World Rabies Day

Maine will recognized the eighth annual World Rabies Day on September 28.

Rabies is a virus found in the saliva, brain and spinal cord of infected mammals. Rabies is spread most commonly through a bite from an infected animal. Rabies can also be spread from transfer of infected tissue or saliva into an open wound or mucous membrane, such as eyes, nose and mouth. Rabies is not transmitted through urine, feces, blood or any bodily fluid other than spinal cord fluid and saliva.

Rabies is a very serious and fatal disease if not treated. Rabies kills approximately 55,000 people each year worldwide. Though the last human case of rabies in Maine was documented in 1937, rabies is still a public health concern in Maine. Due to the availability of rabies post-exposure treatment, many potential human rabies deaths have been avoided. In Maine, 81 people were recommended for post-exposure prophylaxis (PEP) in 2013. The best way to stay rabies-free is to avoid wildlife and any animal that you don’t know. Report all exposures to your healthcare provider or Maine CDC right away.

In 2013, the State of Maine diagnosed 51 cases of animal rabies at the Health Environmental Testing Laboratory (HETL). As of August 15, 2014, there were 26 animal rabies cases in 2014 diagnosed in the following species: raccoon, skunk, fox, cat, cow, and woodchuck. Rabies is endemic in wildlife in Maine. The majority of animal rabies cases occur in wildlife, including in raccoons, skunks, foxes, and bats.

All Mainers are encouraged to consider ways in which they can prevent the spread of rabies. These include:

• Vaccinate your pet cats and dogs against rabies; it is the law.
• Avoid contact with wild animals or other animals that you do not know.
• Bat proof your home. Wildlife biologists can provide tips on how to bat proof your home without harming bats but preventing them from entering your home. 

In 2006, the Alliance for Rabies Control, a U.K. charity, formed to promote rabies prevention worldwide. The Alliance, along with the U.S. Centers for Disease Control and Prevention, declared September 28 World Rabies Day. All partners, including international health organizations, national, state and local public health partners, professional organizations, commercial pharmaceutical companies and foundations are called upon to plan events throughout the world to increase awareness about rabies and to raise support and funding towards its control and prevention.

For more information, visit our website at www.mainepublichealth.gov/rabies.

World Rabies Day

World Rabies Day is on Saturday, September 28. Why should Mainers know about this worldwide event? Because the rabies virus kills over 55,000 people worldwide each year and is found in Maine’s wildlife. We have seen 38 animals with rabies so far this year. Maine’s Health and Environmental Testing Lab (HETL) confirmed rabies in the following animals: 18 raccoons, 11 skunks, five bats (big brown), and four foxes (1 gray, 3 red). One of the rabid skunks was from Washington County, which is concerning because it was the first report of a rabid animal in that county in six years. Last year, Maine confirmed its first rabid dog since 2003. For these reasons, it’s more important than ever to learn how to stay rabies-free.

Before going on a brisk fall hike or hunting trip, read these simple tips for rabies prevention:

•  Avoid contact with wildlife and any animal you don’t know
•  Keep your pets up-to-date on rabies vaccination
•  Report exposures to Maine CDC at 1-800-821-5821
•  Bat-proof your home

For more tips, visit our website at www.mainepublichealth.gov/rabies.

Friday is World Rabies Day

On September 28, the State of Maine will celebrate the sixth annual World Rabies Day. Although Maine has not had a case of human rabies since 1937 due to reporting and effective control measures, the threat of rabies remains.

Last month, Maine CDC was notified of a domestic dog that tested positive for rabies. This is the first case of rabies in a domestic dog in Maine since 2003. This case reminds us of the importance of keeping pets up-to-date on rabies vaccine and avoiding contact with wild animals to prevent the spread of rabies. The dog was infected with a variant of the rabies virus that circulates most commonly in raccoons and is predominant in the eastern United States.

Rabies is a preventable viral disease of mammals. The virus is spread when infected animals bite or scratch a person or another animal. The virus can also be spread if saliva or tissue from the brain or spinal cord of a rabid animal touches broken skin or gets into the mouth, nose or eyes of a person or another animal.

All mammals are susceptible to rabies infection, but only a few wildlife species are important reservoirs for the disease, including raccoons, skunks, bats, and foxes. While wildlife are more likely to be rabid than are domestic animals in the United States, domestic animals can be infected when they are bitten by wild animals.

Rabies in humans is preventable through prompt appropriate medical care. If you or someone you know is bitten or scratched by an animal, wash the wound with soap and water right away, and contact your healthcare provider to find out if you need to be treated for a rabies exposure. Usually, medical care can be delayed if rabies can be ruled out in the biting animal either through a confinement period for domestic animals or rabies testing for wild animals.

All Mainers are encouraged to consider ways in which they can prevent the spread of rabies including:

• Vaccinate your pet cats and dogs against rabies; it is the law.
• Avoid contact with wild animals or other animals that you do not know.
• Bat proof your home. Wildlife biologists can provide tips on how to bat proof your home without harming bats but preventing them from entering your home.  

For more information, contact your local animal control officer or Maine CDC at 1-800-821-5821. Stop by at our World Rabies Day Table in the lobby of KeyBank Plaza on Water Street in Augusta from 8 a.m. to 2 p.m. Thursday, September 27.

World Rabies Day

On September 28, Maine CDC will celebrate the fifth annual World Rabies Day. Established in 2007 by U.S. CDC and the Alliance for Rabies Control, a U.K. charity, this day is dedicated to raise awareness about rabies. Worldwide, more than 50,000 people die from rabies each year.

Rabies is a deadly disease caused by a virus. Rabies is 100% preventable by avoiding wild animals and any animal that you do not know, or by getting rabies shots if an exposure already occurred. A rabies exposure happens when a person or animal comes into contact with the saliva or tissue from the nervous system (brain or spinal cord) of a rabid animal. This contact can be from a bite or scratch, or if the animal’s saliva gets into a cut in the skin or in the eyes, nose, or mouth.

Rabies in people is very rare in the United States, with only one to two cases each year. The last human case of rabies in Maine was in 1937, but this does not mean that rabies is not a problem. Rabies in animals, especially wildlife, is common in most parts of the country, including Maine. The most commonly infected animals in Maine are raccoons, skunks, bats, and foxes. To date in 2011, 51 animals tested positive for rabies.

If you think that you have been exposed to rabies, wash the wound right away with soap and water. Then, call your doctor and the Maine CDC at 1-800-821-5821 to evaluate the need for animal testing and rabies shots. In addition, if you or your pet is exposed to a suspect rabid animal, call your veterinarian and local Animal Control Officer. If you or your pet is exposed to a wild animal, call your local Game Warden.

Follow these steps to prevent rabies:

• Vaccinate your pet cats and dogs against rabies; it is the law.
• Avoid contact with wild animals or other animals that you do not know.
• Bat-proof your home. Wildlife biologists can provide tips on how to bat proof your home without harming bats but preventing them from entering your home.

For more information about rabies, visit the Maine CDC website at www.mainepublichealth.gov/rabies.

Rabies update

US CDC and the Maryland Department of Health and Mental Hygiene, with assistance from Montgomery County Department of Health and Human Services and Suburban Hospital-Johns Hopkins Medicine, have developed an online course to educate healthcare providers and public health professionals about rabies, the approach used in evaluating patients for rabies virus exposure, and the administration of rabies postexposure prophylaxis (PEP). There is no cost to view the course or to receive continuing education credit.

As a reminder to clinicians, PEP for rabies is reportable in Maine.

The second quarter animal rabies update for Maine is now available at http://www.maine.gov/tools/whatsnew/attach.php?id=277584&an=1

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

World Rabies Day

Today Maine CDC recognizes the third annual World Rabies Day. US CDC and the Alliance for Rabies Control, a UK charity, established this day in 2007 to raise awareness about rabies, which kills more than 50,000 people worldwide each year.

Rabies is a deadly disease caused by a virus. Rabies is 100% preventable by avoiding wild animals and any animal that you do not know, or by getting rabies shots if an exposure already occurred. A rabies exposure happens when a person or animal comes into contact with the saliva or tissue from the nervous system (brain or spinal cord) of a rabid animal. This contact can be from a bite or scratch, or if the animal’s saliva gets into a cut in the skin or in the eyes, nose, or mouth.

Rabies in people is very rare in the United States, with only one to two cases each year. The last human case of rabies in Maine was in 1937, but this does not mean that rabies is not a problem. Rabies in animals, especially wildlife, is common in most parts of the country, including Maine. The most commonly infected animals in Maine are raccoons, skunks, bats, and foxes. To date this year, 52 animals have tested positive for rabies.

If you think that you have been exposed to rabies, wash the wound right away with soap and water. Then, call your doctor and the Maine CDC at 1-800-821-5821 to evaluate the need for animal testing and rabies shots. In addition, if you or your pet is exposed to a suspected rabid animal, call your veterinarian and local Animal Control Officer. If you or your pet is exposed to a wild animal, call your local Game Warden.

Follow these steps to prevent rabies:

• Vaccinate your pet cats and dogs against rabies; it is the law.
• Avoid contact with wild animals or other animals that you do not know.
• Bat-proof your home. Wildlife biologists can provide tips on how to bat-proof your home without harming bats.

For more information about rabies, visit the Maine CDC website at www.mainepublichealth.gov/rabies.

Maine CDC/DHHS Public Health Update 03/26/10

MAINE H1N1 FEEDBACK SURVEY

Maine CDC is conducting numerous in-person debriefings across the state with stakeholders on our H1N1 efforts. In addition, this Maine CDC H1N1 Feedback Survey is being distributed widely. If you have not done so already, please complete the survey and share the link with others.

INFECTIOUS DISEASE SURVEILLANCE REPORTS

Maine CDC’s Infectious Epidemiology Program has issued several disease surveillance reports for distribution.

A graph of selected reportable diseases that displays preliminary Year-To-Date (through February, 2010) totals with median Year-To-Date totals for the previous five-year period is available at: http://www.maine.gov/dhhs/boh/ddc/epi/publications/reportable-diseases-0210.pdf. This graph shows higher reported cases of Lyme Disease and Gonorrhea through February than the 5-year median.

The annual surveillance report on Group A Strep can be found here: http://www.maine.gov/dhhs/boh/ddc/epi/airborne/gas_survreport2009.pdf

The annual surveillance report on Group B strep is available here: http://www.maine.gov/dhhs/boh/ddc/epi/airborne/gbs_survreport2009.pdf


INFLUENZA UPDATE

What’s New With Flu?

Flu Activity. Virtually all detected influenza activity seen across the country is with the pandemic strain of H1N1. Most states are reporting sporadic, local, or no flu activity. The full national report can be found at: http://www.cdc.gov/flu/weekly/index.htm.

Maine’s influenza activity was coded “sporadic” this week, mainly because of continued reports of influenza-like-illness. Maine’s weekly influenza surveillance report can be found at: http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml. Maine and the U.S. continue to see virtually no seasonal influenza virus strains except for some very occasional type B. Almost all the detectable influenza viruses remain the pandemic strain of H1N1 influenza.

For the 2010-2011 season, flu vaccine will be recommended for all people. Although Maine CDC does not and never has provided the majority of seasonal flu vaccine in Maine, we are able to purchase sufficient seasonal flu vaccine for the 2010-2011 season for:
· all Maine children ages 6 months to 18 years-old;
· employees of schools that are providing onsite vaccine clinics on school days;
· pregnant women and their partners;
· nursing home employees and residents;
· high risk adults in limited public health settings, the scope and number of such settings determined by our vaccine supply.

The 2010-2011 seasonal flu vaccine will contain the pandemic Type A H1N1 component as well as a strain of Type B and Type A H3N2. Those who received the pandemic H1N1 vaccine will need to also receive the seasonal flu vaccine this coming season. More details about ordering will be coming soon.

Morbid Obesity and Flu: Increasingly the national data are showing that minority populations have been harder-hit by the 2009 H1N1 pandemic than non-minority groups, and there is growing evidence to support early concerns that people who are morbidly obese are at greater risk of serious 2009 H1N1 complications.

Don’t Forget Spring Break: With spring break coming up and large numbers of students expected to travel both domestically and internationally, vaccination of college-age students, who have been hard-hit by illness during this pandemic, continues to be recommended. Vaccine clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Ongoing Flu Issues:

Flu activity, caused by either 2009 H1N1 or seasonal flu viruses, may rise and fall, but is expected to continue, especially in areas that did not see large surges in disease and/or did not have high vaccine rates. Testing for and reporting of cases and outbreaks to Maine CDC continue to be important strategies to track the virus’s spread.

It is still important to continue to offer the H1N1 vaccine to those at high risk for severe disease or those who are in a high priority category and who may have been missed earlier. If someone is vaccinated now, they can still receive the seasonal flu vaccine in the fall, which will contain the 2009 H1N1 strain. Those who should be focused on for ongoing H1N1 flu vaccination include:
women who are now pregnant;
infants who are now 6 months of old or older;
caregivers and household contacts of newborns and other young infants;
people 65 and older who may have been waiting for others to be vaccinated;
those with chronic diseases;
all young people ages 6 months to 25 years of age; and
all health care workers and EMS, including caregivers of people with developmental and/or physical disabilities.

Disposing of and Reporting Unused/Expired Vaccine
Unused or expired H1N1 vaccines may not be returned to the distributor. If vaccine cannot be redistributed prior to expiration, the health care provider is responsible for disposing of the vaccine appropriately, in compliance with Maine’s biomedical and/or hazardous waste rules. However, US CDC is working on a possible centralized national system for disposal of vaccine, and we will know more about this later this month.

Discarded vaccine needs to be reported to Maine CDC. Providers should report the doses discarded on the same weekly reporting form used for vaccine administration (http://www.maine.gov/dhhs/boh/maineflu/schools/documents/Aggregate-H1N1-weekly-reporting_V3.pdf) – please note any discarded doses in the space between the two “Total” cells at the lower right corner of the form with a mark of “Expired (and discarded) doses.”


WORLD TUBERCULOSIS DAY

TB Elimination: Together We Can! was the U.S. theme for World TB Day on March 24. World TB Day is observed each year to commemorate the date in 1882 when Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB).

Tuberculosis is a disease caused by bacteria that usually infects the lungs but can affect any part of the body. TB is spread through the air when a person with active TB disease of the lungs or throat coughs, speaks, sneezes or sings. Signs and symptoms include a cough lasting 3 weeks or more, night sweats, fatigue, weight loss, coughing up blood, fever, and chills.

Worldwide, TB remains one of the leading causes of death from infectious disease. Each year, approximately 9 million persons around the world become ill with TB, and nearly 2 million TB-related deaths occur worldwide. In the United States, however, the number of reported TB cases is at an all-time low with 17 consecutive years of decline.

Although both the nation and the state of Maine have successfully achieved decreased numbers of tuberculosis cases, there is still much to be done in the elimination of TB in at-risk populations, including minorities, foreign-born persons, substance abusers and those associated with homelessness who account for a disproportionate percentage of TB cases.

In 2009, Maine had 9 cases of TB, the same number of cases that were reported in 2008. Males accounted for 6 of the cases (67%). The median age of cases was 48 years (range 5-86 years). Risk factors included substance abuse (33%), homelessness (11%), and foreign-born status (44%).

The state of Maine is actively engaged in partnerships and collaborations with community-based organizations throughout the state to reach this population and succeed in the elimination of TB. For more information: http://www.cdc.gov/Features/WorldTBDay/

Maine CDC has recently identified TB among two people who are homeless in Cumberland County. More information on this can be found at:
http://www.maine.gov/tools/whatsnew/attach.php?id=94284&an=1

RABIES

US CDC has established a new rabies webpage, which includes updated ACIP recommendations on human rabies post-exposure prophylaxis and new content organization: http://www.cdc.gov/rabies/

Maine CDC provides a quarterly update on animal rabies to veterinarians and other animal health professionals, which may be used to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine. The 4th quarter update is available here: http://www.maine.gov/tools/whatsnew/attach.php?id=91596&an=2

FDA RECOMMENDS TEMPORARY SUSPENSION OF ROTARIX VACCINE

The US Food and Drug Administration (FDA) has learned that DNA material from porcine circovirus type 1 (PCV1) is present in Rotarix, a vaccine used to prevent rotavirus disease. Although there is no evidence at this time that this DNA material poses a safety risk, finding the material was unexpected and FDA is assessing the situation. As a result, FDA is recommending that clinicians temporarily suspend the use of Rotarix. FDA will keep the public and clinical community updated through www.fda.gov.

Rotavirus vaccines are given by mouth to young infants to prevent rotavirus disease, which can cause severe diarrhea and dehydration. Rotavirus disease causes the deaths of more than 500,000 infants around the world each year, primarily in low- and middle-income countries. Before the introduction of vaccination, the disease caused more than 50,000 hospitalizations and several dozen deaths in the United States each year.

There are two licensed rotavirus vaccines in the United States: RotaTeq (Merck) and Rotarix (GlaxoSmithKline). Because RotaTeq was licensed in 2006 and Rotarix in 2008, most children vaccinated in the United States received RotaTeq.

RotaTeq is made using a different process from Rotarix. Preliminary studies on the RotaTeq vaccine, both by the academic research team and by FDA, have not shown the presence of PCV1 DNA. FDA is working with Merck to confirm these findings.

Within approximately four to six weeks, FDA will convene an advisory committee to review the available data and make recommendations on the licensed rotavirus vaccines. FDA will also seek input on the use of new techniques for identifying viruses or viral particles in vaccines.


MAINE AWARDED FEDERAL OBESITY PREVENTION FUNDS

First Lady Michelle Obama and US DHHS Secretary Kathleen Sebelius announced last week that Maine is one of 9 states to receive American Recovery & Reinvestment Act funds focused on preventing obesity. Maine’s award is $4.28 million over a 2-year period.

Maine CDC’s Division of Chronic Disease conducted a mini-RFP process prior to submitting the federal application, which resulted in the selection of two Healthy Maine Partnerships – Healthy Portland and Communities Promoting Health Coalition, which serves the Sebago Lakes region.

To view a complete listing of grant awardees, visit http://www.hhs.gov/recovery/programs/cppw/grantees.html

To view a fact sheet on Communities Putting Prevention to Work visit http://www.hhs.gov/recovery/programs/cppw/factsheet.html

To learn more about Communities Putting Prevention to Work, visit http://www.hhs.gov/recovery and http://www.cdc.gov/chronicdisease/recovery

STAY UPDATED

· Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”) http://www.facebook.com/pages/Augusta-ME/Maine-CDC/135584761549
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
· For clinical consultation and outbreak management guidance, call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
· For general questions on flu, call 2-1-1 from 8 a.m. to 8 p.m. seven days per week

Public Health Update 2/12/10

Maine CDC/DHHS Public Health Update
February 12, 2010

Influenza Activity in Maine and the US
H1N1 activity continues in Maine as well as across the U.S. but in diminished levels than in November and December. There was one outbreak of influenza like illness in a Hancock County K-12 school last week. Nationally and in Maine, virtually all of the influenza viruses identified are the 2009 pandemic strain of influenza A. More information can be obtained at: http://www.cdc.gov/flu/weekly/index.htm#whomap.

Influenza Vaccine
Sanofi Pasteur has shortened the expiration period of all of its 2009 H1N1 influenza vaccine in pre-filled syringes; all lots should now be administered by February 15, 2010 regardless of the expiration imprinted on the package. There are no safety concerns with the recalled lots of 2009 H1N1 vaccine and no re-administration of the vaccine is required. For more information, see this US CDC Q&A: http://www.cdc.gov/h1n1flu/vaccination/qa_recall.htm?s_cid=tw_flu104. Maine health care providers who have received this vaccine have been contacted directly by Maine CDC’s Immunization Program staff.

With more than 900,000 doses of H1N1 vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated against H1N1 flu. Clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Parents are reminded to ensure that children younger than 10 years-old get both doses of 2009 H1N1 vaccine. The recommended interval between the first and second dose is 28 days.

Even those not at high-risk for complications from influenza should consider vaccine, because either they themselves can suffer complications or can infect those who are at higher risk for complications. Health care providers who treat people at high risk for complications from influenza (such as those with underlying conditions, pregnant women, young children, and those older than 64) are urged to vaccinate those patients and to treat with antiviral medicines at the onset of symptoms.

Disposing of and Reporting Unused/Expired Vaccine
Health care providers who have sufficient supplies and no longer need vaccine that is being shipped to them should contact their local vaccine coordinator to arrange for redistribution. Unused or expired H1N1 vaccines may not be returned to the distributor. If vaccine cannot be redistributed prior to expiration, the health care provider is responsible for disposing of the vaccine appropriately.

For information on hazardous waste disposal in Maine, see the Biomedical Waste Management Rules (06-096 CMR 900): http://www.maine.gov/sos/cec/rules/06/096/096c900.doc and 38 MRSA Chapter 13, Waste Management: http://www.mainelegislature.org/legis/statutes/38/title38ch13sec0.html

Discarded vaccine needs to be reported to Maine CDC. Providers Please discard the expired vaccine doses as providers do with their other expired medicines and ask them to report the doses discarded on the same weekly reporting form used for vaccine administration (http://www.maine.gov/dhhs/boh/maineflu/schools/documents/Aggregate-H1N1-weekly-reporting_V3.pdf) – please note any discarded doses in the space between the two “Total” cells at the lower right corner of the form with a mark of “Expired (and discarded) doses.”

Group A Strep Update
Maine CDC has now received 13 reports of cases of invasive Group A Streptococcal (GAS) infections since January in Maine. Cases have been confirmed in Androscoggin, Cumberland, Hancock, Kennebec, Oxford, Penobscot, and York counties in people ages 6 through 90. Seven of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year.

There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in this Maine CDC health advisory http://bit.ly/bswpU2 or this US CDC site: http://bit.ly/cP0vIl.

Earthquakes and Public Health
The American Public Health Association has developed a web page with links to information about relief efforts in Haiti, which includes resources for people who are interested in volunteering: http://www.apha.org/programs/globalhealth/issues/

There are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones, such as Haiti, to assist in recovery efforts. These two US CDC sites provide advice for relief workers, including travel guidance specific to workers traveling to Haiti: http://wwwnc.cdc.gov/travel/content/relief-workers.aspx and http://emergency.cdc.gov/disasters/earthquakes/responders.asp

Updates from Federal Partners
US CDC issued an abbreviated Pandemic Influenza Plan template for primary care provider offices, which will allow providers to rapidly (within 1-5 days) develop a pandemic influenza plan: http://www2c.cdc.gov/podcasts/download.asp?af=h&f=761031

Maine Animal Rabies Fourth Quarter Update
Maine CDC provides a quarterly update on animal rabies to veterinarians and other animal health professionals, which may be used to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine. Read the update here: http://www.maine.gov/tools/whatsnew/attach.php?id=91596&an=2

To read the full update, click here: http://bit.ly/bhbbuw