Avoid carbon monoxide poisoning when opening camps this weekend

As summer approaches and Mainers start opening up their camps for the season, the Maine Center for Disease Control and Prevention warns of the dangers of carbon monoxide poisoning.

Health officials urge camp owners to make sure their propane-fueled stoves and refrigerators are working properly and vented safely when turned on for the season. Camp owners should make sure they have working carbon monoxide detectors equipped with a battery back-up located close to where people sleep. Most hardware stores or places that sell smoke detectors also carry carbon monoxide detectors.

"This is the time of year when we start to get reports of people poisoned in their camps from high levels of carbon monoxide," said state toxicologist, Dr. Andrew Smith. "Usually, blocked exhaust vents or poorly maintained gas-fueled appliances are the culprits. Unfortunately, some of the poisonings are life-threatening."

Boaters are also at risk for carbon monoxide poisoning, Smith said. Carbon monoxide is present in the exhaust of inboard and outboard motors. Gasses can build to dangerous levels in areas just behind the boat. Boaters should stay away from exhaust vent areas, like the back platform. They should not swim in these areas when the motor is on.

Carbon monoxide, or CO, is an odorless and colorless gas created by any combustion engine or device. Improper venting, maintenance, operation or placement of combustion devices can result in poisoning when CO gas builds up in enclosed spaces and in garages, barns and sheds—even if the doors and windows are open.

There are more than 100 emergency department visits each year in Maine due to carbon monoxide poisoning, Smith said.

The Me-CDC estimates that the overall number of households with detectors is increasing and that about half of owner-occupied homes now have them. Yet, in 90 percent of reported carbon monoxide poisonings, there are no carbon monoxide detectors present where the poisonings occur. Maine law requires carbon monoxide detectors to be installed in all rental units, including seasonal rentals, and new single family dwellings. Detectors are also required in existing single-family dwellings whenever there is a transfer of ownership or an addition of one or more bedrooms. The law applies to camps and seasonal homes as well.

To prevent carbon monoxide poisoning this summer:

• Make sure gas-powered appliances in your camp are working and vented properly.
• Don't use a gas-powered generator, charcoal grill, camp stove, or other gas- or charcoal-burning device inside your camp or near a window or door. Generators should be more than 15 feet from your home when running. -Don't run a car, truck, lawn mower, tractor or any other motor inside a garage, barn or shed, even if you leave the door open.
• Make sure you have a CO detector with a battery back-up in your camp near where people sleep. Check or replace the battery during your first visit.
• If your CO alarm goes off, get out right away and call 911. Get prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.

Additional Background on Carbon Monoxide Poisoning

• Carbon monoxide can starve body tissues of the oxygen they need to work. Warning signs of poisoning can be confused with illness, intoxication or motion sickness. Symptoms include headache, nausea, vomiting, dizziness, drowsiness, and confusion, but no fever. Carbon monoxide poisoning can cause coma and death.
• Each year in Maine, there are more than 100 emergency department visits and between one and five deaths due to carbon monoxide poisoning. In 90 percent of the cases, there are no carbon monoxide detectors present where the poisonings occur. For Maine CDC data on carbon monoxide poisonings visit the Maine Tracking Network: https://tracking.publichealth.maine.gov
• For information on the State law requiring carbon monoxide detectors: http://www.mainelegislature.org/legis/bills/bills_124th/chappdfs/PUBLIC162.pdf

Hantavirus Pulmonary Syndrome

Maine CDC was recently notified of the first documented case of hantavirus pulmonary syndrome (HPS) in a Maine resident. This resident had not traveled outside of Maine and was reported to have exposures known to be associated with hantavirus.

HPS was first identified in 1993 following an outbreak of unexplained severe pulmonary illness among residents of the southwestern United States. HPS is a serious and life-threatening viral disease (fatality rate approximately 30-40%) that is transmitted to humans by exposure to infected rodents. Only certain kinds of mice and rats can give people hantaviruses that cause HPS. In North America, they are the deer mouse, the white-footed mouse, the rice rat, and the cotton rat but not every mouse or rat will carry the virus.

Early symptoms of HPS include fatigue, fever, chills, and muscle aches especially in the thighs, hips, back, and shoulders. There may also be headaches, dizziness, and abdominal complaints including nausea, vomiting, and diarrhea. Four to ten days after the initial symptoms, patients experience coughing and shortness of breath as the lungs fill with fluid. There is no specific treatment or cure. Medical care is supportive in nature.

Humans become infected after breathing fresh aerosolized urine, droppings, saliva, or nesting materials of infected rodents or when these materials are directly introduced into broken skin, the nose, or the mouth. If a rodent with the virus bites someone, the virus may be spread to that person, but this is rare. HPS in the United States has not been demonstrated to be transmitted from person to person.

HPS can be prevented by:

· Keeping mice and rats out of your home.

· Cleaning up mouse and rat urine, droppings, and nesting materials with a disinfectant or a mixture of bleach and water.

· Do not sweep or vacuum up rodent urine, droppings, or nests as this will cause virus particles to go into the air where they can be breathed in.

• For more information on hantavirus, visit the Maine CDC website or the US CDC website.

• For more information on prevention of hantavirus infection and precautions for limiting household, recreational, and occupational exposures, see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5109a1.htm.

Hepatitis awareness

Hepatitis is an inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viruses that affect the liver causing illness characterized by nausea, abdominal pain, and jaundice. The most common types in the United States are hepatitis A, B, and C.

These viruses are spread from one person to another through different routes. By understanding how they are spread, you can take steps to prevent infection.

• Hepatitis A is spread by ingestion of fecal matter, even in microscopic amounts, from close person-to-person contact or ingestion of contaminated food or drinks. It can be prevented by vaccination, hand washing, drinking only clean water, cooking food thoroughly, and by practicing safe sex.

• Hepatitis B is spread by direct contact with infected blood or bodily fluids. It can be prevented by vaccination, practicing safe sex, and not sharing any items that might be contaminated with someone else’s blood such as nail clippers, tooth brushes, razors, needles or sharps, and injection drug equipment.

• Hepatitis C is spread by direct contact with infected blood. It can be prevented by not sharing any items that might be contaminated with someone else’s blood, such as nail clippers, tooth brushes, razors, needles or sharps, and injection drug equipment, and by practicing safe sex.

Vaccines are only available to protect against hepatitis A and B. Hepatitis B and C can cause long-term infection that is associated with an increased risk for chronic liver disease and liver cancer, so testing and vaccination is especially important.

US CDC has issued several recent MMWRs that discuss hepatitis, including:

• Assessing the completeness of perinatal hepatitis B virus infection reporting
• Hepatitis C virus infection among adolescents and young adults in Massachusetts

• Highlighting Hepatitis Awareness Month

The US Department of Health and Human Services has also released Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, its strategic plan to raise awareness about hepatitis and create opportunities to train health professionals to vaccinate, diagnose, treat, and ultimately save lives.

For more information: http://www.mainepublichealth.gov/hepatitis

May is National Celiac Awareness Month

One in 133 people are affected with celiac disease, an autoimmune digestive disease. For people with celiac disease, or gluten sensitive enteropathy, eating foods with gluten - a protein found in wheat, rye and barley - damages the intestinal lining. Once damaged, the intestine cannot absorb the many nutrients supplied by food. The risk of malnutrition in people who have celiac disease is high.

The symptoms some with celiac disease, or gluten sensitive enteropathy, may experience include weakness, abdominal cramping, lack of appetitite, or diarrhea. Celiac disease may be inherited or triggered by an event. The care and treatment for people with this disease is very individual and includes eating a gluten-free diet and working with a registered dietitian and physician to find the best solutions for living life to the fullest.

More and more gluten-free breads, baked goods, coatings, and other products are available in mainstream grocery stores as well as specialty stores. There are also support groups available online and at some Maine hospitals.

Some people are “gluten sensitive” but don’t have celiac disease. These individuals experience milder and more subtle symptoms and do not test positive for celiac disease. These individuals may also benefit from eating a well-balanced low gluten diet and working on a personal plan with their registered dietitian and physician to live their life to the fullest.

To learn more, contact your local hospital or go to http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/ for more information.

Measles alert

In the past week, Massachusetts identified 5 new cases of measles, ranging in age from 16 months to 65 years. All confirmed and suspect cases have either unknown or undocumented history of measles vaccination. Maine clinicians are asked to increase surveillance for rash illness suggestive of measles to help with early identification of potential cases and to assist in preventing the spread of disease in Maine.

Measles is a highly contagious respiratory disease caused by a virus and is spread from person to person through the air by infectious droplets. Symptoms include fever, runny nose, cough, loss of appetite, pink eye, and a rash. The rash usually lasts 5 – 6 days, beginning at the hairline, moving to the face and upper neck, and proceeding down the body.

Diagnosis

Maine CDC requests that clinicians report suspect case of measles to 1-800-821-5821 and advising suspect patients to remain at home until test results are known to prevent exposing others to the measles virus.

Measles testing is available at Maine’s Health and Environmental Testing Laboratory (HETL). Laboratory tests for acute measles infection include viral culture, serology, and PCR. Acceptable specimens include throat swabs, NP swabs, urine, and blood (requires acute and convalescent specimens). http://www.maine.gov/dhhs/etl/micro/measles_lsis.pdf

Case Management

It takes an average of 10 – 12 days from exposure to the first symptom which is usually fever. The measles rash does not usually appear until approximately 14 days after exposure. Measles is infectious for 4 days prior to 4 days after the onset of rash. All suspect patients should be placed in a separate waiting area or a private room with negative pressure.

Control Measures

Maine CDC will work with patients, and clinicians to identify all exposed contacts and to assess individuals for evidence of immunity. Measles vaccine may prevent disease if given within 72 hours of exposure.

Vaccinate

· Children. All children >12 months of age should receive their first dose of MMR at the 12-15 month routine health care visit, and every effort should be made to identify and vaccinate children who are not up-to date. All school-aged children should have two doses of MMR vaccine.

· Adults. All adults should have acceptable proof of immunity to measles. Certain groups at high risk should have received two doses of MMR, such as international travelers, health care workers, and college students. Women are advised not to receive any live virus vaccine during pregnancy including MMR.

Please report any suspicious cases and suspect cases of measles to Maine CDC at 1-800-821-5821

Do you know the signs of stroke?

Tyra Tarbox is a 45 year old mother of four from Cumberland who suffered a significant seizure resulting in a stroke late one evening after returning home from work. Luckily, her husband was there and he took quick action, calling 911. She was rushed to the hospital, evaluated, and quickly flown to a Boston hospital for surgery.

When she awoke six days later, Tyra had no body movement and could not move her eyes to the right. She had survived not only a stroke, but also a series of complications resulting from her brain’s lack of blood. After almost a month of inpatient rehabilitation in Portland, she returned home on her husband’s birthday and is now leading a full life.

Tyra’s story is one of many stories of Mainers who have had a stroke. Unfortunately, not all the stories end so happily. Stroke is the fourth leading cause of death in Maine and the United States and is also a leading cause of serious long-term disability in adults. The Maine CDC/DHHS Cardiovascular Health Program is working with the Maine Affiliate of the American Stroke Association and other statewide partners to help more Mainers recognize the symptoms of stroke and the importance of calling 911 at the first sign of stroke.

To bring attention to National Stroke Awareness Month, Tyra Tarbox will join statewide partners working to improve stroke systems of care at the American Stroke Association Legislative Awareness Day on Tuesday, May 3, 2011, from 9:00 AM to 11:30 AM at the Maine State House in the Hall of Flags.

Early recognition of stroke symptoms is critical – time lost is brain lost. Stroke symptoms include sudden:

• Numbness or weakness in the face, arm or leg
• Slurred speech
• Blurred vision
• Dizziness or loss of balance
• Severe headache

“A patient’s survival and successful recovery are greatly increased if symptoms are recognized quickly and medical attention is given right away,” said Dr. Stephen Sears, Acting Director Maine CDC/DHHS. “Our goal is to raise awareness and empower everyone — patient and bystander — to see stroke as a medical emergency requiring an immediate call to 911. If we increase people’s ability to recognize stroke symptoms, we can positively impact patients and hopefully increase their chance of having little or no long-term physical or mental disability.”

Nearly 75% of all strokes occur in people aged 65 years and older. Risk factors such as high blood pressure, high cholesterol, smoking, lack of physical activity, poor nutrition, and a history of cardiovascular disease or diabetes also increase the possibility of stroke.

More information is available at the following websites: www.mainehearthealth.org and www.strokeassociation.org.

May Awareness Campaigns

May is a busy month for awareness campaigns. It’s National Arthritis Awareness Month, Asthma Awareness Month, Healthy Vision Month, and Hepatitis Awareness Month.

Drinking Water Week is May 1-7. Followed by Women’s Health Week, which starts on Mother’s Day (May 8).

As the weather warms up and people spend more time outside, we also run into Lyme Disease Awareness Month and Skin Cancer Awareness Month. Heat Safety Awareness Day is May 27 and Recreational Water Illness and Injury Prevention Week is May 23-29.

May is also both High Blood Pressure Education Month and Stroke Awareness Month.

CDC Report Highlights Children’s Food Environment in Maine

A report out from the US Centers for Disease Control and Prevention this week shows that Maine is doing better than the nation at improving access to healthy foods for its children — one piece of the puzzle in fighting childhood obesity — but that there is still more work to be done. The 2011 Children’s Food Environment State Indicator Report notes that Maine is above the national averages when it comes to providing access to healthy foods in Maine communities.

“States and communities are uniquely positioned to help improve the food environment for children where they live, play, and learn,” said William Dietz, M.D., Ph.D., director of CDC's Division of Nutrition, Physical Activity, and Obesity. “If we hope to reverse the trend of childhood obesity, we need to work together at the local, state, and national level to create environments that support healthy eating for children.”

The report looked closely at each state to examine community food environments in order to understand the types of foods most accessible to children and their families on a daily basis. The report looked at the variety of food retailers in each state and categorized them into two different groups: food retailers that typically sell healthier foods such as supermarkets, supercenters and produce stores and those retailers that are less likely to sell healthy food such as fast-food restaurants and convenience stores. Maine and Montana were among the higher scoring states with a score of 15 and 16 respectively, compared to the national average of 10; lower scoring states were Rhode Island at 5 followed by the District of Columbia at a score of 4. A score of 100 would mean all food retailers in a community provide access to healthy foods. It is clear all states need to improve accessibility to healthier foods, but the ideal target score for a state was not given in the report.

The CDC report also shows that as of December 2008, Maine had enacted one of the state child care licensure regulations of three listed in the report as important indicators: limiting screen time (television and video) for all child care facilities. Only one state had enacted all of the regulations, while 13 states and the District of Columbia had enacted none.

Additionally, for the school foods indicator Maine outperformed the national average with respect to the number of middle and high schools that do not allow students to purchase less healthy foods outside the usual school lunch (such as in vending machines and school stores). About 66% of Maine schools do not allow the purchase of less healthy foods; above the national average of 49%. Maine also has more middle and high schools that do not offer sugar drinks — 44% don’t offer sugar drinks compared to the national average of only 36% that don’t.

“It is wonderful to see that our state is performing better than most of the nation to improve access to healthy foods for our children,” said Stephen Sears, M.D., MPH, Acting Director, Maine CDC. “Our progress in this area is due to the commitment, hard work and collaboration of Maine people, local efforts such as Communities Putting Prevention to Work and Healthy Maine Partnerships, and others who partner with the Maine CDC such as the Maine Nutrition Network and the Maine-Harvard Prevention Research Center. However, there is still much to be done if we are to reduce childhood obesity rates in Maine — one out of every three of our children is currently overweight or obese.”

Maine is currently working in many ways to improve access to healthier foods for all residents, particularly children. These efforts include creating positive food and physical activity environments in child care settings, growing already thriving farm-to-school programs in schools and making strides to meet the USDA definition of a healthier school environment in all of Maine’s schools.

The Children’s Food Environment State Indicator Report compiles data from a variety of sources, including Preventing Obesity in the Child Care Setting: Evaluating State Regulations and CDC’s School Health Profiles. To view the full CDC report visit www.cdc.gov/obesity.

Browntail Moths

Browntail moths make their webs in the fall in oak, apple, serviceberry and other trees and shrubs. Hairs from the larvae can cause a rash similar to poison ivy and can also cause respiratory distress in sensitive individuals. The larvae begin to emerge from their webs in late April and feed on the foliage as soon as it appears. Larvae hairs persist for a number of years and can continue to cause problems when mowing or other activities stir them up.

The browntail moth population has intensified in the southern Merrymeeting Bay area, which may mean more people are at risk of exposure to the larvae hairs. The area primarily affected by this insect includes parts of Bath, West Bath, Brunswick, Topsham and Bowdoinham; other affected towns include Augusta, Falmouth, Freeport, Kennebunkport, Lewiston, Lisbon Falls, Turner, and Wiscassett.

Most people developing the rash will do so within hours of outdoor activity. The duration of the rash varies, from hours to days.

For more information from the Maine Forest Service: http://www.state.me.us/doc/mfs/fhm/pages/BrowntailMoth.htm

Salmonella risk

Now is the time to remind people about the risk of Salmonella infection from handling live baby chicks, often purchased as Easter presents. There has already been one case of salmonellosis in a Maine child in 2011 after contact with baby chicks that were kept inside.

Salmonella causes diarrhea, fever and stomach cramps and can be life-threatening in infants, children under five years of age, and in people with weakened immune systems. The stress of hatching and shipping many chicks at one time increases the chance that the chicks will become infected and shed bacteria. Baby chicks do not usually seem sick even when they are infected.

What can parents do to keep children safe?

It is best if infants and children under five do not touch chicks. If they do, take the following steps to lower the spread of bacteria:

· Supervise children while playing with baby chicks.

· Do not allow children to kiss or put hands or other objects (pacifiers, toys, bottles) in their mouths after handling chicks.

· Pacifiers, toys, bottles, or other objects should not touch the baby chicks or their living environment.

· Wash children’s hands well with plenty of running water and soap after contact with chicks.

· Keep chicks away from food handling areas.

· Do not eat or drink while interacting with baby chicks or their environment.

· If baby chicks are kept inside due to cold weather, keep them away from living spaces.

If your child has had contact with baby chicks and gets diarrhea, fever, and stomach cramps, contact your healthcare provider.

For more information: www.cdc.gov/healthypets/easter_chicks.htm or call 1-800-821-5821.

April Awareness Campaigns

April is a busy month for awareness campaigns. Check out the following topics:

National Public Health Week, April 4-10

World Health Day, April 7

National Infant Immunization Week, April 23-30

National Autism Awareness Month

National Cancer Control Month

National Donate Life Month

National Minority Health Month

STD Awareness Month

2011 County Health Rankings

Hancock County has the healthiest residents in Maine and Oxford County remains the least healthy county in the state, according to the second annual County Health Rankings, released today by the University of Wisconsin Population Health Institute with funding from the Robert Wood Johnson Foundation. According to the Rankings, residents of Oxford County are more likely to die a premature death than those in Hancock County.

Rankings were completed in all 50 states, including Maine. Counties were ranked within states only, with no comparison between states. Full Maine rankings are available at: http://www.countyhealthrankings.org/maine/downloads-and-links

The report helps identify factors that influence health in each county. All counties in Maine, regardless of their ranking, have both strengths to celebrate and challenges to address.

For years, public health data have shown that many counties in Maine with lower incomes and educational attainment are less healthy. Such disparities continue to be reflected in these rankings. However, the report also shows significant variation. For instance, some counties with similar socioeconomic profiles have very different rankings for health factors and outcomes, suggesting that a complex array of factors influences the health of our communities.

Although some of our counties have better health outcomes than others, it is important to note that overall Maine is one of the healthiest states in the nation. Maine ranked as the 8th healthiest state in the country for 2010 by the United Health Foundation’s America’s Health Rankings. Maine also ranks 4th overall for child health in a new Commonwealth Fund state-by-state scorecard. These positive state rankings reflect a concerted effort to address health challenges through collaboration of a variety of public health stakeholders at the local, regional and state levels.

Maine’s public health system is charged with using a variety of data sources, including rankings such as these, to improve the health of all communities in Maine. Significant health improvement planning efforts are underway at the local, district, and state levels.

The University of Wisconsin also provided District Rankings this year to coincide with the 8 geographic public health districts in the state. In the District Rankings, Cumberland is the healthiest district and Aroostook is least healthy

Influenza Update

There were four new outbreaks of influenza in the week ending March 19, compared with nine the previous week. There has been one pediatric influenza-associated death reported from York in a vaccinated child. Flu continues to be widespread in Maine.

Vaccination is still recommended for those who have not been vaccinated this season. One flu vaccine is protective for the entire flu season, and a second dose is not recommended for adults, even if they were vaccinated early in the fall.

Two doses of flu vaccine are only recommended for young children who have never been vaccinated before. Children younger than 9 who have never had a seasonal flu vaccine should receive two doses, spaced at least 4 weeks apart.

Weekly updates on flu activity are available

• For Maine
  
• For the US
  
• For the world
  

World Water Day

World Water Day is held every year on March 22 to highlight the importance of the availability of clean freshwater and the key role that water plays around the world.

This year’s theme is “Water for Cities: Responding to the Urban Challenge,” designed to bring awareness to the rapid growth of the world’s population in urban areas and the increasing demand for clean freshwater.

In Maine, we are fortunate to have abundant, clean, and safe drinking water. However, in many parts of the world, access to safe, clean water is scarce. According to UNICEF estimates, over 884 million people lack access to safe drinking water worldwide.

If you have a private well, make sure you know your well is safe. Test your water. For more information on testing your well, visit http://wellwater.maine.gov.

For information on public water systems in Maine, visit the Maine CDC Drinking Water Program.

Natural Disasters and Public Health

There are many public health concerns as a result of natural disasters, such as the recent earthquakes and tsunami. The US CDC’s natural disasters website has helpful information for those who may be involved with relief efforts or who are interested in improving their preparations here at home.

Radiation concerns

Maine CDC's Radiation Control Program is following events in Japan closely. Several federal agencies with expertise in radiation control are closely monitoring the problems occurring at the nuclear power plant in Japan including the Nuclear Regulatory Commission, Environmental Protection Agency, Department of Energy, and the Department of Homeland Security Federal Emergency Management Agency.

While no radiation from Japan has been detected in the United States, and it is presently unlikely that any will be, we will continue to closely monitor the situation as it continues to unfold. There are three separate air sampler stations located in Orono, Augusta, and Portland that monitor ambient air regularly. These samplers would detect any unusual levels of radiation in the air. Further updates will be forthcoming.

Maine CDC's Radiation Control Program has posted frequently asked questions about Japan and radiation and information about Potassium Iodide.

UPDATE: A web site with various federal resources and information has been established at http://www.usa.gov/Japan2011.shtml

National Women and Girls HIV/AIDS Awareness Day

Tomorrow is National Women and Girls HIV/AIDS Awareness Day, which is coordinated by the national Office on Women's Health. Women make up a quarter of all new HIV infections in Maine. Every 35 minutes, a woman tests positive for HIV in the US. In 2010, 20% of people accessing HIV medical case management in Maine were women.

Women have unique issues and special challenges that make it harder for them to prevent HIV or take care of themselves if they have HIV:

• Women's bodies are different. A woman is twice as likely as a man to get HIV infection during vaginal sex (because the lining of the vagina provides a large area of potential exposure to HIV-infected semen). Some diseases or disorders unique to women make HIV more serious.
• Women can give HIV to their babies. Women who have HIV can give it to their babies during pregnancy, delivery, or breast-feeding.
• Women may lack control in relationships: they may be scared to refuse sex or insist that their partner use a condom, or can’t talk to their partner about abstinence, faithfulness, or using condoms.
• Women may not know if their partner is doing things that put him (and therefore her) at risk for HIV.
• Women may not earn much money, which makes it hard for them to pay doctors or even get a ride to their doctor appointments. In extreme instances, some women even end up trading sex for money or drugs.
• Women may be caregivers for others and not feel they have the time to take care of themselves or are unable to find someone to take care of their loved ones when they want to access services. Women may not earn much money, which makes it hard for them to pay doctors or even get a ride to their doctor appointments. In extreme instances, some women even end up trading sex for money or drugs.

What can providers do?

• Emphasize and make HIV testing a routine part of health care. Integrate HIV testing into reproductive health care and other key services.
• Reach out and educate, especially among young women and women of color. Many women want more information and are most likely to get it from doctors, other women with HIV/AIDS, the Internet, television, and radio.
• Decrease mother-to-child transmission by testing, educating, and treating.
• Prevent new infections by working with HIV-infected partners.
• Improve access to care and support services for women, as well as support women’s roles as caregivers and mothers.

HIV test sites in Maine

Pertussis Update

Since January 1, 2011, there have been 28 cases of pertussis (whooping cough) reported to Maine CDC. Cases have been reported in Cumberland, Hancock, Kennebec, Oxford, Penobscot, Piscataquis, Somerset and Waldo counties. Cases range in age from 1 month to 57 years.

Coughing fits due to pertussis infection can last for up to 10 weeks or more; sometimes known as the “100-day cough.” Pertussis can cause serious illness in infants, children, and adults and can even be life-threatening, especially in infants. More than half of infants less than 1 year of age who get pertussis must be hospitalized.

The most effective way to prevent pertussis is through vaccination with DTaP for infants and children and with Tdap for pre-teens, teens and adults — protection from the childhood vaccine fades over time. Pertussis is generally treated with antibiotics, which are used to control the symptoms and to prevent infected people from spreading the disease.

The December 20, 2010, Health Alert on pertussis is available at: http://www.maine.gov/tools/whatsnew/attach.php?id=173192&an=2

For more information about pertussis, visit: http://www.maine.gov/dhhs/boh/ddc/epi/vaccine/pertussis.shtml

Tdap Vaccination Strategies

Representatives from the Association for Professionals in Infection Control and Epidemiology, US CDC, the National Foundation for Infectious Diseases, and the Society for Healthcare Epidemiology of America co-authored a report titled Tdap Vaccination Strategies for Adolescents and Adults, Including Health Care Personnel, which is available at http://www.jointcommission.org/tdap/

The report is intended to help health care organizations of all types (hospitals, long term care facilities, ambulatory settings, home health organizations, etc.) improve Tdap vaccination rates.

The report notes that some important changes to the previously published ACIP recommendations were approved at the October 2010 ACIP meeting:

1. For adults ages 65 years and older, a single dose of Tdap vaccine may be given in place of a tetanus and diphtheria toxoids (Td) vaccine in persons who have not received Tdap.
2. Adults ages 65 years and older who have or anticipate having close contact with an infant age less than 12 months should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission of pertussis to infants age less than 12 months.
3. Tdap can be administered regardless of the interval since the last tetanus- or diphtheria-containing vaccine.
4. Children ages 7 through 10 years who are not fully immunized against pertussis and for whom no contraindication to pertussis vaccines exists should receive a single dose of Tdap to provide protection against pertussis. If additional doses of tetanus and diphtheria toxoid–containing vaccines are needed, then children ages 7 through 10 years should be vaccinated according to catch-up guidance.

PCR Diagnosing of Pertussis – Best Practices

US CDC has issued a Health Alert on the best practices for health care professionals related to the use of polymerase chain reaction (PCR) for diagnosing pertussis in light of the continuing resurgence of pertussis and the likelihood that health care professionals will see more patients with suspected pertussis.

• For guidance in distinguishing signs and symptoms of pertussis from those of other conditions, see http://www.cdc.gov/pertussis/clinical/features.html
• For more information on diagnostic testing, see http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html
• For information on specimen collection, see http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html
• For the entire guidance on PCR best practices in diagnosing pertussis, see http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html

Influenza Update 3/3/11

Surveillance

Flu is widespread in Maine. In the week ending Feb. 19, there were 12 new outbreaks – 10 in long term care facilities, 1 in a K-12 school, and 1 in an institution.

Weekly updates on flu activity are available

• For Maine: http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml
• For the US: http://www.cdc.gov/flu/weekly/summary.htm
• For the world: http://www.cdc.gov/flu/international/activity.htm

The January 31 Health Alert on influenza is available at: http://www.maine.gov/tools/whatsnew/attach.php?id=191687&an=2

Vaccination

Some people have expressed concern about needing a second flu vaccine if they were vaccinated early in the fall. One flu vaccine is protective for the entire flu season and a second dose is not recommended for adults.

An MMWR from August 2010 notes that “additional vaccine doses during the same season do not increase the antibody response” and that the “frequency of breakthrough infections is not known to be higher among those who were vaccinated early in the season.”

Two doses of flu vaccine are only recommended for young children who have never been vaccinated before. Children younger than 9 who have never had a seasonal flu vaccine should receive two doses, spaced at least 4 weeks apart.

It is not too late to be vaccinated against the flu this season. To obtain flu vaccine, contact your health care provider, or look up clinics at www.flu.gov or www.211maine.org

Update on HIV, STDs, and Viral Hepatitis

The Maine HIV, STD, and Viral Hepatitis program has updated its web site. For easy access to information and resources, check out www.mainepublichealth.gov/hivstdhep

The Sixth Annual Comprehensive Sexuality Education Conference will be held from 8:30 a.m. to 3:30 p.m. April 7 at the Augusta Civic Center.

Keynote speaker is Pamela Wilson, M.S.W., author of Our Whole lives: Sexuality Education for Grades 7-9. Workshops focus on foundational knowledge and skills, networking opportunities, and innovative ideas to put into practice.

The cost is $40 before March 18 and $50 after March 18.

The conference is co-sponsored by: Family Planning Association of Maine; Maine Department of Education; Maine Center for Disease Control & Prevention, an Office of the Department of Health & Human Services; New Beginnings; University of Maine Farmington; and the Maine Association for Health, Physical Education, Recreation, and Dance.

For more information and to register: https://www.mainefamilyplanning.org/forms/conference_form.php

HIV

The Institute of Medicine (IOM) has released the report HIV Screening and Access to Care: Exploring the Impact of Policies on Access to and Provision of HIV Care. The report examines how Federal and State laws and policies and private health insurance policies affect entry into clinical care and the provision of continuous and sustained care for people with HIV.

US CDC has published an article on disparities in HIV diagnoses among African Americans and other racial and ethnic minorities.

STDs

US CDC published the article “Discordant Results from Reverse Sequence Syphilis Screening” in the MMWR.

Viral Hepatitis

US CDC has made new patient education materials related to hepatitis available on its website.

The following articles have been published in the MMWR:

• Potential Transmission of Viral Hepatitis Through Use of Stored Blood Vessels as Conduits in Organ Transplantation
• Deaths from Acute Hepatitis B Virus Infection Associated with Assisted Blood Glucose Monitoring in an Assisted-Living Facility

Update on Vaccine Preventable Diseases

Recommended Immunization Schedules for Children

Advisory Committee on Immunization Practices (ACIP) has issued its annual Recommended Immunization Schedules for Persons Aged 0 Through 18 Years: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6005a6.htm?s_cid=tw_mmwr90

National Vaccine Plan

The U.S. Department of Health & Human Services has unveiled a new National Vaccine Plan to enhance coordination of all aspects of federal vaccine and immunization activities. Its goal is to ensure that all Americans can access the preventive benefits of vaccines. http://www.hhs.gov/news/press/2011pres/02/20110216b.html

Tdap Vaccination Strategies

Representatives from the Association for Professionals in Infection Control and Epidemiology, US Centers for Disease Control and Prevention, the National Foundation for Infectious Diseases, and the Society for Healthcare Epidemiology of America co-authored a report titled Tdap Vaccination Strategies for Adolescents and Adults, Including Health Care Personnel, which is available at http://www.jointcommission.org/tdap/

The report is intended to help health care organizations of all types (hospitals, long term care facilities, ambulatory settings, home health organizations, etc.) improve Tdap vaccination rates.

The report notes that some important changes to the previously published ACIP recommendations were approved at the October 2010 ACIP meeting:

1. For adults ages 65 years and older, a single dose of Tdap vaccine may be given in place of a tetanus and diphtheria toxoids (Td) vaccine in persons who have not received Tdap.
2. Adults ages 65 years and older who have or anticipate having close contact with an infant age less than 12 months should receive a single dose of Tdap to protect against pertussis and reduce the likelihood of transmission of pertussis to infants age less than 12 months.
3. Tdap can be administered regardless of the interval since the last tetanus- or diphtheria-containing vaccine.
4. Children ages 7 through 10 years who are not fully immunized against pertussis and for whom no contraindication to pertussis vaccines exists should receive a single dose of Tdap to provide protection against pertussis. If additional doses of tetanus and diphtheria toxoid–containing vaccines are needed, then children ages 7 through 10 years should be vaccinated according to catch-up guidance.

PCR Diagnosing of Pertussis – Best Practices

US CDC has issued a Health Alert on the best practices for health care professionals related to the use of polymerase chain reaction (PCR) for diagnosing pertussis in light of the continuing resurgence of pertussis and the likelihood that health care professionals will see more patients with suspected pertussis.

• For guidance in distinguishing signs and symptoms of pertussis from those of other conditions, see http://www.cdc.gov/pertussis/clinical/features.html
• For more information on diagnostic testing, see http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html
• For information on specimen collection, see http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html
• For the entire guidance on PCR best practices in diagnosing pertussis, see http://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-pcr-bestpractices.html

Influenza Update

Flu is widespread in Maine. In the week ending Feb. 12, there were seven new outbreaks – one in a long term care facility and six in K-12 schools. It is not too late to be vaccinated against the flu this season. To obtain flu vaccine, contact your health care provider, or look up clinics at www.flu.gov or www.211maine.org

Weekly updates on flu activity are available

• For Maine: http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml
• For the US: http://www.cdc.gov/flu/weekly/summary.htm
• For the world: http://www.cdc.gov/flu/international/activity.htm