World Hepatitis Day

July 28 is World Hepatitis Day, which aims to increase awareness about viral hepatitis on a global level.  The World Health Organization (WHO) estimates that 400 million people worldwide have chronic viral hepatitis. A approximately 1 million individuals die  each year from viral hepatitis-related causes. 

Hepatitis A is a liver disease spread by ingestion of contaminated food or water or by direct contact with an infected individual. The hepatitis A virus (HAV) can cause mild to severe illness with symptoms ranging from nausea and fever to jaundice. HAV cannot become chronic. Once a person is infected, he or she cannot become infected again.  There is a vaccine available for HAV, which is recommended for all children at age 1 and any adults at risk of infection.

Hepatitis B is caused by the hepatitis B virus (HBV) and can be both acute and chronic. HBV is spread though contact with blood or other bodily fluids of an infected individual.  HBV infection may be symptomatic, but infected individuals may also go years before symptoms or complications occur.  If left undiagnosed and untreated, HBV may result in serious liver disease, cirrhosis, end-stage liver disease or death in 25 percent of people.  There is an effective vaccine available for HBV prevention, which is recommended for all babies at birth and adults at risk of infection.

Hepatitis C is a serious liver disease caused by the hepatitis C virus (HCV), which can be both acute and chronic. HCV is spread by blood-to-blood contact with an infected individual. It is estimated that only 20 percent of people with acute cases experience symptoms of HCV. It’s  possible that patients may live with HCV infection for years without experiencing symptoms until serious liver damage occurs.  Hepatitis C is the leading cause of liver transplant in the United States. The U.S. CDC estimates that there are 3.2 million people living with chronic hepatitis C nationwide, and most individuals are  unaware of their infection. 

Symptoms of hepatitis C include fever, fatigue and loss of appetite, nausea, vomiting, abdominal pain, darkened urine, clay-colored stools, joint paint and jaundice.  People who have ever injected drugs, shared needles and equipment or who were born to a hepatitis C-positive mother join Baby Boomers in the highest risk category.

Recent advancement in therapies for treatment of hepatitis C can cure up to 95 percent of infections. Maine CDC recommends that people talk to their health care provider about their risk for hepatitis C testing. There is no vaccine available for hepatitis C.

For more information about viral hepatitis resources in Maine, visit: www.mainepublichealth.gov/hepatitis

For more information about hepatitis, visit: http://www.cdc.gov/knowmorehepatitis 

Are you at risk for viral hepatitis?  Find out if you should get tested:  www.cdc.gov/hepatitis/riskassessment/index.htm 

Hepatitis

May is National Hepatitis Awareness Month, and Maine CDC urges people to talk with their providers about testing for hepatitis. 

US CDC reports that people born from 1945 through 1965 are five times more likely to be infected with Hepatitis C than other adults.  There are approximately 3.2 million individuals living with hepatitis C in the country, and it is estimated that 75 percent of these individuals are Baby Boomer age (ages 50 to 70). 

Most people living with hepatitis C do not know they are infected and can live with the disease for decades without having symptoms or feeling sick. If left untreated, hepatitis C can lead to serious liver damage, including cirrhosis and liver cancer.  Hepatitis C is the leading cause of liver transplant in the United States. 

Symptoms of hepatitis C include fever, fatigue and loss of appetite, nausea, vomiting, abdominal pain, darkened urine, clay-colored stools, joint paint and jaundice.  It is estimated that only 20 to 30 percent of individuals who have Hepatitis C experience symptoms. People who have ever injected drugs, shared needles and equipment, or who were born to a Hepatitis C positive mother join Baby Boomers in the highest risk category. 

Recent advancement in therapies for treatment of hepatitis C can cure up to 95 percent of infections. Maine CDC recommends that people talk to their health care provider about their risk for hepatitis C. 

Testing days are scheduled in May for individuals who are uninsured and at high risk for hepatitis C. The dates and locations are:

• May 18: Waterville Family Planning  18 Silver Street Waterville 207-509-3267
• May 19: Florence House (women's shelter) via Portland Public Health. 103 India St Portland 207-874-8446

Those who are interested in being tested should call the test site prior to the testing day to find out if they qualify for the free test. 

For more information about hepatitis, visit: http://www.cdc.gov/knowmorehepatitis 

For more information about viral hepatitis resources in Maine, visit: www.mainepublichealth.gov/hepatitis

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

Hepatitis B

May is Hepatitis Awareness Month. One in in 12 Asian Americans and Pacific Islanders has Hepatitis B.

Hepatitis B is common worldwide, especially in many parts of Asia and the Pacific Islands. In the US, Hepatitis B disproportionately affects Asian Americans and Pacific Islanders (AAPIs). While AAPIs make up less than 5% of the U.S. population, they account for more than 50% of Americans living with Hepatitis B. 

Hepatitis B is serious, but treatments are available.

Left untreated, nearly 1 in 4 people living with hepatitis B develop serious liver problems, even liver cancer. In fact, Hepatitis B-related liver cancer is a leading cause of cancer deaths among Asian Americans. Getting tested for Hepatitis B can help many people access lifesaving treatments that can prevent serious liver damage.

Two in three Asian Americans with Hepatitis B don't know they are infected.

People can live with Hepatitis B for decades without having any symptoms or feeling sick. Hepatitis B is spread when blood or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. This can happen through multiple ways, including getting Hepatitis B from an infected mother at birth or from a family member as a young child. Many AAPIs living with Hepatitis B got infected as infants or young children. Testing is the only way to know if someone has Hepatitis B.

Who should get tested for Hepatitis B?

• Anyone born in Asia or the Pacific Islands (except New Zealand and Australia)
• Anyone born in the United States, who was not vaccinated at birth, and has at least one parent born in East or Southeast Asia (except Japan) or the Pacific Islands (except New Zealand and Australia).

Hepatitis B testing identifies people living with Hepatitis B so they can get medical care to help prevent serious liver damage. Talk to a health care provider about getting tested for Hepatitis B. 

For more information, see:http://www.cdc.gov/knowhepatitisb/FAQs.htm or 

http://www.cdc.gov/knowhepatitisb/ProResources.htm

or  www.mainepublichealth.gov/hep

Viral hepatitis plan

On April 3, the U.S. Departments of Health and Human Services (HHS), Housing and Urban Development (HUD), Justice (DOJ), and Veterans Affairs (VA) released a 3-year update of Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care, & Treatment of Viral Hepatitis, which builds on the success of the nation's first comprehensive cross-agency action plan, released in 2011.   The updated Viral Hepatitis Action Plan builds on the foundation of and momentum generated by the original action plan and seeks to harness:

• New recommendations for health care providers regarding screening for hepatitis C;
• Promising new developments in treatments for hepatitis C;
• Mounting public awareness of and concern about hepatitis B and hepatitis C; and
• The expansion of access to viral hepatitis prevention, diagnosis, care, and treatment offered by the Affordable Care Act.

For more information: http://www.aids.gov/news-and-events/hepatitis/

Hepatitis

World Hepatitis Day is July 28. In recognition of the day, Maine CDC is highlighting US CDC’s Know Hepatitis B Campaign.

Hepatitis B is common worldwide, especially in many parts of Asia and the Pacific Islands. In the US, Hepatitis B disproportionately affects Asian Americans and Pacific Islanders (AAPIs). While AAPIs make up less than 5% of the U.S. population, they account for more than 50% of Americans living with Hepatitis B. One in 12 AAPIs has Hepatitis B.

For more information about the campaign, visit http://www.cdc.gov/KnowHepatitisB/

For general information about World Hepatitis Day, go to http://www.cdc.gov/features/worldhepatitisday/

Baby Boomers and Hepatitis C

In recognition of Hepatitis Awareness Month, Maine CDC is featuring a three-part series on viral hepatitis in public health updates released in May.

Part 3: Baby Boomers and Hepatitis C

About 3 million adults in the US are infected with the hepatitis C virus, most are baby boomers. Anyone can get hepatitis C, but adults born from 1945-1965, or baby boomers, are 5 times more likely to have hepatitis C.

US CDC now recommends that baby boomers, or those born during 1945-1965, get tested for hepatitis C virus (HCV).  The reason that baby boomers have high rates of Hepatitis C is not completely understood. Most boomers are believed to have become infected in the 1970s and 1980s when rates of Hepatitis C were the highest. Since people with Hepatitis C can live for decades without symptoms, many baby boomers are unknowingly living with an infection they got many years ago.

Hepatitis C is primarily spread through contact with blood from an infected person. Many baby boomers could have gotten infected from contaminated blood and blood products before widespread screening of the blood supply began in 1992 and universal precautions were adopted. Others may have become infected from injecting drugs, even if only once in the past. Still, many baby boomers do not know how or when they were infected.

Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born during 1945–1965

·              Adults born during 1945–1965 should receive one-time testing for HCV without prior ascertainment of HCV risk.

·              All persons with identified HCV infection should receive a brief alcohol screening and intervention as clinically indicated, followed by referral to appropriate care and treatment services for HCV infection and related conditions.

For more information see: http://www.cdc.gov/knowmorehepatitis/  or www.mainepublichealth.gov/hep

Hepatitis B Vaccination for Adults with Diabetes

In recognition of Hepatitis Awareness Month, Maine CDC is featuring a three-part series on viral hepatitis in public health updates released in May.

Part 2: Hepatitis B Vaccination for Adults with Diabetes Mellitus

CDC's Advisory Committee on Immunization Practices (ACIP) now recommends hepatitis B vaccination for all unvaccinated adults with diabetes who are younger than 60 years of age. Vaccination should occur as soon as possible after diagnosis of diabetes, and vaccination should also be given to adults diagnosed with diabetes in the past.

Vaccination requires 3 doses at 0, 1, and 6 months, although other schedules are available. Longer intervals between doses are possible so that it is not necessary for patients to make extra medical visits for vaccination. However, longer intervals will leave adults with diabetes at risk for hepatitis B infection until the vaccination series is completed.

On the basis of available information about hepatitis B virus (HBV) risk, morbidity and mortality, available vaccines, age at diagnosis of diabetes, and cost-effectiveness, ACIP recommends the following:

• Hepatitis B vaccination should be administered to unvaccinated adults with diabetes mellitus who are aged 19 through 59 years (recommendation category A; evidence type 2).
• Hepatitis B vaccination may be administered at the discretion of the treating clinician to unvaccinated adults with diabetes mellitus who are aged ≥60 years (recommendation category B; evidence type 2).

For more information:

• CDC Expert Commentary on Hepatitis B Vaccine for Adults with Diabetes
• Use of Hepatitis B Vaccination for Adults with Diabetes Mellitus: Recommendations of the Advisory Committee on Immunization Practices (ACIP) 
• www.mainepublichealth.gov/hep