Selected Prevention, Public Health & Workforce Provisions in the Patient Protection and Affordable Care Act (HR 3590)

from Trust for America's Health (www.healthyamericans.org)

Selected Prevention and Public Health Provisions

Essential Health Benefits Requirements (Sec. 1302) – Includes an essential health benefits package that covers essential health benefits defined by the Secretary and limits cost-sharing. Included in the general benefit categories are preventive and wellness services and chronic disease management, maternity and newborn care, mental health and substance use disorder services, and pediatric services, among other things.

Coverage of Preventive Health Services (Sec. 2713) – Stipulates that a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for:
(1) evidence based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the US Preventive Services Task Force (USPSTF);
(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the CDC with respect to the individual involved;
(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by HRSA;
(4) with respect to women, additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by HRSA;States that for the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.

States that nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by the Task Force.

Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan (Sec. 4103) – Provides Medicare Part B coverage, with no co-payment or deductible, for personalized prevention plan services. Personalized prevention plan services means the creation of a plan for an individual that includes a health risk assessment and may include other elements, such as updating family history, listing providers that regularly provide medical care to the individuals, BMI measurement, and other screenings and risk factors. The personal prevention plan would take into account the findings of the health risk assessment and would be completed prior to or as part of a visit with a health professional. The personalized health advice and referral may include community-based lifestyle interventions to reduce health risks and promote self-management and wellness, as well as lists of risk factors and a screening schedule.

Directs the Secretary to establish publicly available guidelines for health risk assessments, standards for interactive telephonic or web-based programs to furnish health-risk assessments and a health risk assessment model.

Removal of Barriers to Preventive Services in Medicare (Sec. 4104) – Waives coinsurance requirements for most preventive services, requiring Medicare to cover 100 percent of the costs. Services for which no coinsurance or deductible would be required are the personalized prevention plan services, an initial preventive physical examination and any covered preventive service if it is recommended with a grade of A or B by the USPSTF. Clarifies that cost sharing for colorectal cancer screening services would be waived.

Evidence-Based Coverage of Preventive Services in Medicare (Sec. 4105) – Provides the Secretary with the authority to modify coverage of existing preventive services, consistent with USPSTF recommendations. It would allow the Secretary to withdraw Medicare coverage for services not rated as A, B, C, or I by the USPSTF.

Improving Access to Preventive Services for Eligible Adults in Medicaid (Sec. 4106) – The current Medicaid State option to provide other diagnostic, screening, preventive, and rehabilitation services would be expanded to include: (1) any clinical preventive service recommended with a grade of A or B by the USPSTF and (2) with respect to adults, immunizations recommended by the Advisory Committee on Immunization Practices and their administration. States that cover these additional services and vaccines, and also prohibit costsharing for such services and vaccines, would receive an increased Federal medical assistance percentage (FMAP) of one percentage point for these services.

Coverage of Comprehensive Tobacco Cessation Services for Pregnant Women in Medicaid (4107) - States would be required to provide Medicaid coverage for counseling andpharmacotherapy for tobacco cessation by pregnant women. Prohibits cost-sharing for these services.

Incentives for Prevention of Chronic Diseases in Medicaid (Sec. 4108) – Directs the Secretary to award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who successfully participate in a healthy lifestyles program and demonstrate changes in health risk and outcomes. The program shall be comprehensive, evidence-based, widely available, and easily accessible and shall be proposed by the state and approved by the Secretary. It shall be designed to address the needs of Medicaid beneficiaries to achieve: ceasing the use of tobacco;controlling or reducing weight; lowering cholesterol; lowering blood pressure; avoiding the onset of diabetes or improving management of diabetes.
The programs shall last for 5 years. The section includes impact assessments, evaluation and reporting requirements. The section appropriates $100 million for the program, out of any funds not otherwise appropriated in the Treasury.

National Prevention, Health Promotion & Public Health Council (Sec. 4001) – Creates a Council within HHS to provide coordination and leadership at the Federal level, and among Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system and integrative health care in the U.S. & to develop the National Prevention Strategy. The Council shall be composed of departmental Secretaries from across the federal government, with the Surgeon General serving as Chair.

National Prevention and Health Promotion Strategy (Sec. 4001) – Tasks the Council with creating a national strategy to: set goals and objectives for improving health through federally-supported prevention, health promotion and public health programs, establish measurable actions and timelines to carry out the strategy, and make recommendations to improve Federal prevention, health promotion, public health and integrative health care practices.

Prevention and Public Health Fund (Sec. 4002) Establishes a fund, to be administered through the Office of the Secretary at HHS, to provide for an expanded and sustained national investment in prevention and public health programs (over the FY 2008 level). The Fund will support programs authorized by the Public Health Service Act, for prevention, wellness and public health activities, including prevention research and health screenings and initiatives, such as the Community Transformation grant program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs. Funding levels: FY 2010 - $500 million; FY2011 - $750 million; FY 2012 - $1 billion; FY 2013 - $1.25 billion; FY 2014 - $1.5 billion; FY 2015 and each fiscal year thereafter- $2 billion.

Community Health Centers and the National Health Service Corps Fund (Sec. 10503) -Creates a Community Health Center Fund that provides enhanced funding for the Community Health Center program, the National Health Service Corps, and construction and renovation of community health centers. Fund totals $10 billion over 5 years. **Of note, the President’s proposal would invest $11 billion in Community Health Centers over five years.

Clinical and Community Preventive Services Task Forces (Sec. 4003) – Defines, clarifies duties of, and provides better coordination between the U.S. Preventive Services Task Force and the Community Preventive Services Task Force.

Education & Outreach Campaign Regarding Preventive Benefits (Sec. 4004) - Directs the Secretary to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the lifespan.

Requires the Secretary, acting through the CDC Director, to establish and implement a national science-based media campaign on health promotion and disease prevention. Directs the Secretary, acting through the CDC Director, to enter into a contract for the development and operation of a Federal Internet website personalized prevention plan tool. Funding for activities authorized under this section shall take priority over funding provided by CDC for grants with similar purposes. Funding for this section shall not exceed $500 million.

Directs the Secretary to provide guidance and relevant information to States and health care providers regarding preventive and obesity-related services that are available to Medicaid enrollees, including obesity screening and counseling for children and adults. States shall design a public awareness campaign to educate Medicaid enrollees regarding availability and coverage of such services. The Secretary shall report on the status and effectiveness of these efforts.

School-Based Health Centers (Sec. 4101) – Directs the Secretary to award grants to support the operation of school-based health centers, with an emphasis on communities with barriers in access to health services. Out of any funds in the Treasury not otherwise appropriated, there is appropriated for each of the fiscal years FY 2010-2013 $50 million for expenditures for facilities and equipment or similar expenditures. Authorizes the Secretary to award grants to pay the costsassociated with expanding and modernizing existing buildings for use as a School-Based Health Center.

Oral Health (Sec. 4102) Directs the Secretary (subject to the availability of appropriations) to establish a 5-year national public health education campaign focused on oral healthcare prevention and education. Establishes demonstration grants to show the effectiveness of research-based dental caries disease management. Includes various oral health improvement provisions relating to school-based sealant programs, oral health infrastructure, and surveillance.

Community Transformation Grants (Sec. 4201) – Authorizes CDC to award competitivegrants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-base of effective prevention programming. Eligible entities shall submit to the Director a detailed plan including the policy, environmental programmatic and as appropriate infrastructure changes needed to promote healthy living and reduce disparities. Activities may focus on creating healthier schoolenvironments, creating infrastructure or programs to support active living and access to nutritious foods, smoking cessation and other chronic disease priorities; implementing worksite wellness; working to highlight healthy options in food venues; reducing disparities; and addressing special population needs. The section includes evaluation and reporting requirements.

Healthy Aging, Living Well; Evaluation of Community-Based Prevention; and WellnessPrograms for Medicare Beneficiaries (Sec. 4202) - Authorizes the Secretary, acting through the CDC Director, to award competitive grants to health departments and Indian tribes to carry out five-year pilot programs to provide public health community interventions, screenings, and when necessary, clinical referrals for individuals who are between 55-64 years old. Grantees must design a strategy to improve the health status of this population through community based public health interventions. Intervention activities may include efforts to improve nutrition,increase physical activity, reduce tobacco use and substance abuse, improve mental health and promote healthy lifestyles among the target population. Screenings may include mental health/behavioral health and substance abuse disorders; physical activity, smoking and nutrition; and any other measures deemed appropriate by the Secretary. The section includes an evaluation component.

The Secretary shall conduct an evaluation of community-based prevention and wellness programs and develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries. The evaluation shall include programs sponsored by the Administration on Aging that are evidence-based and have demonstrated potential to help Medicare beneficiaries reduce their risk of disease, disability and injury by making healthy lifestyle choices. CMS and AOA shall also conduct an evaluation of exiting community prevention and wellness programs. The Secretary shall submit a report to Congress on recommendations to promote healthy lifestyles and chronic disease self-management for Medicare beneficiaries; relevant findings; and the results of the evaluation.

Removing Barriers and Improving Access to Wellness for Individuals with Disabilities (Sec. 4203) – Requires the establishment of standards for accessible medical diagnostic equipment for individuals with disabilities.

Immunizations (Sec. 4204) – Authorizes states to obtain additional quantities of adult vaccines through the purchase of vaccines from manufacturers at the applicable price negotiated by the Secretary and authorizes a demonstration program to improve immunization coverage.

Reauthorizes the Immunization Program under Section 317 of the PHSA. Requires a GAO study and report on Medicare beneficiary access to vaccines and coverage of vaccines under Medicare Part D.

Nutrition Labeling of Standard Menu Items at Chain Restaurants (Sec. 4205) – Establishes nutrition labeling of standard menu items at chain restaurants (20 or more locations doing business under the same name). This includes disclosing calories on menu boards and in a written form, available on request, additional information pertaining to total calories and calories from fat, amounts of fat and saturated fat, cholesterol, sodium, total and complex carbohydrates, sugars, dietary fiber, and protein.

Demonstration Project Concerning Individualized Wellness Plan (Sec. 4206) – Directs the Secretary to establish a pilot program to test the impact of providing at-risk populations who utilize community health centers funded under this section an individualized wellness plan designed to reduce risk factors for preventable conditions identified by a comprehensive risk factor assessment.

Reasonable Break Time for Nursing Mothers (Sec. 4207) – Requires employers to provide reasonable break times for nursing mothers and a place, other than a bathroom, which may be used to express breast milk. Employers with less than 50 employees shall not be subject to this requirement if it would impose an undue hardship by causing significant difficulty or expense.

Research on Optimizing the Delivery of Public Health Services (Sec. 4301) – Directs the Secretary, acting through the CDC Director, to fund research in the area of public health services and systems. Research shall include examining best practices relating to prevention, with a particular focus on high priority areas identified by the Secretary in the National Prevention Strategy or Healthy People 2020; analyzing the translation of interventions to real-world settings;and identifying effective strategies for organizing, financing or delivering public health services in real world community settings, including comparing State and local health department structures and systems in terms of effectiveness and cost.

Understanding Health Disparities: Data Collection and Analysis (Sec. 4302) – Requires the Secretary to ensure that any ongoing or federally conducted or supported health care or public health program, activity, or survey collects and reports, to the extent practicable, data on race,ethnicity, gender, geographic location, socioeconomic status, language and disability status, inaddition to data at the smallest geographic level. The Secretary shall analyze the data to detect and monitor trends in health disparities and disseminate this information to relevant Federal agencies.

Employer-Based Wellness Programs (Sec. 4303) – Directs CDC to provide employers with TA, consultation and tools in evaluating wellness programs and build evaluation capacity among workplace staff. Directs CDC to study and evaluate employer-based wellness practices. Clarifies that any recommendations, data or assessments carried out under this part shall not be used to mandate requirements for workplace wellness programs.

Grants for Small Businesses to Provide Comprehensive Workplace Wellness Programs(Sec. 10408) - Directs the Secretary to award grants to small businesses to provide employees with access to comprehensive workplace wellness programs.

Pain Management (Sec. 4305) – Calls for an IOM Conference on Pain and includes various provisions relating to pain research and pain care education and training.

Funding for Childhood Obesity Demonstration Project (Sec. 4306) – CHIPRA established a Childhood Obesity Demonstration Project and authorized $25 million for FY 2009-2013. This section appropriates $25 million for the Secretary to carry out the demonstration project in FY 2010 – FY 2014.

Effectiveness of Federal Health and Wellness Initiatives (Sec. 4402) - Requires the Secretary of HHS to evaluate all existing Federal health and wellness initiatives and report to Congress concerning the evaluation, including conclusions concerning the reasons that such existing programs have proven successful or not successful and what factors contributed to such conclusions.

Better Diabetes Care (Sec. 10407) - Directs the Secretary, acting through the CDC Director, to prepare on a biennial basis, a national diabetes report card. Directs the Secretary and the IOM to study the impact of diabetes on the practice of medicine and the level of diabetes medical education that should be required prior to licensure, board certification and board recertification.

Cures Acceleration Network (Sec. 10409) - Requires the NIH Director to establish a Cures Acceleration Network to accelerate the development of high need cures, including the development of medical products and behavioral therapies.

Centers of Excellence for Depression (Sec. 10410) - Establishes a Network of HealthAdvancing National Centers of Excellence for Depression.

Programs Relating to Congenital Heart Disease (Sec. 10411) - Authorizes the Secretary, acting through the Director, to establish programs relating to congenital heart disease, including the formation of a National Congenital Heart Disease Surveillance System.

Young Women’s Breast Health Awareness and Support of Young Women Diagnosed withBreast Cancer (Sec. 10413) - Establishes a public education and a healthcare professional education campaign regarding women’s breast health.

National Diabetes Prevention Program (Sec. 5316) - Creates a CDC National DiabetesPrevention Program targeted at adults at high risk for diabetes, which entails a grant program for community-based diabetes prevention program model sites.

Selected Workforce Provisions

National Health Care Workforce Commission (Sec. 5101) – Establishes a commission toserve as a national resource for Congress, the President, States and Localities, determine whether the demand for health care workers is being met, identify barriers to coordination and encourage innovation. It shall disseminate information on retention practices for health care professionals and shall review current and projected health care workforce supply and demand and make recommendations regarding healthcare workforce priorities, goals and policies. The Commissionshall communicate and coordinate with a variety of federal agencies and departments. Specific topics to be reviewed include health care workforce supply and distribution, health care workforce education and training capacity; existing education loan and grant programs, the implications of federal policies; the healthcare workforce needs of specific populations, and recommendations creating or revising loan repayment and scholarship programs. Public health professionals are included in the definition of health care workforce and the definition of healthprofessionals. Public health workforce capacity is also included in the high priority areas list.

State Health Care Workforce Development Grants (Sec. 5102) – Establishes a competitive healthcare workforce development grant program to enable Statepartnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels.

Authorizes $8 million for planning grants and $150 million for implementation grants for FY 2010 and such sums for each subsequent year.

Health Care Workforce Program Assessment (Sec. 5103) – Codifies the existing National Center for Health Care Workforce Analysis to provide for the development of information describing the health care workforce and the analysis of related issues and collect, analyze and report data related to programs under this title. The National Center and relevant regional and State centers and agencies shall collect labor and workforce information and provide analyses and reports to the Commission.

Public Health Workforce Recruitment and Retention Programs (Sec. 5204) – Establishes a public health workforce loan repayment program to eliminate critical public health workforce shortages in Federal, State, local and tribal public health agencies. Individuals receiving assistance must work at least three years in these agencies. In FY 2010, $195 million is authorized to be appropriated for this program, and such sums as necessary for FY 2011-2015. Sec. 5205 creates allied health workforce recruitment and retention programs.

Training for Mid-Career Public and Allied Health Professionals (Sec. 5206) - Authorizes the Secretary to make grants or enter into contracts to award scholarships to mid-career public health and allied health professionals to enroll in degree or professional training programs. Authorizes $60 million for these programs in FY 2010 and such sums as necessary for FY 2011-2015.

Elimination of cap on Commissioned Corps (Sec. 5209) This section strikes the required cap of 2,800 for members of the Regular Corps.

Establishing a Ready Reserve Corps (Sec. 5210) - Assimilates active duty Ready Reserve Officers into the Regular Corps & establishes a Ready Reserve to participate in training exercises, be available and ready for involuntary calls to active duty during national emergencies and public health crises, be available for deployment and for backfilling positions left vacant during deployment of active duty Corps members, and be available for service in isolated, hardship & medically underserved communities. This section authorizes $5 million for FY 2010– FY 2014 for carrying out the duties and responsibilities of the Commissioned Corps under this section and for recruitment and training; and $12.5 million for the Ready Reserve Corps for FY 2010 – FY 2014.

Grants to Promote the Community Health Workforce (Sec. 5313) – Directs the Director of CDC to award grants to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.

Epidemiology-Laboratory Capacity Grants (Sec. 4304) Directs the Secretary (subject to the availability of appropriations) to establish an Epidemiology and Laboratory Capacity Grant Program to award grants to eligible entities to assist public health agencies in improving surveillance for and response to infectious diseases and other conditions of public health importance. Authorizes $190 million for each year of fiscal years 2010-2013 to carry out this section.

Fellowship Training in Public Health (Sec. 5314) – Authorizes funding for fellowship training in applied public health epidemiology, public health laboratory science, public health informatics, and expansion of the epidemic intelligence service in order to address documented workforce shortages in State and local health departments. Authorizes, for each of fiscal years 2010 through 2013, $5 million for epidemiology fellowship training programs, $5 million forlaboratory fellowship training programs; $5 million for the Public Health Informatics Fellowship Program; and $24,500,000 for expanding the Epidemic Intelligence Service.

Training in General, Pediatric and Public Health Dentistry (Sec. 5303) – Authorizes the Secretary to make grants to, or enter into contracts with, a school of dentistry, public or nonprofit private hospital or a public or private nonprofit entity to plan, develop and operate or participate in an approved professional dentistry program; to provide financial assistance to dental students, residents, practicing dentists and dental hygiene students, and for other purposes.

United States Public Health Sciences Track (Sec. 5315) Authorizes the establishment of a United States Public Health Sciences Track with authority to grant appropriate advanced degrees in a manner that uniquely emphasizes team based service, public health, epidemiology, and emergency preparedness and response. Students receive tuition remission and a stipend and are accepted as Commissioned Corps officers with a 2-year service commitment for each year of school covered. Included among the graduates shall be 100 public health students annually. Includes a provision that would develop elite federal disaster teams.

Preventive Medicine & Public Health Training Grant Program - Directs the Secretary to award grants to or enter into contracts with eligible entities to provide training to graduate medical residents in preventive medicine specialties.

What is Maine's HealthInfoNet?

HealthInfoNet is an important statewide patient information resource that can help support health care providers’ treatment of patients. Clinicians from around Maine have reported on how they are using HealthInfoNet today to improve their access to patient clinical information when they need it most.

Take eight minutes to learn more about HealthInfoNet from Maine clinicians who are finding real value in using the statewide health information exchange. As you'll see, the video includes interviews from sites across the state. Just click on this link: http://www.youtube.com/watch?v=sXJXg4vNbOM.

Cell Phone Use and Possible Health Effects

A number of people have been asking about possible health effects from cell phone use. Below is an excerpt from the US FDA’s website that is an excellent brief summary of the knowledge to date. Links to additional resources are also included.

Do cell phones pose a health hazard?

Many people are concerned that cell phone radiation will cause cancer or other serious health hazards. The weight of scientific evidence has not linked cell phones with any health problems.

Cell phones emit low levels of radiofrequency energy (RF). Over the past 15 years, scientists have conducted hundreds of studies looking at the biological effects of the radiofrequency energy emitted by cell phones. While some researchers have reported biological changes associated with RF energy, these studies have failed to be replicated. The majority of studies published have failed to show an association between exposure to radiofrequency from a cell phone and health problems.

The low levels of RF cell phones emit while in use are in the microwave frequency range. They also emit RF at substantially reduced time intervals when in the stand-by mode. Whereas high levels of RF can produce health effects (by heating tissue), exposure to low level RF that does not produce heating effects causes no known adverse health effects.

The biological effects of radiofrequency energy should not be confused with the effects from other types of electromagnetic energy.

Very high levels of electromagnetic energy, such as is found in X-rays and gamma rays can ionize biological tissues. Ionization is a process where electrons are stripped away from their normal locations in atoms and molecules. It can permanently damage biological tissues including DNA, the genetic material.

The energy levels associated with radiofrequency energy, including both radio waves and microwaves, are not great enough to cause the ionization of atoms and molecules. Therefore, RF energy is a type of non-ionizing radiation. Other types of non-ionizing radiation include visible light, infrared radiation (heat) and other forms of electromagnetic radiation with relatively low frequencies.

While RF energy doesn’t ionize particles, large amounts can increase body temperatures and cause tissue damage. Two areas of the body, the eyes and the testes, are particularly vulnerable to RF heating because there is relatively little blood flow in them to carry away excess heat.

Cell Phone Use and Children
The scientific evidence does not show a danger to any users of cell phones from RF exposure, including children and teenagers. The steps adults can take to reduce RF exposure apply to children and teenagers as well.
• Reduce the amount of time spent on the cell phone
• Use speaker mode or a headset to place more distance between the head and the cell phone.

Some groups sponsored by other national governments have advised that children be discouraged from using cell phones at all. For example, The Stewart Report from the United Kingdom made such a recommendation in December 2000. In this report a group of independent experts noted that no evidence exists that using a cell phone causes brain tumors or other ill effects. Their recommendation to limit cell phone use by children was strictly precautionary; it was not based on scientific evidence that any health hazard exists.

Cell Phones (excerpt above is from this website)http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/HomeBusinessandEntertainment/CellPhones/default.htm

Radiofrequency Safety
http://www.fcc.gov/oet/rfsafety/rf-faqs.html

Wireless Safety
http://www.fcc.gov/cgb/cellular.html

National Cancer Institute (part of National Institutes of Health)
Fact Sheet on Cell Phone Use and Cancer Risks
http://www.cancer.gov/cancertopics/factsheet/Risk/cellphones

Public Health Update 2/25/10

Maine CDC/DHHS Public Health Update
February 25, 2010

Travel-related Disease Conditions
Maine CDC has investigated multiple cases of travel-related illness since January. During school vacation weeks in February and April, Maine residents may travel to warmer climates, which put them at risk for mosquito-borne diseases. See this health alert for information about travel-related disease conditions: http://bit.ly/ddYiJT

In addition, these two US CDC sites provide advice for relief workers, including travel guidance specific to workers traveling to Haiti: http://wwwnc.cdc.gov/travel/content/relief-workers.aspx and http://emergency.cdc.gov/disasters/earthquakes/responders.asp

US CDC Recommends Universal Annual Flu Vaccination
CDC’s Advisory Committee on Immunization Practices (ACIP) voted Feb. 24 to expand the recommendation for annual influenza vaccination to include all people aged 6 months and older, beginning in the 2010-2011 flu season. The new recommendation seeks to remove barriers to influenza immunization and signals the importance of preventing influenza across the entire population. For more information, see: http://www.cdc.gov/media/pressrel/2010/r100224.htm

The US Food and Drug Administration (FDA) and World Health Organization (WHO) have both recommended that the 2010-2011 seasonal flu vaccine include the 2009 pandemic H1N1 flu strain, along with a type A H3N2 and a type B strain. This inclusion of the 2009 pandemic strain of H1N1 will eliminate the need for two separate flu vaccines next fall. These recommendations typically guide vaccine manufacturers in preparing each season’s flu vaccines.

Please note that protection from the 2009 H1N1 flu vaccine lasts through the whole 2009-2010 season. Children younger than 10 are the only people recommended to receive two doses of H1N1 vaccine this season.

Influenza Activity in Maine and the US
H1N1 activity continues in Maine as well as across the U.S., but in more diminished levels than in November and December. Since the last update, there has been one outbreak of influenza-like illness in a long-term care facility and two hospitalizations due to H1N1 - one in adult older than 64, and an intensive care unit admission of a toddler. Maine’s weekly influenza surveillance reports can be found here: http://bit.ly/b6dCfZ

Virtually all of those hospitalized the past 2 months have not been vaccinated. Almost all are considered high-risk, yet were also not started on antiviral medicines within 48 hours of symptom onset. It is especially important for health care providers to offer vaccine to patients who are now in high risk groups that were not earlier in the season, such as women who are recently pregnant, people who are now caring for infants younger than six months-old, and infants who are now older than six months.

With more than 900,000 doses of H1N1 vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated against H1N1 flu. This includes seniors (http://bit.ly/9Py6xX), recently pregnant women (http://bit.ly/76KrZb), new parents and caregivers of infants younger than six months (http://bit.ly/5eckZK), and parents of children older than six months (http://bit.ly/7lrdRH). Children ages nine and younger need a second dose of vaccine about a month after the first dose for full immunity.

Vaccine clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.


Group A Strep Update
Maine CDC has now received 16 reports of cases of invasive Group A Streptococcal (GAS) infections since January, an increase of 3 cases since the last update.

Cases have been confirmed in Androscoggin, Cumberland, Hancock, Kennebec, Oxford, Penobscot, Somerset, and York counties in people ages 6 through 90. Nine of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), an increase of two since the last update. Five people with STSS have died.

Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year.

There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in this Maine CDC health advisory http://bit.ly/bswpU2 or this US CDC site: http://bit.ly/cP0vIl.

RSV
Several anecdotal reports indicate possible high rates of Respiratory Syncytial virus (RSV), and the percentage of positive samples tested for RSV at two reference laboratories in Maine is higher than last year at this time. RSV is not a reportable disease in Maine, so exact numbers and rates are not available.

RSV is a contagious viral disease that can lead to serious health problems—especially for young children and older adults. There is no vaccine to prevent RSV. However, there are simple ways you can protect your child or yourself from getting sick during RSV season.

People with cold-like symptoms should cover their coughs and sneezes, wash hands frequently, avoid sharing cups and utensils, and refrain from kissing. Cleaning contaminated surfaces (such as doorknobs) may help stop the spread of viruses.

Symptoms of RSV infection are similar to other respiratory infections. A person with an RSV might cough, sneeze, and have a runny nose, fever, and decrease in appetite. Wheezing may also occur. In very young infants, irritability, decreased activity, and breathing difficulties may be the only symptoms of infection. Most otherwise healthy infants infected with RSV do not need to be hospitalized.

For more information about RSV, see this US CDC web site: http://bit.ly/9mPfDi

County Health Rankings
The University of Wisconsin, with funding from the Robert Wood Johnson Foundation, issued a report titled County Health Rankings, Mobilizing Action Toward Community Health on Feb. 17. Rankings were completed in all 50 states, including Maine. Counties were ranked within states only, with no comparison between states.

The county health rankings and data are available at http://www.countyhealthrankings.org/.

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

For years, public health data have shown that many counties in Maine with lower incomes and educational attainment are less healthy. Such disparities continue to be reflected in these rankings. However, the report also shows significant variation. For instance, some counties with similar socioeconomic profiles have very different rankings for other health factors and for health outcomes, suggesting that a complex array of factors influence the health of our communities.
Maine is already working on addressing our health challenges. It is also important to note that Maine is one of the healthiest states in the nation. The 2009 America’s Health Rankings report released by the United Health Foundation ranked Maine 9th in overall health.

Several years ago, public health stakeholders worked to form a new statewide public health system that addresses health issues across the state and in every community. We continue working to strengthen this system, which includes Healthy Maine Partnerships, Maine CDC District Public Health Units, municipal health departments, local health officers, and District Coordinating Councils.

We hope the data in this report are another motivating factor for Maine people to improve their own health, as well as to become involved with the public health system to improve the overall health of their communities.

One such new resource is the Keep ME Well website, a tool produced by Maine’s public health system that individuals can use to find out how to improve health, stay well and find low cost healthcare services. The site can be accessed at http://www.keepmewell.org/.

Maine CDC has recently posted an updated compilation of comprehensive health indicators for each of Maine’s 8 public health districts, most with state and national comparisons. They can be found at: http://www.maine.gov/dhhs/boh/health_indicator_comparison.htm.

Updates from Federal Partners
• US CDC issued this Q&A about H1N1 and seasonal flu and Hispanic communities: http://www.cdc.gov/h1n1flu/qa_hispanic.htm
• This MMWR describes an outbreak of H1N1 flu on a Peruvian Navy ship in June-July 2009: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5906a3.htm?s_cid=mm5906a3_e%0d%0a
• As of Feb. 17, business associates of HIPAA covered entities must comply with, and are subject to penalties for violations of, the HIPAA Security Rule (http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/index.html).
• New requirements for notifying individuals when their protected health information is breached went into effect Feb. 22. For more information: http://bit.ly/93PXS4

How to Stay Updated
• Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”) http://www.facebook.com/pages/Augusta-ME/Maine-CDC/135584761549
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
• For clinical consultation and outbreak management guidance call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
• For general questions:
o call 2-1-1 from 8 a.m. to 8 p.m. seven days per week

Public Health Update 2/12/10

Maine CDC/DHHS Public Health Update
February 12, 2010

Influenza Activity in Maine and the US
H1N1 activity continues in Maine as well as across the U.S. but in diminished levels than in November and December. There was one outbreak of influenza like illness in a Hancock County K-12 school last week. Nationally and in Maine, virtually all of the influenza viruses identified are the 2009 pandemic strain of influenza A. More information can be obtained at: http://www.cdc.gov/flu/weekly/index.htm#whomap.

Influenza Vaccine
Sanofi Pasteur has shortened the expiration period of all of its 2009 H1N1 influenza vaccine in pre-filled syringes; all lots should now be administered by February 15, 2010 regardless of the expiration imprinted on the package. There are no safety concerns with the recalled lots of 2009 H1N1 vaccine and no re-administration of the vaccine is required. For more information, see this US CDC Q&A: http://www.cdc.gov/h1n1flu/vaccination/qa_recall.htm?s_cid=tw_flu104. Maine health care providers who have received this vaccine have been contacted directly by Maine CDC’s Immunization Program staff.

With more than 900,000 doses of H1N1 vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated against H1N1 flu. Clinics can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Parents are reminded to ensure that children younger than 10 years-old get both doses of 2009 H1N1 vaccine. The recommended interval between the first and second dose is 28 days.

Even those not at high-risk for complications from influenza should consider vaccine, because either they themselves can suffer complications or can infect those who are at higher risk for complications. Health care providers who treat people at high risk for complications from influenza (such as those with underlying conditions, pregnant women, young children, and those older than 64) are urged to vaccinate those patients and to treat with antiviral medicines at the onset of symptoms.

Disposing of and Reporting Unused/Expired Vaccine
Health care providers who have sufficient supplies and no longer need vaccine that is being shipped to them should contact their local vaccine coordinator to arrange for redistribution. Unused or expired H1N1 vaccines may not be returned to the distributor. If vaccine cannot be redistributed prior to expiration, the health care provider is responsible for disposing of the vaccine appropriately.

For information on hazardous waste disposal in Maine, see the Biomedical Waste Management Rules (06-096 CMR 900): http://www.maine.gov/sos/cec/rules/06/096/096c900.doc and 38 MRSA Chapter 13, Waste Management: http://www.mainelegislature.org/legis/statutes/38/title38ch13sec0.html

Discarded vaccine needs to be reported to Maine CDC. Providers Please discard the expired vaccine doses as providers do with their other expired medicines and ask them to report the doses discarded on the same weekly reporting form used for vaccine administration (http://www.maine.gov/dhhs/boh/maineflu/schools/documents/Aggregate-H1N1-weekly-reporting_V3.pdf) – please note any discarded doses in the space between the two “Total” cells at the lower right corner of the form with a mark of “Expired (and discarded) doses.”

Group A Strep Update
Maine CDC has now received 13 reports of cases of invasive Group A Streptococcal (GAS) infections since January in Maine. Cases have been confirmed in Androscoggin, Cumberland, Hancock, Kennebec, Oxford, Penobscot, and York counties in people ages 6 through 90. Seven of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year.

There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in this Maine CDC health advisory http://bit.ly/bswpU2 or this US CDC site: http://bit.ly/cP0vIl.

Earthquakes and Public Health
The American Public Health Association has developed a web page with links to information about relief efforts in Haiti, which includes resources for people who are interested in volunteering: http://www.apha.org/programs/globalhealth/issues/

There are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones, such as Haiti, to assist in recovery efforts. These two US CDC sites provide advice for relief workers, including travel guidance specific to workers traveling to Haiti: http://wwwnc.cdc.gov/travel/content/relief-workers.aspx and http://emergency.cdc.gov/disasters/earthquakes/responders.asp

Updates from Federal Partners
US CDC issued an abbreviated Pandemic Influenza Plan template for primary care provider offices, which will allow providers to rapidly (within 1-5 days) develop a pandemic influenza plan: http://www2c.cdc.gov/podcasts/download.asp?af=h&f=761031

Maine Animal Rabies Fourth Quarter Update
Maine CDC provides a quarterly update on animal rabies to veterinarians and other animal health professionals, which may be used to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine. Read the update here: http://www.maine.gov/tools/whatsnew/attach.php?id=91596&an=2

To read the full update, click here: http://bit.ly/bhbbuw

Flu Vaccine Available at Basketball State Championships

Flu clinics will be held at the Maine Principal’s Association high school basketball tournament in Augusta. Clinics will be held February 16th,17th, and 18th. H1N1 (swine flu) and seasonal flu vaccine will be offered at the clinics.

“Now that plenty of vaccine is available we strongly recommend everyone get vaccinated,’’ said Dr. Dora Anne Mills, Director of the Maine CDC. “Although the H1N1 disease surge is on the decline, this virus is expected to circulate for months, if not years, to come. Now is an excellent time to get vaccinated, especially given the amount of vaccine available,” said Dr. Mills.

The clinics will be held:

Feb 17 & 18th
9 AM- 4 PM (Seasonal flu and H1N1)


Feb 16th, 17th & 18th
5:30- 7 PM (H1N1 only)


Augusta Civic Center - Penobscot Room
76 Community Drive, Augusta, Maine

People interested in receiving a vaccine should bring their insurance cards; however, the clinics are free for the uninsured.

These clinics are being provided by Public Health Nursing and Concentra.

For more information about flu, please visit: http://www.maineflu.gov or call 2-1-1 from 8 a.m. to 8 p.m.

Maine Public Health Update 2/4/10

Maine CDC/DHHS Public Health Update
February 4, 2010

Dr. Stephen Sears is our new State Epidemiologist
We at Maine CDC are extremely pleased to announce the arrival of Dr. Stephen Sears as our new State Epidemiologist. A well-known infectious disease physician with a master degree in public health, Dr. Sears is from Maine and comes to us after a career that involves hospital administration (MaineGeneral and Mercy Hospitals) as well as infectious disease and public health work. More information can be found at: http://www.maine.gov/tools/whatsnew/index.php?topic=DHS+Press+Releases&id=90686&v=cdc_article.

Influenza Activity in Maine and the US
There has been another death due to H1N1, bringing the total to 19 reported since August. This death occurred in an adult in the 25-49 age group in southern Maine. All deaths related to H1N1 in Maine have occurred among people with underlying health conditions. A total of 11 people in Maine have been hospitalized the past month with H1N1, including 4 children. Of these hospitalizations, 4 included an admission to an intensive care unit, including 1 child and 2 young adults. Only 1 of the 11 had been vaccinated at least a few days prior to illness and only 2 had received early antiviral medicines.

Nationally, influenza activity is reported to be sporadic in most states, with no states reporting widespread activity. Almost all of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception. More information can be obtained at: http://www.cdc.gov/flu/weekly/index.htm#whomap.

With over 900,000 doses of vaccine distributed in Maine to about 500 health care providers and a variety of free flu clinic settings throughout the state, everyone should consider getting vaccinated with the H1N1 pandemic strain of influenza. Even those not at high-risk for complications from influenza should consider vaccine because either they can suffer complications or can become infect those who are at higher risk for complications.

Health care providers who treat people at high risk for complications from influenza (such as those with underlying conditions, pregnant women, young children, and those older than 64) are urged to vaccinate those patients and to treat with antiviral medicines at the onset of symptoms.

Vaccine can still be found in a number of public clinics, including many that are offering it for free. These can be located by calling 211 or by visiting www.maineflu.gov. The free clinics are in bold font.

Group A Strep Update
Maine CDC has now received 11 reports of cases of invasive Group A Streptococcal (GAS) infections seen in January in Maine. Four of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year. There is no reported increase in cases in nearby states, and these patients in Maine do not appear to be associated with a specific area of the state, or with influenza or with health care facilities. More information, including recommendations, can be found in last week’s health advisory at: www.mainepublichealth.gov or at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm.

Earthquakes and Public Health
There are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones such as Haiti to assist in recovery efforts. The US CDC’s earthquake website has helpful information for those who may be involved with the Haiti relief efforts or who are interested in improving their preparations here at home. http://www.bt.cdc.gov/disasters/earthquakes/

Feb. 7 is National Black HIV/AIDS Awareness Day. This article from the Black AIDS Institute describes the HIV/AIDS infrastructure in Haiti after the earthquake: http://www.blackaids.org/ShowArticle.aspx?articletype=SITEFEATURE&articleid=770&pagenumber=1. For more information on HIV/AIDS in Maine, become a fan of Maine CDC’s HIV, STD, and Viral Hepatitis program on Facebook: http://www.facebook.com/pages/Augusta-ME/Maine-HIV-STD-and-Viral-Hepatitis-Program/91975685100

Updates from Federal Partners
US CDC updated this Q&A about the 2009-2010 flu season: http://www.cdc.gov/flu/about/season/current-season.htm
This MMWR discusses H1N1 outbreaks in long term care facilities. There have been 11 such outbreaks in Maine, including one described in this report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5903a3.htm?s_cid=mm5903a3_e%0d%0a
A non-safety, voluntary recall of some .5 mL Sanofi Pasteur pre-filled syringe doses of H1N1 vaccine has been announced. US CDC answers common questions about the recall here: http://www.cdc.gov/h1n1flu/vaccination/qa_recall.htm Maine health care providers with this vaccine are being notified.

Check Out Our Partners on Facebook
Maine CDC: http://bit.ly/cBNhXp
Maine HIV, STD, Viral Hepatitis Program: http://bit.ly/aphqWA Maine WIC Nutrition Program: http://bit.ly/bDFndk
Portland Public Health: http://bit.ly/5bh6wj


Read the full update at : http://bit.ly/9UkoA3

Maine Public Health Update 01/28/10

Maine CDC/DHHS Public Health Update
January 28, 2010

Keep ME Well
Governor Baldacci, in his State of the State Speech and in a January 27th press conference, launched the Keep ME Well initiative. This novel tool helps people to assess their health risks, to obtain a report that helps them take action and find local resources and support in their own communities, and to find low-cost health care services. This will be a very useful web site for health care providers and their patients. Check it out at http://bit.ly/bJRAHK

2010 District Health Indicator Tables are posted!
In 2008, Maine CDC published tables comparing major health indicators for each of the 8 public health districts, Maine, and the U.S. These tables have just been updated and include additional indicators such as some on preventable hospitalizations by district and cost data associated with them. District data that are significantly different than the state data are yellow highlighted. Both the 2008 and 2010 tables along with the data resources used can be found under “Health Indicator Comparison Tables” on the upper left hand side of our homepage (http://bit.ly/ciXQkx) or directly at http://bit.ly/9d2FJj. We hope you find these tables useful.

Group A Strep
Maine CDC issued a health advisory last week to health care providers on an increase in the number and severity of invasive Group A Streptococcal (GAS) infections seen in January in Maine. Since then, additional cases have been identified, bringing the total thus far this month to ten, with an age range of 15 – 90 years-old. Four of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year. More information, including recommendations, can be found in last week’s health advisory at: http://bit.ly/bswpU2 or visit this US CDC web site: http://bit.ly/cP0vIl.

Earthquakes and Public Health
There are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones such as Haiti to assist in recovery efforts. The US CDC’s earthquake website has helpful information for those who may be involved with the Haiti relief efforts or who are interested in improving their preparations here at home.
http://www.bt.cdc.gov/disasters/earthquakes/

Influenza Activity in Maine and the US
There were no new confirmed cases of H1N1 influenza reported in Maine last week. However, 10 people in Maine have been hospitalized due to H1N1 since the beginning of this month, including four children. Of those hospitalized, three required admission to an intensive care unit, including one child and one young adult. Only one of those hospitalized was fully vaccinated and only two had received early antiviral medicines, despite risk factors for severe disease. These hospitalizations are reminders of the importance of health care providers offering H1N1 flu vaccine to every patient at every encounter. Vaccination against influenza and early detection with prompt treatment are still very important, especially for those at risk for complications. We expect to see the pandemic form of H1N1 to circulate for months to come. We have not yet detected any seasonal influenza virus in samples submitted for testing this winter, and there have been no outbreaks of seasonal flu reported in other parts of the country. Vaccine can still be found in a number of public clinics, including many that are offering it for free. These can be located by calling 211 or by visiting http://bit.ly/5xdkVe. The free clinics are in bold font.

H1N1 Vaccine Supply
There is now plenty of H1N1 vaccine in Maine, with over 900,000 doses of H1N1 vaccine available statewide since October to about 500 health care providers. The Maine CDC is able to process orders with about a 4-day business day turnaround between order and receipt of vaccine. More than half of the doses of vaccine distributed have not been reported as administered. Vaccine administrators are required to report doses administered weekly. The weekly vaccine reporting form can be found at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml. Detailed instructions are also available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/H1N1-Weekly-Reporting-Form-instructions.pdf.

Messages to the Public
• Many people are still susceptible to this virus and would benefit from vaccination. Being vaccinated not only protects you, but it helps protect the people around you who are more likely to suffer serious complications from the flu.
• To find a vaccine, call your health care provider, or get the list of public vaccine clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).
• If you think you have the flu, cannot reach your doctor, and/or your health plan does not have a nurse call line available, you may call 2-1-1 from 8 a.m. to 8 p.m. to be connected with a health professional who can assess your symptoms.

Check Out Our Partners on Facebook
Maine CDC: http://bit.ly/cBNhXp
Maine HIV, STD, Viral Hepatitis Program: http://bit.ly/aphqWA
Maine WIC Nutrition Program: http://bit.ly/bDFndk
Portland Public Health: http://bit.ly/5bh6wj


View the full update here: http://bit.ly/cZKqbK

Weekly update on H1N1 in Maine 1/21/10

Maine CDC/DHHS Public Health Update
January 21, 2010

Flu Activity in Maine and the US
We continue to see H1N1 circulate in Maine, though at declining levels from a month ago. This last week there were two new hospitalizations, one of whom required intensive care. Since the beginning of January, 10 Mainers have been hospitalized for H1N1, including four children. Of those hospitalized, three required admission to an intensive care unit, including one child and one young adult. We are finding an increasing number of hospitalized patients who have neither been vaccinated nor received early treatment with antiviral medicines. Vaccination against influenza and early detection of infection with prompt treatment are still important, especially for people at risk of complications. These cases are also a reminder that we expect to see the pandemic form of H1N1 influenza virus to continue to circulate for months to come, so it is important to keep H1N1 in the differential for people presenting with symptoms.

We have not yet detected any seasonal influenza virus in samples submitted for testing this winter, and there have been no reported outbreaks of seasonal influenza in other parts of the country as well.

H1N1 Vaccine Supply
There is now plenty of vaccine in Maine, with about 800,000 doses of H1N1 vaccine distributed statewide since October. Maine CDC is now processing orders for H1N1 vaccine the same day the request comes in from a health care provider, with about a four-day turnaround between order and receipt of vaccine.

About 500 health care providers in the state have received H1N1 vaccine. We strongly urge health care providers to offer the H1N1 flu vaccine to every patient at every encounter.

Public clinics can be located by calling 211 or visiting www.maineflu.gov. There are many clinics that are offering free vaccine, identified by the bold font on the website.

December 2009 National Survey of H1N1 and Seasonal Flu Vaccine Coverage
US CDC has released data from a national survey conducted through much of December on H1N1 and seasonal flu vaccine coverage. Maine stood out as having an H1N1 vaccine rate among children that is more than twice the national average – 60% versus 28%. Although we do not know our formal ranking, we know only 4 states had pediatric coverage rates of over 40%.

Maine also had higher rates of H1N1 vaccine in health care personnel working with high-risk patients (46% vs. 27% nationally) and of seasonal flu vaccine coverage among children (52% vs. 34% nationally).

Additional information on vaccine coverage can be found in this MMWR: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm59e0115a1.htm

Main Messages to the Public
Many people are still susceptible to this virus and would benefit from vaccination. Being vaccinated not only protects you, but it helps protect the people around you who are more likely to suffer serious complications from the flu.
To find a vaccine, call your health care provider, or get the list of public vaccine clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).
If you think you have the flu, cannot reach your doctor, and/or your health plan does not have a nurse call line available, you may call 2-1-1 from 8 a.m. to 8 p.m. to be connected with a health professional who can assess your symptoms.

To view the full update: http://bit.ly/5X7I9G

Dr. Martin Luther King, Jr. and Health Care

Below is a wonderful tribute to Dr. Martin Luther King, Jr., written 10 years ago by the then head of US DHHS' AHRQ. About a year after this was published, Dr. John Eisenberg was diagnosed with an aggressive brain cancer, and died in 2002. I think this piece is a wonderful tribute to both men we were so fortunate to have on this planet, though for too short a time. Dora



Birthday Observance of Dr. Martin Luther King, Jr.
Remember! Celebrate! Act! A Day On, Not a Day Off!
John M. Eisenberg, MD, Director, Agency for Healthcare Research and Quality, January 14, 2000

--------------------------------------------------------------------------------

When I was invited to welcome you to the Department of Health and Human Service's 26th observance of Martin Luther King, Jr.'s birthday, my first thought was about how honored I was to be asked. My second thought was about what Martin Luther King's birth could mean to a rebirth of health care in this country. Few have had as much impact upon the American consciousness.

But what did Martin Luther King, Jr. think about health care?

My colleagues and I searched through his writings and his speeches, and realized that he didn't give speeches about health care. Martin Luther King, Jr. was confronting the basic nature of American society. He had mountains to move—and mountaintops to climb—for this country so that today we can address the issues of high quality health care for all Americans.

If Dr. King were alive today he'd be 71 years old. He'd be eligible for Medicare. Like many 71-year-olds, he might be dealing with a chronic medical condition—maybe arthritis, or hypertension, or diabetes. What would he think of the health care system we have today? What would he think of the medical care he might receive? And what advice would he be giving the Department of Health and Human Services?

No, Dr. King didn't give many speeches about health care. But like the rest of society, health care had to change too.

When I was a teenager in Memphis, before the Medicare program was passed, the Baptist Hospital was the biggest in town, and the proudest of the care it gave. But if you were African-American in Memphis and you went to the Baptist Hospital, you'd go in through a back entrance. And you'd go to a segregated ward, where you would be in a big room with about 15 or 20 other people. And your doctor, if he was black, would not have privileges on staff. And the same would have been true for Dr. King in Montgomery or in Atlanta.

Dr. Vanessa Gamble, who is the new director of minority affairs at the Association of American Medical Colleges here in Washington, has documented the incredibly important role that Medicare and Medicaid played in helping to desegregate hospitals. Medicare was a lever that lifted equity and equality in hospitals. In 1965, our Department issued regulations mandating that hospitals had to be in compliance with Civil Rights Act—which had been passed just the year before—in order to be eligible for Federal assistance or to participate in any federally assisted program. The passage of Medicare and Medicaid legislation that year made every hospital a potential recipient of federal funds, and therefore obligated every hospital to comply with civil rights legislation if they wanted to get paid.

The law changed, but practice was slower.

When I was a medical student in St. Louis, at Barnes Hospital around 1970, researchers asked why the hospital still seemed to be segregated. Why? Because clerks in the admissions office—both black and white—were so accustomed to the old ways that they continued to admit the races to their old units. The law had changed, but racial stereotypes had remained. Racist practices were illegal, but racism was institutionalized, and the seeds of racism grew into practices that amounted to discrimination.

I ask you, is it any different today, 31 years after Dr. King was shot in my hometown, and we grieved over the loss of a great American? Is it different 31 years after I was ashamed of the symbol that my hometown had become, when all that Dr. King wanted was to put into practice the placards that the Memphis sanitation workers wore, that read, "I am a man"?

Today, research shows that African-Americans are one-third less likely to have coronary bypass surgery than whites with the same conditions. Why? And today, African-Americans with HIV are less likely to receive antiviral treatment. Why do these disparities occur?

The easy answer is that it is because African-Americans are more often uninsured. And that is true. But even with the same insurance, African-Americans don't have the same access to primary care doctors, specialists and hospitals. And most distressing, even with the same insurance and being cared for at the same hospitals, African-Americans get different care. In one study I did, if you were a black woman you were much less likely to get referred for cardiac catheterization.

The reason—I fear—is that, despite Dr. King's advances, and despite civil rights laws, and despite Medicare, racism is a part of the institution of American life, and the seeds of racism still grow into discriminatory practices.

So, now 31 years after Dr. King's death and 35 years after Medicare broke down segregated wards in the nation's hospitals, the question for us is: What can we do today in our Department to eliminate these disparities, whether they grow out of lack of insurance, lack of access, or lack of quality care for those who get access?

No matter where we work in this Department—

At the Health Care Financing Administration, where care is funded.

At the Health Resources and Services Administration, where programs are supported to help access.

At the Food and Drug Administration, where safe drugs are assured.

At the National Institutes of Health, where research can identify the causes of disease.

At the Agency for Healthcare Research and Quality, where we find out why the quality of care isn't what it can be, and where our name itself speaks of an arc, of closing gaps.

In every operating and staff division—

We can use the levers that we are so lucky to have, and so privileged to use, to eliminate the barriers to high quality health care.

Because we shall overcome.

We shall overcome the disparities in health care, whether they are due to economic barriers, or institutionalized racism, or even unconscious discrimination. We—as public servants—can build on Dr. King's contribution to the moral health of our country to make our own contributions to the physical and mental health of all of its people.

Let's make that commitment today.

Current as of January 2000


--------------------------------------------------------------------------------

Internet Citation:

Birthday Observance of Dr. Martin Luther King, Jr.: Remember! Celebrate! Act! A Day On, Not a Day Off! Opening Remarks by John M. Eisenberg, M.D., Director, Agency for Healthcare Research and Quality, January 14, 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/mlkspch.htm


--------------------------------------------------------------------------------

Haiti Earthquake

This US CDC website is very useful for earthquake preparedness. Believe it or not, we have them in Maine on occasion, and certainly many Mainers frequently travel to zones of higher earthquake activity. It also has good information for those who may be traveling to Haiti to assist in the recovery efforts there, including which vaccines to obtain and what other health issues to be concerned about.

Weekly update on H1N1 in Maine 1/14/10

Flu Activity in Maine and the US
We continue to see H1N1 in Maine, including three new hospitalizations this week – one in a child younger than 5, another child younger than 18, and an adult in the 50-64 age range. There was also an outbreak of H1N1 at a long term care facility. Although H1N1 flu activity has decreased in Maine in recent weeks, there have been increases in H1N1 illness in other areas of the U.S.

Many people are still susceptible to this virus and would benefit from vaccination. Being vaccinated not only protects you, but it helps protect the people around you who are more likely to suffer serious complications from the flu.

Flu is unpredictable, but it often comes in waves. There was a mild surge in the spring of 1957, followed by a large surge in the fall, another large one in the winter of 1958, and others following that with the virus circulating for several years. All pandemics are different, but most have multiple waves of illness and death.


H1N1 Vaccine Supply
There is now plenty of vaccine in Maine, so it’s an excellent time for people who have not been vaccinated against H1N1 and seasonal flu to do so before the next wave of disease. Nearly 800,000 doses of H1N1 vaccine have been distributed statewide since October. Close to 500 health care providers in the state have received H1N1 vaccine. Call your health care provider, or get the list of public vaccine clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).

Maine CDC recommends that health care providers offer H1N1 vaccine to every patient at every visit, every hospitalization, or other health care encounter, assuming contraindications do not exist.

Treatment Recommendations
Maine CDC issued a health alert on Jan. 11 to reinforce recommendations for early treatment of patients with increased risk of complications from influenza. Early treatment for influenza may prevent secondary bacterial infections. This alert can be viewed here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=88550&v=alert

If you think you have the flu, cannot reach your doctor, and your health plan does not have a nurse call line available, you may call 2-1-1 from 8 a.m. to 8 p.m. to be connected with a health professional who can assess your symptoms.

Information for People with Chronic Underlying Health Conditions
Pneumonia, bronchitis, acute respiratory distress syndrome, sinus infections and ear infections are examples of flu-related complications. The flu can also make chronic health problems worse. H1N1 has caused more deaths among adults with chronic medical conditions than in any other group. All 18 H1N1-related deaths in Maine have been in adults with chronic underlying conditions.

If you have a high-risk condition, getting vaccinated is the single best action you can take to protect yourself from the flu. Still, most adults with high-risk conditions have not been vaccinated yet. Many people in these groups do not realize that their medical conditions increase their risk. The following conditions put people are risk for flu-related complications:
· asthma;
· heart disease
· chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis);
· diabetes and other endocrine disorders;
· neurological or neurodevelopmental disorders, and especially those that affect lung capacity (muscular dystrophy, cerebral palsy, strokes, etc);
· blood disorders, such as sickle cell disease;
· kidney and liver disorders;
· weakened immune system due to disease or medication, such HIV/AIDS, cancer, or steroids;
· long-term aspirin therapy in people younger than 19.

If you have a chronic health condition and have not yet received your vaccine against H1N1, get one now. Contact your health care provider, specialist, call 2-1-1 from 8 a.m. to 8 p.m. for a list of public clinics, or check www.maineflu.gov (clinics listed in bold are free).

If you have an underlying health condition and experience flu-like symptoms, contact your health care provider immediately to receive a prescription for antiviral medications (such as Tamiflu®).

To read the full update: bit.ly/8CFsPI

People with chronic health conditions should be vaccinated against the flu

It’s National Influenza Vaccination Week, and although H1N1 flu activity has decreased in recent weeks, people in Maine and across the country are still being hospitalized and dying from influenza.

All 18 deaths due to H1N1 flu in Maine since August have been among people with underlying health conditions. If you have a high-risk condition, getting vaccinated is the single best action you can take to protect yourself from the flu.

Flu is unpredictable, but it often comes in waves. Now is an excellent time for people who have not been vaccinated against H1N1 and seasonal flu to do so before the next wave of disease. Vaccine is widely available in Maine now. Call your health care provider, or get the list of public clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).

If you have an underlying health condition and experience flu-like symptoms, contact your health care provider immediately to receive a prescription for antiviral medications (such as Tamiflu®).





A schedule of events for National Influenza Vaccination Week is available on US CDC’s web site at: http://www.cdc.gov/flu/NIVW/activities.htm?s_cid=cs_000&s_cid=cs_000

Weekly update on H1N1 in Maine 1/7/10

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
January 7, 2010

Flu Activity in Maine and the US
Flu activity in Maine has decreased enough to be classified as “regional” instead of “widespread.” However, people are still being hospitalized due to H1N1, and it is important to be aware that flu comes in waves. Vaccination is the best protection for yourself and the people you care about.

An Aroostook County resident in the 50 to 64 age group died earlier this week in part due to complications related to H1N1. The deceased was diagnosed with H1N1 in mid-December and had multiple serious underlying conditions. (This death was reported to Maine CDC after the surveillance information at the end of this report was compiled, and therefore will not be reflected in that data at the end of this update.)

All 18 deaths due to H1N1 since August have been among people with underlying health conditions, which emphasizes the importance of getting vaccinated if you have a high-risk condition, including asthma, emphysema, diabetes, heart disease, kidney and liver disorders, neurological disorders, blood disorders, cancer, HIV or AIDS, and others.

There were 5 new hospitalizations due to H1N1 last week, up from 3 the week before. Two children under age 18 were hospitalized, with one in intensive care; one young adult under age 24 was hospitalized and in intensive care; and two adults under age 65 were hospitalized. Hospitalizations occurred in Aroostook, Hancock, and Penobscot counties.

Vaccine is widely available, and we encourage everyone to be vaccinated. Information on flu vaccine clinics, including many free ones, is available by calling 211, checking www.maineflu.gov (free ones in bold font) or by contacting one’s health care provider.

H1N1 Vaccine Supply and Prioritization
Nearly 800,000 cumulative doses of H1N1 vaccine have arrived in Maine since October, which is an increase of 300,000 in just the last 2 ½ weeks. Maine CDC is able to meet the demand for vaccine, so if a health care provider needs more vaccine, they should order additional doses, as per the instructions below. We recommend health care providers offer H1N1 vaccine to every patient at every visit, every hospitalization, or other health care encounter, assuming contraindications do not exist. Such strategies as standing orders and adding H1N1 vaccine status to intake and discharge questions are appropriate to consider. It is important to take advantage of this window of opportunity (declining disease burden and expanded vaccine supply) to encourage vaccine.

There is an abundant supply of nasal spray vaccine in the state. We request that nasal spray vaccine be given to anyone who is eligible to receive it. The nasal spray vaccine is a safe and effective vaccine option for healthy people ages 2 through 49 years old who are not pregnant. For more information on nasal spray vaccine, please see our Fact Sheet at: http://www.maine.gov/dhhs/boh/maineflu/LAIV_factsheet.pdf.

Important Information for Vaccine Administrators
Vaccination is the best way to protect patients and to slow down the circulation of the virus, which may also help to prevent unwanted changes in the virus. Maine CDC encourages all appropriately licensed health care providers to register for, order, and offer H1N1 vaccine to their patients, including those health care providers in non-traditional settings for vaccine, such as specialists and those providing care for populations who may not seek vaccine, such as those with serious mental illness.

For health care providers to receive vaccine for the first time to administer to patients there is a simple two-step process:
Register for a PIN: http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider-agreement-2009-2010.shtml.
Once the PIN is received, place an order for vaccine:http://www.maine.gov/DHHS/boh/maineflu/h1n1/health-care-providers.shtml.

Please note that all H1N1 vaccine providers and/or administrators must submit the vaccine administration data into Maine CDC’s weekly vaccine reporting system. The weekly vaccine reporting form can be found at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml. Detailed instructions are also available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/H1N1-Weekly-Reporting-Form-instructions.pdf.

If a health care provider is already registered but is running low on H1N1 vaccine, the provider should:
Confirm that you have placed orders for all the vaccine you need. You may order more by completing this form: http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/h1n1-vaccine-orderform.shtml.
It often takes 7-10 days to replenish a health care provider’s vaccine supply. If you have acute vaccine needs or other related concerns or questions, email flu.questions@maine.gov or call the Immunization Program at: 287-3746 or toll free at 1-800-867-4775 Monday – Friday 8 am – 5 pm.

If local vaccine supplies are not sufficient while awaiting more vaccine, Maine CDC recommends focusing the limited supply on those patients in the five high priority groups (pregnant women, people ages 6 months through 24 years-old, people 25 through 64 years-old with an underlying medical condition, caregivers and household contacts of infants younger than 6 months, and health care workers). Patients can also be referred to public clinics which can be found by calling 211 or checking http://www.maineflu.gov/.

Health care providers who have too much vaccine should contact their local Vaccine Coordinator to arrange for redistribution.

Vaccine Coordinators:
District 1 – York: Sharon Leahy-Lind, 490-4625, sharon.leahy-lind@maine.gov
District 2 – Cumberland: Becca Matusovich, 797-3424, becca.matusovich@maine.gov
District 3 – Western Maine: MaryAnn Amrich, 753-9103, maryann.amrich@maine.gov
(Franklin, Oxford, and Androscoggin counties)
District 4 – Mid Coast: Jen Gunderman-King, 596-4278, jennifer.gunderman-king@maine.gov
(Waldo, Knox, Lincoln, and Sagadahoc counties)
District 5 – Central Maine: Sue Lee, 592-5634, susan.j.lee@maine.gov
(Somerset and Kennebec counties)
District 6 – Penquis: Jessica Fogg, 592-5633, jessica.fogg@maine.gov
(Penobscot and Piscataquis counties)
District 7 – Downeast: Al May, 263-4975, alfred.may@maine.gov
(Washington and Hancock counties)
District 8 – Aroostook: Stacy Boucher, 592-5632, stacy.boucher@maine.gov
Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15, jireland@maliseets.com

Vaccine Return:
The only vaccines that should be returned are those that arrive non-viable or appear to be damaged during transit. Providers with concerns about vaccine viability during transit from the McKesson Distributor should call 877-836-7123 immediately upon receipt of the package.

Once a provider takes receipt of the vaccine as a usable product, it is that provider’s responsibility to ensure proper disposal of any damaged, expired, or un-used vaccine unless it has been recalled. Health care providers who have sufficient supplies and no longer need vaccine they receive should contact their local vaccine coordinator (listed above) to arrange for redistribution.

Changes in Ancillary Supply Kits:
As supplies of Influenza Vaccination Record cards are exhausted, US CDC will no longer be including these cards in shipments of H1N1 vaccine. Within a single shipment, cards could be included with one type of vaccine and not others.

Vaccinating Small Children
The 0.25 mL pre-filled syringe presentation of vaccine for children ages 6-36 months will no longer be available for order. Maine CDC makes the following recommendations for vaccinating small children:
Use the Sanofi or CSL multidose vial for all children ages 6 months to two years of age
Use the nasal spray vaccine for healthy children ages two years and older, when available and appropriate
Use the Sanofi or CSL multidose vial for children ages two and older who are not eligible to receive nasal spray vaccine, or when nasal spray is unavailable

People with concerns about thimerosal in multidose vial presentations of vaccine should see US CDC’s new fact sheet on thimerosal at: http://www.cdc.gov/h1n1flu/vaccination/vaccine_factsheet.htm

Seasonal Flu Vaccine
Maine CDC’s Immunization Program has filled all of its orders for seasonal flu vaccine, and is unable to place additional orders for vaccine. Most seasonal flu vaccine in the state is ordered privately and is not under the control of Maine CDC.

There have been several national delays in privately supplied seasonal flu vaccine, and more demand for this vaccine than usual. Limited amounts of seasonal flu vaccine remain. Providers who are seeking more information about seasonal flu vaccine availability and ordering may check these web sites: http://www.preventinfluenza.org/ivats/ and http://www.cdc.gov/flu/professionals/vaccination/#supply

US CDC continues to encourage those at highest risk from flu complications to seek seasonal flu vaccine and receive H1N1 vaccine, as recommended. People ages 65 and older at highest risk for complications from seasonal flu. Others are high risk for complications from seasonal flu include pregnant women, children younger than 2 years-old, and people with underlying health conditions. If you fall into one of these groups and have not been able to locate vaccine, check with your health care provider or look for seasonal flu clinics listed at http://www.maineflu.gov/ and with 211.

Conference Call for Partners Holding Public Vaccine Clinics
A conference call to address questions regarding expectations of partners who have agreed to host H1N1 vaccine clinics and receive funding from Maine CDC to support those efforts will be held at noon on Monday, Jan. 11. The call-in number is 1-800-244-5901 with the pass code 749239. This call will focus on the development of some concrete ideas for how to meet the objectives of funding provided to partners, and approaches to develop and implement plans for administration of vaccine to broad populations statewide. Representatives of hospitals, health centers and schools will be invited to join this discussion. During calls, please press *6 to mute your line un-mute when you are actively participating.

View the full weekly update here: http://bit.ly/6I8oDA