Arboviral diseases

Summer is here, which means mosquitoes are here as well.  Arboviral diseases, including eastern equine encephalitis (EEE) and West Nile virus (WNV), are very serious infections that are transmitted by the bite of an infected mosquito.  Additionally, Powassan virus is an arboviral disease transmitted by the bite of an infected tick.  Although rare, these diseases have potentially severe and even fatal consequences for those who contract them.  Maine CDC reminds clinicians of the potential for human disease activity in Maine and to consider testing for arboviral disease in patients presenting with unexplained encephalitis, meningitis or fever (≥100.4°F or 38°C) during the summer and early fall.

EEE and WNV were first detected in Maine in 2001 in birds.  In 2009, Maine experienced unprecedented EEE activity with 19 animals and two mosquito pools testing positive.  In 2012, Maine reported its first human case of locally-acquired WNV neuroinvasive illness.  In 2014, Maine reported its first human case of locally-acquired EEE neuroinvasive illness. Powassan was first identified in Maine in 2000 but is rarely reported; a confirmed case in 2013 was the first reported case in nearly a decade.  In 2014, Maine reported EEE in an emu from Cumberland County, 22 mosquito pools from York County and one human from York County.

Many people infected with arboviral illness remain asymptomatic. The following groups of people are at higher risk for clinically significant arboviral infection:

• Residents of and visitors to areas with mosquito or tick activity
• People who engage in outdoor work and recreational activities
• People older than 50 and younger than 15 

Additional Information

• For more information on arboviral disease: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/index.shtml

• HETL Laboratory Submission Sheet: http://www.maine.gov/dhhs/mecdc/public-health-systems/health-and-environmental-testing/micro/documents/wnv-sle-eee.pdf

• Weekly arboviral reports will be posted throughout the season at: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/arboviral-surveillance.shtml

• Disease consultation and reporting available through Maine CDC at 1-800-821-5821

Mosquito-borne diseases

EEE and WNV

 

Arboviral diseases, including Eastern equine encephalitis (EEE) and West Nile virus (WNV), are very serious infections that are transmitted by the bite of an infected mosquito. Although rare, these diseases have potentially severe and even fatal consequences for those who contract them.  Vermont has already detected EEE.  

 

Clinicians should be aware of the potential for human disease activity in Maine, and to consider testing for arboviral disease in patients presenting with unexplained encephalitis, meningitis or fever ≥100.4°F or 38°C during the summer and early fall.

 

For more information, see the Health Alert from July 2: http://go.usa.gov/X9MV 

Chikungunya

Chikungunya virus is also transmitted to people by mosquitoes. Outbreaks have occurred in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. In late 2013, chikungunya virus was found for the first time in the Americas on islands in the Caribbean. This week, New Hampshire reported two cases of chikungunya in people who traveled to the Caribbean.

The most common symptoms of chikungunya virus infection are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. There is no vaccine to prevent or medicine to treat chikungunya virus infection.

Travelers can protect themselves by preventing mosquito bites. When traveling to countries with chikungunya virus, use insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

For more information, visit http://www.cdc.gov/chikungunya/ 

Mosquito-borne disease update

Maine CDC has confirmed the presence of Eastern Equine Encephalitis (EEE) in more than 20 mosquito pools and has reported the death of a pheasant and two horses from EEE. In addition, one mosquito pool has tested positive for West Nile virus (WNV), the first WNV positive this year. More information is available in the press release at http://go.usa.gov/Dn9R

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

EEE and WNV are viruses transmitted through the bite of an infected mosquito. Maine CDC recommends the following preventative measures to protect against 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.

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

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

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.

West Nile Virus

Maine CDC has identified the presence of West Nile virus (WNV) neuroinvasive disease in a Maine resident from Cumberland County.


This is Maine’s first ever locally-acquired case of WNV in a Maine resident.

The patient, who is recovering at home, presented with symptoms including fever, encephalitis, meningitis, weakness, and double vision beginning on October 1.

Maine CDC issued a health advisory Oct. 31 to alert clinicians of the presence of human WNV disease activity in Maine, and to remind clinicians to consider testing for arboviral disease in patients presenting with unexplained encephalitis, meningitis, or a febrile illness of unknown etiology through the end November.

For more information, see the health alert: http://go.usa.gov/Yfhx

Know how to protect yourself from West Nile and EEE

Arboviral diseases, including Eastern equine encephalitis (EEE) and West Nile virus (WNV), are very serious infections that are transmitted by the bite of an infected mosquito. Although rare, these diseases have the potential to be severe and even fatal.


On Aug. 17, a mosquito pool (a collection which contains between 1-50 mosquitoes) tested positive for WNV at Maine’s Health and Environmental Testing Laboratory. The pool of mosquitoes was collected Aug. 1 in the town of Lebanon, as described in this health alert. Since then, a second mosquito pool from Cumberland County tested positive.

This is the earliest WNV has been identified in mosquitoes in Maine. The last time WNV was identified in Maine was from a mosquito pool in 2010. There has been a significant increase in arboviral activity in the last month.

Maine CDC recommends the following preventative measures to protect against mosquitoborne illnesses:

Control what you can. Improve your odds of avoiding mosquito spread viruses by using a repellent on exposed skin and clothes while outdoors. 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, and remove standing water from artificial water-holding containers in and around the house.


Insect Repellent: It keeps you from being what’s for dinner.

There are always excuses for not using repellent— forgot it, didn't want to go back and get it, it doesn't smell good, it's not in the budget, or "mosquitoes don't bite me"…

Think of repellent as you would an important article of clothing, and increase your chances of avoiding weeks (or even months) of aches and fatigue that come with West Nile fever, dengue fever, or any number of other mosquito borne diseases. More severe problems are possible. Being hospitalized with swelling of the brain, or even worse, are possibilities from many of these diseases.


What repellent should I use?

US CDC recommends a variety of effective repellents. The most important step is to pick one and use it. There are those that can protect you for a short while in the backyard or a long while in the woods. DEET, picaridin, IR3535 and the plant-based oil of lemon eucalyptus are all repellents recommended by US CDC. All contain an EPA-registered active ingredient and have been studied to make sure they are effective and safe. EPA has a long listing of repellent brands in the United States. Check out US CDC’s traveler’s health page on repellents here.


When should you wear repellent?

Mosquitoes can bite anytime. Most of the mosquitoes that carry West Nile virus bite from around sundown to around sun-up (throughout the night). Put a few bottles or packets of repellent around—in the car, by the door, in a purse or backpack.

Public Health Updates

· Infectious Disease Conference. Since 1983, Maine CDC’s Division of Infectious Disease has organized an annual infectious disease conference targeting public health issues of emerging concern. This year’s conference will be held from 8 a.m. to 4 p.m. November 9 at the Augusta Civic Center. Health care practitioners, laboratorians, and public health partners are invited to receive current information on surveillance, clinical management and diagnosis, and disease control interventions. The conference will feature cases of interest, epidemiology presentations, and clinical updates. The conference brochure and agenda are now available online. Click here to register.

· Bed Bugs. Bed bugs are small insects that feed on human blood. Although bed bugs do not transmit disease, infestations are very difficult and expensive to control. Unlike head lice, bed bugs do not live on a person. However, they can hitchhike from one place to another in backpacks, clothing, luggage, books and other items. Maine CDC has established a web page with links to information and a list of resources related to bed bugs following a number of recent calls for consultations. The page is accessible at www.mainepublichealth.gov/bedbugs

· EEE and West Nile Virus. There was unprecedented EEE activity in Maine in 2009. Several surrounding states have already seen EEE and WNV activity this year, including increased risk of EEE in southeastern Massachusetts resulting in aerial spraying in that area (more information can be found at http://westnile.ashtonweb.com/). For the most recent surveillance reports on EEE and WNV, visit: http://www.maine.gov/dhhs/boh/ddc/epi/vector-borne/arboviral_surveillance.shtml

· Animal rabies. Maine CDC provides quarterly updates on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities. The third quarter report can be found here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=140633&v=alert

· Fingerstick devices and bloodborne pathogens. US CDC has become increasingly concerned about the risks for transmitting hepatitis B virus (HBV) and other bloodborne pathogens to people undergoing fingerstick procedures for blood sampling, such as people with diabetes. As reports of HBV infection outbreaks linked to diabetes have been increasing, CDC issued an important reminder that fingerstick devises should never be used for more than one person (http://www.cdc.gov/injectionsafety/Fingerstick-DevicesBGM.html). For more information, visit: http://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html

Tips for enjoying this weekend and the rest of the summer

Watch out for heat-related illness


Over the past 30 years more people have died in this country from heat than from hurricanes, lightning, tornadoes, floods, and earthquakes combined. This Maine CDC web site has a variety of resources describing the signs of heat-related illness, what you can do if you suspect someone has a heat-related illness, and ways to prevent these illnesses.


Water Safety

· This web site has some basic tips for keeping children safe around open waters.

· This Maine CDC web site has tips for avoiding recreational water illnesses.


Food Safety

· This USDA fact sheet gives information on how to safely defrost frozen foods before cooking them.

· This food safety blog discusses food safety at farmer’s markets.

· US CDC describes food safety at fairs and festivals.


Other Precautions

· Playing outdoors this summer can mean getting cuts that may become infected with bacteria commonly found in soil, including the ones that cause tetanus. Tetanus vaccine can help prevent tetanus disease.

· A single mosquito bite can give you West Nile Virus. Why take a chance? Use repellant.