Tracking Updates
Maine CDC reported on Aug. 11 that a York County man in his 50s was the first death linked to H1N1 flu in the state. The man died last week. His name and the date of his death are not being released to protect the privacy of the family.
While most people with H1N1 in Maine and the nation have had a relatively mild infection, this news demonstrates how serious influenza can be, especially in those with underlying medical conditions, pregnant women, and very young children.
Maine has identified 335 cases of H1N1, which include 19 individuals requiring hospitalization. Of Maine residents with H1N1, 60 percent have been under 25 years of age.
How Influenza Tracking (Surveillance) Works
Maine CDC’s influenza surveillance program tracks the spread of influenza in Maine. Surveillance information is used to determine where and when influenza transmission is occurring, who is most at risk for contracting influenza and experiencing severe illness, and to track the current severity of influenza in Maine.
Surveillance data is collected through hospitals, private labs, physician offices, and Maine CDC’s Health and Environmental Testing Laboratory (HETL). Maine CDC is currently recruiting outpatient health care providers to report the total number of patients seen in their practices and the number of those patients seen for influenza-like illness (ILI) by age group on a weekly basis for the 2009-2010 season. This information is one of several strategies that help measure the extent of illness in the state.
Maine CDC and other public health authorities use surveillance information to direct influenza response activities – such as communicating information to the public, targeting prevention and treatment messages to specific populations, and directing community mitigation efforts. Surveillance information also informs public policy, such as guidelines on the use of vaccines and antiviral medications. Maine surveillance information contributes to a standardized national surveillance system.
Special Populations
Health care Workers – Maine CDC monitors confirmed cases of H1N1 Influenza in health care workers to determine the impact on the health care system and to intervene when possible to prevent transmission in the health care setting.
Pregnant Women - Because pregnant women have been severely impacted by H1N1 influenza, Maine CDC follows up on cases confirmed by the HETL in pregnant women to monitor the impact of the disease on this population and to help health care providers and their patients understand the CDC recommendations.
Outbreaks
Monitoring outbreaks provides information on the intensity and impact of influenza transmission in communities throughout the state. Outbreak surveillance provides the opportunity to inform and assist facilities experiencing outbreaks and to lessen the transmission and impact of influenza where possible.
Outbreaks of influenza or influenza-like illness are reportable by law in Maine. The definition used to recognize outbreaks of influenza-like illness varies by setting.
In a typical influenza season, most outbreaks affect persons greater than 65 years of age. However, current surveillance data suggest that H1N1 is affecting younger people more than seasonal influenza typically does, so outbreaks are expected to occur in more diverse settings.
Outbreaks will be detected and monitored in two ways. First, institutional outbreaks are reportable to Maine CDC by law. Institutions experiencing an outbreak should report to Maine CDC (through the toll free 24 hour disease reporting and clinical consultation line, 1-800-821-5821), and we will initiate an investigation to characterize the outbreak. Secondly, laboratory submission of specimens to HETL now requires completion of a form that describes potential exposure settings. Laboratory confirmed results that have significant institutional exposures will be evaluated to measure the extent of outbreak activity in Maine.
School Reporting
Maine schools report absenteeism greater than 15% or sudden increases in reported illness to Maine CDC. School nurses should also make direct reports to the Maine CDC if they see a sudden increase in influenza-like illness. Should school closures become necessary at any point, Maine CDC will be monitoring school closures in cooperation with the US CDC.
Good Health Habits Can Help Stop Germs
Prevention of H1N1 is most important, especially now that the virus is widespread in many parts of Maine. Covering coughs and sneezes with a sleeve or tissue, washing hands frequently, and staying home if ill with a fever are shared responsibilities of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1 (http://www.cdc.gov/h1n1flu/vaccination/acip.htm).
Health Advisory
Maine CDC issued an advisory through the Health Alert Network today that provides information on four important novel H1N1 updates recently issued by US CDC. These federal updates include: changes to the recommended isolation period for people recovering from an influenza-like illness; updated guidance for K-12 schools to respond to H1N1 influenza; H1N1 vaccine recommendations; and informational resources for those planning vaccination clinics.
To view/subscribe to Health Alerts, visit: http://www.maine.gov/dhhs/boh/newhan.shtml.
Staying Home When Ill
US CDC now recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever, without using fever-reducing medications (http://www.cdc.gov/h1n1flu/guidance/exclusion.htm). For additional information, including exceptions to this recommendation for the health care setting, see today’s health advisory mentioned above.
Updated Guidance and Information for Schools
US CDC issued new guidance to help decrease the spread of flu among K-12 students and school staff during the 2009-2010 school year: http://www.flu.gov/plan/school/schoolguidance.html. The guidance includes recommendations for conditions with similar severity to spring 2009, and recommendations for more severe conditions. A report detailing the reasons behind these strategies and suggestions on how to use them is available at http://www.flu.gov/plan/school/k12techreport.html.
With these guidance documents, CDC also issued a tool kit to provide basic information and communication resources to help school administrators implement its recommendations (http://www.flu.gov/plan/school/toolkit.html).
H1N1 Preparations for Residential Schools
On August 10, Maine CDC hosted a conference call for residential schools – including K-12 boarding schools, colleges, and universities – which discussed the health advisory issued last week: H1N1 Preparations for Residential Schools (http://www.maine.gov/tools/whatsnew/attach.php?id=77501&an=1). Following are the questions and answers from that call:
Q: Will test kits for H1N1 be provided? What’s the turnaround time?
A: Test kits may be ordered through the Health and Environmental Testing Lab (HETL) by physicians or schools. Turnaround is about 48 hours.
Q: Should students wear masks?
A: People who are ill should be isolated according to current US CDC guidelines (http://www.cdc.gov/h1n1flu/guidance/exclusion.htm), to prevent the spread of disease. Putting a mask on an ill person can be effective in limiting transmission of infection if the person needs to leave isolation (e.g., for a doctor's visit). http://www.cdc.gov/h1n1flu/masks.htm
Q: Should residential schools have a supply of antivirals on hand?
A: This is an individual decision to be made in consultation with a physician. Antivirals are prescription medications. For some schools, having a supply of antivirals would be appropriate.
Q: Can students get the seasonal flu and H1N1 vaccine at the same time?
A: This will depend on the results of the clinical trials currently being conducted. US CDC recommends people get the seasonal flu vaccine as soon as it is available, preferably in September, rather than waiting until the H1N1 vaccine is available (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e).
Q: Can residential schools get free flu vaccine through the state?
A: For seasonal flu vaccine, the state will be offering free vaccine to all K-12 schools (including residential K-12 schools). In the unlikely event that there is excess vaccine available, the state may offer vaccine to the state colleges.
For H1N1 vaccine, we expect that eventually there will be enough vaccine for everyone in the state, free of charge.
Q: Will the H1N1 vaccine require two shots?
A: Clinical trials will determine the number of doses necessary for H1N1 vaccine. Trials are currently ongoing. At this time, it appears likely that H1N1 vaccine will require two doses, about 3 – 4 weeks apart.
Q: Is there any guidance about setting up dining hall procedures to minimize the spread of flu?
A: Maine CDC is not aware of specific guidance on this subject. The recommendation is for ill individuals to avoid public areas (http://www.cdc.gov/h1n1flu/guidance/exclusion.htm). Schools should consider having plans in place to ensure that ill individuals receive their meals without entering the public dining space, and that hand sanitizer is readily available.
Q: Do ill individuals have to be isolated from each other?
A: No, but schools might consider separating the acutely ill from those who are nearing the end of their isolation.
Q: Should day students be isolated the same as residential students?
A: All individuals with influenza-like illness should be isolated according to current US CDC guidelines (http://www.cdc.gov/h1n1flu/guidance/exclusion.htm).
H1N1 Summit August 20
Maine CDC continues to work closely with high-risk settings and organizations on preparing for a possible escalation of H1N1 in the fall, especially as schools reconvene and transmission is then expected to pick up. More than 1,100 people have already registered to attend the H1N1 Influenza Preparedness Summit co-sponsored by Maine CDC/DHHS, Maine Emergency Management Agency, Maine Department of Education, and Maine EMS. The Summit will be held from 8 a.m. to 4 p.m. Aug. 20 at the Augusta Civic Center, 76 Community Drive.
A $15 registration fee is required (with scholarships by special request). For more information, contact MCD Meeting Services at conferences@mcd.org or 207-622-7566, ext 232. To register online: http://www.mcdregistration.org/signup.asp?ID=172 by Monday, Aug. 17.
Vaccination
Maine CDC continues to work with a number of statewide partners to plan for large scale vaccine campaigns this fall. A conference call for health care providers related to both seasonal flu vaccine and H1N1 vaccine will be held from noon to 1 p.m. Monday, Aug. 17. The call-in number is 1-800-914-3396 and the pass code is 473623.
US CDC recommends that all children ages 6 months to 18 years be vaccinated against the regular seasonal flu this year, and that vaccination should begin in September, or as soon as seasonal flu vaccine is available, and continue through the flu season. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e)
The seasonal flu vaccine is not expected to specifically protect against the novel H1N1 influenza virus. However, with H1N1 and seasonal influenza viruses both expected to be circulating, getting a seasonal influenza vaccine early will help a person’s overall protection against the flu. Maine CDC expects H1N1 vaccine to arrive in the state in mid-October at the earliest.
Clinical trials for H1N1 vaccine have begun. The World Health Organization has issued briefing notes on the H1N1 vaccine manufacturing process and timeline (http://www.who.int/csr/disease/swineflu/notes/h1n1_vaccine_20090806/en/index.html) as well as safety (http://www.who.int/csr/disease/swineflu/notes/h1n1_safety_vaccines_20090805/en/index.html).
The federal government has contracted with five vaccine manufacturers to produce H1N1 vaccine. This vaccine production is being funded by the federal government and will be provided to state health departments as a free federal resource. The goal of the vaccine production effort is to provide enough vaccine to be available for everyone in the United States. Vaccine will only be available through state health departments (Maine CDC/DHHS in Maine), and will not be available for private purchase from manufacturers.
The actual number of doses of vaccine to be distributed to Maine CDC is not currently known, but is expected to number upward of several hundred thousand within the first month. A supply of vaccine sufficient to vaccinate the entire population in Maine will not be available all at once. Therefore, CDC has made recommendations about the groups that should be considered the highest priority to receive the first available doses of vaccine. They are:
Pregnant women, because they are at higher risk of complications – especially in the second and third trimesters – and can potentially provide protection to infants who cannot be vaccinated;
Household members and caregivers for children under 6 months old, because younger infants are at higher risk of complications and cannot be vaccinated;
Health care and emergency medical services personnel, because infections among health care workers have been reported and this can be a potential source of infection for patients;
All people ages 6 months through 24 years of age:
Children ages 6 months to 18 years, because there have been many cases of H1N1 in children and they are in close contact with each other in school and day care settings, which increases the chances of spreading disease;
Young adults ages 19 through 24, because there have been many cases of H1N1 in healthy young adults, and they often live, work, and study in close proximity, and they are a frequently mobile population;
People ages 25 through 64 who have health conditions associated with a higher risk of medical complications from the flu, including those with asthma, COPD, diabetes, chronic cardiovascular disease, and immuno-compromised persons. Morbid obesity may also represent an additional risk factor for severe illness.
The H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used in addition to seasonal flu vaccine to protect people. At this point in time, there is no evidence that vaccinations will be mandatory. For more information about H1N1 vaccine, visit US CDC’s Q&A: http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.
Vaccine Distribution:
The large volume of H1N1 vaccine to be distributed and the newly established priority populations require a new approach to vaccine distribution for the H1N1 vaccination effort. This approach will be built on extensive vaccine distribution experience within Maine CDC, established emergency preparedness infrastructure and partnerships and a spirit of shared responsibility between public health, health care providers, and the private sector.
H1N1 vaccine will be distributed to states through a nationwide distributor that now handles the distribution of pediatric vaccine for Maine CDC’s Vaccines For Children Program. This company will directly ship vaccine and associated supplies as designated by Maine CDC to sites in Maine. Some of these sites will include public health sites throughout Maine (including Public Health Nursing sites and city health departments) and through the private sector routes that are traditional providers of seasonal flu vaccine. It is a goal of Maine CDC pandemic response activities to minimize the impact on the health care system. Therefore, there will be a strong need for vaccination in non-traditional settings to reach the defined priority populations.
Vaccine Distribution and Administration Planning:
Maine CDC field staff located in each DHHS District will serve as District Vaccine Coordinators, who will identify those populations prioritized to receive H1N1 Influenza vaccine who often do not have easy access to vaccine through the health care system. They will work with district and local partners to determine the most efficient and effective means for offering the vaccine to these priority groups.
Vaccine Coordinators will be one component of district leadership teams, which also include staff from the three Regional Resource Centers for Public Health Emergency Preparedness, and Emergency Management Agencies.
Vaccine Coordinators will be participating in the afternoon planning sessions at the Statewide H1N1 Summit on Aug. 20, and will begin their work after the Summit. They are:
District 1 – York: Sharon Leahy-Lind, 490-4625
District 2 – Cumberland: Meredith Tipton, 592-5631
District 3 – Western Maine: MaryAnn Amrich, 753-9103
(Franklin, Oxford, and Androscoggin counties)
District 4 – Mid Coast: Jen Gunderman-King, 596-4278
(Waldo, Knox, Lincoln, and Sagadahoc counties)
District 5 – Central Maine: Sue Lee, 592-5644
(Somerset and Kennebec counties)
District 6 – Penquis: Debra Roy, 592-5633
(Penobscot and Piscataquis counties)
District 7 – Downeast: Jen Gunderman-King/Cindy Look, 596-4278
(Washington and Hancock counties)
District 8 – Aroostook: Sharon Ramey, 592-5632
Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15
Other New or Recently Updated US CDC H1N1 Guidance or News
This MMWR evaluates three commercially available rapid influenza diagnostic tests (RIDTs) for their ability to detect novel H1N1: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5830a2.htm.
How to Stay Updated
Weekly Updates: Check the Wednesday late afternoon updates on H1N1 in Maine on Maine CDC’s H1N1 website: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
H1N1 Summit: August 20th at the Augusta Civic Center. More information above.
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at http://www.mainepublichealth.gov/ (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
My Space (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. The next call will be held from noon to 1 p.m. Monday, Aug. 17, and will be an update for health care providers on seasonal influenza vaccine and H1N1 vaccine. The call-in number is 1-800-914-3396 and the pass code is 473623. Check Wednesday Weekly Updates for schedule of topics.
Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207)629-5751Monday - Friday 9am - 5pm
Email Us Your Questions at: Sue.Dowdy@maine.gov
U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/
Maine CDC H1N1 Website and Related Links:
http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
Wednesday, August 12, 2009
Wednesday, August 5, 2009
Weekly Update on H1N1 in Maine 8/5/09
Epidemiologic Trends
There have been 323 confirmed and probable cases of H1N1 total to date, with 176 in Maine residents and 147 in out-of-state residents. A total of 14 Maine residents and 5 out-of-state residents have been hospitalized. No deaths have been reported to date. Nearly all (90%) of lab confirmed H1N1 cases in Maine residents and out-of-state visitors are under the age of 50 (range 0-81 years, mean of 22 years).
US CDC has shifted to reporting total hospitalizations and deaths nationally, instead of by state. Maine CDC will no longer be following up on every person who tests positive for H1N1, and instead will focus on those associated with certain settings (day care, health care workers, prisons, schools, shelters, nursing homes, group homes, etc), those who are high risk for complications, and those who are hospitalized.
The Lancet published an article about the increased risk of severe or fatal illness in pregnant women infected with H1N1 (www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61304-0/fulltext). WHO strongly recommends that pregnant women, and the clinicians treating them, be alert to the symptoms of influenza-like illness (http://www.cdc.gov/h1n1flu/sick.htm#2), especially during the second and third trimesters of pregnancy (http://www.who.int/csr/disease/swineflu/notes/h1n1_pregnancy_20090731/en/index.html). US CDC has several guidance documents on its web site related to pregnancy: http://www.cdc.gov/h1n1flu/pregnancy.
Respiratory Etiquette
Prevention of H1N1 is most important, especially now that the virus is becoming more widespread in Maine. Respiratory etiquette (covering coughs and sneezes with a sleeve or tissue, washing hands frequently, and staying home if ill with a fever) is a shared responsibility of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1. Those at higher risk for complications from H1N1 should take extra precautions (see CDC Information for Specific Groups: http://www.cdc.gov/h1n1flu/groups.htm
and Maine CDC’s H1N1 website at http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml).
Seasonal Influenza Vaccine
US CDC recommends that all children ages 6 months to 18 years be vaccinated against the regular seasonal flu this year, and that vaccination should begin in September, or as soon as seasonal flu vaccine is available, and continue through the flu season. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e)
Maine CDC is working with a number of statewide partners to plan for large scale vaccine campaigns this fall, beginning with a school-located seasonal flu vaccine campaign. The number of schools who have signed up or shown an interest in signing up for the seasonal flu vaccine now represents about half of all school children in Maine – about 95,000.
The seasonal flu vaccine is not expected to specifically protect against the novel H1N1 influenza virus. However, with H1N1 and seasonal influenza viruses both expected to be circulating, getting a seasonal influenza vaccine will help a person’s overall protection against the flu.
H1N1 Vaccine
Maine CDC expects H1N1 vaccine to arrive in the state in mid-October at the earliest, and staff continues to meet frequently to plan for vaccination clinics much like the seasonal flu clinics. Clinical trials for the H1N1 vaccine have recently started (http://www.reuters.com/article/healthNews/idUSTRE5734KX20090804).
For more information about H1N1 vaccine trials: http://www3.niaid.nih.gov/news/QA/vteuH1N1qa.htm.
US CDC released the priority groups for receiving this vaccine, and they are:
Pregnant women, because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
Household members and caregivers for children under 6 months old, because younger infants are at higher risk of complications and cannot be vaccinated;
Health care and emergency medical services personnel, because infections among health care workers have been reported and this can be a potential source of infection for patients;
All people ages 6 months through 24 years of age:
Children ages 6 months to 18 years, because there have been many cases of H1N1 in children and they are in close contact with each other in school and day care settings, which increases the chances of spreading disease;
Young adults ages 19 through 24, because there have been many cases of H1N1 in healthy young adults, and they often live, work, and study in close proximity, and they are a frequently mobile population;
People ages 25 through 64 who have health conditions associated with a higher risk of medical complications from the flu, including those with asthma, COPD, diabetes, chronic cardiovascular disease, and immuno-compromised persons. Morbid obesity may also represent an additional risk factor for severe illness. (http://www.cdc.gov/h1n1flu/vaccination/acip.htm)
Once the demand for vaccine for these prioritized groups has been met, CDC recommends that providers offer vaccinations to everyone ages 25 through 64 years. People age 65 or older have shown some immunity to H1N1 and are considered at lower risk than younger age groups. However, as supply and demand for vaccine among younger age groups is met, CDC recommends that providers also offer vaccination to people 65 years and older.
The H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used with seasonal flu vaccine to protect people.
At this point in time, there is no evidence that vaccinations will be mandatory.
US CDC expects that H1N1 vaccines will be available in multiple formulations, including some that are preservative (thimerosal) free.
For more information about H1N1 vaccine, visit US CDC’s Q&A: http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.
CDC has also issued guidance on vaccination clinic planning (http://www.cdc.gov/h1n1flu/vaccination/statelocal).
Testing and Management for H1N1
Maine CDC issued a health advisory July 28 on Testing and Management for Novel Influenza A H1N1 (http://www.maine.gov/tools/whatsnew/attach.php?id=77176&an=1). Maine CDC held a conference call for health care providers on Aug. 3 related to the advisory, which gave an update on surveillance and shifting focus from tracking individual cases to outbreaks in certain settings (schools, jails, shelters, etc).
H1N1 Preparations for Residential Schools
Maine CDC has issued the following health advisory: H1N1 Preparations for Residential Schools (http://www.maine.gov/tools/whatsnew/attach.php?id=77501&an=1). A conference call giving suggestions on how residential schools, such as secondary boarding schools, colleges, and universities, can prepare for H1N1 this fall will be held Aug. 10. See below for more information.
H1N1 Conference Calls
Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. The information for the next two calls is as follows:
Date: Monday, Aug. 10
Time: Noon to 1 p.m.
Topic: Residential Schools and how they can prepare for H1N1 through communication, prevention, early detection, isolation, and treatment
Call-in number: 1-800-914-3396
Pass code: 473623
Date: Monday, Aug. 17
Time: Noon to 1 p.m.
Topic: Update for Health Care Providers on seasonal influenza vaccine and H1N1 vaccine
Call-in number: 1-800-914-3396
Pass code: 473623
H1N1 Summit planned for August 20
Maine CDC continues to work closely with high-risk settings and organizations on preparing for a possible escalation of H1N1 in the fall, especially as schools reconvene and transmission is then expected to pick up. At least 850 people have already registered to attend the H1N1 Influenza Preparedness Summit co-sponsored by Maine CDC/DHHS, Maine Emergency Management Agency, Maine Department of Education, and Maine EMS. The Summit will be held from 8 a.m. to 4 p.m. Aug. 20 at the Augusta Civic Center, 76 Community Drive.
A $15 registration fee is required (with scholarships by special request). For more information, contact MCD Meeting Services at conferences@mcd.org or 207-622-7566, ext 232. To register online: http://www.mcdregistration.org/signup.asp?ID=172
Other New or Recently Updated US CDC H1N1 Guidance or News
Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Tests
http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm
School Dismissal Monitoring System
http://www.cdc.gov/h1n1flu/schools/dismissal_form/index.htm
How to Stay Updated
U.S. CDC H1N1 Recommendations and Guidance
http://www.cdc.gov/h1n1flu/
Maine CDC H1N1 Website and Related Links
http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at http://www.mainepublichealth.gov/ (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
My Space (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
Maine CDC Clinical Consultation 24x7 line: 1-800-821-5821
H1N1 Conference Calls: Check Wednesday Weekly Updates for schedule of topics. See information above for upcoming calls.
H1N1 Summit: August 20th at the Augusta Civic Center. More information above.
Weekly Updates: Check the Wednesday late afternoon updates on H1N1 in Maine on Maine CDC’s H1N1 website: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
Maine CDC Clinical Consultation: For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
There have been 323 confirmed and probable cases of H1N1 total to date, with 176 in Maine residents and 147 in out-of-state residents. A total of 14 Maine residents and 5 out-of-state residents have been hospitalized. No deaths have been reported to date. Nearly all (90%) of lab confirmed H1N1 cases in Maine residents and out-of-state visitors are under the age of 50 (range 0-81 years, mean of 22 years).
US CDC has shifted to reporting total hospitalizations and deaths nationally, instead of by state. Maine CDC will no longer be following up on every person who tests positive for H1N1, and instead will focus on those associated with certain settings (day care, health care workers, prisons, schools, shelters, nursing homes, group homes, etc), those who are high risk for complications, and those who are hospitalized.
The Lancet published an article about the increased risk of severe or fatal illness in pregnant women infected with H1N1 (www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61304-0/fulltext). WHO strongly recommends that pregnant women, and the clinicians treating them, be alert to the symptoms of influenza-like illness (http://www.cdc.gov/h1n1flu/sick.htm#2), especially during the second and third trimesters of pregnancy (http://www.who.int/csr/disease/swineflu/notes/h1n1_pregnancy_20090731/en/index.html). US CDC has several guidance documents on its web site related to pregnancy: http://www.cdc.gov/h1n1flu/pregnancy.
Respiratory Etiquette
Prevention of H1N1 is most important, especially now that the virus is becoming more widespread in Maine. Respiratory etiquette (covering coughs and sneezes with a sleeve or tissue, washing hands frequently, and staying home if ill with a fever) is a shared responsibility of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1. Those at higher risk for complications from H1N1 should take extra precautions (see CDC Information for Specific Groups: http://www.cdc.gov/h1n1flu/groups.htm
and Maine CDC’s H1N1 website at http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml).
Seasonal Influenza Vaccine
US CDC recommends that all children ages 6 months to 18 years be vaccinated against the regular seasonal flu this year, and that vaccination should begin in September, or as soon as seasonal flu vaccine is available, and continue through the flu season. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e)
Maine CDC is working with a number of statewide partners to plan for large scale vaccine campaigns this fall, beginning with a school-located seasonal flu vaccine campaign. The number of schools who have signed up or shown an interest in signing up for the seasonal flu vaccine now represents about half of all school children in Maine – about 95,000.
The seasonal flu vaccine is not expected to specifically protect against the novel H1N1 influenza virus. However, with H1N1 and seasonal influenza viruses both expected to be circulating, getting a seasonal influenza vaccine will help a person’s overall protection against the flu.
H1N1 Vaccine
Maine CDC expects H1N1 vaccine to arrive in the state in mid-October at the earliest, and staff continues to meet frequently to plan for vaccination clinics much like the seasonal flu clinics. Clinical trials for the H1N1 vaccine have recently started (http://www.reuters.com/article/healthNews/idUSTRE5734KX20090804).
For more information about H1N1 vaccine trials: http://www3.niaid.nih.gov/news/QA/vteuH1N1qa.htm.
US CDC released the priority groups for receiving this vaccine, and they are:
Pregnant women, because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
Household members and caregivers for children under 6 months old, because younger infants are at higher risk of complications and cannot be vaccinated;
Health care and emergency medical services personnel, because infections among health care workers have been reported and this can be a potential source of infection for patients;
All people ages 6 months through 24 years of age:
Children ages 6 months to 18 years, because there have been many cases of H1N1 in children and they are in close contact with each other in school and day care settings, which increases the chances of spreading disease;
Young adults ages 19 through 24, because there have been many cases of H1N1 in healthy young adults, and they often live, work, and study in close proximity, and they are a frequently mobile population;
People ages 25 through 64 who have health conditions associated with a higher risk of medical complications from the flu, including those with asthma, COPD, diabetes, chronic cardiovascular disease, and immuno-compromised persons. Morbid obesity may also represent an additional risk factor for severe illness. (http://www.cdc.gov/h1n1flu/vaccination/acip.htm)
Once the demand for vaccine for these prioritized groups has been met, CDC recommends that providers offer vaccinations to everyone ages 25 through 64 years. People age 65 or older have shown some immunity to H1N1 and are considered at lower risk than younger age groups. However, as supply and demand for vaccine among younger age groups is met, CDC recommends that providers also offer vaccination to people 65 years and older.
The H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used with seasonal flu vaccine to protect people.
At this point in time, there is no evidence that vaccinations will be mandatory.
US CDC expects that H1N1 vaccines will be available in multiple formulations, including some that are preservative (thimerosal) free.
For more information about H1N1 vaccine, visit US CDC’s Q&A: http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.
CDC has also issued guidance on vaccination clinic planning (http://www.cdc.gov/h1n1flu/vaccination/statelocal).
Testing and Management for H1N1
Maine CDC issued a health advisory July 28 on Testing and Management for Novel Influenza A H1N1 (http://www.maine.gov/tools/whatsnew/attach.php?id=77176&an=1). Maine CDC held a conference call for health care providers on Aug. 3 related to the advisory, which gave an update on surveillance and shifting focus from tracking individual cases to outbreaks in certain settings (schools, jails, shelters, etc).
H1N1 Preparations for Residential Schools
Maine CDC has issued the following health advisory: H1N1 Preparations for Residential Schools (http://www.maine.gov/tools/whatsnew/attach.php?id=77501&an=1). A conference call giving suggestions on how residential schools, such as secondary boarding schools, colleges, and universities, can prepare for H1N1 this fall will be held Aug. 10. See below for more information.
H1N1 Conference Calls
Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. The information for the next two calls is as follows:
Date: Monday, Aug. 10
Time: Noon to 1 p.m.
Topic: Residential Schools and how they can prepare for H1N1 through communication, prevention, early detection, isolation, and treatment
Call-in number: 1-800-914-3396
Pass code: 473623
Date: Monday, Aug. 17
Time: Noon to 1 p.m.
Topic: Update for Health Care Providers on seasonal influenza vaccine and H1N1 vaccine
Call-in number: 1-800-914-3396
Pass code: 473623
H1N1 Summit planned for August 20
Maine CDC continues to work closely with high-risk settings and organizations on preparing for a possible escalation of H1N1 in the fall, especially as schools reconvene and transmission is then expected to pick up. At least 850 people have already registered to attend the H1N1 Influenza Preparedness Summit co-sponsored by Maine CDC/DHHS, Maine Emergency Management Agency, Maine Department of Education, and Maine EMS. The Summit will be held from 8 a.m. to 4 p.m. Aug. 20 at the Augusta Civic Center, 76 Community Drive.
A $15 registration fee is required (with scholarships by special request). For more information, contact MCD Meeting Services at conferences@mcd.org or 207-622-7566, ext 232. To register online: http://www.mcdregistration.org/signup.asp?ID=172
Other New or Recently Updated US CDC H1N1 Guidance or News
Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Tests
http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm
School Dismissal Monitoring System
http://www.cdc.gov/h1n1flu/schools/dismissal_form/index.htm
How to Stay Updated
U.S. CDC H1N1 Recommendations and Guidance
http://www.cdc.gov/h1n1flu/
Maine CDC H1N1 Website and Related Links
http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at http://www.mainepublichealth.gov/ (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
My Space (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
Maine CDC Clinical Consultation 24x7 line: 1-800-821-5821
H1N1 Conference Calls: Check Wednesday Weekly Updates for schedule of topics. See information above for upcoming calls.
H1N1 Summit: August 20th at the Augusta Civic Center. More information above.
Weekly Updates: Check the Wednesday late afternoon updates on H1N1 in Maine on Maine CDC’s H1N1 website: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
Maine CDC Clinical Consultation: For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
Monday, August 3, 2009
Weekly Update on H1N1 in Maine 7/29/09
Epidemiologic Trends
A total of 20 cases have been identified since the last update, for a total of 302 confirmed and probable cases to date. Most of the cases continue to be in the southern half of the state. The number of cases is only a barometer of community transmission, not of actual case counts. US CDC and WHO are no longer providing case numbers, since increasingly the numbers of those tested are a significant underestimate of those with the infection.
Three summer camps have reported at least one confirmed case of H1N1 in the last week. All camps reporting outbreaks have been able to remain open and isolate ill children following US CDC recommendations (http://www.cdc.gov/h1n1flu/sick.htm). Many camps are starting their second sessions and having visiting days, so prevention and screening efforts have increased.
Massachusetts, which has had more cases of H1N1 than Maine and therefore more data, has a hospitalization rate of about 12%, which is close to the national rate for H1N1 of 11%. This is significantly higher than the hospitalization rate for seasonal influenza, which is about 1%. Seasonal influenza is most serious in those 65 and older, while the average age for those most seriously ill with H1N1 in MA is 14. Out of the 5 deaths in MA, 3 had underlying conditions and 2 did not.
Since the southern hemisphere is in its seasonal influenza (winter) season, with both H1N1 and seasonal influenza strains circulating, the situation there is being monitored carefully as a barometer of our upcoming fall/winter seasonal influenza season. Viral isolates from the southern hemisphere have not indicated any significant genetic changes thus far in H1N1, and the profile of those encountering serious illness with H1N1 there is the same as is seen in the U.S. Some countries are seeing strains on the health care systems and some have closed schools, providing strong evidence that the U.S. should move forward with H1N1 vaccine.
Respiratory Etiquette
Prevention of H1N1 is most important, especially now that the virus is becoming more widespread in Maine. Respiratory etiquette (covering coughs and sneezes with a sleeve or tissue, washing hands frequently, and staying home if ill with a fever) is a shared responsibility of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1. Those at higher risk for complications from H1N1 should take extra precautions (see CDC Information for Specific Groups: http://www.cdc.gov/h1n1flu/groups.htm
and Maine CDC’s H1N1 website at http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml).
Vaccination
Maine CDC is working with a number of statewide partners to plan for large scale vaccine campaigns this fall. The first is a school-located seasonal influenza vaccine campaign. The FDA has approved the vaccine for 2009-2010 seasonal influenza (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm172772.htm).
The Advisory Committee on Immunization Practices (ACIP) has released recommendations for seasonal influenza vaccine, including that all children ages 6 months to 18 years be vaccinated against seasonal influenza, and that vaccination efforts should begin as soon as vaccine is available and continue through the influenza season. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e)
Maine CDC staff continues to meet weekly to plan for the possible arrival of H1N1 vaccine later in the fall, which may be a two-dose vaccine a month apart. US CDC has updated its Q&A on H1N1 vaccine (http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm). Clinical trials for the H1N1 vaccine are starting soon (http://www.nih.gov/news/health/jul2009/niaid-22.htm).
H1N1 Summit planned for August 20
Maine CDC continues to work closely with high-risk settings and organizations on preparing for a possible escalation of H1N1 in the fall, especially as schools reconvene and transmission is then expected to pick up. Maine CDC/DHHS, Maine Emergency Management Agency, and Maine Department of Education are co-sponsoring an H1N1 Influenza Preparedness Summit 8 a.m. to 4 p.m. Aug. 20 at the Augusta Civic Center, 76 Community Drive.
A $15 registration fee is required, with scholarships by request. For more information, contact MCD Meeting Services at conferences@mcd.org or 207-622-7566, ext 232. To register online: http://www.mcdregistration.org/signup.asp?ID=172
H1N1 Vaccine Q&A (source: US CDC)
Q. What are the plans for developing novel H1N1 vaccine?
A. Vaccines are the most powerful public health tool for control of influenza, and the U.S. government is working closely with manufacturers to take steps in the process to manufacture a novel H1N1 vaccine. Working together with scientists in the public and private sector, CDC has isolated the new H1N1 virus and modified the virus so that it can be used to make hundreds of millions of doses of vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete. Candidate vaccines will be tested in clinical trials over the few months.
Q. When is it expected that the novel H1N1 vaccine will be available?
A. The novel H1N1 vaccine is expected to be available in the fall. More specific dates cannot be provided at this time as vaccine availability depends on several factors including manufacturing time and time needed to conduct clinical trials
Q. Will the seasonal flu vaccine also protect against the novel H1N1 flu?
A. The seasonal flu vaccine is not expected to protect against the novel H1N1 flu.
Q. Can the seasonal vaccine and the novel H1N1 vaccine be given at the same time?
A. Clinical trial results will be necessary to confirm that novel H1N1 and seasonal vaccine will be safe and effective if given at the same time. We expect the seasonal vaccine to be available earlier than the H1N1 vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Individuals are encouraged to get their seasonal flu vaccine as soon as it is available.
Q. Who will be recommended as priority groups to receive the novel H1N1 vaccine?
A. Based on what we're currently seeing with respect to the virus and epidemiologic data, states, communities, and health care providers should begin planning strategies for how they will vaccinate younger people (children and younger adults), pregnant women, healthcare personnel, and people who have underlying health conditions. The Advisory Committee on Immunization Practices (ACIP) and other federal advisory bodies will continue to monitor the virus and review epidemiologic data over the summer. We'll be looking to the ACIP and other stakeholders, as well as the public, as we move forward in our planning. It is possible that vaccine priority groups will differ from earlier guidance as more data becomes available however it's very important for planning to continue based on information currently available.
Q. Where will the vaccine be available?
A. Every state is developing a vaccine delivery plan. Vaccine will be available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces.
Q. Are there other ways to prevent the spread of illness?
A. Take everyday actions to stay healthy.
· Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
· Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
· Avoid touching your eyes, nose or mouth. Germs spread that way.
· Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. These measures will continue to be important after a novel H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections.
Q. What about the use of antivirals to treat novel H1N1 infection?
A. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. This fall, antivirals may be prioritized for persons with severe illness or those at higher risk for flu complications.
Neurologic Complications Associated with H1N1 Infection in Children
This US CDC MMWR report describes the clinical findings related to four children in Dallas, Texas, who experienced neurological complications associated with influenza A (H1N1) virus infection in May. All four patients recovered fully. These findings indicate that, as with seasonal influenza, neurologic complications can occur after respiratory tract infection with novel influenza A (H1N1) virus.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a2.htm?s_cid=mm5828a2_e
Other New or Recently Updated US CDC H1N1 Guidance or News
Interim Guidance for People who have Close Contact with Pigs in Non-commercial Settings
http://www.cdc.gov/h1n1flu/guidelines_pig_workers.htm
H1N1 Monitoring Questions and Answers
http://www.cdc.gov/h1n1flu/reportingqa.htm
For more information
U.S. CDC H1N1 Recommendations and Guidance
http://www.cdc.gov/h1n1flu/recommendations.htm
http://www.cdc.gov/h1n1flu/guidance/
Maine CDC H1N1 Website
http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
Maine CDC Clinical Consultation 24x7 line: 1-800-821-5821
To view surveillance data and other updates: http://www.maine.gov/dhhs/boh/swine-flu-update-archives.shtml
A total of 20 cases have been identified since the last update, for a total of 302 confirmed and probable cases to date. Most of the cases continue to be in the southern half of the state. The number of cases is only a barometer of community transmission, not of actual case counts. US CDC and WHO are no longer providing case numbers, since increasingly the numbers of those tested are a significant underestimate of those with the infection.
Three summer camps have reported at least one confirmed case of H1N1 in the last week. All camps reporting outbreaks have been able to remain open and isolate ill children following US CDC recommendations (http://www.cdc.gov/h1n1flu/sick.htm). Many camps are starting their second sessions and having visiting days, so prevention and screening efforts have increased.
Massachusetts, which has had more cases of H1N1 than Maine and therefore more data, has a hospitalization rate of about 12%, which is close to the national rate for H1N1 of 11%. This is significantly higher than the hospitalization rate for seasonal influenza, which is about 1%. Seasonal influenza is most serious in those 65 and older, while the average age for those most seriously ill with H1N1 in MA is 14. Out of the 5 deaths in MA, 3 had underlying conditions and 2 did not.
Since the southern hemisphere is in its seasonal influenza (winter) season, with both H1N1 and seasonal influenza strains circulating, the situation there is being monitored carefully as a barometer of our upcoming fall/winter seasonal influenza season. Viral isolates from the southern hemisphere have not indicated any significant genetic changes thus far in H1N1, and the profile of those encountering serious illness with H1N1 there is the same as is seen in the U.S. Some countries are seeing strains on the health care systems and some have closed schools, providing strong evidence that the U.S. should move forward with H1N1 vaccine.
Respiratory Etiquette
Prevention of H1N1 is most important, especially now that the virus is becoming more widespread in Maine. Respiratory etiquette (covering coughs and sneezes with a sleeve or tissue, washing hands frequently, and staying home if ill with a fever) is a shared responsibility of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1. Those at higher risk for complications from H1N1 should take extra precautions (see CDC Information for Specific Groups: http://www.cdc.gov/h1n1flu/groups.htm
and Maine CDC’s H1N1 website at http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml).
Vaccination
Maine CDC is working with a number of statewide partners to plan for large scale vaccine campaigns this fall. The first is a school-located seasonal influenza vaccine campaign. The FDA has approved the vaccine for 2009-2010 seasonal influenza (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm172772.htm).
The Advisory Committee on Immunization Practices (ACIP) has released recommendations for seasonal influenza vaccine, including that all children ages 6 months to 18 years be vaccinated against seasonal influenza, and that vaccination efforts should begin as soon as vaccine is available and continue through the influenza season. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e)
Maine CDC staff continues to meet weekly to plan for the possible arrival of H1N1 vaccine later in the fall, which may be a two-dose vaccine a month apart. US CDC has updated its Q&A on H1N1 vaccine (http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm). Clinical trials for the H1N1 vaccine are starting soon (http://www.nih.gov/news/health/jul2009/niaid-22.htm).
H1N1 Summit planned for August 20
Maine CDC continues to work closely with high-risk settings and organizations on preparing for a possible escalation of H1N1 in the fall, especially as schools reconvene and transmission is then expected to pick up. Maine CDC/DHHS, Maine Emergency Management Agency, and Maine Department of Education are co-sponsoring an H1N1 Influenza Preparedness Summit 8 a.m. to 4 p.m. Aug. 20 at the Augusta Civic Center, 76 Community Drive.
A $15 registration fee is required, with scholarships by request. For more information, contact MCD Meeting Services at conferences@mcd.org or 207-622-7566, ext 232. To register online: http://www.mcdregistration.org/signup.asp?ID=172
H1N1 Vaccine Q&A (source: US CDC)
Q. What are the plans for developing novel H1N1 vaccine?
A. Vaccines are the most powerful public health tool for control of influenza, and the U.S. government is working closely with manufacturers to take steps in the process to manufacture a novel H1N1 vaccine. Working together with scientists in the public and private sector, CDC has isolated the new H1N1 virus and modified the virus so that it can be used to make hundreds of millions of doses of vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete. Candidate vaccines will be tested in clinical trials over the few months.
Q. When is it expected that the novel H1N1 vaccine will be available?
A. The novel H1N1 vaccine is expected to be available in the fall. More specific dates cannot be provided at this time as vaccine availability depends on several factors including manufacturing time and time needed to conduct clinical trials
Q. Will the seasonal flu vaccine also protect against the novel H1N1 flu?
A. The seasonal flu vaccine is not expected to protect against the novel H1N1 flu.
Q. Can the seasonal vaccine and the novel H1N1 vaccine be given at the same time?
A. Clinical trial results will be necessary to confirm that novel H1N1 and seasonal vaccine will be safe and effective if given at the same time. We expect the seasonal vaccine to be available earlier than the H1N1 vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Individuals are encouraged to get their seasonal flu vaccine as soon as it is available.
Q. Who will be recommended as priority groups to receive the novel H1N1 vaccine?
A. Based on what we're currently seeing with respect to the virus and epidemiologic data, states, communities, and health care providers should begin planning strategies for how they will vaccinate younger people (children and younger adults), pregnant women, healthcare personnel, and people who have underlying health conditions. The Advisory Committee on Immunization Practices (ACIP) and other federal advisory bodies will continue to monitor the virus and review epidemiologic data over the summer. We'll be looking to the ACIP and other stakeholders, as well as the public, as we move forward in our planning. It is possible that vaccine priority groups will differ from earlier guidance as more data becomes available however it's very important for planning to continue based on information currently available.
Q. Where will the vaccine be available?
A. Every state is developing a vaccine delivery plan. Vaccine will be available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces.
Q. Are there other ways to prevent the spread of illness?
A. Take everyday actions to stay healthy.
· Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
· Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
· Avoid touching your eyes, nose or mouth. Germs spread that way.
· Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. These measures will continue to be important after a novel H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections.
Q. What about the use of antivirals to treat novel H1N1 infection?
A. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. This fall, antivirals may be prioritized for persons with severe illness or those at higher risk for flu complications.
Neurologic Complications Associated with H1N1 Infection in Children
This US CDC MMWR report describes the clinical findings related to four children in Dallas, Texas, who experienced neurological complications associated with influenza A (H1N1) virus infection in May. All four patients recovered fully. These findings indicate that, as with seasonal influenza, neurologic complications can occur after respiratory tract infection with novel influenza A (H1N1) virus.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a2.htm?s_cid=mm5828a2_e
Other New or Recently Updated US CDC H1N1 Guidance or News
Interim Guidance for People who have Close Contact with Pigs in Non-commercial Settings
http://www.cdc.gov/h1n1flu/guidelines_pig_workers.htm
H1N1 Monitoring Questions and Answers
http://www.cdc.gov/h1n1flu/reportingqa.htm
For more information
U.S. CDC H1N1 Recommendations and Guidance
http://www.cdc.gov/h1n1flu/recommendations.htm
http://www.cdc.gov/h1n1flu/guidance/
Maine CDC H1N1 Website
http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
Maine CDC Clinical Consultation 24x7 line: 1-800-821-5821
To view surveillance data and other updates: http://www.maine.gov/dhhs/boh/swine-flu-update-archives.shtml
Friday, December 19, 2008
Carbon Monoxide Poisoning and Portable Generators
The graphic posted on this blog post shows the proper placement of a portable gasoline-powered generator. The photos on the 12/14/08 blog post are a few of the 30 or so photos I took of generators in southern Maine during last week's ice storm. They are all NOT properly placed because they are not far enough away from the houses.
So far we have tallied over 30 people in Maine with documented carbon monoxide poisoning from last week's storm. Preliminary analysis indicates that the vast majority were associated with misplaced generators. And, my own perusal of southern Maine indicates that is quite common. In fact, out of the 30 photos I took, not one is of a properly-placed generator! Consider a few facts:
Carbon Monoxide = CO is an odorless, tasteless, invisible and deadly gas.
CO is created from any combustion or burning of fuel.
In Maine, we have on average 150 people per year seen in emergency departments for CO poisoning, and 1 - 5 deaths.
The Maine 1998 ice storm - 2 deaths from CO poisoning, and well over 100 people were seen for CO poisoning in hospital emergency departments, mostly associated with the use of gasoline generators.
What can we do?
1. Know that gasoline-powered generators make a LOT of deadly carbon monoxide gas – one portable generator can produce the same amount of CO as 100 idling cars!! (http://blogs.consumerreports.org/safety/2006/12/growing_concern.html)
2. NEVER operate a generator in an enclosed or semi-enclosed space such as a basement, garage, barn, or enclosed porch. Doing so may send you and your family to the hospital and may even kill you.
3. Place generators outside far away (at least 20 feet) from any doors and windows that may allow CO gas back into the house, and make sure the exhaust is directed away from the house. Buy an appropriate electrical cord sufficiently long.
4. Keep generator and your hands dry to avoid electrocution. Many people use a canopy-like structure on a dry surface where water cannot reach the generator. It is important to plan ahead on where and how to place a generator safely outside of your home.
5. Have a working battery-operated CO alarm, especially if you have a generator. Only about 1/3 - 1/2 of Maine homes have a CO detector at all.
6. Do not use cooking equipment for heating inside - such as grills, stoves, or ovens.
7. Know that CO symptoms are: flu-like symptoms - headache, nausea, vomiting, dizziness - plus confusion and loss of consciousness. Some may have shortness of breath, palpitations, or chest pain. Often multiple people and pets are sick at the same time.
8. If the CO alarm goes off and you have symptoms, call 911 and get everyone
outside.
9. If you have questions call the Northern New England Poison Center at 1-800-222-1222.
A battery-operated CO detector makes a wonderful Christmas or Hanukkah gift!!
Sunday, December 14, 2008
Wednesday, December 10, 2008
On December 1st, the 20th Anniversary of World AIDS Day, Governor Baldacci and Dr. Mills joined Andrew Bossie, the Executive Director of the Maine AIDS Alliance and a number of others in the State House Hall of Flags for an event marked by celebration, somber remembrances, and a garnering of leadership.
We celebrated that life expectancy for those diagnosed with AIDS has increased from 4 months for those diagnosed 20 years ago to 8 years and climbing for those diagnosed now. We remembered the hundreds of Mainers who have died of AIDS over the years. And, we garnered political, health, and faith-based leadership to address the challenges faced by the estimated 1,600 Mainers diagnosed with HIV and to prevent the further spread of the infection.
I felt privileged to play a role in this day, and met some incredible Mainers with inspiring stories!
For more information on AIDS
Maine CDC HIV Website: http://www.maine.gov/dhhs/boh/ddc/hiv_std_vh.htm
Maine AIDS Alliance: http://www.maineaidsalliance.org/
US CDC HIV/AIDS Website: http://www.cdc.gov/hiv/
Dora
Heating Crisis in Maine
We have been quite busy the past few weeks with budget deliberations, the annual fall public health and medical conferences and meetings, and addressing some public health brushfires (hepatitis A outbreak, etc) that are exacerbated by a staffing shortage.
Despite these challenges, it is important we continue to address emerging health issues. One of these is the current heating and economic crisis. Mainers are more dependent on oil for heating their homes than any other state. So, the current economic and heating crisis has a number of public health ramifications.
Three ramifications are the focus of a recent health advisory: carbon monoxide poisoning, hypothermia, and respiratory health secondary to wood-burning. This health advisory and other fact sheets and information can be found on our Stay Healthy This Winter webpage at: http://www.maine.gov/dhhs/boh/heat_2008.shtml.
Additionally, Maine CDC funded a telephone survey this fall of about 32,000 Mainers on a variety of heating and energy issues, including on transportation, carbon monoxide, and commuting issues. The results of this survey, along with district results, can also be found on the Stay Healthy This Winter webpage.
Our epidemiologists are also tracking more intensely illness and deaths due to these three major issues - hypothermia, carbon monoxide, and respiratory health. The information gathered and resulting analyses we hope will inform future efforts.
We hope these materials and efforts can help the many Maine organizations and people who are working hard on assuring a safety net for people this winter. Let us know if there are additional ideas you have!
Saturday, October 4, 2008
October, Breast Cancer Awareness Month
Breast Cancer Awareness Month started with some wonderful events. First, was the launch of the new Maine Breast Cancer License Plates. Representative Meredith Strang Burgess sponsored the enabling legislation for this effort and was the leading torchbearer through the last two years’ of complicated legislative and motor vehicles process.
I asked my children a few weeks ago what they wanted on our license plate. Because their childcare provider, Barbara, had passed away nearly two years ago from breast cancer, they had followed the legislative process enabling these plates, and this became a personal cause for them. They felt strongly the word “hope” should be on the plate, in honor of Barbara, who worked hard to instill hope in the children, even as she was dying. Rep Burgess searched for letter combinations available with the word “hope” in them, and found “HPE4ME”, which she felt appropriate because it stands for “Hope for Maine”, with the rest of the plate having a map of Maine and the breast cancer ribbon on it.
So, Wednesday morning Secretary of State Matt Dunlap, Representative Meredith Strang Burgess, Senator Dennis Damon (chair of the Transportation Committee), and representatives from the three benefiting organizations from the sales of the plate – Maine Cancer Foundation, Maine Breast Cancer Coalition, and Maine Breast and Cervical Health Program (within the Maine CDC) – gathered at the Bureau of Motor Vehicles (BMV) to launch the new plates.
This was an exciting moment, since, as Rep Burgess commented, “this is the only license plate that will save lives!”. It is hoped that about $40,000 - $50,000 will be raised annually from the sales of the vanity plates. Link to the BMV website http://www10.informe.org/bmv/vanity/) or go to a local BMV office to order your breast cancer plate, which is $20 for a specialty plate, $25 for a vanity plate, and $2 for the online agent fee.
There is also a no-cost step women can take to help prevent breast cancer. The famed breast cancer physician, Dr. Susan Love, has teamed up with researchers to start a movement called “Army of Women”. This initiative offers a new way for every woman to partner with research scientists by signing up to indicate possible interests in participating in research to find the causes of breast cancer. You can sign up even if you have no history or family history of breast cancer. Sign up by linking to Army of Women at http://www.armyofwomen.org/.
After the launch of the license plates, I attended the Maine Cancer Foundation’s Cure Breast Cancer For ME luncheon. Inspired by the stories shared around the table I was sitting at as well as the many presented on stage, I have rarely cried and laughed so hard in one 2 ½ hour period! Filled with over 500 who have gathered to raise money for the Maine Women’s Cancer Fund, the luncheon has become a stellar event of celebration and inspiration. I was fortunate to sit next to a young woman who has recently finished chemotherapy for breast cancer. When I found out she has three young children, I asked how she had coped the last several months. She replied, “it’s because of her”, pointing to Eileen Skinner, the CEO of Mercy Hospital, sitting on the other side of me. She went on to explain that her husband works at Mercy, and he was told to take the time he needed to be with his wife and children. It seems that all of us can do something to help someone with cancer.
If you know someone with breast cancer or another type of cancer and you’re not sure how you can help them, or you yourself have cancer, the American Cancer Society’s “I Can Cope” website is a great resource for providing such tools (http://www.cancer.org/docroot/ESN/content/ESN_3_1X_I_Can_Cope_Online.asp.) and the Massachusetts General Hospital also has such tools (http://www.massgeneral.org/cancer/crr/topics/help/index.asp).
Throughout Wednesday I was inspired by so many cancer survivors I was privileged to meet. I also couldn’t help but think about the many different strides we have made the past 40 years. When my Aunt Elizabeth died in the early 1970s of breast cancer, we hardly uttered the word “cancer”, and much less “breast cancer” to describe the disease that took her life. Now, we have an opportunity to proclaim our desires to prevent and cure breast cancer on our car license plates!
Friday, September 19, 2008
Washington County Update
Friday September 12th Representative Anne Perry convened a meeting in Machias to discuss health disparity issues faced in Washington County, along with Commissioner of Maine DHHS Brenda Harvey, Senator Kevin Raye, Representative Donald Soctomah, and a number of others. Lisa Sockabasin, the Director of Minority Health, and I drove together to the meeting. About 25 people attended, including many health and social service providers and representatives from the Maine Department of Economic and Community Development and Maine Department of Labor. I presented the health profile data that Maine CDC staff have been working hard helping me compile. The data are found in four documents:
“Public Health Data Comparison Tables, Washington County” is a Health District Profile with a column for Washington County that provides comparisons between Washington County, other regions of the state, the state as a whole, and the nation;
“Washington County Data” is a compilation of Washington County data that includes some trend data;
“Community Health Status Report, Washington County” is a report comparing Washington County health data to peer counties around the country; and
“Washington County Highlights of the Health Profile” is a summary of some highlights of the above three documents.
These documents can be found on our new Public Health Data Reports website (http://www.maine.gov/dhhs/boh/phdata/), under the Regional and Local Reports section or directly at http://www.maine.gov/dhhs/boh/phdata/county_level_reports.htm.
The gathered group then shared observations and ideas. What was most impressive to me was the high level of passion, energy, and thoughtful ideas in the room. From ideas related to economic development, educational opportunities, improving prevention, screening, and treatment of health issues, to infrastructure improvements (yes, the poor condition of Route 1 and lack of internet and cell phone coverage were mentioned several times), to environmental concerns were discussed. Disparities among the poor and minority communities were also recognized.
However, although “hopelessness” and “poverty” were the two most common words I heard during the two hour meeting, I left with a strong sense of optimism. First, there was the recent news of the US DHHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) award to Washington County’s Community Caring Collaborative of a ~$900,000 per year 5-year grant to help expand prevention programs for underserved communities in Washington County, including the Passamaquoddy tribal members. Marjorie Withers from the Collaborative was at the meeting and her excitement about the impact this grant may have was quite palpable. Cheryl DiCara, Valerie Ricker, Lisa Sockabasin and others from the Maine CDC who assisted on this grant were also bursting with excitement the preceding days. It also looks like Maine CDC may be able to fund a prevention specialist using Fund for a Healthy Maine dollars for the Passamaquoddy Tribe in the coming weeks. And, we are hopeful to be able to soon hire a Maine CDC Public Health District Liaison for the Downeast District, and perhaps locate the person in Machias.
Second, the attendees agreed to use the Washington County: One Community initiative as a central point of contact for ongoing efforts. Eleody Libby, their Executive Director and Healthy Maine Partnership Director, is a well known public health professional and has been very involved with statewide public health activities. Representatives from the Passamaquoddy Tribe were present and also invited to join the One Community initiative.
This effort will clearly take the energy and dedication of many to successfully address the many health-related challenges in Washington County. However, I left with a sense of hope, and was honored to be invited to join them in the journey.
On the way home we stopped to buy a 10-pound box of wild fresh blueberries that now sits in my freezer with containers of them in the refrigerator. It’s wonderful to have a daily healthy reminder of the great resources in Washington County!
Dora Anne Mills, MD, MPH
Washington County Health Profile Documents:
http://www.maine.gov/dhhs/boh/phdata/county_level_reports.htm.
Wednesday, August 27, 2008
Public Health and the Upcoming Heating Crisis
There has been a lot of discussion lately about the role of public health in the upcoming heating and energy crisis. Clearly, when people cannot heat their homes their health may be affected directly, such as suffering from hypothermia. Or, their health may be indirectly affected, such as by the need to take on a second job in order to pay for heating bills. And, with two papermills just this week in Maine laying off people, those second jobs and even first jobs may not even be available.
We also realize that our public health system may be stretched by the crisis. Already, WIC (Women Infants and Children Program) is seeing a record number of clients ever served in Maine, and about 14% higher than the number of clients served just over 2 years ago.
I thought it would be helpful to review some of the activities of the Maine CDC to address the upcoming winter heating crisis, and invite others to use this blog to share ideas about the current and potential role of public health at the state and local level in this crisis.
Thus far, at Maine CDC our current and planned work includes:
· We are funding and helping to develop a telephone poll that the American Lung Association of Maine is conducting to help determine geographical and population variations in heating, transportation, and carbon monoxide issues. It is hoped this survey will help policymakers and community members address specific heating and energy-related issues. Results are expected by early October. (Essential Public Health Services=EPHS #1 and 2)
· Some of our epidemiologists (Dr. Eric Tongren) and others (Dr. Andy Smith, our State Toxicologist and Dr. Andy Pelletier, a medical epidemiologist) are designing and implementing a system to track health issues such as carbon monoxide poisoning, hypothermia, asthma, and other respiratory illnesses through this upcoming winter. We hope these data will help us monitor the direct health effects of the crisis, and help us to modify our interventions to improve effectiveness. (EPHS # 1 and 2)
· We are developing public education materials, including written speaking points and radio/tv PSAs, regarding preventing the health-related issues of carbon monoxide poisoning, hypothermia, and asthma and other respiratory illnesses. These materials are being and will be shared with media outlets as well as public health, health care, and social services professionals. (EPHS # 3)
· Some of our district staff, such as our public health nurses, are participating on regional community collaboratives that have been convened mostly by United Way agencies, to address the heating crisis in their area. (EPHS # 4 and 7)
· Maine CDC is conducting a survey of its own staff and has met with energy experts to implement changes in the way it conducts business in order to save energy costs for the agency as well as for our employees. Examples include: turning many of our lights off during office hours and putting the rest of them on a timer, working on flex time alternatives, and increasingly offering meetings with teleconferencing capabilities. (EPHS #5)
What other ideas are there at the state or local level? Thank you! Dora
Governor's Stay Safe and Warm Website
http://www.maine.gov/governor/baldacci/contact/citizen_services/safeandwarm.html
Governor's Energy Website with Energy Task Force Report and Short Term Strategies
http://www.maine.gov/governor/baldacci/policy/energy.shtml
Ten Essential Public Health Services:
EPHS #1 Monitor health status to identify community health problems.
EPHS #2 Diagnose and investigate health problems and health hazards in the community.
EPHS #3 Inform, educate, and empower people about health issues.
EPHS #4 Mobilize community partnerships to identify and solve health problems.
EPHS #5 Develop policies and plans that support individual and community health efforts.
EPHS #6 Enforce laws and regulations that protect health and ensure safety.
EPHS #7 Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
EPHS #8 Assure a competent public health and personal health care workforce.
EPHS #9 Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
EPHS #10 Research for new insights and innovative solutions to health problems.
Sunday, August 24, 2008
Downeast Trip - Homeward Bound
Leaving the county, I felt a wide mixture of emotions. On one hand I felt shaken by seeing the dozens of graves of young people. On the other hand, I also felt inspired by the many people we met and the beauty of Washington County.
I also kept thinking of the eagles we witnessed on Big Lake. The eagle needs our respect and trust. Without these, the eagle can tragically dwindle to endangerment. With them, the eagle can flourish and give us strength and inspiration.
As the sun set, we drove home through Routes 1 and 6, across the northern part of Washington County. I could see the changes in the landscape from the rocky granite and blueberry barrens along the coast, to the heavy woods along the county’s mid-section, to now the more rolling hills and lakes, very reminiscent of adjacent Aroostook County to the north, the home area of my mother.
After passing through Lincoln, Interstate 95 whisked us southbound. As we drove home I asked my children what they liked best about their visit of Washington County. One replied they were delighted my Blackberry and cell phone, because of poor reception, did not interrupt their time with me and the friends we made. The other said combing the beaches and the boat ride on the lake with Mr. Sockabasin was what they liked best. It seems that both children tapped into what made the trip special to me as well – the beauty of spending time with each other and our Downeast friends as well as the natural beauty of the area.
Indeed, Downeast Maine is extremely precious, and I am grateful for our short trip there and the many gifts we were blessed with. Thank you – Woliwon!
Washington County
http://www.washingtoncountymaine.com/
Downeast Trip Day #5 - Peter Dana Point and Big Lake
After spending a relaxing morning hanging out in our cabin by Grand Lake Stream, getting some work done on the laptop, my son voraciously reading a book (and with his dyslexia, that’s always a blessing), and visiting with Kathy and Kurt at the store, we drove down the road and met Lisa at Peter Dana Point, also known as Indian Township, the other Washington County Passamaquoddy Reservation.
Lisa’s father, Allen Sockabasin, was our host for the afternoon. Sitting by the shore of Big Lake, we spent a relaxing time talking while the children explored the woods and waterfront. His stories are full of struggles as well as inspiration – about his growing up on the Reservation, his years as Passamaquoddy Governor, his efforts to preserve Passamaquoddy language, history, and culture, and his dedication to working with today’s youth through his books, his many guest appearances in Maine schools, and his work with Native youth.
Although I would have enjoyed sitting and talking with Allen all afternoon, after a while he took us for a boat ride. For over two hours we skimmed over Big Lake, and except for Peter Dana Point, we encountered no other motorized boats, no houses, and no people - just lake, woods, and bald eagles. Allen pointed out his favorite hunting and fishing grounds. I imagined that over the past 12,000 years many have hunted and fished here and shared the exact same views that we enjoyed today.
From a distance across the water, Alan easily pointed out several bald eagles atop trees. Realizing how important these rare birds are to Native American history and culture, I was even more touched by their appearances. In Native American culture, it is an eagle’s wings that flap and make snow, and an eagle’s wings that likewise make wind. The bald eagles looked like they had been peering over life on Big Lake for thousands of years.
As I left Peter Dana Point, I made one last stop - the cemetery. On one hand, it is a place of beauty, blanketing the slopes overlooking the peaceful lake. On the other hand, there is striking evidence of struggles and tragedy. The graves were primarily of young Native Americans – people in their 20s, 30s, and 40s. Only occasionally was a grave for someone in their 60s or older. Clearly, this cemetery told a story of too many people dying too young. The cemetery gave a grim picture of what we have been told – life expectancy is decreasing in this corner of Maine.
As we drove away, I explained this to my children, and they asked, “It’s so beautiful here, why are young people dying?” I told them the answers are complex and perhaps not fully known right now. I told them that poverty, lack of educational opportunities, and isolation all contribute to health risks such as smoking, substance abuse, poor nutrition, and physical inactivity. And, these risks in turn contribute to causes of death such as cancer, heart disease and stroke, diabetes, and suicide.
But, the data can only tell us so much. The people of Washington County probably know more about the reasons and more of the solutions than the data alone can tell us. I told them that it is part of our job as state officials to gather and analyze the data, but it is also part of our job to listen to and learn from what those in Washington County have to say.
Monday, August 18, 2008
Downeast Trip Day #4 - Pleasant Point Indian Days to Grand Lake Stream
After a morning walk around Eastport, which reminded me of my hometown of Farmington, and a couple of hours of combing the beaches at Prince Cove, we drove to the annual Indian Days celebration at the Passamaquoddy Reservation in nearby Pleasant Point.
We spent a picturesque and delightful afternoon with Lisa Sockabasin and some friends. With views of and breezes from the water and islands on both sides of a large field, the setting was perfect for such a gathering. While enjoying some Indian tacos and Tom Francis bread, we chatted with various friends, including Representative Donald Soctomah, who represents the Passamaquoddy Tribe in the Maine Legislature, and sits on the Health and Human Services Committee. Rep Soctomah is well recognized for his many efforts to preserve Passamaquoddy history, which is especially important because of the oral history tradition that is easily lost in these days of reliance on technology.
We also chatted with Sandra Yarmal and some others from the Pleasant Point Health Center, one of five Indian Health Centers in Maine (the others being a Passamaquoddy health center at Indian Township, a Penobscot health center at Indian Island, a Maliseet health center in Houlton, and a Mic Mac health center in Presque Isle).
The Passamaquoddy have lived in the watershed area of the St. Croix (formerly the Passamaquoddy River) for over 12,000 years. Those living on the Canadian side of the river are know as the St. Croix or Schoodic Band. Those living on the US side of the river have two reservations – one at Pleasant Point (the Sipayik members of the Passamaquoddy Tribe) and one at Indian Township (Peter Dana Point) near Princeton, Maine.
According to the Passamaquoddy website, a total of 3,369 tribal members are listed on the tribal census rolls in Maine with about two-thirds listed at Pleasant Point, and one-third at Indian Township. The US Census data for 2006 only lists 1,629 Native Americans in Washington County. This kind of discrepancy in data unfortunately is too common when trying to track health issues among our racial and ethnic minority populations. For instance, a 2005 study conducted by the then Bureau of Health (now Maine CDC) and Indian health centers in Maine showed multiple types of data quality errors apparently contributing to underestimates of death rates for certain diseases among American Indians in Maine. These errors not only included incorrect recording of race on death certificates but also errors in data coding, data entry and analysis. Complicating these errors is a lack of standardized data quality procedures (such as double data entry and automatic edit checking) in our Vital Records office because of a lack of staff and funds. These quality processes were in place until the early 1990s when Vital Records was depleted of much of its resources. Unfortunately, we are now seeing more of the effects of this depletion, including the undercounting of a number minority populations and the inability to accurately track health issues confronting them.
An afternoon visit to the nearby Waponahki Museum was very worthwhile. With Passamaquoddy history and art on display, there are exhibits that interest any age.
Coincidently and delightfully, we ran into a friend Ben Levine and his partner, Julia Schulz, at the museum. Hailing from Rockland, Ben is a filmmaker and Julia a cultural anthropologist and linguist, who are working with the Passamaquoddy Tribe and fluent Passamaquoddy speakers on a project to document and preserve this endangered language.
While at the museum we also ran into Fredda Paul a practitioner of traditional Passamaquoddy medicine, including the use of herbs, hands-on healing, and other methods he learned as a child from his grandmother. Having had a long-standing interest in multiple healing methods, especially sparked from living and traveling in Africa and Asia and observing a number of successful non-western healings, I wished I had more lifetimes to fully study them. I am humbled by the dimensions of healing, and how western medicine teaches one of a number of paradigms. Fredda is a well-respected healer, including having received an honorary degree from Unity College last year. I greatly appreciate the time he spent with me sharing some of his life’s story.
After a wonderful afternoon at Pleasant Point, the children and I drove north to Grand Lake Stream. While approaching Calais, I saw Representative Anne Perry driving south, and figured she was probably heading to Pleasant Point for Indian Days as well. We stopped briefly at the St. Croix Island International Historic Site, which is the site of the first French attempt to settle in North America in 1604, and included the famous explorer, Samuel Champlain. During the first winter, nearly half of the 79 members of the expedition died (mostly due to scurvy, from insufficient vitamin C). Thanks to trading with nearby Native Americans in the spring, the survivors were able to gain strength, and eventually moved on to permanently settle in Nova Scotia.
We arrived in Grand Lake Stream just in time to watch a glorious sunset over the lake. My childhood friend Kurt Cressey and his wife Kathy own and run the Pine Tree Store there, so we spent much of the evening catching up on news of family and friends. We finally settled into a nearby cabin and sleep after a wonderful Washington County day!
Passamaquoddy Pleasant Point
http://www.wabanaki.com/index.html
Passamaquoddy Indian Township
http://www.passamaquoddy.com/index.htm
Houlton Band of Maliseets
http://www.maliseets.com/index.htm
Aroostook Band of Micmacs
http://www.micmac-nsn.gov/
Penobscot Indian Nation
http://www.penobscotnation.org/
Underestimation of Cardiovascular Disease Mortality Among Maine American Indians: The Role of Procedural and Data Errors
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1449262
Abbe Museum of Maine's Native American Heritage
http://www.abbemuseum.org/
The Wabanaki Center at the University of Maine — http://www.nap.umaine.edu/Wab_Home.html
St. Croix Island National Historic Site
http://www.nps.gov/sacr/planyourvisit/index.htm
Thursday, August 14, 2008
Downeast Trip Day #3 - Connectivity
We woke up just down the road from the West Quoddy Lighthouse – the eastern most point in the lower 48 states. I always thought the name was “East Quoddy Lighthouse”, but learned that East Quoddy Lighthouse is located on Campobello Island, making the one outside of Lubec west of the one on the island, and therefore West Quoddy Lighthouse.
After spending the morning exploring picturesque Lubec, West Quoddy Lighthouse, and some of Campobello – the Roosevelt Cottage and a couple of hours beachcombing on Herring Cove Beach – we drove the 45 minutes around the bay to Eastport.
This afternoon’s tour of Raye’s Mustard Mill, the last remaining traditional stone-ground mustard mill, was one of the highlights of the trip for the children. Big fans of mustard, they were intrigued to see the equipment and process for making it as well as to taste several of the 24 varieties. I was interested to learn of the connection with the sardine industry. Raye’s Mustard was started over 100 years ago to provide mustard for canned sardines. With the decline in that industry, Raye’s has adjusted to focus more on table mustard. And, wow, do they do that! They’ve won a number of awards and recognition, including from Martha Stewart. Needless to say, we left loaded down with future Christmas gifs from the pantry store. We also enjoyed a nice visit with Karen Raye, one of the owners, along with her husband, Senator Kevin Raye, who was out of town on business.
By early evening I realized that we had been two days with only intermittent and weak cell phone and internet service. As we ate dinner on Eastport’s waterfront, my cell phone caught a signal from Canada across the bay, and suddenly several messages appeared – some from my husband, frantic to make sure we were okay, and some from staff alerting me to flooding in southern Maine (although partially overcast in Downeast, there was little or no rain). On one hand, not being tied so much to the phone or email was a welcomed relief. On the other hand, it made me realize how challenging it must be for people living in many areas of Downeast to not have that connectivity that many of us take for granted.
Speaking of connectivity, tonight we gathered in a common living area around the one tv in an Eastport bed and breakfast and watched the opening ceremonies of the Olympics. Squeezed onto couches and carpeting with strangers from a variety of states and Canada, we shared a special enthusiasm and awe in the ceremonies as well as pride in both our countries and the athletes. This was a connection no internet or phone can provide!
Downeast Trip Day #2 - Blueberries!
The children and I enjoyed waking to the sounds of lobster boats motoring out to sea this morning. Walking over to Stinson’s cannery before breakfast, we joked about needing our rain gear to keep from getting “rained” upon by the hundreds of sea gulls who were hovering overhead, apparently attracted to the herring being loaded into the cannery. Although we were not allowed inside the factory, we did peek through the windows, and watched as thousands of herring and cans made their way on various conveyor belts and handled by men and women.
After I made a comment about something being a red herring, my son asked me what the term meant and its connection to herring. I told him that the term refers to a false lead, but I didn’t know the connection to actual herring. I later looked it up and learned that “red” means smoked, and smoked herring can have such strong smells that they can be used to create a false scent that causes hunting animals (such as dogs) to lose their track. Interesting!
By mid-morning, we had driven to Milbridge and met up with Anais Tomezsko, the Director of the Mano en Mano (Hand in Hand) Program, Barbara Ginley, the Director of the Maine Migrant Health Program, and Lisa Sockabasin, Maine CDC’s Director of Minority Health. Anais generously gave us a tour of Mano en Mano’s facilities and an overview of their history and programs. The program was started a few years ago after an influx of Latino migrant workers who decided to settle in the area. There is an estimated 300 such residents in Washington County, mostly originally from Mexico and Honduras.
Although Mano en Mano has its roots in literacy – teaching preschoolers, school-aged children, and adults English – it includes some needed bridging between people living in the area. For instance, the program offers Spanish classes for area businesses and others as well as brings youth together to help each other with homework. They also have a health education program that focuses on immigrant women.
Barbara, Lisa, the children, and I then drove several miles through some thick woods and blueberry barrens outside of Milbridge. I totally lost my sense of direction after a while, the curvy road wound its way through scenery that was solely woods interrupted by blueberry barrens. Finally, after a number of miles without any signs of houses or towns, we came across a migrant camp, maintained by one of the blueberry companies for their migrant workers to live while working for them.
Although the camp houses about 300 workers, most were raking in the fields, so it was relatively quiet there. Rows of dozens of small blue camps framed a large central area that contained a soccer field, food vendors (all serving Mexican food), and bath houses. Ordering lunch from one of the vendors, I was surprised at how good the food was – tacos, burritos, and nachos, and all in the middle of woods and blueberry fields!
Although there are other camps that also house mostly Hispanic migrant workers, there are also those that mostly house Native Americans. Northeastern Blueberry Company is owned by the Passamaquoddy Tribe, and employs many rakers who are Passamaquoddy and Mic Mac, including a number from Canada.
We were fortunate that coincidently, Juan Perez-Febles arrived at the camp and joined us at lunchtime. As the Director of the Maine Department of Labor’s Migrant and Immigrant Services Division, Juan helps both employers and foreign workers. Since there are so many migrant workers this time of year in Washington County, he spends most of the month of the blueberry harvest here. Some of the workers who were having lunch greeted him, so it was evident he is well known.
After lunch we drove across more winding roads through woods and blueberry barrens to the Rakers’ Center, held in and around the town hall of Columbia Falls. This central location to many of the blueberry barrens provides one-stop shopping for migrant workers for access to a number of services. For instance, in the parking lot was a large truck that serves as a food pantry, using surplus federal foods. Inside the town hall were several tables set up by various services, such as WIC, legal aid, and employment services.
The main focus of our visit to the Rakers’ Center was the Maine Migrant Health Program’s mobile health clinic, also located in the parking lot. The visit was also a reunion of sorts with some wonderful friends. Mike Rowland, MD and Sara Roberts, PA were on duty. Mike was an emergency department physician when I practiced in Farmington, and Sara and I grew up in the same neighborhood in Farmington, and our families have been close for decades. Mike and Sara are some of a variety of medical personnel from across Maine who generously volunteer their services here.
Their days are fairly long. The clinic is held at the Rakers’ Center during most days, then travels to different migrant camps most evenings. With two exam rooms, equipment squeezed into the small space, and a generator that provides some power, moving the unit around is no easy task. But, the effort appears to be well worth it. Last year they saw almost 1,200 migrant and seasonal workers. Although most blueberry rakers they see here are from Mexico and Honduras, most are young and otherwise healthy men. However, the work is quite hard, requiring long hours of being bent over and raking the wild blueberries. As a result, there are frequent back problems. The health clinic is able to provide some relief in the form of medicines (non-narcotic), physical therapy, and exercises. This treatment is crucial to keeping workers healthy and on the job.
While I was visiting the health clinic, Lisa met with some summer interns who are working at the clinic. They are four minority students – Native American and Hispanic – who are getting an important introduction to the health field. During my brief meeting with them, I shared how much I hope they consider a health career, since minority students often serve minority populations more effectively than others. And, health careers are rewarding. I’m grateful that Lisa has helped provide such opportunities for minority students – an important investment in our future.
During several stops today my children enjoyed trying out some of their elementary school Spanish with some of the workers we met. They were greeted with pleasant smiles and enthusiastic greetings.
After spending most of the day with Barbara Ginley, Lisa Sockabasin, and in the morning Anais Tomezsko, the children and I drove eastward in the late day sun across miles of more blueberry barrens, many dotted with bent over rakers. I can see why migrant workers are considered so invisible – it took a day’s drive and travels on many back roads to even find some, and even then, most whom we saw were bent over, faces to the ground raking blueberries. How grateful I am to put a face on some of them, and for all the hard labor they provide in order to provide us healthy foods for our plates!
Mano en Mano, Milbridge, Maine
http://manoenmanocenter.org/
Maine Migrant Health Program
http://www.mainemigrant.org/
Wyman’s Blueberries
http://www.wymans.com/
August 2008 “Invisible Mainers” - Article from Down East Magazine on Migrant Workers in Maine
http://www.downeast.com/Down-East-Magazine/August-2008/Invisible-Mainers/
After I made a comment about something being a red herring, my son asked me what the term meant and its connection to herring. I told him that the term refers to a false lead, but I didn’t know the connection to actual herring. I later looked it up and learned that “red” means smoked, and smoked herring can have such strong smells that they can be used to create a false scent that causes hunting animals (such as dogs) to lose their track. Interesting!
By mid-morning, we had driven to Milbridge and met up with Anais Tomezsko, the Director of the Mano en Mano (Hand in Hand) Program, Barbara Ginley, the Director of the Maine Migrant Health Program, and Lisa Sockabasin, Maine CDC’s Director of Minority Health. Anais generously gave us a tour of Mano en Mano’s facilities and an overview of their history and programs. The program was started a few years ago after an influx of Latino migrant workers who decided to settle in the area. There is an estimated 300 such residents in Washington County, mostly originally from Mexico and Honduras.
Although Mano en Mano has its roots in literacy – teaching preschoolers, school-aged children, and adults English – it includes some needed bridging between people living in the area. For instance, the program offers Spanish classes for area businesses and others as well as brings youth together to help each other with homework. They also have a health education program that focuses on immigrant women.
Barbara, Lisa, the children, and I then drove several miles through some thick woods and blueberry barrens outside of Milbridge. I totally lost my sense of direction after a while, the curvy road wound its way through scenery that was solely woods interrupted by blueberry barrens. Finally, after a number of miles without any signs of houses or towns, we came across a migrant camp, maintained by one of the blueberry companies for their migrant workers to live while working for them.
Although the camp houses about 300 workers, most were raking in the fields, so it was relatively quiet there. Rows of dozens of small blue camps framed a large central area that contained a soccer field, food vendors (all serving Mexican food), and bath houses. Ordering lunch from one of the vendors, I was surprised at how good the food was – tacos, burritos, and nachos, and all in the middle of woods and blueberry fields!
Although there are other camps that also house mostly Hispanic migrant workers, there are also those that mostly house Native Americans. Northeastern Blueberry Company is owned by the Passamaquoddy Tribe, and employs many rakers who are Passamaquoddy and Mic Mac, including a number from Canada.
We were fortunate that coincidently, Juan Perez-Febles arrived at the camp and joined us at lunchtime. As the Director of the Maine Department of Labor’s Migrant and Immigrant Services Division, Juan helps both employers and foreign workers. Since there are so many migrant workers this time of year in Washington County, he spends most of the month of the blueberry harvest here. Some of the workers who were having lunch greeted him, so it was evident he is well known.
After lunch we drove across more winding roads through woods and blueberry barrens to the Rakers’ Center, held in and around the town hall of Columbia Falls. This central location to many of the blueberry barrens provides one-stop shopping for migrant workers for access to a number of services. For instance, in the parking lot was a large truck that serves as a food pantry, using surplus federal foods. Inside the town hall were several tables set up by various services, such as WIC, legal aid, and employment services.
The main focus of our visit to the Rakers’ Center was the Maine Migrant Health Program’s mobile health clinic, also located in the parking lot. The visit was also a reunion of sorts with some wonderful friends. Mike Rowland, MD and Sara Roberts, PA were on duty. Mike was an emergency department physician when I practiced in Farmington, and Sara and I grew up in the same neighborhood in Farmington, and our families have been close for decades. Mike and Sara are some of a variety of medical personnel from across Maine who generously volunteer their services here.
Their days are fairly long. The clinic is held at the Rakers’ Center during most days, then travels to different migrant camps most evenings. With two exam rooms, equipment squeezed into the small space, and a generator that provides some power, moving the unit around is no easy task. But, the effort appears to be well worth it. Last year they saw almost 1,200 migrant and seasonal workers. Although most blueberry rakers they see here are from Mexico and Honduras, most are young and otherwise healthy men. However, the work is quite hard, requiring long hours of being bent over and raking the wild blueberries. As a result, there are frequent back problems. The health clinic is able to provide some relief in the form of medicines (non-narcotic), physical therapy, and exercises. This treatment is crucial to keeping workers healthy and on the job.
While I was visiting the health clinic, Lisa met with some summer interns who are working at the clinic. They are four minority students – Native American and Hispanic – who are getting an important introduction to the health field. During my brief meeting with them, I shared how much I hope they consider a health career, since minority students often serve minority populations more effectively than others. And, health careers are rewarding. I’m grateful that Lisa has helped provide such opportunities for minority students – an important investment in our future.
During several stops today my children enjoyed trying out some of their elementary school Spanish with some of the workers we met. They were greeted with pleasant smiles and enthusiastic greetings.
After spending most of the day with Barbara Ginley, Lisa Sockabasin, and in the morning Anais Tomezsko, the children and I drove eastward in the late day sun across miles of more blueberry barrens, many dotted with bent over rakers. I can see why migrant workers are considered so invisible – it took a day’s drive and travels on many back roads to even find some, and even then, most whom we saw were bent over, faces to the ground raking blueberries. How grateful I am to put a face on some of them, and for all the hard labor they provide in order to provide us healthy foods for our plates!
Mano en Mano, Milbridge, Maine
http://manoenmanocenter.org/
Maine Migrant Health Program
http://www.mainemigrant.org/
Wyman’s Blueberries
http://www.wymans.com/
August 2008 “Invisible Mainers” - Article from Down East Magazine on Migrant Workers in Maine
http://www.downeast.com/Down-East-Magazine/August-2008/Invisible-Mainers/
Wednesday, August 13, 2008
Downeast Trip Day #1 - Sardines
See August 12th post for an introduction to the Downeast Trip.
We started driving Wednesday afternoon (August 6th). Our first stop was the new Penobscot Narrows Bridge (http://www.penobscotnarrowsbridge.com/). Rounding the curve on Route 1 with the first view of the new bridge took my breath away. I had the same feeling years ago driving through the Midwest and seeing the St. Louis Arch for the first time. In fact, just as the Arch is considered the “Gateway to the West”, it seems like this majestic bridge is a gateway of sorts to Downeast Maine.
A few minutes after our first sighting, we found ourselves zooming up in the elevator to the bridge’s 42-story observatory. After the first few minutes of plastering myself to the inner wall, nervously watching the children run around by the windows, I managed to acclimate, and even climbed the final stairs to the glass room, soaring well over 400 feet above the river. What an architectural marvel with spectacular views of nearby Bucksport and the Penobscot River flowing into Penobscot Bay!
After climbing around Fort Knox in a steady drizzle; stopping by Rosen’s Store in Bucksport (to buy a replacement for a long-lost raincoat of mine), including a nice visit with Rep. Kimberly Rosen (Senator Rosen was out of town on legislative work); picking up a few secondhand books at the Big Chicken Barn (a favorite day trip destination for my husband and me before we had children); and climbing on the rocks at Schoodic Point for an hour, we finally settled down for the night in Prospect Harbor, the home of the last sardine cannery in the United States, Stinson’s Cannery.
Sardines (young herring under 7 inches long) I learned are an integral part of the recent history of the Downeast area. Herring are a family of over 200 fish species that are generally small, flat, and silvery, swim in large schools, feed on plankton, have soft fins that lack a spine. Native Americans are believed to be the first fishermen in Maine who used weirs to capture herring. Made of sticks driven into the muddy bottom of the bay with branches woven in between as nets, Native American weirs were well adapted to capture these small fish traveling in large schools.
When Europeans arrived, many were already familiar with herring as a staple in their diet from their home countries. In 1875 the first sardine cannery was opened in Eastport. By the early 1990s, about 56 canneries dotted the coast of Washington County, out of a total of about 75 in Maine.
The industry soared in part because canned sardines were a staple in many American workers’ lunch pails. The height of the demand appeared to be World War II, when canned sardines were purchased by the US Government for their troops. Even after the war, demand expanded by those wanting herring for fish bait, especially for lobsters and crabs; for animal feeds such as for pets, livestock, poultry, and fish raised in fish farms; and the scales for the pearl coat used in nail polish, lip gloss, paint, and buttons.
However, with a steady decline in demand for sardines as exemplified by a 70% drop in US consumption of sardines over the past 50 years, with only 7% of American now saying they eat them; with a decline in herring stocks in the Bay of Fundy, especially those close to shore that can be easily caught by weirs or coastal seiners; and with competition from other countries (India, Scandanavia, etc), the sardine industry has practically collapsed, relative to its former self.
On the other hand, some optimists feel the sardine industry may be on the brink of a revival. With a renewed interest in healthy foods, sardines certainly meet many criteria for a healthy source of protein. They are very high in omega 3 fatty acids, so critical for healthy neurological development. They are also high in vitamins B12, B3, D, calcium, selenium, tryptophan, and phosphorus. And, sardines are low in mercury and other toxins. With herring being the most common source of bait for lobster and some other fish as well as being such a healthy food, perhaps the optimists are right. Let’s hope so!
A Brief History of the Sardine Industry in Washington County, Maine, a Power Point by Val Mitchell, August, 2007
http://windowsonmaine.library.umaine.edu/fullrecord.aspx?ObjectID=13-13001
“Weathering the Tide of the Last Sardine Cannery”, Bangor Daily News, January, 27, 2007
http://bangornews.com/news/t/news.aspx?articleid=145656&zoneid=500
Gulf of Maine Research Institute Herring Web Resource
http://www.gma.org/herring/default.asp
Grand Manan website with descriptions on how herring are caught
http://www.grandmanannb.com/weir.htm
Health Benefits of Sardines
http://www.whfoods.com/genpage.php?tname=foodspice&dbid=147
Beach Cliff (Stinson) Sardines
http://www.beachcliff.info/beachcliff/usaenglish/beachcliffstory.asp
A few minutes after our first sighting, we found ourselves zooming up in the elevator to the bridge’s 42-story observatory. After the first few minutes of plastering myself to the inner wall, nervously watching the children run around by the windows, I managed to acclimate, and even climbed the final stairs to the glass room, soaring well over 400 feet above the river. What an architectural marvel with spectacular views of nearby Bucksport and the Penobscot River flowing into Penobscot Bay!
After climbing around Fort Knox in a steady drizzle; stopping by Rosen’s Store in Bucksport (to buy a replacement for a long-lost raincoat of mine), including a nice visit with Rep. Kimberly Rosen (Senator Rosen was out of town on legislative work); picking up a few secondhand books at the Big Chicken Barn (a favorite day trip destination for my husband and me before we had children); and climbing on the rocks at Schoodic Point for an hour, we finally settled down for the night in Prospect Harbor, the home of the last sardine cannery in the United States, Stinson’s Cannery.
Sardines (young herring under 7 inches long) I learned are an integral part of the recent history of the Downeast area. Herring are a family of over 200 fish species that are generally small, flat, and silvery, swim in large schools, feed on plankton, have soft fins that lack a spine. Native Americans are believed to be the first fishermen in Maine who used weirs to capture herring. Made of sticks driven into the muddy bottom of the bay with branches woven in between as nets, Native American weirs were well adapted to capture these small fish traveling in large schools.
When Europeans arrived, many were already familiar with herring as a staple in their diet from their home countries. In 1875 the first sardine cannery was opened in Eastport. By the early 1990s, about 56 canneries dotted the coast of Washington County, out of a total of about 75 in Maine.
The industry soared in part because canned sardines were a staple in many American workers’ lunch pails. The height of the demand appeared to be World War II, when canned sardines were purchased by the US Government for their troops. Even after the war, demand expanded by those wanting herring for fish bait, especially for lobsters and crabs; for animal feeds such as for pets, livestock, poultry, and fish raised in fish farms; and the scales for the pearl coat used in nail polish, lip gloss, paint, and buttons.
However, with a steady decline in demand for sardines as exemplified by a 70% drop in US consumption of sardines over the past 50 years, with only 7% of American now saying they eat them; with a decline in herring stocks in the Bay of Fundy, especially those close to shore that can be easily caught by weirs or coastal seiners; and with competition from other countries (India, Scandanavia, etc), the sardine industry has practically collapsed, relative to its former self.
On the other hand, some optimists feel the sardine industry may be on the brink of a revival. With a renewed interest in healthy foods, sardines certainly meet many criteria for a healthy source of protein. They are very high in omega 3 fatty acids, so critical for healthy neurological development. They are also high in vitamins B12, B3, D, calcium, selenium, tryptophan, and phosphorus. And, sardines are low in mercury and other toxins. With herring being the most common source of bait for lobster and some other fish as well as being such a healthy food, perhaps the optimists are right. Let’s hope so!
A Brief History of the Sardine Industry in Washington County, Maine, a Power Point by Val Mitchell, August, 2007
http://windowsonmaine.library.umaine.edu/fullrecord.aspx?ObjectID=13-13001
“Weathering the Tide of the Last Sardine Cannery”, Bangor Daily News, January, 27, 2007
http://bangornews.com/news/t/news.aspx?articleid=145656&zoneid=500
Gulf of Maine Research Institute Herring Web Resource
http://www.gma.org/herring/default.asp
Grand Manan website with descriptions on how herring are caught
http://www.grandmanannb.com/weir.htm
Health Benefits of Sardines
http://www.whfoods.com/genpage.php?tname=foodspice&dbid=147
Beach Cliff (Stinson) Sardines
http://www.beachcliff.info/beachcliff/usaenglish/beachcliffstory.asp
Tuesday, August 12, 2008
Downeast Trip - Reasons for the Trip
Earlier this year a study by public health scientists at the Harvard School of Public Health looked at variations of trends in life expectancy among counties in the United States between 1961 and 1999 (“The Reversal of Fortunate: Trends in County Mortality and Cross-Country Mortality Disparities in the United States”, http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050066&ct=1).
Although life expectancy increased in the United States during this time period (more than 7 years for men and 6 years for women between the periods 1961-1983 and 1983-1999), some counties saw reductions in life expectancy.
The authors note that the data from these counties indicate a widening of health disparities in populations that are defined by race, income, geography, social class, education, and community deprivation.
One of the counties identified with the most severe declines in life expectancy among women is Washington County, Maine. Nationally, such declines appear to be due to increases in death rates from lung cancer, COPD, and diabetes. As a result of this national study, several groups have convened here in Maine to further investigate the causes, and Maine CDC is putting together a health profile of the county to provide some insights. Thus far, the preliminary data for Washington County indicate a complex picture of factors.
By mid-July I found myself studying these data related to the county, and realized that except for a number of business trips to Calais and Machias, I had not spent much time in Washington County since I was a child. I decided it was time for me to take a trip there to explore and discover for myself the beauty of Washington County and whatever insights I could glean from a visit.
With my husband away on business during the most convenient time for the trip, I also needed to take my children. Hesitant at first, I then realized this could be a fun opportunity, and we could enjoy and learn from this trip together. I figured having them along would allow me to explore the area through their eyes, and perhaps help me to take the time to breathe a bit more deeply.
More about the trip later.
Although life expectancy increased in the United States during this time period (more than 7 years for men and 6 years for women between the periods 1961-1983 and 1983-1999), some counties saw reductions in life expectancy.
The authors note that the data from these counties indicate a widening of health disparities in populations that are defined by race, income, geography, social class, education, and community deprivation.
One of the counties identified with the most severe declines in life expectancy among women is Washington County, Maine. Nationally, such declines appear to be due to increases in death rates from lung cancer, COPD, and diabetes. As a result of this national study, several groups have convened here in Maine to further investigate the causes, and Maine CDC is putting together a health profile of the county to provide some insights. Thus far, the preliminary data for Washington County indicate a complex picture of factors.
By mid-July I found myself studying these data related to the county, and realized that except for a number of business trips to Calais and Machias, I had not spent much time in Washington County since I was a child. I decided it was time for me to take a trip there to explore and discover for myself the beauty of Washington County and whatever insights I could glean from a visit.
With my husband away on business during the most convenient time for the trip, I also needed to take my children. Hesitant at first, I then realized this could be a fun opportunity, and we could enjoy and learn from this trip together. I figured having them along would allow me to explore the area through their eyes, and perhaps help me to take the time to breathe a bit more deeply.
More about the trip later.
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