Bi-weekly Public Health Update 9/9/10

INFLUENZA UPDATE

Maine CDC has already distributed more than 36,000 doses of flu vaccine. The vaccine distributed so far is earmarked for pre-schoolers as well as residents and employees of nursing homes and long-term care facilities. It is the first time in many years that state-supplied vaccine has been distributed this early.

Most influenza vaccine arrives in Maine through private sector channels, but some federal and state (Tobacco Settlement - Fund for a Healthy Maine) funds allow Maine CDC to purchase flu vaccine for some populations in Maine such as pregnant women, those in nursing homes, K-12 school children and their teachers and other staff, all other children, homeless, and people served by municipal and tribal health departments. Maine CDC will be distributing a total this year of about 290,000 doses of influenza vaccine, most of it over the coming weeks.

Maine CDC has posted materials – including registration forms, consent forms, and sample protocols – for those participating in school-based flu vaccine clinics at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#schoolclinics

Updates from the US CDC can be found on its Influenza Site.


PERTUSSIS

Pertussis is still an important concern in Maine and throughout the U.S., with outbreaks being seen in several states, including significant ones among un and under-vaccinated in California, resulting in 8 infant deaths there. To date in 2010, Maine has seen 32 confirmed cases of pertussis with 11 of those reported in the past month. The majority of people identified are younger than 13 years of age. Half are not up to date on their vaccines or their vaccine status is not known. With school reconvening and with so many children under-vaccinated, we are concerned about increasing outbreaks here in Maine. For more information, see this Health Alert: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=128206&v=alert


NATIONAL HEALTH REFORM

This report (http://www.rwjf.org/coverage/product.jsp?id=68128&cid=xtw_rwjf) examines the demographics and health characteristics of the new population nationally now eligible for Medicaid under health reform.

Although health coverage is currently available to children in families with incomes up to about $45,000 per year in nearly every state, an estimated five million uninsured children are eligible for Medicaid or CHIP but not enrolled. The Centers for Medicare & Medicaid Services (CMS) have built an unprecedented coalition of partners, ranging from state governors to national advocacy organizations, to enroll children in Medicaid and CHIP and educate families. For more information: http://www.hhs.gov/news/press/2010pres/09/20100903a.html

As part of the health reform’s step-by-step efforts to close the Medicare Part D prescription drug coverage gap, more than 1 million eligible Medicare beneficiaries who fall in this “donut hole” this year are mailed a one-time, tax-free $250 rebate check. For more information: http://www.hhs.gov/news/press/2010pres/08/20100830b.html

Through the Affordable Care Act’s Early Retiree Reinsurance Program, employers are going to receive help to maintain health coverage for retirees not yet eligible for Medicare. Nearly 2,000 employers, representing large and small businesses, State and local governments, educational institutions, non-profits, and unions have been accepted into the program and will begin to receive reimbursements for employee claims this fall. For more information: http://www.hhs.gov/news/press/2010pres/08/20100831a.html

The U.S. Department of Health and Human Services has unveiled CuidadodeSalud.gov, the first website in Spanish of its kind to help consumers take control of their health care by connecting them to new information and resources that will help them access quality, affordable health care coverage. This site is the partner of HealthCare.gov, which was launched in July 2010, and is the first website in Spanish to provide consumers with both public and private health coverage options tailored specifically for their needs in a single, easy-to-use tool. For more information: http://www.hhs.gov/news/press/2010pres/09/20100908a.html

For more information about Health Reform in Maine, visit the Governor’s Office of Health Policy and Finance’s web site: http://www.maine.gov/healthreform/


MAINE IS HIGHLIGHTED IN US CDC’S SPOTLIGHT ON TOBACCO USE

CDC Vital Signs is a new report that will appear on the first Tuesday of the month as part of the US CDC journal Morbidity and Mortality Weekly Report (MMWR). Vital Signs is designed to provide the latest data and information on key health indicators. This month’s Vital Signs focus on tobacco use:
• Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years — United States, 2009
• Vital Signs: Nonsmokers’ Exposure to Secondhand Smoke — United States, 1999–2008

Despite the known dangers of tobacco use, 1 in 5 American adults continues to smoke cigarettes, and 4 in 10 nonsmokers were exposed to cigarette smoke during 2007-2008. Among children between the ages of 3 and 11 years old, 54 percent were exposed to secondhand smoke. Nearly all (98%) of children who live with a smoker are exposed and have measureable levels of toxic chemicals from cigarette smoke.

In this report, US CDC commends California for their successful long term comprehensive tobacco control program that has been associated with adult smoking rate reductions. They then commend the successes seen in youth smoking in our state: “Maine, New York, and Washington have seen 45%--60% reductions in youth smoking with sustained comprehensive statewide programs.”

Additionally, the report notes that the 2009 Family Smoking Prevention and Tobacco Control Act gives the Food and Drug Administration authority to regulate the manufacturing, marketing, and distribution of tobacco products and has provided new opportunities to reduce tobacco use.

For more information visit the Partnership for a Tobacco-free Maine, Maine CDC’s tobacco prevention and control program.


SPOTLIGHT ON TATTOOS

Tattoo licensing has been in the local news recently. Licensed tattoo artists in Maine are required to have special training about bloodborne diseases and to utilize safety precautions before, during and after the application of the tattoo. In getting a tattoo, safety should always be vigilantly observed to avoid medical issues. These include preventing diseases such as HIV, AIDS, hepatitis and other diseases that can be acquired through sharing of needles, use of unsterile equipments and sloppy procedures. You can reduce the health risks by only going to tattoo shops and tattoo artists that are fully licensed. The following provides information on the health risks associated with tattoos and the safety precautions that should be used by all licensed tattoo artists in the State of Maine.

Health Risks Associated with Tattoos:
• Bloodborne diseases. If the equipment used to create your tattoo is contaminated with infected blood, you can contract various bloodborne diseases, including hepatitis B, hepatitis C, tetanus and HIV — the virus that causes AIDS.
• Skin infections. Tattoos can lead to local bacterial infections, characterized by redness, swelling, pain and a pus-like drainage.
• Allergic reactions. Tattoo dyes — especially red dye — can cause allergic skin reactions, resulting in an itchy rash at the tattoo site. This may occur even years after you get the tattoo.
• Other permanent skin problems. Sometimes bumps called granulomas form around tattoo ink, especially red ink. Tattooing can also lead to raised areas caused by an overgrowth of scar tissue (keloids).

Safety Precautions for Reducing Health Risk Associated with Tattoos:
• Go to a reputable tattooing studio that employs only licensed, properly trained employees.
• Make sure the tattoo artist washes his or her hands and wears a fresh pair of protective gloves for each procedure.
• Make sure the tattoo artist removes a needle and tubes from sealed packages before your procedure begins. Any pigments, trays and containers should be unused as well.
• Make sure the tattoo artist uses a heat sterilization machine (autoclave) to sterilize all nondisposable equipment after each customer. Instruments and supplies that can't be sterilized with an autoclave — including drawer handles, tables and sinks — should be cleaned with a commercial disinfectant or bleach solution after each use.

If you think your tattoo may be infected or you're concerned that your tattoo isn't healing properly, contact your doctor.


UPDATED RECOMMENDATIONS FOR PNEUMOCOCCAL VACCINE

The U.S. CDC’s Advisory Committee on Immunization Practices (ACIP) has updated its recommendations for prevention of invasive pneumococcal disease through use of the 23-valent pneumococcal polysaccharide vaccine among all adults aged ≥65 years and those adults aged 19–64 years with underlying medical conditions that put them at higher risk for serious pneumococcal infection. The new recommendations include the following changes from previous ACIP recommendations: 1) indications for which PPSV23 vaccination is recommended now include cigarette smoking and asthma, and 2) routine use of PPSV23 is no longer recommended for Alaska Natives or American Indians aged ≤65 years unless they have medical or other indications for PPSV23. For more information, read this MMWR: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm?s_cid=mm5934a3_w

Smokeless Tobacco Dangers

The Partnership for a Tobacco-free Maine (PTM) is the Maine CDC’s tobacco prevention and control program. Its mission is to reduce death and disability from tobacco use among Maine citizens by creating an environment supportive of a tobacco-free life.

Snus is a new smokeless tobacco product that can be found nationwide and is becoming more prevalent. Consumption of smokeless products has risen over the past few years as cigarette consumption has decreased.

A recent segment on 60 Minutes about snus may not have presented enough information about the harmful effects of these products, such as:

· Tobacco is tobacco. ALL tobacco is harmful. Snus is not a safe alternative to smoking. National agencies such as CDC, NCI, and NIH all recommend that any form of tobacco be avoided and discontinued.

· Maine's strong tobacco laws have been proven to discourage youth smoking and support people seeking tobacco treatment, but these new products counter our efforts. Smokers wishing to quit should be encouraged to use approved methods such as counseling, NRT, and medications.

· These products appeal especially to young people and can be a gateway to addiction. These products can be used discretely and are advertised as a way to circumvent smoke-free laws. The piece also briefly discusses the new dissolvables and how they are attractive to youth.

· Using smokeless products can, in a dual user, increase the level of addiction to nicotine. These products allow the individual who may have otherwise quit smoking to perpetuate his or her addiction to nicotine by allowing use in areas where smoking is prohibited.

· Swedish snus and U.S. snus are not the same product. They are regulated and manufactured differently. Dr. Fagerstrom discusses the Swedish form. The Swedish version contains fewer toxins than the American counterpart. Long term research on the health effects of the U.S. snus does not exist.

· Placement of advertising for new products is an issue (most signs are on convenience store entry doors below the waist high handle to become familiar and seen by children). This is not addressed in the piece.

· These are cheap products – they cost about half the price of a pack of cigarettes. Taxes on non-cigarette products have not increased at the same rate as taxes on cigarettes. Increased prices discourage initiation among youth and young adults, prompt quit attempts, and reduce consumption among current users.

· The very fact that the tobacco industry is promoting these products as a harm reduction tool should be concerning to us. Harm reduction is neither an acceptable nor ethical public health practice.