Update on Health Reform

The U.S. Departments of Health and Human Services, Labor, and Treasury have issued regulations on grandfathered health plans under the Affordable Care Act.

This webchat describes how the Affordable Care Act will give individuals and families more choices and provide stronger consumer protections.

This Kaiser Health News article describes additional benefits for new moms and pregnant women as a result of health reform.

Seniors across the country recently joined President Obama’s discussion on health reform and Medicare. This blog post also describes ways that the new legislation will strengthen Medicare.

The IRS has issued regulations on the 10 percent tax on indoor tanning services included in the health reform law.

National Men's Health Week

National Men’s Health Week is celebrated each year the week leading up to and including Father’s Day.

During the week, individuals, families, communities, and others work to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys. This US CDC website describes what you can do to promote awareness during Men’s Health Week.

This US CDC website has daily steps to help men be safer, stronger, and healthier.

Every year, nearly 300,000 American men die of cancer. This US CDC website discusses ways men can lower their risk.

Safe water bond is a good deal

In my job as director of Maine’s public health agency, we work to protect public health for all Maine people. An important part of our core mission for the last 100 years is to ensure that Maine’s drinking water is safe and reliable. However, Maine’s drinking water infrastructure, like that found in most other states, is old and in need of repair and replacement.

In the beginning of May, I watched in awe as Boston’s drinking water operators spent days and nights working to repair a pipe break on a large water transmission line that serves 30 communities surrounding Boston. Because of the potential for contamination, more than 2 million people, including 700,000 households, had to boil their water or use bottled water for three days while the pipe was being repaired. This interruption in service caused great disruption and costs to families, businesses and workers and illustrates the need to maintain our water infrastructure.

On June 8, Question 5 asks whether you favor a $10.25 million state bond that will match $33.25 million in federal funds designated for drinking water and wastewater infrastructure projects, and agriculture irrigation projects.

If the question passes, $3.4 million of the $10.25 million will be used for drinking water infrastructure projects that will receive a match of $17 million in federal funds. For the 2010 construction season, we have received more than $42 million in drinking water funding requests. Public water systems that have requested funding to improve water treatment or upgrade existing facilities include Bangor, Eastport, Vinalhaven, Mechanic Falls, Bath, Hampden, Gardiner, Old Town, Caribou, Portland and Auburn-Lewiston. Without the state match, these projects will not be funded this year.

For every $1 the state invests, the federal government provides $5. The state must provide the state match in order to receive the federal funds. If the state cannot provide matching funds within two years, Maine’s federal funds are forfeited to other states.

Since 1997, the Maine Center for Disease Control and Prevention’s Drinking Water Program has administered the Drinking Water State Revolving Fund that provides low-interest loans and grants to public water systems. The fund serves systems statewide and operates in conjunction with the Maine Municipal Bond Bank. Re-payment of principal and interest on the loans, combined with the state matching funds and federal funds, is put back into the fund so that new loans can be made.

The U.S. Environmental Protection Agency has estimated that Maine’s drinking water infrastructure need over the next 20 years is $900 million, or an average of $45 million per year.

The fund is a notably successful program. Since 1997, we have lent or granted more than $150 million to our public water systems so that they can continue to provide safe and reliable drinking water to people in Maine. These investments also provide well-paying jobs for Maine workers and businesses through the construction, maintenance and operation of these facilities.

Maintenance of our drinking water and wastewater infrastructure does have a cost; however, this is a good deal for Maine people even in these tough economic times. We must continue to make the investment necessary to maintain reliable and safe water for the state of Maine.

Dora Anne Mills is director of the Maine Center for Disease Control and Prevention and the state’s chief health officer.

Originally printed in the Bangor Daily News.

Some tips for safely enjoying Memorial Day Weekend

Temperatures have been in the 80s in Augusta this week, and the forecast is calling for more warm, sunny weather over the long weekend.

Although it's not officially summer, it feels like it.

Keep some of these things in mind as you enjoy the weather and celebrate the holiday:

USDA has several tips for using food thermometers, to avoid under cooking meat. Be careful when you barbecue to prevent foodborne illness.

Having a salad with your barbecue? Remember to check those alfalfa sprouts.

Remember to stay in the shade or take other steps to protect yourself from sunburns and eventual skin cancer.

Going swimming? Think about what you can do to protect yourself and others from recreational water illnesses. And while you're at it, check out www.poolsafely.gov.

Take care and enjoy the weather while it lasts!

Update on health reform

This Kaiser Health Tracking Poll indicates that many Americans are still confused about health reform and what it means to them.

This Health Reform Implementation Brief describes the Prevention and Public Health Fund: http://healthreformgps.org/resources/prevention-and-public-health-fund/

The Internal Revenue Service has released guidance on the health reform law’s health care tax credit for small businesses. More information is available here: http://healthreformgps.org/resources/irs-releases-guidance-on-small-business-tax-credit/

The National Association of Public Hospitals and Health Systems has developed this simple tool to help determine what health reform means to an individual, based on insurance status and age.

National Recreational Water Illness Prevention Week

Just in time for the warm weather, it's National Recreational Water Illness Prevention Week.

Recreational water illnesses (RWIs) are caused by germs spread by swallowing, breathing in mists or aerosols of, or having contact with contaminated water in swimming pools, hot tubs, water parks, water play areas, interactive fountains, lakes, rivers, or oceans. RWIs can be a wide variety of infections, including stomach, skin, ear, respiratory, eye, neurologic and wound infections. The most commonly reported RWI is diarrhea.

Staying healthy while enjoying summer activities is important. Keeping our recreational water sources clean is also important. Here are some very simple steps you can take to keep yourself and others safe:

• Don’t swim when you have diarrhea
• Don’t swallow water when swimming
• Shower with soap before swimming and wash your hands after using the toilet or changing diapers
• Take kids on bathroom breaks or check diapers often
• Change diapers in a bathroom or a diaper-changing area and not at poolside
• Wash children thoroughly (especially the rear end) with soap and water before they go swimming

For more information, check out: www.mainepublichealth.gov/healthyswimming

What's new with the flu?

Flu Activity. Flu activity decreased nationally last week. Read the full national report here. There was no reported influenza activity in Maine last week. Maine’s weekly influenza surveillance report can be found here.

School-based Vaccine Clinics. Maine CDC’s school-based vaccine clinics web page has been updated to include a letter to school nurses and instructions for completing the Maine Immunization Program’s Provider Agreement for schools.

The web page also includes an order form for some of the equipment and supplies schools may need to hold vaccine clinics in the fall, which will be provided by Maine CDC at no charge. Any school that intends to hold a flu vaccine clinic in the fall may now place an order for a small vaccine refrigerator (34” high, 23 7/8” wide, 24 3/8” deep); a cold chain transportation and storage kit, which will include a cooler, ice packs, and related items required to maintain the temperature of the vaccine when transporting it between locations and during clinics; and a vaccine clinic go-kit, which includes the medical and administrative supplies necessary to hold a vaccine clinic.

Health care providers working with schools to store and administer vaccine are also eligible to place an order for these items.

Once received, Maine CDC is not responsible for maintaining the refrigerator. Please contact the manufacturer with any problems, particularly during the one-year warranty period. Refrigerators this size can store more than 1,000 doses of vaccine for school-based clinics. Thermometers, and information related to vaccine storage, will be shipped separately.

A representative from Maine CDC will call to confirm orders prior to shipment. This order process is not the vaccine order. Vaccine order forms will be sent to all providers who have been assigned four-digit PINs by the Maine Immunization Program. Completed order forms should be sent to william.jenkins@maine.gov or faxed to 287-4612 by Tuesday, May 25.

Revised recommendations for rotavirus vaccines

The U.S. Food and Drug Administration has revised its recommendations for rotavirus vaccines and has determined that it is appropriate for clinicians and health care professionals to resume the use of Rotarix and to continue the use of RotaTeq.

In March, FDA recommended temporary suspension of Rotarix after learning that DNA material from porcine circovirus type 1 (PCV1) was present in the vaccine.

The agency reached its decision to recommend resumed use of Rotarix based on a careful evaluation of information from laboratory results from the manufacturers and the FDA’s own laboratories, a thorough review of the scientific literature, and input from scientific and public health experts.

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 U.S. each year.

More information for parents and caregivers: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm205547.htm

More information for health care providers: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm205548.htm

State Public Health System Assessment

National Public Health Performance Standards Program (NPHPSP) is a partnership among six national public health organizations with the goal of improving the quality of public health practice and the performance of public health systems. Stakeholders from a variety of agencies in the public and private sectors came together at the Augusta Civic Center on May 13 for a day-long assessment of the public health system in Maine. The assessment was based on the ten Essential Public Health Services and will be a helpful guide in improving the state’s public health infrastructure. The report out meeting will be held from 9 a.m. to noon June 17 at the Augusta Civic Center.

Stroke Awareness Month: Learn the Symptoms and Act Quickly

A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is either blocked or bursts, and part of the brain begins to die. A person experiencing a stroke may not realize it is occurring, but bystanders can recognize the symptoms and act immediately.

Chances of survival and recovery are improved if immediate medical attention is given; the sooner a stroke patient receives treatment, the more likely that long-term brain damage and disability may be avoided.

Stroke symptoms include SUDDEN:
> Numbness in the face, arm, or leg
> Slurred speech
> Blurred vision
> Dizziness or loss of balance
> Severe headaches

Any ONE of these symptoms is a reason to take action. At the first sign of stroke, Call 911 immediately.

Stroke is the third leading cause of death and a leading cause of adult disability in Maine.

To help increase the number of stroke victims who receive timely treatment, the Maine CDC/DHHS Cardiovascular Health Program (MCVHP) is working with several statewide partners, including the Maine Affiliate of the American Stroke Association, to raise awareness of stroke symptoms and to help improve health care for stroke patients. You can play a key role too, learn the symptoms and at the first sign of stroke call 911.

Drinking Water Week

This week is National Drinking Water Week-– a time to recognize the important role that safe, reliable drinking water plays in our everyday lives. It’s easy to take our drinking water for granted, but every day around the world, thousands of people die from lack of access to clean water. Maine has abundant and safe sources of drinking water and we all work hard to keep it this way.

Three things you can do to help keep your drinking water clean:

1. Handle gasoline, motor oil, fertilizers, pesticides and other hazardous chemicals with care, making sure not to dump them on the ground or pour them down the sink. When you’re done with them, dispose of them properly at a recycling center.
2. Maintain your septic system and make sure it is in good working condition. Failing septic systems are one of the major sources of nitrates in surface water supplies.
3. Encourage your neighbors to take care of their septic tanks, petroleum, and chemicals with as much care as you do

For more information, see this press release.

Women's Health Week coming up

The 11th annual National Women’s Health Week will kick off on Mother’s Day, May 9, 2010 and will be celebrated until May 15, 2010. National Women’s Checkup Day will be Monday, May 10, 2010.

National Women’s Health Week is a week-long health observance coordinated by the U.S. Department of Health and Human Services’ Office on Women's Health (OWH). National Women’s Health Week empowers women to make their health a top priority. With the theme “It’s Your Time,” the nationwide initiative encourages women to take simple steps for a longer, healthier, and happier life. Important steps include:

• Getting at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of both each week
• Eating a nutritious diet
• Visiting a health care professional to receive regular checkups and preventive screenings
• Avoiding risky behaviors, such as smoking and not wearing a seatbelt
• Paying attention to mental health, including getting enough sleep and managing stress

Learn more about National Women's Health Week.

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.

Important information on Lyme disease

A special Review Panel has unanimously agreed that no changes need be made to the 2006 Lyme disease treatment guidelines developed by the Infectious Diseases Society of America (IDSA), the nation’s pre-eminent authority on infectious diseases. These guidelines promote a short-term course of antibiotics for the treatment of Lyme disease.

IDSA’s guidelines, voluntarily used by physicians to help them decide what treatments are best and safest for patients, were the subject of an antitrust investigation about whether the guidelines’ authors had conflicts of interest and failed to consider divergent medical opinions. IDSA maintains those assertions were unfounded and voluntarily agreed to a one-time special review of the guidelines by an independent scientific Review Panel whose members were certified to be free from any conflicts of interest by an independent ombudsman.

The review panel concurred that IDSA’s guidelines, which stated that long-term antibiotic treatment is unwarranted and potentially dangerous, are medically and scientifically valid and do not need to be changed. The full report is available here.

Follow these links for more information on Lyme disease in Maine and recently signed legislation to expand Lyme disease awareness in Maine.

Update on Health Reform

The Congressional Research Service issued this 100-page report reviewing the public health, health workforce, and quality provisions in the Patient Protection and Affordable Care Act (health reform).


Healthreform.gov is a comprehensive federal website on health reform, including this webpage with information on Maine. This link on the same site has information about dependent adults under age 26 being eligible for health insurance in advance of September’s start up date.


This open letter from the president and CEO of the Maine Health Access Foundation includes a summary of the health reform legislation and how it relates to Maine. It also includes links to other summaries.


Gov. Baldacci has formed a committee to work on implementing the health reforms in Maine.

Flu Update 4/8/10

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 “local” 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 occasional type B. Almost all the detectable influenza viruses remain the pandemic strain of H1N1 influenza.

Fall Flu Vaccine Campaign. Flu vaccine is recommended for all people for the 2010-2011 season. 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 decision on which populations we plan on purchasing vaccine for is based on several factors, including: populations designated by some of the vaccine funding sources available (federal funding sources for flu vaccine for some children); populations without other easy access to vaccine (homeless shelter residents); and people who are at high risk for severe complications (pregnant women, nursing home residents). Seniors and health care workers are in high priority groups for vaccine, but generally have existing access to flu vaccine that is not dependent on state dollars.

Please note that, as in years past, the only state-supplied vaccine earmarked for health care workers is for those who work in nursing homes. However, we strongly encourage all health care personnel, including EMS, to be vaccinated.

Anyone wishing to provide state-supplied flu vaccine in the fall must be a registered Maine Immunization Program (MIP) provider; those who are not currently MIP providers must register by April 30. Vaccine order forms will be sent to all registered providers by the middle of May. More detailed instructions, including a timeline for fall flu vaccine campaign activities, are available in this Health Alert.

A conference call for those interested in providing state-supplied seasonal flu vaccine in the fall will be held from 12 noon to 1 p.m. Monday, April 12. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and to un-mute when you are actively participating.

Don’t Forget Spring Break. This US CDC web page provides information and links for travelers who want to reduce their risk of becoming sick with 2009 H1N1. 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 http://www.maineflu.gov/. The free clinics are in bold font.

Maine Among Top States in H1N1 Vaccine Coverage:

US CDC recently issued two reports that highlight H1N1 vaccine successes as well as opportunities to improve future vaccination rates. Maine is among the top states for vaccine coverage against H1N1 flu for all ages.

Maine’s vaccine rate for those in US CDC’s highest priority groups was tied for first place among all states at 51%, compared with the national rate of 33%. These highest priority groups include pregnant women, all people ages six months to 25 years-old, people ages 25 to 65 with chronic health conditions, and health care workers, including emergency medical services personnel.

60% of Maine’s children ages 6 months to 17 years were vaccinated, compared to 37% nationally. Maine’s childhood vaccination rate was tied for second with Vermont and Massachusetts. Rhode Island was first.

Seniors in Maine also had among the highest vaccination rates in the nation. 40% of Maine residents age 65 and older were vaccinated, which is nearly twice the national rate of 22%, and tied for first among all states.

Maine’s overall rate of vaccinating 37% of all people older than 6 months is significantly higher than the national average of 24%

We at Maine CDC are exceedingly grateful to the thousands of Mainers who worked hard to achieve such remarkable success!

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.

In particular, US CDC strongly urges people with underlying health conditions and those over age 65 to get vaccinated against H1N1.

Vaccine supplies are plentiful and the circulating virus still closely matches the one in the pandemic vaccine. We have excellent safety data on the H1N1 vaccine.

Disposing of and Reporting Unused/Expired Vaccine
US CDC issued this Q&A on 2009 H1N1 flu vaccine with long-dated expirations. US CDC is also currently conducting a survey to determine how state laws affect the ability to ship expired vaccine for disposal. The results of this survey will help determine CDC’s centralized national system for vaccine disposal.

Discarded vaccine needs to be reported to Maine CDC. Providers should report the doses discarded on the same weekly reporting form for vaccine administration – 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.”

Health Reform

President Obama signed the Patient Protection and Affordable Care Act into law on March 23. Last week, he spoke about health reform when he visited Portland. The entire speech is available here.

This National Association of State Medicaid Directors document gives a side-by-side comparison of the different health care reform bills, while the Kaiser Family Foundation developed this summary of the final law and implementation timeline.

This Trust for America’s Health web page describes the prevention components of the final legislation.

The Association of Maternal and Child Health Programs’ Health Reform web page has a number of helpful links focused on the impact on maternal and child health programs as well as more general information.

Universal Childhood Immunization Program

LD 1408, An Act to Establish the Universal Childhood Immunization Program, has passed both chambers of the state Legislature and been signed into law by the Governor.

The program provides universal immunization coverage to children in the state by purchasing and making available to health care providers every vaccine for childhood immunization that is recommended by the US CDC’s Advisory Committee on Immunization Practices, approved by the FDA, and available under contract with US CDC.

For more information on this legislation, visit: http://mainelegislature.org/legis/bills/display_ps.asp?paper=HP0984&snum=124

Thank you to the many stakeholders who worked on this bill for 4 years, and to the bill’s sponsor, Representative Connor! Updates on the bill’s implementation, including timelines, will be forthcoming.

April is STD Awareness Month

April is STD Awareness Month. Maine CDC’s STD program conducts disease surveillance for gonorrhea, chlamydia and syphilis. Disease intervention specialists provide critical follow-up activities, including notification of disease; treatment verification for chlamydia, gonorrhea, syphilis and HIV; and partner services for all.

The HIV, STD and Viral Hepatitis Program funds STD clinics in Portland, Bangor, and Lewiston, and partners with the Family Planning Association of Maine and Planned Parenthood of Northern New England on the Infertility Prevention Project, which targets females 15-24 years-old and their partners.

Chlamydia is the most frequently reported STD in Maine, with 2,443 cases in 2009. Chlamydia disproportionately affects individuals in the 15-24 age group, and is reported in three females for every one male.

Gonorrhea typically affects a slightly older age range than Chlamydia, but during 2008 and 2009 nearly half of diagnoses occurred in the 15-24 age range, while less than a quarter were 25-29 years-old. There were 143 cases of gonorrhea reported in 2009, and 60 cases have already been reported in the first three months of 2010. We are seeing more cases among females and fewer diagnoses among men who have sex with men (MSM).

Over the past decade, annual syphilis counts have varied and until recent years had remained low, with fewer than 5 cases during most years. Cases counts peaked in 2008, with 20 cases, compared to 14 last year. Syphilis in Maine affects MSM disproportionately.

For more information about National STD Awareness month visit: www.cdcnpin.org/stdawareness or www.gyt10.org

April is Autism Awareness Month

US HHS Secretary Kathleen Sebelius issued this statement on National Autism Awareness month. This video shows the signs of autism. US CDC’s Study to Explore Early Development (SEED) is the largest collaborative scientific study to date of the risk factors of autism.

This web site discusses the purported link between vaccines and autism. For more information, see our Thimerosal fact sheet and presentation.