Suicide Prevention

As news spreads of the death of actor Robin Williams by suspected suicide, the Maine Suicide Prevention Program at Maine CDC takes a moment to share the following information.

Depression is a leading risk factor for suicide. It doesn’t matter who you are or what your job is, depression can touch anyone. Signs of depression include:

• Mood – sad, irritable, angry
• Withdrawing from friends, family, activities
• Changes in sleep, appetite or weight
• Feeling worthless or guilty
• Not able to think or focus
• Hopelessness – seeing no chance of improvement

The sense of hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. Thoughts of death or suicide are a serious cry for help.

Depression is a treatable medical illness. Help is available, please reach out.

If you are concerned about yourself or about somebody else, call the Maine suicide crisis hotline at 1-888-568-1112. If you need immediate help, dial 911 or go to your nearest emergency room.

If you are not in Maine, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Tick-Borne Diseases Update

Summer is in full swing and the increase in tick-borne diseases demonstrates that. Maine CDC is receiving reports of multiple tick-borne diseases, some in record numbers. Physicians have already reported more Anaplasmosis cases so far this year than all of last year, and Babesiosis and Lyme numbers are steadily increasing as well. Providers should be aware of the risk and prevalence of these diseases and consider them in their diagnoses.

Anaplasmosis:

• Caused by the Anaplasma phagocytophilum bacteria, carried by the deer tick (Ixodes scapularis)
• Signs and symptoms include: fever, headache, malaise, and body aches. Encephalitis/ meningitis may occur but is rare
• 98 cases have been reported to date in 2014, compared to 94 in all of 2013
• Polymerase Chain Reaction (PCR) is the preferred testing method

Babesiosis:

• Caused by the Babesia parasite, carried by the deer tick (Ixodes scapularis)
• Signs and symptoms include: extreme fatigue, aches, fever, chills, sweating, dark urine, and anemia
• 17 cases have been reported to date in 2014, compared to 36 in all of 2013
• PCR or identification of the parasite in a blood smear are the preferred testing methods

Lyme disease:

• Caused by the Borrelia burgdorferi bacteria, carried by the deer tick (Ixodes scapularis)
• Signs and symptoms include: erythema migrans rash, fever, headache, joint and muscle pains, fatigue, arthritis, Bell’s palsy, meningitis, and carditis
• 526 cases have been reported to date in 2014, compared to 1,376 in all of 2013
• Lyme disease cases take several months to be entered and classified, so although these numbers may seem low they will increase dramatically as reports are received and processed
• Two tier testing (ELISA or EIA, followed by Western blot) is the preferred testing method

Powassan:

• Caused by the Powassan virus, carried by the woodchuck tick (Ixodes cookei) and potentially by the deer tick (Ixodes scapularis)
• Signs and symptoms include: fever, headache, vomiting, weakness, confusion, seizures, and memory loss
• 0 cases have been reported to date in 2014, compared to 1 in all of 2013
• Testing is performed by federal CDC, samples should be sent to Maine’s Health and Environmental Testing Laboratory (HETL) to be forwarded to CDC Fort Collins

Co-infections: Because all of these diseases are carried by the same tick (Ixodes scapularis), a patient may be infected with more than one disease.

• To date in 2014, three co-infections have been reported: two co-infections with anaplasmosis and Lyme disease, and one co-infection with babesiosis and Lyme disease
• In 2013, 16 co-infections were reported: nine co-infections of Lyme disease and anaplasmosis, four co-infections of Lyme disease and babesiosis, two co-infections of anaplasmosis and babesiosis, and one co-infection of Lyme disease, anaplasmosis, and babesiosis.

Uncommon illnesses:

• Ehrlichiosis is a bacterial disease, carried by the Lone Star tick which is unusual in Maine, but very common in the southern United States. PCR is the preferred testing method.
• Rocky Mountain Spotted Fever is a bacterial disease carried by multiple ticks. Maine has a tick that is a potential carrier (the dog tick, Dermacentor variabilis), but they are not known to be infected in Maine.

Recommendations for Providers:

• Consider tick-borne illnesses in your differential, particularly for individuals with “summer flu” symptoms
• Submit samples for testing 
• Treat patients appropriately – recommendations for treatment are available from http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
• Report cases. All tick-borne illnesses are reportable in Maine, including the erythema migrans rash which is confirmatory. To ease the reporting burden of EM rashes, a registry report option is available (see page 3). All cases should be reported by phone to 1-800-821-5821 or by fax to 1-800-293-7534.

For more information:

• Maine CDC vectorborne webpages: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/index.shtml
• Maine Physician’s Reference Guide: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/documents/tick-reference-guide.pdf
• Lyme forms for providers: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/lyme/index.shtml#resourcephysicians
• Guidance on treatment: http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
• Lyme disease data: https://data.mainepublichealth.gov/tracking/home

This information originally appeared in a health alert, which is available at http://www.maine.gov/tools/whatsnew/attach.php?id=625757&an=2 

Whooping cough update

Pertussis (whooping cough) is a cyclical disease that continues to affect a significant number of Maine residents.

Maine CDC issued a health alert with an update on pertussis on Aug. 4. It is available here: http://go.usa.gov/NEG4

As of August 4, providers reported a total of 254 pertussis cases from 15 Maine counties. Washington county has the highest rate in the state of 114.94 cases per 100,000 persons compared to the state's case rate of 19.12 cases per 100,000 persons. Seven Maine counties have rates higher than the state rate (Aroostook, Knox, Lincoln, Oxford, Penobscot, Waldo, and Washington counties).

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

Breastfeeding

August is National Breastfeeding Month. Breastfeeding is one of the most effective steps a mother can take to protect the health of her baby. 

US CDC's 2014 Breastfeeding Report Card, which provides state and national data on breastfeeding rates as well as information on supports for breastfeeding, is now available at http://www.cdc.gov/breastfeeding/data/reportcard.htm

All of Maine's breastfeeding rates increased in the 2014 report compared to the 2013 report.

For more information on breastfeeding and its health benefits, visit http://www.cdc.gov/breastfeeding/index.htm