis include: fever, headache, malaise, and body aches.  The most common early symptom of Lyme disease is an expanding red rash that occurs at the site of the tick bite within 3-30 days after being bitten.  Fever, joint and muscle pains may also occur.  People can get infected with anaplasmosis, babesiosis, and/or Lyme disease at the same time.

Last year, health care providers reported 52 cases of anaplasmosis in Maine, compared to 45 cases so far this year.  In 2012, providers reported 1,111 cases of Lyme disease in Maine, so far 489 cases have been reported in 2013.

Additional information:

• For more information on tick borne diseases, including babesiosis, go to: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/index.shtml
• To order tick educational materials, go to:  http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/order-form-wn.shtml

Eastern Equine Encephalitis Positive Mosquito Pool

Maine CDC has confirmed the presence of Eastern Equine Encephalitis virus (EEE) in mosquitoes collected in the state.  One mosquito pool (a collection that contains between 1-50 mosquitoes) tested positive for EEE at the state Health and Environmental Testing Laboratory (HETL) on August 9.  The positive pool of mosquitoes was collected on July 16 in the town of Alfred in York county.
 
This is the earliest in the season that Maine has identified EEE; previously the earliest detection was in the beginning of August.  Last year, Maine identified EEE in a flock of pheasants, and had seven mosquito pools test positive for West Nile Virus (WNV).  The State also identified its first locally acquired case of WNV in a Maine resident during 2012. 

Regionally, other New England states have identified multiple arboviruses this summer.  Massachusetts identified EEE in horses and mosquitoes, and WNV in mosquitoes.  New Hampshire identified WNV in mosquitoes, and Powassan virus and Jamestown Canyon virus in a human.  Vermont identified EEE and WNV in mosquitoes.

Prevention:

Maine CDC recommends the following preventative measures to protect against EEE, WNV, and other mosquito-borne illnesses:

• Use an EPA approved repellent when outdoors, especially around dawn and dusk – always follow the instructions on the product’s label
• Wear protective clothing when outdoors, including long-sleeved shirts, pants, and socks
• Use screens on your windows and doors to keep mosquitoes out of your home
• Avoid being outdoors at dawn and dusk when many species of mosquitoes are most active
• Drain artificial (non-natural) sources of standing water

For more information, see the Health Alert issued Aug. 12 or visit Maine CDC’s Vector-Borne Disease website.

Whooping cough update

Pertussis (whooping cough) is a cyclical disease that continues to affect a significant number of Maine residents. Maine CDC issued an update on statewide pertussis on July 30, which can be found at http://go.usa.gov/jdfe

There have been 210 reported cases of pertussis so far this year in Maine. This is less than the 354 reported cases for the same period last year, but is more than the five-year median of 60 pertussis cases. Oxford county has the highest rate of pertussis in the state, and the majority of cases have occurred in people ages 7-19.
 
Maine CDC encourages providers continue to test and treat patients. DTaP vaccine is recommended for all infants and children. Tdap vaccine is recommended for all preteens, teens, and adults.

For more guidance and information, visit http://go.usa.gov/dCO

Public health accreditation update

Maine CDC continues to prepare for national accreditation by the Public Health Accreditation Board (PHAB), and is on track to submit an application in January 2014.

About 25 employees representing all of Maine CDC’s Divisions currently participate in teams dedicated to each of the 12 accreditation domains. These teams are tasked to review the accreditation guidance and select the documents that best demonstrate that Maine CDC meets the accreditation standards.

Additionally, there are several large accreditation-related projects currently underway, including the State Health Improvement Plan (SHIP) and the enhanced Performance Management System.

Maine CDC thanks the many public health partners who participated in developing the objectives and strategies for the SHIP. As Maine CDC gets closer to accreditation, we will continue to provide short updates here in every other issue. To learn more about the Public Health Accreditation program, visit http://www.phaboard.org, or contact Maine CDC’s Accreditation Coordinator, Kate Marone, at kate.marone@maine.gov