Public health workforce

Maine CDC and the Hanley Center for Health Leadership have been working together and with many organizations statewide and across the New England region to focus on improving the capacity, knowledge, and performance of Maine's current and future public health workforce. The goal is to develop highly engaged and skilled workforce to lead Maine's efforts to accomplish its public health goals.

Shifting priorities in public health, changes in the delivery of health care, and rapidly evolving technology have driven the need for workforce and capacity development. A comprehensive Public Health Workforce Development Plan has been drafted for Maine CDC. The final version of the plan is expected to be available by April 2015. One element of this plan is the creation and sharing of a series of online educational training sessions. The first four trainings are now available; the topics are: Foundations of Public Health,Bedbugs; Drinking Water and Public Wells; and Lyme Disease. Many additional trainings will be made available over the next year and ongoing.

Public health and other health professionals are encouraged to participate in this program. To access the trainings, go to http://mcdc.trainingserver6.net/login/index.php, choose Create a New Account and follow the simple instructions on how to register. Along with the presentation and quiz questions, an evaluation form and certificate of completion are also available online. Feedback is welcome and encouraged, as it will be used to inform future trainings and to ensure that all trainings are as useful and as effective as possible.

For more information about this program, please e-mail christine.zukas@maine.gov. We look forward to your participation and feedback.

Measles

The United States is currently experiencing a large, multi-state outbreak of measles linked to an amusement park in California. The last confirmed case of measles in Maine was in 1997. 

On January 23, 2015, US CDC issued a Health Advisory to notify public health departments and healthcare facilities about the multi-state outbreak and to provide guidance for healthcare providers nationwide (http://emergency.cdc.gov/han/han00376.asp).

Measles is highly contagious and spreads through the air when an infected person coughs or sneezes. Measles can cause serious health complications, such as pneumonia or encephalitis, and even death. Children younger than 5 years of age and adults older than 20 years of age are at high risk of getting a serious case of measles. About 1 in 4 unvaccinated people in the U.S. who get measles will be hospitalized; about 1 in 500 may die.

Guidance for healthcare providers

• Ensure all patients are up to date on measles, mumps, rubella (MMR) vaccine.
• Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms (cough, coryza, and conjunctivitis), and ask patients about recent travel internationally or to domestic venues frequented by international travelers, as well as a history of measles exposures in their communities.
• Promptly isolate patients with suspected measles to avoid disease transmission and immediately report the suspect measles case to the health department.
• Obtain specimens for testing from patients with suspected measles, including viral specimens for genotyping, which can help determine the source of the virus. Contact the local health department with questions about submitting specimens for testing.

For more information, go to http://www.cdc.gov/measles/ 

Routine Pap Tests Can Prevent Cervical Cancer

Maine CDC reminds women of the importance of regular screenings to prevent cervical cancer as it recognizes January as National Cervical Cancer Awareness Month.

“As many as 93 percent of cervical cancers could be prevented by screening and HPV vaccination’’ said Dr. Sheila Pinette, Director of the Maine CDC. “If a woman has never had a Pap test or it has been more than three years since her last test, it may be time for her to speak with a healthcare provider and schedule a test.”

Before the development of the Pap test, cervical cancer was one of the most common causes of cancer death for American women. As an available, accepted, and cost-effective screening test, the Pap test can detect cervical cell changes before they become cancerous. Governor Paul LePage and First Lady Ann LePage encourage Maine women to take this important preventative measure because of its effectiveness.

Starting at age 21, routine Pap tests for women can find potentially cancerous cells growing in the cervix. As the Human papillomavirus (HPV) is associated with most cervical cancers, current cervical cancer screening recommendations include the high-risk HPV DNA test along with the Pap test for women age 30-65. Women should talk with their doctors, as screening recommendations can vary for each individual.

The Maine CDC Breast and Cervical Health Program can provide information about screening tests, as well as limited resources for free cancer screening services for women over age 35 who have never had a Pap test and meet financial eligibility requirements. Those interested can call 1-800-350-5180 or 1-207-287-8068. TTY users can call Maine Relay at 711.

More details can also be found at: http://www.maine.gov/dhhs/mecdc/population-health/bcp/index.htm

Vaccine guidelines for adults and children

Easy-to-read guidelines are available on the Maine CDC and US CDC websites:

• The recommended immunization schedule for children is available at http://go.usa.gov/Gh4A
• The recommended immunization schedule for teens is available at http://go.usa.gov/Gh2Q
• The recommended immunization schedule for adults is available at http://go.usa.gov/GhgR

In addition, US CDC has developed a fact sheet that addresses common questions about pneumococcal vaccination for adults, including the difference between PCV13 and PPSV23 vaccines:

• PCV13 (pneumococcal conjugate vaccine) protects against 13 of the approximately 90 types of pneumococcal bacteria that can cause pneumococcal disease, including pneumonia, meningitis, and bacteremia.
• PPSV23 (pneumococcal polysaccharide vaccine)protects against 23 types of pneumococcal bacteria. This vaccine helps prevent invasive infections like meningitis and bacteremia, but only offers low levels of protection against pneumonia. 

The full fact sheet is available at http://go.usa.gov/Gha9

Shigellosis

Maine is experiencing an increase in reported cases of shigellosis. Transmission of shigellosis is due to direct or indirect contact with contaminated surfaces, individuals with symptoms or asymptomatic carriers of the bacteria, and consumption of contaminated water or food.

The best way to prevent transmission is to wash hands well and frequently. Symptoms of shigellosis include diarrhea, which can be bloody, fever, and abdominal cramps or pain.

To prevent the spread of Shigellosis:

• Wash hands with soap and water carefully and frequently.
• People with diarrheal illness should contact their health care provider and request testing.
• People with diarrhea should not go to work, school, or participate in any activities.
• People employed in high-risk settings (handle food, provide patient care, work in a daycare) must have two negative stool specimens before they can return to work. These stool specimens must be collected 48 hours after antibiotics end and collected 24 hours apart.

For health care providers:

• If prescribing antibiotics: resistance to first-line drugs like ampicillin and trimethoprim-sulfamethoxazole is common, and resistance to other drugs is increasing; determine antibiotic susceptibilities prior to prescribing antibiotics.
• Health care providers with patients with diarrheal illness should order bacterial stool cultures and antibiotic resistance testing.
• Providers should remind patients to stay out of school, work, and other activities while they have diarrhea or follow exclusions for individuals in high risk settings.
• Remind patients to wash hands with soap and water carefully and frequently, especially after using the bathroom.

All suspect cases and positive laboratory reports should be reported to the 24/7 disease reporting and consultation line at 1-800-821-5821 or by fax to 1-800-293-7534.

For More Information:

• Maine CDC website, including hand washing posters:http://www.maine.gov/idepi
• US CDC's shigellosis websitehttp://www.cdc.gov/shigella/general-information.html

Be smart about your heart: Control the ABCS of Diabetes

It is estimated that 87,232 Mainers have diabetes and an additional 32,264 have it but do not know they have it.  If left undiagnosed and untreated diabetes can lead to serious health problems like heart disease, stroke, blindness, kidney disease, amputation, or death.

November is National Diabetes Month.  This year's theme highlights the critical link between diabetes and heart disease.  Adults with diabetes are nearly twice as likely to be hospitalized for a heart attack or die of heart disease and are 1.5 times more likely to be hospitalized for a stroke than adults without diabetes.

Control the ABCS of Diabetes:

• A1c Blood Glucose Level
  • An A1c test shows what your blood glucose (blood sugar) level has been for the last 3 months
  • High blood glucose levels can harm your heart, blood vessels, kidneys, eyes, and feet
• Blood Pressure
  • High blood pressure makes your heart work too hard
  • It can cause heart attack, stroke, and kidney disease
• Cholesterol
  • Bad cholesterol (LDL) can build up and clog your blood vessels
  • Can cause a heart attack or stroke
• Smoking
  • Stop smoking
  • Call the Maine Tobacco Helpline: 1-800-207-1230

Heart disease can be a serious health problem for people with diabetes.  Taking care of your diabetes means you have less chance of having a heart attack or stroke.  Here is what you can do:

• Eat well
• Be active
• Learn how to cope with stress
• Take your medicine
• Stop smoking
• Attend Diabetes Self-Management Training (DSMT).  Ask your doctor or visit the Maine Diabetes Prevention and Control Program website to find a DSMT in your area

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

For more information, Maine DPCP recommends: 

• National Diabetes Education Program
• National Diabetes Prevention Program (NDPP) 

Breast cancer

During 2014, it is estimated that more than 1,200 women will be diagnosed with breast cancer and 190 women will die from the disease. As National Breast Cancer Awareness month winds down, the Maine Center for Disease Control and Prevention reminds women that regular screening mammograms are critical in diagnosing and beginning treatment of the disease.

 Not all breast cancer is accompanied by a lump that is discovered during a breast exam, which is why a regular mammogram is so important.  Women should enter into a personal discussion regarding their screening with their primary care physicians and decisions should be individualized.

 A screening mammogram can detect breast cancer early, even before symptoms arise.  Women between ages 50 to 74 should have a screening mammogram every two years, while women age 40 to 49 should talk to their doctor about when and how often to have this screening.

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

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

More details can also be found at: http://go.usa.gov/GF8R 

Flu update 10/29/14

The flu has officially arrived in Maine for the 2014-2015 season. For more information, see the Oct. 17 health alert at: http://go.usa.gov/G6Vk 

Maine CDC reminds everyone to take everyday preventive measures against the flu:

• Wash your hands frequently;
• Cough and sneeze into your elbow or shoulder;
• Stay home when you feel sick;
• Get vaccinated. 

If you have the flu:

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

Flu Activity

 Maine CDC reported sporadic flu activity for the week ending Oct. 25. Weekly updates are available online:

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

Flu Vaccination

US CDC recommends yearly flu vaccine for everyone 6 months of age and older. It takes about two weeks after vaccination to develop full immunity. To find a flu vaccine in your area, call 211, search www.211maine.org or http://flushot.healthmap.org/, or contact your health care provider.

For more information about flu vaccine: 

• Key facts about flu vaccine: http://go.usa.gov/yksA 
• How flu vaccines are made: http://go.usa.gov/ykHB 
• Vaccine recommendations: http://go.usa.gov/ykHw 
• Vaccine information statements (VIS): http://go.usa.gov/jdAC

For more information, go towww.maineflu.gov or http://www.cdc.gov/flu/ 

New pneumococcal recommendations

In August 2014, the Advisory Committee on Immunization Practices (ACIP) voted to recommend pneumococcal conjugate vaccine (PCV13, Prevnar-13®) for all adults 65 years or older. This dose is in addition to the existing recommendation of one dose of pneumococcal polysaccharide vaccine (PPSV23, Pneumovax®23).

• PCV13 was licensed by the FDA (Food and Drug Administration) for use in adults 50 years or older in 2011.
• Both PCV13 and PPSV23 should be routinely administered in series to all adults 65 years or older.
• The two pneumococcal vaccines should not be administered at the same visit.
• PCV13 should be given before PPSV23 because the optimal immune response is achieved when PCV13 is given first followed by PPSV23 for patients who have NEVER received PPSV23.

Both PCV13 and PPSV23 provide good protection against invasive forms of infection caused by vaccine-type pneumococci. 

 

For adults previously vaccinated with PPSV23:

• Adults 65 years of age or older who have previously received one or more doses of PPSV23 should also receive a dose of PCV13 if they have not yet received it.

• A dose of PCV13 should be given at least 1 year after the receipt of the most recent PPSV23 dose.

For those for whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 6 to 12 months after PCV13 and at least 5 years since the most recent dose of PPSV23.

 For pneumococcal vaccine-naïve adults: 

• Adults 65 years of age or older who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed 6 to 12 months later by a dose of PPSV23.
• If PPSV23 cannot be given during the 6 to 12 month time window, the dose of PPSV23 should be given during the next visit after 12 months. PPSV23 should not be given less than 8 weeks after the PCV13 dose.

Recommendations for routine use of PCV13 in adults at increased risk for pneumococcal disease remain unchanged: 

• Adults 19 years of age or older with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, and who have not previously received PCV13 or PPSV23, should receive a dose of PCV13 first followed by a dose of PPSV23 at least 8 weeks later.
• Adults at increased risk for pneumococcal disease who received PCV13 at 64 years or younger should not receive another dose of PCV13 at 65 years or older. 

For more information visit http://www.cdc.gov/pneumococcal/clinicians/ or http://www.cdc.gov/mmwr/pdf/wk/mm6337.pdf

If you have any questions, please call the Maine Immunization Program at 287-3746 or 1- 800-867-4775

Enterovirus D68

US CDC has notified Maine CDC of a single confirmed case of Enterovirus D68 (EV-D68) in a school-aged child from York county. The child was hospitalized for four days with cough, wheezing, shortness of breath, difficulty breathing, retractions, cyanosis, vomiting, and chest pain. The child was not in intensive care and was released from the hospital and is recovering.

Enteroviruses are associated with various clinical symptoms from mild to severe. EV-D68 causes primarily respiratory illness, although the full spectrum of disease remains unclear. EV-D68 was originally isolated in 1962 and, since then, has been reported rarely in the United States. Small clusters of EV-D68 associated with respiratory illness were reported in the United States during 2009-2010. There are no available vaccines or specific treatments for EV-D68 and clinical care is supportive. All but one confirmed case have been in children. EV-D68 has now been confirmed in more than 40 states; this is the first confirmed case in Maine.

To prevent the spread of EV-D68, wash hands frequently and cough or sneeze into your elbow or shoulder. If you feel sick, stay home and avoid close contact with others. Disinfect commonly used areas, like tables, counters, and doorknobs.

For more information, see the health alert at http://www.maine.gov/tools/whatsnew/attach.php?id=628931&an=2 or visit our website at http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/enterovirus.shtml 

Ebola

A Texas hospital patient has tested positive for ebola, making the patient the first case diagnosed in the United States. The patient is an adult with a recent history of travel to West Africa who developed symptoms days after returning to Texas and was admitted into isolation on Sunday at a hospital in Dallas. Texas health officials and US CDC are working to investigate the case and prevent transmission of the disease.

There have been no reported cases of ebola in Maine. 

The current outbreak of ebola virus disease (EVD) in West Africa is the largest outbreak of EVD ever documented and the first recorded in West Africa. For ongoing information about the outbreak in West Africa, go to http://go.usa.gov/Eu9B
  

US CDC advises US residents to avoid all non-essential travel to the West African countries of Liberia, Sierra Leone, and Guinea and to practice enhanced precautions when traveling to Nigeria. For more details on enhanced precautions, please see http://go.usa.gov/Eu9e.

For travelers who have recently been to affected countries in West Africa, Maine CDC advises that you self-monitor general health for 21 days after departing West Africa. Travelers should be especially vigilant for symptoms of fever (>101.5°F or 38.6°C), severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, and unexplained bleeding. Should you develop any of these signs of symptoms, please seek medical attention immediately and inform your provider of your recent travel history.

Maine CDC issued an update for health care providers Aug. 1. The health alert is available at http://go.usa.gov/NEHH 

While the possibility of infected people entering the US remains low, Maine CDC advises health care providers in Maine to consider EVD in the differential diagnosis of febrile illness with compatible symptoms in any person with recent (within 21 days) travel history in the affected countries, and consider isolation of those patients meeting these criteria, pending diagnostic testing. If a provider suspects EVD, the patient should be placed in isolation and the provider should call Maine CDC (1-800-821-5821) for guidance on possible testing. Other infectious diseases, such as Malaria, Yellow fever, dengue fever, and chikungunya should be ruled out.

Flu update 9/18/14

Weekly updates on flu activity in Maine will resume in October. Maine CDC reminds everyone to take everyday preventive measures against the flu:

• Wash your hands frequently
• Cough and sneeze into your elbow or shoulder
• Stay home when you feel sick
• Get vaccinated

Conference Call

Maine CDC is hosting a "Start of the 2014-15 Influenza Season" conference call from 2-3 p.m. September 24. 

The intent of this call is to provide updates for the season, outline resources available, and remind facilities what the requirements are for the influenza season. 

This call is particularly relevant for: Infection practitioners, providers, laboratorians, employee health, emergency preparedness, hospital administration, and long term care facilities. Talking points will be distributed after the call, as well as questions and information highlighted on the call. 

The call-in number will be 877-455-0244, code 668-182-0529. 

Vaccine recommendations

US CDC recommends a yearly flu vaccine for everyone 6 months of age and older. While there are many different flu viruses, the seasonal flu vaccine is designed to protect against the top three or four flu viruses that research indicates will cause the most illness during the flu season. Medical providers should be vaccinated and begin vaccinating patients soon after flu vaccine becomes available, ideally by October, to ensure that as many people as possible are protected before flu season begins.

Starting this season, US CDC recommends use of the nasal spray vaccine in healthy children ages 2 to 8 when it is immediately available and if the child has no contraindications or precautions to that vaccine. Recent studies suggest that the nasal spray flu vaccine may work better than the flu shot in younger children. However, if the nasal spray vaccine is not immediately available and the flu shot is, children age 2 to 8 years should get the flu shot. Don't delay vaccination to find the nasal spray flu vaccine.

Vaccine is already available in some locations. It takes about two weeks after vaccination to develop full immunity. 

For more information: 

• Key facts about flu vaccine: http://go.usa.gov/yksA 
• How flu vaccines are made: http://go.usa.gov/ykHB 
• Vaccine recommendations: http://go.usa.gov/ykHw 
• Vaccine information statements (VIS): http://go.usa.gov/jdAC

For more information, go to http://www.cdc.gov/flu/ 

Enterovirus D68

US CDC is working closely with hospitals and local and state health departments to investigate recent increases in hospitalizations of patients with severe respiratory illness. From mid-August to September 17, a total of 140 people in 16 states (AL, CT, CO, IL, IN, IA, KS, KY, LA, MO, MT, NY, NE, OK, PA, and VA) were confirmed to have respiratory illness caused by Enterovirus D68 (EV-D68).

Investigations into suspected clusters in other jurisdictions are ongoing. Many states are likely affected by respiratory illnesses caused by EV-D68, but it is too soon to know how widespread it is in the United States. As investigations progress, we will have a better understanding of the whether the trends for EV-D68 infections are going up or down.

Maine CDC issued a health alert on Sept. 15 to provide awareness of EV-D68 as a possible cause of acute unexplained respiratory illness and to provide guidance to health care providers.

No confirmed cases have been identified in Maine, but Maine CDC has sent samples for further typing.  Maine CDC is encouraging providers to consider this illness in their diagnosis and to report any suspect cases or clusters of severe illness. 

For more information, see the health alert at http://go.usa.gov/pj5d

National Childhood Obesity Awareness Month

About 1 of every 5 (17%) children in the United States has obesity, and certain groups of children are more affected than others. Childhood obesity puts America's children at early risk for type 2 diabetes, high blood pressure, and heart disease -conditions usually associated with adulthood.

Self-reported data from the 2013 Maine Integrated Youth Health Survey show that more than 20% of fifth graders, more than 14% of students in 7th and 8th grades, and nearly 13% of high school students in Maine are obese.

There is no single or simple solution to childhood obesity. It is influenced by many different factors, including a lack of access to healthy, affordable food and drinks as well as limited opportunities for physical activity in the places where children live, learn, and play. Working together, states, communities, and parents can help make the healthy choice the easy choice for children and adolescents.

For more information, go to http://go.usa.gov/pjn5

National Preparedness Month

September 2014 marks the eleventh annual National Preparedness Month, which is being supported by more than 3,000 public and private organizations all across the country. One goal of Maine CDC's Public Health Emergency Preparedness Program is to help educate individuals about how to prepare for emergencies, including natural disasters, mass casualties, biological and chemical threats, radiation emergencies, and terrorist attacks. Would you be prepared if there was an emergency today?

Follow these four steps to join Maine CDC's emergency preparedness efforts:

• Get a Kit
• Make a Plan
• Be Informed
• Get Involved

During September, Maine CDC is focusing our emergency preparedness communication efforts on: 

• Home and family preparedness, including older Americans with disabilities and special needs 
• Back-to-school Ready Kids
• Learning how to shelter in place during an emergency

The Emergency Preparedness and Response offers additional information and resources under topics such as hurricane preparedness, extreme heat, and bioterrorism.  

World Rabies Day

Maine will recognized the eighth annual World Rabies Day on September 28.

Rabies is a virus found in the saliva, brain and spinal cord of infected mammals. Rabies is spread most commonly through a bite from an infected animal. Rabies can also be spread from transfer of infected tissue or saliva into an open wound or mucous membrane, such as eyes, nose and mouth. Rabies is not transmitted through urine, feces, blood or any bodily fluid other than spinal cord fluid and saliva.

Rabies is a very serious and fatal disease if not treated. Rabies kills approximately 55,000 people each year worldwide. Though the last human case of rabies in Maine was documented in 1937, rabies is still a public health concern in Maine. Due to the availability of rabies post-exposure treatment, many potential human rabies deaths have been avoided. In Maine, 81 people were recommended for post-exposure prophylaxis (PEP) in 2013. The best way to stay rabies-free is to avoid wildlife and any animal that you don’t know. Report all exposures to your healthcare provider or Maine CDC right away.

In 2013, the State of Maine diagnosed 51 cases of animal rabies at the Health Environmental Testing Laboratory (HETL). As of August 15, 2014, there were 26 animal rabies cases in 2014 diagnosed in the following species: raccoon, skunk, fox, cat, cow, and woodchuck. Rabies is endemic in wildlife in Maine. The majority of animal rabies cases occur in wildlife, including in raccoons, skunks, foxes, and bats.

All Mainers are encouraged to consider ways in which they can prevent the spread of rabies. These include:

• Vaccinate your pet cats and dogs against rabies; it is the law.
• Avoid contact with wild animals or other animals that you do not know.
• Bat proof your home. Wildlife biologists can provide tips on how to bat proof your home without harming bats but preventing them from entering your home. 

In 2006, the Alliance for Rabies Control, a U.K. charity, formed to promote rabies prevention worldwide. The Alliance, along with the U.S. Centers for Disease Control and Prevention, declared September 28 World Rabies Day. All partners, including international health organizations, national, state and local public health partners, professional organizations, commercial pharmaceutical companies and foundations are called upon to plan events throughout the world to increase awareness about rabies and to raise support and funding towards its control and prevention.

For more information, visit our website at www.mainepublichealth.gov/rabies.

Suicide Prevention

As news spreads of the death of actor Robin Williams by suspected suicide, the Maine Suicide Prevention Program at Maine CDC takes a moment to share the following information.

Depression is a leading risk factor for suicide. It doesn’t matter who you are or what your job is, depression can touch anyone. Signs of depression include:

• Mood – sad, irritable, angry
• Withdrawing from friends, family, activities
• Changes in sleep, appetite or weight
• Feeling worthless or guilty
• Not able to think or focus
• Hopelessness – seeing no chance of improvement

The sense of hopelessness that goes along with depression can make suicide feel like the only way to escape the pain. Thoughts of death or suicide are a serious cry for help.

Depression is a treatable medical illness. Help is available, please reach out.

If you are concerned about yourself or about somebody else, call the Maine suicide crisis hotline at 1-888-568-1112. If you need immediate help, dial 911 or go to your nearest emergency room.

If you are not in Maine, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Tick-Borne Diseases Update

Summer is in full swing and the increase in tick-borne diseases demonstrates that. Maine CDC is receiving reports of multiple tick-borne diseases, some in record numbers. Physicians have already reported more Anaplasmosis cases so far this year than all of last year, and Babesiosis and Lyme numbers are steadily increasing as well. Providers should be aware of the risk and prevalence of these diseases and consider them in their diagnoses.

Anaplasmosis:

• Caused by the Anaplasma phagocytophilum bacteria, carried by the deer tick (Ixodes scapularis)
• Signs and symptoms include: fever, headache, malaise, and body aches. Encephalitis/ meningitis may occur but is rare
• 98 cases have been reported to date in 2014, compared to 94 in all of 2013
• Polymerase Chain Reaction (PCR) is the preferred testing method

Babesiosis:

• Caused by the Babesia parasite, carried by the deer tick (Ixodes scapularis)
• Signs and symptoms include: extreme fatigue, aches, fever, chills, sweating, dark urine, and anemia
• 17 cases have been reported to date in 2014, compared to 36 in all of 2013
• PCR or identification of the parasite in a blood smear are the preferred testing methods

Lyme disease:

• Caused by the Borrelia burgdorferi bacteria, carried by the deer tick (Ixodes scapularis)
• Signs and symptoms include: erythema migrans rash, fever, headache, joint and muscle pains, fatigue, arthritis, Bell’s palsy, meningitis, and carditis
• 526 cases have been reported to date in 2014, compared to 1,376 in all of 2013
• Lyme disease cases take several months to be entered and classified, so although these numbers may seem low they will increase dramatically as reports are received and processed
• Two tier testing (ELISA or EIA, followed by Western blot) is the preferred testing method

Powassan:

• Caused by the Powassan virus, carried by the woodchuck tick (Ixodes cookei) and potentially by the deer tick (Ixodes scapularis)
• Signs and symptoms include: fever, headache, vomiting, weakness, confusion, seizures, and memory loss
• 0 cases have been reported to date in 2014, compared to 1 in all of 2013
• Testing is performed by federal CDC, samples should be sent to Maine’s Health and Environmental Testing Laboratory (HETL) to be forwarded to CDC Fort Collins

Co-infections: Because all of these diseases are carried by the same tick (Ixodes scapularis), a patient may be infected with more than one disease.

• To date in 2014, three co-infections have been reported: two co-infections with anaplasmosis and Lyme disease, and one co-infection with babesiosis and Lyme disease
• In 2013, 16 co-infections were reported: nine co-infections of Lyme disease and anaplasmosis, four co-infections of Lyme disease and babesiosis, two co-infections of anaplasmosis and babesiosis, and one co-infection of Lyme disease, anaplasmosis, and babesiosis.

Uncommon illnesses:

• Ehrlichiosis is a bacterial disease, carried by the Lone Star tick which is unusual in Maine, but very common in the southern United States. PCR is the preferred testing method.
• Rocky Mountain Spotted Fever is a bacterial disease carried by multiple ticks. Maine has a tick that is a potential carrier (the dog tick, Dermacentor variabilis), but they are not known to be infected in Maine.

Recommendations for Providers:

• Consider tick-borne illnesses in your differential, particularly for individuals with “summer flu” symptoms
• Submit samples for testing 
• Treat patients appropriately – recommendations for treatment are available from http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
• Report cases. All tick-borne illnesses are reportable in Maine, including the erythema migrans rash which is confirmatory. To ease the reporting burden of EM rashes, a registry report option is available (see page 3). All cases should be reported by phone to 1-800-821-5821 or by fax to 1-800-293-7534.

For more information:

• Maine CDC vectorborne webpages: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/index.shtml
• Maine Physician’s Reference Guide: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/documents/tick-reference-guide.pdf
• Lyme forms for providers: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/lyme/index.shtml#resourcephysicians
• Guidance on treatment: http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
• Lyme disease data: https://data.mainepublichealth.gov/tracking/home

This information originally appeared in a health alert, which is available at http://www.maine.gov/tools/whatsnew/attach.php?id=625757&an=2 

Whooping cough update

Pertussis (whooping cough) is a cyclical disease that continues to affect a significant number of Maine residents.

Maine CDC issued a health alert with an update on pertussis on Aug. 4. It is available here: http://go.usa.gov/NEG4

As of August 4, providers reported a total of 254 pertussis cases from 15 Maine counties. Washington county has the highest rate in the state of 114.94 cases per 100,000 persons compared to the state's case rate of 19.12 cases per 100,000 persons. Seven Maine counties have rates higher than the state rate (Aroostook, Knox, Lincoln, Oxford, Penobscot, Waldo, and Washington counties).

Maine CDC encourages providers continue to test and treat patients. DTaP vaccine is recommended for all infants and children. Tdap vaccine is recommended for all preteens, teens, and adults.

For more guidance and information, visit http://go.usa.gov/dCO

Breastfeeding

August is National Breastfeeding Month. Breastfeeding is one of the most effective steps a mother can take to protect the health of her baby. 

US CDC's 2014 Breastfeeding Report Card, which provides state and national data on breastfeeding rates as well as information on supports for breastfeeding, is now available at http://www.cdc.gov/breastfeeding/data/reportcard.htm

All of Maine's breastfeeding rates increased in the 2014 report compared to the 2013 report.

For more information on breastfeeding and its health benefits, visit http://www.cdc.gov/breastfeeding/index.htm