Vigilant Guard

Maine CDC staff recently participated in a five-day full-scale disaster response exercise. The Vigilant Guard exercise began with a briefing to the Initial Response Team on Monday, Nov. 5, and concluded on Friday, Nov. 8.

Vigilant Guard is a national-level exercise conducted four times a year by the National Guard Bureau and the United States Northern Command in conjunction with civilian first responders and local governments around the United States. This year, Maine was chosen to participate in Vigilant Guard. The response to participate from Maine's emergency preparedness and health care communities was impressive. Maine CDC participated along with multitude of partners including the Maine Emergency Management Agency, local EMA, Regional Resource Centers, physicians and hospitals, EMS, Civil Air Patrol, National Guard, hospitals, police, and fire departments. Federal partners from FEMA and US CDC as well as partners from other states and Canada participated as well.

Maine CDC's Public Health Emergency Preparedness team has been planning this exercise with our health care partners for well over a year to test our response capabilities and identify any gaps in those capabilities. The exercise scenario was developed in collaboration with Maine CDC's Infectious Disease and Medical Epidemiology programs in order to develop a plausible and realistic scenario that would push our response capabilities to the breaking point.

The exercise scenario involved an intentional release of anthrax, which allowed us to test our request process with US CDC regarding receiving assets from the Strategic National Stockpile. We also tested the delivery, receipt, and distribution of medical countermeasures to closed and open Points of Dispensing (PODs) statewide. In addition to responding to the anthrax scenario, the Public Health Emergency Operations Center (PHEOC) also provided support to health care facilities for numerous simulated mass casualties, hazardous materials incidents, major blizzards, freezing temperatures, and significant power outages statewide.

The Public Health Emergency Preparedness staff would like to thank everyone who helped us plan for this exercise as well as those staff members who placed their regular work duties on hold in order to staff the PHEOC during the exercise. We could not have done it without your help!

National Diabetes Awareness Month

November is National Diabetes Awareness Month.

You have the power to help prevent and control diabetes. If you already have diabetes, work to lower your risk of serious complications. If you don't have diabetes, learn if you are at high risk for developing type 2 diabetes. You may also find out more about the National Diabetes Prevention Program by visiting http://go.usa.gov/W26W. You can take the Pre-Diabetes Risk Quiz, find a Lifestyle Change program near you, or learn more about how you can support family and friends in their prevention of type 2 diabetes. US CDC also has a special feature about diabetes available at http://go.usa.gov/W26R

This year the National Diabetes Education Program is focusing on the theme, “Diabetes is a family affair.” Diabetes is a challenging disease that affects the entire family in many ways. If you are living with diabetes or have a loved one with the disease, family support is very important when it comes to managing diabetes and preventing serious health problems. It's also important to know that if you have a family history of diabetes, such as a mother, father, brother, or sister, you are at higher risk for developing type 2 diabetes.

For more information go to: http://go.usa.gov/W26C

Maine CDC’s Diabetes Prevention and Control Program focuses on promoting excellence in diabetes care; increasing access to care; promoting and supporting diabetes self-management education; preventing and reducing diabetes risk factors; and eliminating disparities related to diabetes prevention and control.

For more information visit: http://go.usa.gov/W26d

Flu update 10/30/13

Maine CDC issued a health alert about the beginning of flu season in Maine on Oct. 28. The health alert is available at: http://go.usa.gov/W2jz

Maine reported sporadic flu activity for the week ending Oct. 26. Weekly updates are available online:

• for Maine: http://go.usa.gov/NoK
• for the US: http://go.usa.gov/ITB
• for the world: http://go.usa.gov/ITK

Prevention and Treatment

Take everyday preventive measures against the flu:

• Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
• Avoid touching your nose, mouth, and eyes. Germs can spread this way.
• Get vaccinated against the flu. To find locations where vaccine is available, contact your health care provider or pharmacy, call 211, or visit www.211maine.org or www.flu.gov
• Consult your health care provider about getting a pneumococcal vaccine for anyone who is younger than 5, between ages 5 and 64 with high risk conditions, or age 65 and older.
• Avoid contact with sick people. If you are at very high risk for complications, you may want to avoid large crowds.

If you have the flu:

• Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
• Cough and sneeze into your elbow or into a tissue. Throw the tissue away.
• Although most people can stay home to recover without seeing a health care provider, it is possible for healthy people to develop severe illness from the flu. Anyone with the flu should seek medical attention for:
• Dehydration
• Trouble breathing
• Getting better, then suddenly getting a lot worse
• Any major change in condition

Guidance

US CDC has published a summary of the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the 2013-2014 flu season at http://go.usa.gov/jdfB

US CDC has an influenza app for clinicians and health care providers to make it easy to access the latest guidelines and information. For more information about the app, go to http://go.usa.gov/43nR

The Vaccine Information Statements (VIS) for this coming season’s vaccines are available at http://go.usa.gov/jdAC

For more information, visit www.maineflu.gov.

Hepatitis A outbreak and response

Maine CDC’s Infectious Disease Epidemiology Program recently investigated a case of hepatitis A virus (HAV) infection that was traced to a community event in Durham. A person infected with HAV prepared and served food at a church supper attended by about 100 people.

When administered within two weeks of exposure to hepatitis A, vaccination is very effective in preventing illness. Representatives from Maine CDC’s Public Health Nursing (PHN) Program, Infectious Disease Epidemiology Program, and Maine Immunization Program collaborated to plan and execute a free, public hepatitis A vaccine clinic.

The Maine Immunization Program procured the vaccine and assisted in the clinic logistics, including answering questions about the vaccine and other doses needed. Five public health nurses and the PHN supervisor participated in the clinic, administering vaccine to 52 adults and six children.

For more information about the initial investigation and response, see the press release at http://go.usa.gov/Dz4F

For more information about prophylaxis and treatment, see the health alert at http://go.usa.gov/Dz23

Gluten-free standardization on food labels

The Food and Drug Administration (FDA) has finalized the definition of the term “gluten-free” and is regulating its use on food labels. No longer can manufacturers simply label foods as “gluten-free” without following proper guidelines. The term "gluten" refers to proteins that occur naturally in wheat, rye, barley and cross-bred hybrids of these grains. In people with celiac disease, an autoimmune digestive condition, foods that contain gluten trigger production of antibodies that attack and damage the lining of the small intestine. Such damage limits the ability of celiac disease patients to absorb nutrients and puts them at risk of other very serious health problems, including nutritional deficiencies, osteoporosis, growth retardation, infertility, miscarriages, short stature, and intestinal cancers.

Here are the guidelines:

According to the FDA, the term “gluten-free” now refers to foods that are either inherently gluten-free or foods that do not contain any ingredient that is:

• A gluten-containing grain (e.g. spelt wheat)
• Derived from a gluten-containing grain that has not been processed to remove gluten (e.g. wheat flour)
• Derived from a gluten-containing grain that has been processed to remove gluten (e.g. wheat starch), if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food

Foods that contain an unavoidable bit of gluten must keep that presence to less than 20 ppm.

The guidelines are based on the smallest amount of gluten that can be detected using scientific analysis tools and are in line with the international bodies that set guidelines for food safety standards. Manufacturers have until Aug. 5, 2014, to comply with the rule. For more information, go to http://go.usa.gov/DHe2

Meaningful use

The American Reinvestment & Recovery Act of 2009 includes many measures to modernize our nation's infrastructure, one of which is the "Health Information Technology for Economic and Clinical Health (HITECH) Act." The HITECH Act supports the concept of meaningful use of electronic health records.

The Stage 2 measures for public health reporting state that an Eligible Hospital (EH) or Eligible Provider (EP) must register intent to submit ongoing submission of electronic data to the Public Health Authority (PHA) for the following types of reporting:

• Immunization Registries
• Syndromic Surveillance
• Reportable Lab Results
• Cancer Registries
• Specialized Registries

The EH or EP must register with the PHA within 60 days of the start of the organization’s EHR reporting period, if they plan on attesting for such public health reporting for that period. Once registered, the EH or EP is immediately considered to be engaged in ongoing submission to the PHA. However, to remain engaged in ongoing submission the EH or EP must do the following:

• Be ready to participate in the on-boarding process when the PHA is ready to engage.
• Respond to any PHA written requests for actions. Note: The EH or EP does not meet the measure if there is a failure to respond to two written requests within 30 days on two separate occasions.

For more information about meaningful use, visit http://go.usa.gov/DHhC. For Maine CDC’s Meaningful Use Stage 2 Registration page, go to http://go.usa.gov/DHS4.

Dental bond assists dental school and community-based clinics

The University of New England’s new College of Dental Medicine held its formal ribbon-cutting ceremony on October 2. Gov. Paul LePage spoke and helped cut the ribbon, as one of the supporters of this program.

The inaugural class of 64 students includes 24 from Maine. As they proceed through their professional training, the students will spend up to a year as externs in community-based dental clinics throughout Northern New England, including a number in Maine.

Funds from a bond approved by Maine voters in November 2010 contributed to UNE’s state-of –the-art Oral Health Center and teaching clinic in Portland. Bond-related grants will now assist nine organizations in 11 locations throughout the state, from Sanford to Presque Isle, to upgrade their dental clinics to meet standards for hosting students, with the more immediate impact of improving access to dental services by allowing more efficient and cost-effective care. Contracts are in process for those projects, most of which will be completed within three to six months. All will be completed by the end of 2014.

SCC Briefed on Accreditation Status from Maine CDC and Portland Public Health

The Statewide Coordinating Council for Public Health (SCC) received an update at their September 19 meeting in Augusta. Shane Gallagher and Kate Marone, Accreditation Coordinators from Portland Public Health and Maine CDC respectively, provided a brief overview of Accreditation, followed by status updates from their agencies.

Maine CDC continues to prepare to apply for Accreditation, and plans to submit its application in January 2014. Portland Public Health applied in late spring, and is now gathering the necessary documents to submit to the Public Health Accreditation Board (PHAB). The Accreditation process includes gathering and preparing several hundred documents in order to demonstrate how the organization is meeting the 32 Accreditation Standards. Both agencies hope to achieve national Public Health Accreditation status by the end of 2014.

To request a copy of the presentation, or to learn more, please contact Maine CDC’s Accreditation Coordinator, Kate Marone, at kate.marone@maine.gov

It's Breast Cancer Awareness Month

During 2013, it is estimated that more than 1,150 women will be diagnosed with breast cancer and 190 women will die from the disease. As October marks National Breast Cancer Awareness month, Maine CDC reminds women that regular screening mammograms are critical in diagnosing and beginning treatment of the disease.

A screening mammogram can detect breast cancer early, even before symptoms arise. The American Congress of Obstetricians and Gynecologists and the American Cancer Society recommend annual mammogram, starting at age 40. The US Preventive Services Task Force recommends screening every one to two years, starting at age 50. Women with a first degree relative with breast cancer may warrant testing prior to these age recommendations. All patients should enter into a personal discussion regarding their screening with their primary care physicians and decisions should be individualized.

Women with hyper dense breast tissue may be at increased risk, as a mass may be masked by the dense tissue. Not all breast cancer is palpable as a lump on breast exam, which is why mammogram is so important.

The Maine CDC Breast and Cervical Health and Colorectal Cancer Control Programs can provide information about cancer screening tests and has some resources available for free cancer screenings.

Women must be age 40 or older and meet financial and other program criteria. Interested women are encouraged to call 1-800-350-5180 or 1-207-287-8068; TTY users call Maine Relay 711.

More details can also be found at: http://go.usa.gov/DHJ5