Antimicrobial-resistant Gonorrhea

Gonorrhea is the second most commonly reported notifiable disease in the United States. National concerns about increasing rates of gonorrhea and increasing antimicrobial resistant strains of N. gonorrhoeae are prompting increased efforts to ensure adherence to the revised 2015 Sexually Transmitted Disease Treatment Guidelines.

U.S. CDC now recommends treating gonorrhea with ceftriaxone 250 mg as a single intramuscular dose and azithromycin 1 g orally.

Clinicians need to use dual therapy and stay up to date with treatment recommendations: 

• Data show that resistance decreases when the correct dual therapy is used.
• Using azithromycin as a monotherapy to treat gonorrhea might promote the emergence of azithromycin resistance.
• Patients with cephalosporin allergies should be treated with azithromycin 2 g plus either gentamicin or gemifloxacin.

There has been a steady increase in the number of reported gonorrhea cases in Maine. As of June 30, 2016, 251 cases of gonorrhea have been reported to the Maine CDC. The five-year median for this time period is 116 cases. The increase in gonorrhea in Maine mirrors a national trend reported by U.S. CDC. 

Tick-borne Diseases Update

Reports of multiple tick-borne diseases to Maine CDC are indicating an increase in all tick-borne diseases. 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:

• 228 cases reported to date in 2016, compared to 186 in all of 2015
• 116 cases reported from the Mid Coast region (Knox 49, Lincoln 43, Sagadahoc 18 and Waldo six)

Babesiosis:

• 49 cases have been reported to date in 2016, compared to 55 in all of 2015
• 13 cases reported from York county, ten cases from Knox county

Lyme disease:

• Lyme disease cases take several months to be entered and classified, so current numbers are not available at this time

Powassan:

• No cases have been reported to date in 2016, compared to one in all of 2015

Co-infections: 

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

• To date, 11 co-infections have been reported: four co-infections with anaplasmosis and Lyme disease, two co-infections with babesiosis and Lyme disease and five co-infections with anaplasmosis and babesiosis.
• In 2015, 22 co-infections were reported: ten co-infections of Lyme disease and anaplasmosis; eight co-infections of Lyme disease and babesiosis; one co-infection of anaplasmosis and babesiosis; one co-infection of Lyme disease, anaplasmosis and babesiosis; one co-infection of Lyme disease and ehrlichiosis; and one co-infection of babesiosis and ehrlichiosis.

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. 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

National Breastfeeding Awareness Month

Breastfeeding is one of the most effective steps a mother can take to protect the health of her baby. All major medical authorities recommend that mothers breastfeed exclusively for six months. In 2013, 87 percent of Maine infants were ever breastfed, similar to the national average. More Maine infants were exclusively breastfed for six months, 32 percent, than compared to the U.S., 22 percent.

Maine’s efforts to protect, promote and support breastfeeding include:

• 6 for ME, a healthcare quality improvement initiative focused on breastfeeding  best practices
• Women Infants and Children Nutrition Program (WIC): Breastfeeding Peer Counseling Program and Breast Pump Loaner Program
• An active Maine State Breastfeeding Coalition
• Collaborating with businesses and communities to implement Maine’s Nursing Mothers in the Workplace and Right to Breastfeed laws