Influenza Update

Surveillance

There was no flu activity reported in Maine for the week ending Nov. 20. Weekly updates on flu activity in Maine are available at http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml

Weekly updates for the US are available at http://www.cdc.gov/flu/weekly/summary.htm and international updates are available at http://www.cdc.gov/flu/international/activity.htm.

Update on state-supplied vaccine distribution

Most influenza vaccine arrives in Maine through private sector channels, but Maine CDC will be distributing a total of about 290,000 doses of flu vaccine this year; 92% of doses have already been shipped out to providers in the state. Almost 350 schools have received a total of more than 80,000 doses of state-supplied vaccine for school-based clinics.

Prevent Carbon Monoxide Poisoning

Recent severe weather has caused power outages, which raises concern about carbon monoxide poisoning. To prevent carbon monoxide poisoning:

• Have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.
• Don't use a gas-powered generator, charcoal grill, camp stove, or other gas or charcoal-burning device inside your home, basement, or garage or near a window or door. Generators should be more than 15 feet from your home when running.
• Don't run a car, truck or any other motor inside a garage or other enclosed space, even if you leave the door open.
• Don't try to heat your house with a gas oven.
• Make sure you have a CO detector with a battery back-up in your home near where people sleep. Check or replace the battery when you change the time on your clocks each spring and fall. You can buy an alarm at most hardware stores or stores that sell smoke detectors. By law, all rental units must have a CO alarm—talk to your landlord if you don’t have one in your apartment or rental house.
• If your CO alarm goes off, get out of the house right away and call 911. Get prompt medical attention if you suspect CO poisoning and are feeling dizzy, light-headed, or nauseous.

For more information, see this Maine CDC press release: http://www.maine.gov/tools/whatsnew/index.php?topic=DHS+Press+Releases&id=151572&v=cdc_article

Worried about wind turbines?

In recent months, several government agencies such as Australia, Minnesota, Ontario, and the Wisconsin PUC have conducted reviews of the science on wind turbine noise and health. They all have made similar conclusions — that there is no evidence of a direct health or disease impact from wind turbines, especially if properly placed. Maine’s noise regulations are within or comparable to the World Health Organization’s recommendations for noise.

Summaries of recent research and reviews are available at http://www.maine.gov/dhhs/boh/documents/community-involvement-critica.doc, which can also be found on Maine CDC’s wind turbine site: http://www.maine.gov/dhhs/boh/wind-turbines.shtml.

Health Reform Update

Health Reform News

An important provision of the Affordable Care Act requires insurance companies to meet new requirements concerning their “medical loss ratios” – the percentage of premium dollars that an insurance company spends on providing health care and improving the quality of care, versus how much is spent on administrative and overhead costs. To be sure that premium dollars are spent primarily on health care itself, the law requires that 80% to 85% of the money collected by insurance companies be spent on health care services and health care quality improvement. For more information on medical loss ratios, see http://www.healthcare.gov/news/blog/MLR.html

HealthCare.gov’s insurance finder (http://finder.healthcare.gov/) now features pricing and detailed benefit information for private insurance plans for individuals and families. The finder also provides enhanced information about public health resources.

Health Reform in Maine

Thirteen employers have enrolled in the Early Retiree Reinsurance Program, which provides financial relief to businesses, schools and other educational institutions, unions, State and local governments, and non-profits, in order to help retirees and their families continue to have quality, affordable health coverage. Find a list of organizations accepted into this program at http://www.healthcare.gov/law/provisions/retirement/states/me.html

Several grants to support biomedical research have been made through the Affordable Care Act. For more information, see this HHS press release: http://www.hhs.gov/news/press/2010pres/11/20101103b.html

HealthCare.gov has state-by-state summaries of Affordable Care Act grants. Summaries of funds awarded in Maine are available at: http://www.healthcare.gov/center/states/me.html##

For more information about Health Reform in Maine, visit the Governor’s Office of Health Policy and Finance’s web site: http://www.maine.gov/healthreform/

Influenza Update, 11/12/10

Surveillance

The first case of laboratory-confirmed influenza in Maine this season was reported this week. It was a case of type B influenza in someone who recently returned from a visit out of state. Type B as well as type A 2009 H1N1 pandemic strain and type A H2N3 have all been detected circulating in the U.S. All three are also reflected in this year’s seasonal flu vaccine, which is now recommended for all ages 6 months and older. For more information, see this Health Alert: http://www.maine.gov/tools/whatsnew/attach.php?id=151569&an=2

Weekly updates on flu activity in Maine are available at http://www.maine.gov/dhhs/boh/influenza_surveillance_weekly_updates.shtml

Weekly updates for the US are available at http://www.cdc.gov/flu/weekly/summary.htm and international updates are available at http://www.cdc.gov/flu/international/activity.htm.

Update on state-supplied vaccine distribution

Most influenza vaccine arrives in Maine through private sector channels, but Maine CDC will be distributing a total of about 290,000 doses of flu vaccine this year.

Doses Approved for Shipment as of Nov. 10:

Population	Doses
Children ages 6 months to 18 years	174,650*
Adults	70,430
Nursing homes and long-term care facilities	20,360
Total	265,440

* This includes doses shipped to both schools and private health care providers.

Number of schools that have received flu vaccine so far: 336

Number of doses distributed to schools so far: 82,688

Flu information for the general public

Now is the perfect time for most people to get vaccinated against the flu. Maine CDC strongly encourages everyone who is older than six months of age to get vaccinated against the flu this season – a new recommendation from the US CDC, which had previously focused on people at high risk of flu. There is already a significant amount of vaccine available in Maine, and many schools are offering vaccine to students during the school day.

Anyone can get sick from the flu, but certain people are at greater risk for serious complications from the flu, including:

· older people,

· young children,

· people with chronic lung disease (such as asthma and COPD), diabetes (type 1 and 2), heart disease, neurologic conditions, and certain other long-term health conditions,

· pregnant women, as well as

· American Indians and Alaska Natives, and

· people with a Body Mass Index (BMI) of 40 or more.

Vaccination is the most effective way to prevent the flu and its complications. Vaccine is already available in many places – you can check listings by zip code at www.flu.gov or www.211maine.org. Over the years, hundreds of millions of people in the U.S. have safely received seasonal flu vaccines. Last flu season, about 80 million people in the U.S. also received the vaccine made to protect against the 2009 H1N1 virus, and the vaccine’s safety was similar to that of seasonal flu vaccines.

The 2010-2011 flu vaccine will protect against three types of flu including the 2009 H1N1 virus. The 2010-2011 seasonal flu vaccine is recommended even if you got the 2009 H1N1 flu vaccine last season. People who were sick with the flu last season should also still get a flu shot this year.

Protect yourself and others from the flu

• Cover coughs and sneezes with a tissue or sleeve.
• Wash hands frequently.
• Stay home if ill with a fever.
• Get vaccinated against the flu.
• Ask your doctor if you should receive a pneumococcal vaccine.

Worried about smart meters?

A complaint was filed with the Maine Public Utilities Commission at the end of October, focusing on concerns related to the health, safety (malfunctioning, shorting out, and igniting), and security (vulnerability to hacking) of smart meters, also known as advanced metering infrastructure.

Maine CDC conducted a review focused on the health concerns expressed in the complaint. The review did not indicate any consistent or convincing evidence to support a concern for health effects related to the use of radio frequency in the range of frequencies and power used by smart meters. The review also did not indicate an association of EMF exposure and symptoms that have been described as electromagnetic sensitivity.

For more information, visit http://www.maine.gov/dhhs/boh/smart_meters.shtml. The full review is about 70 pages, but the executive summary is only 5 pages.

Be safe this Halloween

Halloween will be here this weekend. Here are some tips to make sure it's a healthy, fun holiday.

This Fact Sheet from the American Academy of Pediatrics has a lot of great safety information -- from pumpkin carving to costumes to actual trick-or-treating activities -- in simple bullet points. US CDC and FDA have similar advice.


Check out these resources for additional information:

Costumes

When purchasing a costume, masks, beards, and wigs, look for the label Flame Resistant. Although this label does not mean these items won't catch fire, it does indicate the items will resist burning and should extinguish quickly once removed from the ignition source. To minimize the risk of contact with candles or other sources of ignition, avoid costumes made with flimsy materials and outfits with big, baggy sleeves or billowing skirts. For more safety information, read this US Consumer Product Safety Commission's Halloween Safety Alert.

Does your costume involve face paint or other makeup? Make sure you check out FDA's website on novelty makeup before you apply it.


Candy and Treats

Some candies have recently been recalled due to allergy and safety concerns. Stay on top of FDA's recalls. Chocolate past its expiration date can cause illness -- check out this HealthFinder.gov article on shelf life.

These Halloween Food Safety Tips for Parents include basis information about inspecting your children's candy and not accepting anything that isn't commercially packaged. It also describes how to avoid bacteria from apple cider and if you go bobbing for apples.

Does your child have nut allergies? Find out how you can make sure Halloween is safe and fun despite allergies.

Do you want to provide more nutritious treats? Here are some excellent ideas from Clemson University Cooperative Extension in South Carolina.

Public Health Updates

· Infectious Disease Conference. Since 1983, Maine CDC’s Division of Infectious Disease has organized an annual infectious disease conference targeting public health issues of emerging concern. This year’s conference will be held from 8 a.m. to 4 p.m. November 9 at the Augusta Civic Center. Health care practitioners, laboratorians, and public health partners are invited to receive current information on surveillance, clinical management and diagnosis, and disease control interventions. The conference will feature cases of interest, epidemiology presentations, and clinical updates. The conference brochure and agenda are now available online. Click here to register.

· Bed Bugs. Bed bugs are small insects that feed on human blood. Although bed bugs do not transmit disease, infestations are very difficult and expensive to control. Unlike head lice, bed bugs do not live on a person. However, they can hitchhike from one place to another in backpacks, clothing, luggage, books and other items. Maine CDC has established a web page with links to information and a list of resources related to bed bugs following a number of recent calls for consultations. The page is accessible at www.mainepublichealth.gov/bedbugs

· EEE and West Nile Virus. There was unprecedented EEE activity in Maine in 2009. Several surrounding states have already seen EEE and WNV activity this year, including increased risk of EEE in southeastern Massachusetts resulting in aerial spraying in that area (more information can be found at http://westnile.ashtonweb.com/). For the most recent surveillance reports on EEE and WNV, visit: http://www.maine.gov/dhhs/boh/ddc/epi/vector-borne/arboviral_surveillance.shtml

· Animal rabies. Maine CDC provides quarterly updates on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities. The third quarter report can be found here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=140633&v=alert

· Fingerstick devices and bloodborne pathogens. US CDC has become increasingly concerned about the risks for transmitting hepatitis B virus (HBV) and other bloodborne pathogens to people undergoing fingerstick procedures for blood sampling, such as people with diabetes. As reports of HBV infection outbreaks linked to diabetes have been increasing, CDC issued an important reminder that fingerstick devises should never be used for more than one person (http://www.cdc.gov/injectionsafety/Fingerstick-DevicesBGM.html). For more information, visit: http://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html

Depression Rates in Maine and US

The current issue of U.S. CDC’s MMWR (Morbidity and Mortality Weekly Report) contains updated data on current depression among adults in the United States and for each state. Maine’s rates are listed as: 3.5% reporting major depression; 4.4% reporting some kind of depression; for a total of 7.9% prevalence (or 1 in 13).

These rates are comparable with the U.S. rates of 3.4%, 5.7%, and 9.0% respectively. The link to the full report is: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a2.htm?s_cid=mm5938a2_w#tab2. A separate analysis of Maine data indicates that about 20% of adults have been told at one time during their lifetime they are or have been depressed.

Health Reform Update 10/14/10

School-based Health Center Funding Opportunity

US HHS Secretary Sebelius has designated $100 million in new investments from the Affordable Care Act for school-based health centers (SBHCs). The Health Resources and Services Administration (HRSA) expects to award an estimated 200 grants in FY2011 to construct, renovate, or purchase equipment in SBHCs. An eligible applicant must be a school-based health center or sponsoring facility, and should certify that the SBHC site(s) serves children eligible for medical assistance under the state Medicaid plan. The application deadline is December 1.

Recent Health Reform Grants in Maine

· Maine DHHS, Husson College, and the University of New England were awarded a total of $822,796 from the American Recovery & Reinvestment Act (ARRA) to purchase equipment for training current and future health professionals across disciplines at the undergraduate, graduate, and post-graduate education levels.

· Maine was one of 20 states funded to strengthen Aging and Disability Resource Centers (ADRCs) Options Counseling and Assistance Programs for community-based health and long-term care services. Options counseling programs help people understand, evaluate, and manage the full range of services and supports available in their community.

· Maine was one of 16 states funded to coordinate and continue to encourage evidence-based care transition models which help older persons or persons with disabilities remain in their own homes after a hospital, rehabilitation or skilled nursing facility stay. These grants will help break the cycle of readmission to the hospital that occurs when an individual is discharged into the community without the social services and supports they need.

· The University of New England in Biddeford was awarded $990,000 to fund its primary care physician assistant training program by providing student stipends.

· Maine DHHS was awarded $747,632 to develop and evaluate a competency-based uniform curriculum to train qualified personal and home care aides. Personal and home care aides (PHCAs) are projected to be the fourth-fastest growing direct care occupation in the United States between 2008 and 2018. Maine is one of six states participating in the 3-year project.

· The Maine Jobs Council was awarded a $150,000 planning grant to assess the state’s current health workforce. These activities are expected to result in a 10 to 25 percent increase in the primary care health workforce over a 10-year period.

· Maine CDC was awarded $250,000 for a personal responsibility education program as part of $155 million in national teen pregnancy prevention grants.

· US HHS awarded nearly $49 million to help plan for the establishment of health insurance exchanges, a key part of the Affordable Care Act set to begin in 2014. In Maine, the Governor’s Office of Health Policy and Finance was awarded $1 million to support the development and implementation plan for the Exchange.

· US HHS awarded $727 million in Affordable Care Act funds to 143 community health centers to address pressing construction and renovation needs and expand access to quality health care. The following table shows the 19 Maine health centers that received a total of almost $20 million:

Health Center Grantee Name	City	Total Award
Bucksport Regional HC	Bucksport	$3,394,076
City of Portland Maine	Portland	$1,747,510
DFD Russell Medical Center	Leeds	$670,557
Eastport Health Care, Inc.	Eastport	$586,626
Fish River Rural Health	Eagle Lake	$491,222
Harrington Family HC	Harrington	$501,579
Health Access Network, Inc.	Lincoln	$903,820
Healthreach Community HC	Waterville	$1,687,496
Islands Community Medical Services, Inc	Vinalhaven	$408,654
Katahdin Valley HC	Patten	$678,154
Maine Migrant Programs, Inc.	Augusta	$407,295
Maine Primary Care Association	Augusta	$446,250
Penobscot Community HC, Inc.	Bangor	$3,741,093
Pines Health Services	Caribou	$829,605
Regional Medical Center at Lubec, Inc.	Lubec	$549,613
Sacopee Valley HC	Porter	$1,341,309
Sebasticook Family Doctors	Pittsfield	$585,950
St. Croix Regional Family HC	Princeton	$488,368
York County Community Action Corporation	Sanford	$455,900

Other Health Reform News

People who retire early often have a difficult time finding affordable coverage, and are too young to be eligible for Medicare. But today, more early retirees can rest easier knowing that their health security won’t be compromised by their early retirement after today’s announcement that more employers and unions will participate in HHS’s Early Retiree Reinsurance Program. For more information: http://www.healthcare.gov/news/blog/ERRPLetters.html

This HealthCare.gov web site lets you search your insurance options: http://finder.healthcare.gov/

For more information about Health Reform in Maine, visit the Governor’s Office of Health Policy and Finance’s web site: http://www.maine.gov/healthreform/

Maine Influenza Update 10/14/10

Flu information for the general public

The first and most important step in protecting against the flu is to get a flu vaccination each season. US CDC recommends that everyone 6 months of age and older be vaccinated against the flu this year. Vaccine is already available in many places – you can check listings by zip code at www.flu.gov – and it will provide protection through the entire flu season.

The 2010-2011 flu vaccine will protect against:

· an influenza type A H3N2 virus,

· an influenza type B virus, and

· the 2009 H1N1 virus that caused so much illness last season.

You need to get the 2010-11 seasonal flu vaccine even if you got the 2009 H1N1 flu vaccine last season.

While there is a universal vaccination recommendation this season, it continues to be especially important that people at increased risk of serious flu complications get vaccinated against the flu. This includes:

· older people,

· young children,

· people with chronic lung disease (such as asthma and COPD), diabetes (type 1 and 2), heart disease, neurologic conditions, and certain other long-term health conditions,

· pregnant women, as well as

· American Indians and Alaska Natives, and

· people who are morbidly obese (defined as Body Mass Index (BMI) of 40 or more)

Over the years, hundreds of millions of people in the U.S. have safely received seasonal flu vaccines. Last flu season, about 80 million people in the U.S. also received the vaccine made to protect against the 2009 H1N1 virus, and the vaccine’s safety was similar to that of seasonal flu vaccines. Over the last 50 years, flu vaccines have been shown to be safe. Every year, CDC works closely with FDA, health care providers, state and local health departments, and other partners to ensure the highest safety standards for flu vaccines. CDC also works closely with FDA to ensure systems are in place to promptly detect unexpected health problems following vaccination.

Update on state-supplied vaccine distribution

Most influenza vaccine arrives in Maine through private sector channels, but some federal and state funds allow Maine CDC to purchase flu vaccine for some populations in Maine such as pregnant women, those in nursing homes, K-12 school children and their teachers and other staff, all other children, homeless people,, and people served by municipal and tribal health departments. Maine CDC will be distributing a total this year of about 290,000 doses of influenza vaccine, with over half of it having already arrived.

Doses Approved for Shipment as of Oct. 4:

Population	Doses
Children ages 6 months to 18 years	131,680*
Adults	34,560
Nursing homes and long-term care facilities	11,650
Total	177,890

* This includes doses shipped to both schools and private health care providers.

Number of schools that have received flu vaccine so far: 156

Number of doses distributed to schools so far: 49,090

All health care providers who have fulfilled the requirements in their provider agreements have received some vaccine toward their orders. If you are a provider who has not yet received vaccine, ensure that you have submitted all the appropriate paperwork and temperature logs.

Billing for state-supplied flu vaccine administration

Providers who receive state-supplied vaccine may not bill insurance for the cost of the vaccine itself. However, it is reasonable and allowable to bill insurance or charge for an administration fee for the administering the state-supplied vaccine in some circumstances, provided that:

1. MaineCare eligible children are not charged an out of pocket administration fee;
2. Administration fees do not exceed the regional Medicare maximum ($14.37/vaccine administration); and
3. No one is denied vaccine because of their inability to pay an administration fee.

Maine CDC and the Office of MaineCare Services have worked together to enable roster billing for administration fees provided to MaineCare-eligible individuals. The ability to roster bill through ImmPact2 will be available October 18. For more information: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators-RosterBillingUpdateMeCare.pdf

Due to the large number of private insurers, Maine CDC has not been able to arrange for roster billing arrangements with private insurers. For more information on how to bill private insurers for flu vaccine administration, contact the insurer directly.

School-based Flu Vaccine Clinics

The governor has issued an executive order to provide certain liability protections to volunteer health care workers who register with Maine Emergency Management Agency and participate in school-based flu vaccine clinics. To register, visit https://www.maineresponds.org/.

Maine CDC has posted materials – including registration forms, consent forms, sample protocols, and a copy of the governor’s executive order – at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#schoolclinics.

Flu Information for Health Care Workers (HCW)

Flu can spread rapidly in health care settings. Vaccination is the first and most important step all Health Care Workers (HCW) can take to protect against the flu. HCW include all people whose occupational activities involve contact with patients or contaminated material in health care settings, including home health care or clinical laboratory settings. This includes those who do not provide direct patient care, but have patient contact as well as those working in clinical settings within non-health care institutions, such as school nurses or those staffing clinics in correctional facilities. For more information on who is considered a Health Care Worker and why HCW should get vaccinated against the flu, see our new Health Care Workers and Flu web site at http://www.maine.gov/dhhs/boh/maineflu/hc-workers.shtml

US CDC, Maine CDC, and other professional groups recommend that all Health Care Workers get annual influenza vaccine. However, fewer than half of HCW nationwide get the flu vaccine. With the emergence of the pandemic H1N1 flu in 2009, Maine CDC required health care facilities to report the rate of their workers vaccinated against H1N1. For these rates and other information, please see our Current Messages to Health Care Providers at http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml

Maine CDC has also issued a health alert (http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=143003&v=alert) for health care providers to provide information and guidance for the 2010-2011 flu season.