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

Public Health Update 7/24/14

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.  Other New England states have already detected both EEE and WNV this summer.      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    Weekly arboviral surveillance reports will be posted to the following website through October: http://go.usa.gov/55u3  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. The first locally acquired case of chikungunya in the US was reported July 17 in Florida. For case information on chikungunya in the US, seehttp://go.usa.gov/55uA. 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. Although US CDC does not expect widespread cases of chikungunya in the United States this summer, American travelers infected overseas may continue to return and bring the virus with them. 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://go.usa.gov/55hP or http://www.cdc.gov/chikungunya/

Tick-borne diseases Ticks are generally found in brushy or wooded areas, near the ground; they cannot jump or fly. Ticks are attracted to a variety of host factors, including body heat and carbon dioxide. They will transfer to a potential host when one brushes directly against them and then seek a site for attachment. Ticks cause a variety of diseases in Maine, including Lyme disease, Anaplasmosis, Babesiosis, Ehrlichiosis, and Powassan. More than 1,375 cases of Lyme disease were reported statewide in 2013, a record high for Maine. So far in 2014, there have been 246 reported cases of Lyme disease.  Other case counts for tickborne diseases reported in Maine so far in 2014 include: 80 cases of Anaplasmosis, compared to 94 for all of 2013 9 cases of Babesiosis, compared to 36 cases for all of 2013 5 cases of Ehrlichiosis, compared to 3 for all of 2013 No cases of Powassan, compared to 1 in 2013     For more information: More information on tickborne diseases is available at http://go.usa.gov/kGYV For Lyme disease testing and treatment information, see the health alert at http://go.usa.gov/kscC  Lyme disease data are available on Maine CDC's website at http://go.usa.gov/kGYx A Physician's Reference Guide is available and describes the most common tickborne diseases in Maine.  This guide can be found on our website at:http://go.usa.gov/kGrw For IDSA Lyme disease treatment guidelines: http://cid.oxfordjournals.org/content/43/9/1089.full To order Lyme educational materials: http://go.usa.gov/kGYh

Cyclosporiasis    Cyclosporiasis is an intestinal infection caused by a microscopic parasite. Cases are usually reported from May to August. Five cases have been reported in Maine between June 24 and July 21. Maine CDC issued a Health Alert on July 8 to increase awareness among clinicians about cyclosporiasis and the need to specifically request testing for Cyclospora in patients with prolonged diarrheal illness. The Health Alert is available at http://go.usa.gov/XXDR  Cyclosporiasis is not a reportable condition in Maine due to the low number of cases in previous years (last known case in Maine resident in 2010). However, due to large numbers of cases in the United States in 2013, Maine CDC is requesting providers report cyclosporiasis cases as an unusual condition,  since it is not commonly seen in Maine residents.      For more information, visit http://go.usa.gov/X9tF

Pertussis (whooping cough)    Pertussis (whooping cough) is a cyclical disease that continues to affect a significant number of Maine residents.   There have been 230 reported cases of pertussis so far in 2014, an increase of 43 cases from two weeks ago.  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

TB Hero Dr. Shulamith Bonham, former medical director for Health Care for the Homeless in Portland, has been named 2014 TB Hero by the New England Tuberculosis Consortium.  Dr. Bonham was recognized for creating a low-barrier system for screening and treatment of latent TB infection (LTBI) within the Health Care for the Homeless clinic.

Hepatitis    Health IT and telemedicine are important tools to help early diagnosis and treatment of the growing problem of hepatitis C (HCV) infection in the United States.  US CDC has launched a new pilot program to help use telemedicine to fight HCV, develop new treatment tools, and get them in the hands of providers to try to stem the tide of HCV infections.   For more information, see: http://www.healthit.gov/buzz-blog/health-innovation/pilot-helps-battle-hepatitis-c-health-telemedicine/

Heat-related illness Here in Maine, we don't have very hot weather too often. So when it does get really hot, we are more likely to become sick from heat. This is because our bodies are not used to high heat, and many of our homes and buildings do not have air conditioning.   Certain people like older adults, infants, pregnant women, and people who have chronic diseases or who are sick already may feel much worse or have serious problems in extreme heat. Heat-related illnesses happen when your body cannot cool itself. Some heat illnesses are mild, like heat rash, sunburn, and heat cramps. Others like heat exhaustion, dehydration, and heat stroke can be severe or even life-threatening. To find out how to keep cool and healthy as the weather gets hotter this summer, go to http://go.usa.gov/X9uw

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

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.

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.