Salmonella risk

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

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

What can parents do to keep children safe?

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

· Supervise children while playing with baby chicks.

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

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

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

· Keep chicks away from food handling areas.

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

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

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

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

April Awareness Campaigns

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

National Public Health Week, April 4-10

World Health Day, April 7

National Infant Immunization Week, April 23-30

National Autism Awareness Month

National Cancer Control Month

National Donate Life Month

National Minority Health Month

STD Awareness Month

2011 County Health Rankings

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

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

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

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

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

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

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

Influenza Update

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

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

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

Weekly updates on flu activity are available

• For Maine
  
• For the US
  
• For the world
  

World Water Day

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

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

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

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

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

Natural Disasters and Public Health

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

Radiation concerns

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

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

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

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

National Women and Girls HIV/AIDS Awareness Day

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

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

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

What can providers do?

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

HIV test sites in Maine

Pertussis Update

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

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

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

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

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

Tdap Vaccination Strategies

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

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

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

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

PCR Diagnosing of Pertussis – Best Practices

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

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

Influenza Update 3/3/11

Surveillance

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

Weekly updates on flu activity are available

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

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

Vaccination

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

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

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

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

Update on HIV, STDs, and Viral Hepatitis

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

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

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

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

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

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

HIV

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

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

STDs

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

Viral Hepatitis

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

The following articles have been published in the MMWR:

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

Update on Vaccine Preventable Diseases

Recommended Immunization Schedules for Children

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

National Vaccine Plan

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

Tdap Vaccination Strategies

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

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

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

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

PCR Diagnosing of Pertussis – Best Practices

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

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

Influenza Update

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

Weekly updates on flu activity are available

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

What do you know about cardiovascular disease?

It’s American Heart Month and this month’s edition of US CDC’s Vital Signs focuses on cardiovascular disease and what we can do to increase control of high blood pressure and cholesterol -- reducing the number of heart attacks, strokes, and other cardiovascular diseases.

Today is National Wear Red Day, established to raise awareness about heart disease in women. Heart disease is the number one killer of women. It can begin early, even in the teen years. A woman's risk for heart disease rises between the ages of 40 and 60. No matter how old you are, you can take steps to lower your risk for heart disease.

Cardiovascular disease claims the lives of more than 800,000 adults each year, 150,000 of whom are under the age of 65. Every 39 seconds, an adult dies from a cardiovascular disease such as a heart attack or stroke. Know what to ask your doctor if you have high blood pressure. Know the signs and symptoms of heart attack.

Managing your cholesterol is another way to help keep your heart healthy.

Check out My Life Check from the American Heart Association/American Stroke Association. For more information on cardiovascular health, visit http://www.mainehearthealth.org/

Combat cervical cancer through regular screening

Early detection continues to be the best way to combat breast and cervical cancer. The Maine Breast and Cervical Health Program (MBCHP) is a comprehensive breast and cervical cancer early detection program housed within Maine CDC’s Division of Chronic Disease. The program’s mission is to help low-income, uninsured and underinsured women gain access to breast and cervical cancer screening and diagnostic services to support and enhance breast and cervical cancer control activities statewide.

January is Cervical Health Awareness Month. To date, more than 318 breast cancers and 86 cervical cancer/pre-cancerous conditions have been detected because of the quality and timely services delivered by MBCHP providers statewide.

What do you know about radon?

January is National Radon Action Month. Radon is a radioactive gas that is formed from naturally occurring elements in rocks and soil. It can filter through soil and enter the basement of a home. It can also dissolve in the water and be released to the air in the home as you use the water. Radium and uranium, the naturally occurring elements that produce radon, can also dissolve in well water. These elements emit a type of radiation known as alpha radiation. Some people who drink water with high levels of alpha emitters over many years may have an increased risk of getting cancer and other health problems.

Radon and other alpha emitters can be detected through laboratory tests. These test kits are available at the Maine Health and Environmental Testing Laboratory and at private laboratories.

Maine CDC’s Radiation Control Program provides free information packets on different aspects of radon.

January is National Birth Defects Prevention Month

Birth defects affect approximately one in 33 newborns and are a leading cause of infant mortality in the United States. Congenital heart defects affect nearly 1% of all babies born in the US.

This year, National Birth Defects Prevention Month focuses on medication use before, during, and after pregnancy. This includes over-the-counter or prescription medications and herbal or dietary products, such as folic acid. Below you will find links that provide further information and materials to have a healthy pregnancy.

The Maine Birth Defects Program (MBDP) was established by law in 1999 and is designed to be a central source of information on the occurrence of birth defects in Maine. Check out these additional resources.

Stay safe and healthy this winter

Winter storms and cold temperatures can be hazardous, but if you plan ahead, you can stay safe and healthy. Maine CDC has updated its Winter Health web site with current information on safe wood burning, carbon monoxide poisoning prevention, and hypothermia prevention.

Additional Information and Resources

• Maine Prepares winter safety and preparedness information from MEMA
• Winter weather health from US CDC
• Winter weather preparedness from FEMA
• Cold stress information for outdoor workers from the National Institute for Occupational Safety and Health and OSHA
• Monitor Maine-specific information from the National Weather Service
• Road conditions

Food safety

About 48 million people (1 in 6 Americans) get sick; 128,000 are hospitalized; and 3,000 die each year from foodborne diseases, according to new estimates from US CDC. The Food Safety Modernization Act brings sweeping improvements to the security and safety of our nation’s food supply.

For more information, see this Q&A from from the US Food & Drug Administration (FDA).

Increase in pertussis

Since November 1, 2010, there have been 14 cases of pertussis (whooping cough) reported to Maine CDC. Cases have been reported in Cumberland, Aroostook, Androscoggin, and Hancock counties with an identified cluster of cases in Penobscot county. Cases range in age from 7 years to 60 years. For the same time frame in 2009, 7 cases of pertussis were reported.

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

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

For more information, see this Health Alert.

Influenza Update

A report detailing Maine CDC’s response to the 2009 H1N1 pandemic and recommendations for similar events is now available on our web site. The 2009 H1N1 Influenza Pandemic After Action Summary includes a discussion of events and actions, findings from evaluation activities and debriefings, recommendations, and current progress.

Sporadic seasonal flu activity has been reported in Maine for the past week. 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.

New acting director at Maine CDC

Stephen D. Sears, MD, MPH is the Acting Director of Maine CDC. Dr. Sears has been the State Epidemiologist for almost a year. A well-known infectious disease physician, Dr. Sears joined Maine CDC after being Vice President for Medical Administration and Chief Quality Officer at Mercy Hospital. He had previously been the Chief Medical Officer at MaineGeneral Health.

Dr. Dora Anne Mills has resigned after 14 and a half years as Maine’s public health director. She has joined the Office of MaineCare Services as Medical Director.