Early start to flu season in Maine

The flu has officially arrived in Maine for the 2017-2018 season. U.S. CDC recommends a yearly flu vaccine as the first and most important step in protecting against flu viruses. Vaccine for the 2017-2018 flu season has been updated to better match circulating flu viruses.

Disease Surveillance and Reporting

Maine CDC is hosting a “Start of the 2017-18 Influenza Season” conference call at 1:00 p.m. Thursday, September 28. The intent of this call is to provide updates for the season, outline resources available, and remind facilities of the requirements for the flu season. This call is particularly relevant for: infection practitioners, providers, laboratorians, employee health, emergency preparedness, hospital administration, and long term care facilities. Talking points will be distributed after the call, as well as questions and information highlighted on the call.

Lines may be limited, so if multiple people from one location intend to call in, please call in together.

Call in number:  877-455-0244 Code:  6681820529#

For up-to-date information and recommendations on influenza for health professionals, go to http://www.cdc.gov/flu/professionals

For influenza surveillance information in Maine, go to www.maineflu.gov.

2017-2018 Vaccine Information for Providers

Children younger than eight who have never received flu vaccine will need a booster dose no less than 28 days after the first dose of flu vaccine.

Vaccine is open for ordering. Limited supplies of multi-dose vials are available. If interested in ordering multi-dose vials, please call vaccine management at 287-3347.

Influenza vaccine ordered for the 2017/2018 season IS subject to replacement for preventable wastage.

Children under the age of 19 only are eligible for vaccine through the Maine Immunization Program. Repeated fraudulent administration of this public vaccine to individuals 19 years and older will result in a referral to CMS for fraud investigation.

Under Maine statute, all doses of public vaccine administered must be recorded in the Immunization Registry within five working days.

Ordering guidelines:

• 2017 Provider Agreement must be active
• Temperatures and inventory reconciliation must be up to date
• Order only a supply anticipated to be utilized in the next six-week time period

VFC eligibility screening is mandatory for every child and every vaccine. Eligibility screening must be documented in the ImmPact registry.

• Under 19 years of age
• Medicaid
• Uninsured
• American Indian/Alaska Native

Privately insured children do receive public vaccine; however, they must be documented as Not VFC Eligible in ImmPact.

Flu update 3/17/16

U.S. CDC reports that the flu vaccine has been 59 percent effective so far in the current 2015-16 season. That's more than twice the effectiveness of the 2014-15 season, which was found to be only 23 percent effective. 

Flu activity in Maine is still increasing and is expected to continue.  Diagnostic testing is available for influenza-like illness (defined as fever greater than 100° F with cough or sore throat, in the absence of another known cause). Treatment with antiviral medication can decrease the duration and severity of illness but should be started as soon as possible. 

Flu is preventable, so always follow the “No Flu 4 You” guidelines (wash your hands, cover your cough, stay home when you’re sick and get vaccinated) to stay healthy.  For more information visit www.maineflu.gov 

Flu

Although most influenza activity occurs from October to May in the U.S., flu viruses are detected year round.  Providers in Maine have reported positive rapid influenza and serology tests in the last month.  Summer and early fall are also the prime time for agricultural fairs, which provides an increased risk for flu associated with swine contact. 

Maine CDC requests that all rapid positive influenza samples during the summer months be forwarded to Maine’s Health and Environmental Testing Laboratory (HETL) for confirmation and typing.  This will allow us to monitor the circulating strains, and identify any variants if present.

If a provider sees a patient with flu-like symptoms who has swine or bird exposures; samples should be sent to HETL for testing.  Rapid tests may not pick up variant strains, and only the state lab is capable of determining if a strain is a variant.

Reporting requirements

• Suspected novel or variant cases should be reported immediately by phone to 800-821-5821.
• Outbreaks and pediatric deaths are required to be reported
• We appreciate all positive lab tests, reported by fax (207-287-6865 or 800-293-7534) or by phone (800-821-5821) but this is not required

Additional Information

• Maine CDC’s influenza webpage:  www.maineflu.gov
• Federal CDC’s influenza webpage:  www.cdc.gov/flu
• HETL submission forms:  www.mainepublichealth.gov/lab

Flu update 10/29/14

The flu has officially arrived in Maine for the 2014-2015 season. For more information, see the Oct. 17 health alert at: http://go.usa.gov/G6Vk 

Maine CDC reminds everyone to take everyday preventive measures against the flu:

• Wash your hands frequently;
• Cough and sneeze into your elbow or shoulder;
• Stay home when you feel sick;
• Get vaccinated. 

If you have the flu:

• Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
• Cough and sneeze into your elbow or into a tissue. Throw the tissue away.
• Although most people can stay home to recover without seeing a health care provider, it is possible for healthy people to develop severe illness from the flu. Anyone with the flu should seek medical attention for:
• Dehydration
• Trouble breathing
• Getting better, then suddenly getting a lot worse
• Any major change in condition 

Flu Activity

 Maine CDC reported sporadic flu activity for the week ending Oct. 25. Weekly updates are available online:

• for Maine: http://go.usa.gov/NoK
• for the US: http://go.usa.gov/ITB
• for the world: http://go.usa.gov/ITK

Flu Vaccination

US CDC recommends yearly flu vaccine for everyone 6 months of age and older. It takes about two weeks after vaccination to develop full immunity. To find a flu vaccine in your area, call 211, search www.211maine.org or http://flushot.healthmap.org/, or contact your health care provider.

For more information about flu vaccine: 

• Key facts about flu vaccine: http://go.usa.gov/yksA 
• How flu vaccines are made: http://go.usa.gov/ykHB 
• Vaccine recommendations: http://go.usa.gov/ykHw 
• Vaccine information statements (VIS): http://go.usa.gov/jdAC

For more information, go towww.maineflu.gov or http://www.cdc.gov/flu/ 

Flu update 9/18/14

Weekly updates on flu activity in Maine will resume in October. Maine CDC reminds everyone to take everyday preventive measures against the flu:

• Wash your hands frequently
• Cough and sneeze into your elbow or shoulder
• Stay home when you feel sick
• Get vaccinated

Conference Call

Maine CDC is hosting a "Start of the 2014-15 Influenza Season" conference call from 2-3 p.m. September 24. 

The intent of this call is to provide updates for the season, outline resources available, and remind facilities what the requirements are for the influenza season. 

This call is particularly relevant for: Infection practitioners, providers, laboratorians, employee health, emergency preparedness, hospital administration, and long term care facilities. Talking points will be distributed after the call, as well as questions and information highlighted on the call. 

The call-in number will be 877-455-0244, code 668-182-0529. 

Vaccine recommendations

US CDC recommends a yearly flu vaccine for everyone 6 months of age and older. While there are many different flu viruses, the seasonal flu vaccine is designed to protect against the top three or four flu viruses that research indicates will cause the most illness during the flu season. Medical providers should be vaccinated and begin vaccinating patients soon after flu vaccine becomes available, ideally by October, to ensure that as many people as possible are protected before flu season begins.

Starting this season, US CDC recommends use of the nasal spray vaccine in healthy children ages 2 to 8 when it is immediately available and if the child has no contraindications or precautions to that vaccine. Recent studies suggest that the nasal spray flu vaccine may work better than the flu shot in younger children. However, if the nasal spray vaccine is not immediately available and the flu shot is, children age 2 to 8 years should get the flu shot. Don't delay vaccination to find the nasal spray flu vaccine.

Vaccine is already available in some locations. It takes about two weeks after vaccination to develop full immunity. 

For more information: 

• Key facts about flu vaccine: http://go.usa.gov/yksA 
• How flu vaccines are made: http://go.usa.gov/ykHB 
• Vaccine recommendations: http://go.usa.gov/ykHw 
• Vaccine information statements (VIS): http://go.usa.gov/jdAC

For more information, go to http://www.cdc.gov/flu/ 

Flu update 1/9/14

Influenza activity in Maine is widespread with laboratory confirmed influenza reported in all counties. Influenza A/pH1N1, Influenza A/H3, and influenza B have been confirmed in Maine indicating all three strains are circulating.  Maine CDC has followed up on six outbreaks of influenza as of Tuesday, January 7th. Influenza vaccination is still strongly encouraged and is widely available, especially to protect those persons at risk of severe disease.  The vaccine appears to be a good match to the circulating strains this year, and it is not too late to get vaccinated.  

For more information, see the Health Alert from Dec. 26 about Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season at http://go.usa.gov/Zp6w and the Health Alert from Jan. 8 about Widespread Influenza Activity in Maine at http://go.usa.gov/ZdAj

Weekly updates on flu activity are available online:

• for Maine: http://go.usa.gov/NoK
• for the US: http://go.usa.gov/ITB
• for the world: http://go.usa.gov/ITK

In addition, people and clinicians may review or anonymously report flu at www.flunearyou.org  

Prevention 

Take everyday preventive measures against the flu:

• Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
• Avoid touching your nose, mouth, and eyes. Germs can spread this way.
• Consult your health care provider about getting a pneumococcal vaccine for anyone who is younger than 5, between ages 5 and 64 with high risk conditions, or age 65 and older.
• Avoid contact with sick people. If you are at very high risk for complications, you may want to avoid large crowds.

Vaccination

There is still time to get vaccinated against the flu for this season. Full immunity develops 7-10 days after the vaccine is administered. To find locations where vaccine is available, contact your health care provider or pharmacy, call 211, or visit www.211maine.org  or www.flu.gov 

Maine CDC recommends that Health Care Providers continue vaccinating to protect against influenza this year. To ensure that vaccine is available for all Maine people who are seeking it, please use the following as guidelines:

Health Care Providers should use state-supplied vaccine for patients in the following circumstances:

• The patient is a child ages 6 months through 18 years;
• The patient is pregnant or the partner of a pregnant patient;
• The patient's insurance does not cover vaccinations;
• The patient is uninsured.

Health Care Providers may use state-supplied vaccine for other patients only if:

• The Health Care Provider has already vaccinated all eligible patients listed above and has excess state-supplied vaccine; and
• Privately purchased vaccine is not available.

Please remember that providers may not charge for state-supplied vaccine. It is reasonable and allowable to charge an administration fee for administration of state-supplied vaccine in some circumstances provided that:

1. MaineCare-eligible children are not charged an out of pocket administration fee;
2. Administration fees do not exceed the regional Medicare maximum; and
3. No one is denied vaccine because of their inability to pay an administration fee.  

Treatment

If you have the flu:

• Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
• Cough and sneeze into your elbow or into a tissue. Throw the tissue away.
• Although most people can stay home to recover without seeing a health care provider, it is possible for healthy people to develop severe illness from the flu. Anyone with the flu should seek medical attention for:
• Dehydration
• Trouble breathing
• Getting better, then suddenly getting a lot worse
• Any major change in condition

For more information, visit www.maineflu.gov. 

Flu update 10/30/13

Maine CDC issued a health alert about the beginning of flu season in Maine on Oct. 28. The health alert is available at: http://go.usa.gov/W2jz

Maine reported sporadic flu activity for the week ending Oct. 26. Weekly updates are available online:

• for Maine: http://go.usa.gov/NoK
• for the US: http://go.usa.gov/ITB
• for the world: http://go.usa.gov/ITK

Prevention and Treatment

Take everyday preventive measures against the flu:

• Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
• Avoid touching your nose, mouth, and eyes. Germs can spread this way.
• Get vaccinated against the flu. To find locations where vaccine is available, contact your health care provider or pharmacy, call 211, or visit www.211maine.org or www.flu.gov
• Consult your health care provider about getting a pneumococcal vaccine for anyone who is younger than 5, between ages 5 and 64 with high risk conditions, or age 65 and older.
• Avoid contact with sick people. If you are at very high risk for complications, you may want to avoid large crowds.

If you have the flu:

• Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
• Cough and sneeze into your elbow or into a tissue. Throw the tissue away.
• Although most people can stay home to recover without seeing a health care provider, it is possible for healthy people to develop severe illness from the flu. Anyone with the flu should seek medical attention for:
• Dehydration
• Trouble breathing
• Getting better, then suddenly getting a lot worse
• Any major change in condition

Guidance

US CDC has published a summary of the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the 2013-2014 flu season at http://go.usa.gov/jdfB

US CDC has an influenza app for clinicians and health care providers to make it easy to access the latest guidelines and information. For more information about the app, go to http://go.usa.gov/43nR

The Vaccine Information Statements (VIS) for this coming season’s vaccines are available at http://go.usa.gov/jdAC

For more information, visit www.maineflu.gov.

Infectious disease update

Giardia

Giardiasis is a diarrheal disease caused by parasites, and it is the most common infectious diarrheal illness reported in Maine. So far in 2013, there have been 131 cases of Giardia reported in Maine, compared to 122 in all of 2012.

Giardiasis tends to occur more frequently in the summer and fall months. Individuals at greatest risk of infection with Giardia include people swallowing contaminated drinking water (such as backpackers or campers), travelers to endemic countries, and people with close contact with infected individuals (including childcare settings) and infected animals.

For more information, go to http://go.usa.gov/DTrF


Pertussis (whooping cough)

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 244 reported cases of pertussis so far this year in Maine. This is less than the 476 reported cases for the same period last year, but is more than the five-year median. 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



Flu

Weekly updates on flu activity will resume in October. Maine CDC reminds everyone to take everyday preventive measures against the flu:

• Wash your hands frequently
• Cough and sneeze into your elbow or shoulder
• Stay home when you feel sick
• Get vaccinated

US CDC has published a summary of the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the 2013-2014 flu season at http://go.usa.gov/jdfB

The Vaccine Information Statements (VIS) for this coming season’s vaccines are available at http://go.usa.gov/jdAC

Going to the fair? Exercise good judgment

Maine’s fair season kicks off in July, with 24 licensed agricultural fairs throughout the state.  Fairs offer visitors a unique opportunity to enjoy agricultural events, exhibits, food, amusement rides, and other attractions.  Fairs also may increase the risk of certain diseases, to both humans and animals.

Influenza A H3N2v is associated with pig exposure, most commonly during fairs. Twelve cases were confirmed in 2011 from five states, including two in Maine. Last year, that number increased to more than 300 cases in twelve states. Indiana has already reported 4 cases associated with a fair last month.

Other diseases that may increase during fair season include Shiga toxin-producing E. coli infections (STEC), Salmonellosis, Cryptosporidiosis, and Campylobacteriosis.  The risk of these diseases can be reduced through good hand hygiene.

Recommendations for fair goers:

• Do not attend a fair if you are ill. You are risking infecting not only the people around you, but also the animals. Many animals are susceptible to human illnesses, including the flu.
• Always ask the owner for permission before you touch an animal. Before and after touching animals, wash your hands with soap and water or use alcohol hand gel. This will help reduce the risk of spreading illness from you to the animal and from the animal to you.
•  Before eating, wash your hands with soap and water or use alcohol hand gel. This will help reduce the risk of gastrointestinal illness, such as Salmonella.

It is important that we do everything we can to make fairs as safe an experience as possible, both for the people and the animals, and following these simple rules will help assure good health for everyone involved.

For more information:

• Maine fairs website:  www.mainefairs.org
• Maine CDC Infectious Disease website: www.maine.gov/idepi
• Maine Department of Agriculture, Conservation and Forestry: http://www.maine.gov/acf/index.shtml

Influenza Vaccine Coverage Among Health Care Workers

Each influenza season, health care workers (HCW) become infected with the flu, an infectious respiratory illness caused by influenza viruses. The Advisory Committee on Immunization Practices (ACIP) recommends that HCW receive the influenza vaccine annually. All health care facilities in the state are required to report data on influenza vaccine coverage among their employees to Maine CDC annually.

Maine CDC worked in collaboration with hospitals for the past 3-4 years to improve HCW vaccination rates. Each year, Maine CDC analyzes data on flu vaccine rates reported by the hospitals and compares it to the state average. The result of the analysis is illustrated graphically and shared with each hospital.

Over the past three years, the vaccination rate among HCW in Maine has steadily improved from a statewide average of 65.2% in 2011-12 to 77.1% in 2011-12 to 84.2% in the 2012-13 season. We hope that health care facilities will keep working with their staff and continue this upward trend. 

To see the graphical results over the last three years, go to: http://go.usa.gov/b4eA

Maine CDC Public Health Update 12/13/12

Pertussis (whooping cough)

Thirty cases of pertussis (whooping cough) have been reported in children younger than 1 year old in Maine so far this year. Maine CDC has issued new clinical guidance for providers treating infant pertussis. It is available on the Maine CDC website.

In total, more than 660 cases of pertussis have been reported in Maine this year, with the majority in children ages 7 to 19. Reported cases appear to be on a downward trend.

Weekly updates on pertussis in Maine are posted to www.mainepublichealth.gov on Thursdays.

DTaP vaccine is recommended for all infants and children. Tdap vaccine is recommended for all preteens, teens, and adults.

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


Recent health alerts

• Group A Strep: Maine CDC is investigating a cluster of invasive Group A Streptococcal (GAS) infections in patients who have reported a history of injecting bath salts. Four cases of invasive GAS have been reported among persons aged 23-37 years, two of which resulted in Streptococcal Toxic Shock Syndrome (STSS). All cases reported injecting bath salts, all required hospitalization, one required intensive care, and one had necrotizing fasciitis. All four cases are from Aroostook and Penobscot counties. The health alert is at: http://go.usa.gov/gPfj

• Gonorrhea: Gonorrhea is a sexually transmitted disease caused by the Neisseria gonorrhoeae bacterium. Gonococcal infection is reportable to Maine CDC within 48 hours of recognition or strong suspicion of disease. In men, common symptoms include burning sensation when urinating or a white, yellow or green penile discharge. In women, symptoms are uncommon, but may include painful or burning sensation when urinating or increased vaginal discharge. Gonorrhea is a major cause of serious reproductive complications in females. Case reports of gonorrhea in Maine have been increasing in recent years from 96 cases in 2008 to 272 cases in 2011. The health alert is available at: http://go.usa.gov/gPf5

Influenza

Maine CDC reported regional flu activity for the week ending Dec. 8. Weekly updates are available online:

• for Maine: http://go.usa.gov/NoK
• for the US: http://go.usa.gov/ITB
• for the world: http://go.usa.gov/ITK

Maine CDC reminds everyone to take everyday preventive measures against the flu: 

• Wash your hands frequently
• Cough and sneeze into your elbow or shoulder
• Stay home when you feel sick
• Get vaccinated – find locations at www.flu.gov

America's Health Rankings

Maine ranked ninth overall (up from tenth last year) in the recently released America’s Health Rankings by the United Health Foundation.

These rankings are used to stimulate action by individuals, elected officials, medical professionals, public health professionals, employers, educators and communities to improve the health of the population of the U.S.

For more information, visit http://www.americashealthrankings.org/ME


HIV and hepatitis screenings

Recently, the U.S. Preventive Services Task Force (USPSTF) issued draft recommendations pertaining to HIV and viral hepatitis screening and is inviting public comments on both.


The Task Force is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.

The draft recommendation for HIV screening applies to all people aged 15 to 65 and all pregnant women. Public comments can be submitted online until December 17.

Public comments on the draft recommendations for screening adults for hepatitis C virus infection can be submitted online until December 24.

For more information and to submit comments, go to http://www.uspreventiveservicestaskforce.org/index.html