Influenza Update 9/29/11

Maine CDC has already distributed almost 154,000 doses of state-supplied influenza vaccine to registered providers for the 2011-2012 season.

Information about second doses for children under 9, school-located vaccine clinic (SLVC) registration forms, and other related materials are available in our SLVC toolkit.

Almost 160 clinics at 49 school districts have already been registered for this season. Maine CDC is pleased to announce that certain vaccine clinic supplies will be available for free to schools offering SLVC this year. Schools that have the supplies they need for clinics can still order items that may help in the prevention and control of influenza in the school. For more information: http://www.maine.gov/dhhs/boh/maineflu/h1n1/toolkit/SLVC-supplies.pdf

US CDC has posted a study on 115 influenza-associated pediatric deaths from September 2010 through August 2011 and highlights the importance of both annual vaccination and rapid antiviral treatment.

A searchable county listing of flu clinics is available at http://www.211maine.org/flu-clinics/

Breast Cancer Awareness Month

The 14th Annual Silver Tea to kick off Breast Cancer Awareness Month was held Sept. 28. The tea was sponsored by Maine First Lady Ann LePage and the member organizations of the Breast Health Cooperative:

American Cancer Society, Maine CDC’s Breast and Cervical Health program, Maine Breast Cancer Coalition, Maine Breast Nurse Network, Maine Cancer Foundation, and the Maine affiliate of Susan G. Komen for the Cure.

Mrs. LePage read the 2011 Governor’s Proclamation designating October as Breast Cancer Awareness Month.

Robert J. Ferguson, PhD, from the Maine Outpatient Rehabilitation Center at Eastern Maine Medical Center, spoke about the association between adjuvant chemotherapy and mild cognitive decline among breast cancer survivors.

Donna Green, RN, BSN, OCN, Clinical Manager of Oncology Administration at Maine Medical Center, was honored with the 2011 Breast Health Leadership Award among professionals.

Patco Construction Company, a family-owned construction business in Sanford, received the 2011 Breast Health Leadership Award among volunteers. The company annually sponsors breast cancer awareness activities, and this year coordinated the production of a two-CD collection that brings together more than two dozen of Maine’s most talented female performers.

World Rabies Day

On September 28, Maine CDC will celebrate the fifth annual World Rabies Day. Established in 2007 by U.S. CDC and the Alliance for Rabies Control, a U.K. charity, this day is dedicated to raise awareness about rabies. Worldwide, more than 50,000 people die from rabies each year.

Rabies is a deadly disease caused by a virus. Rabies is 100% preventable by avoiding wild animals and any animal that you do not know, or by getting rabies shots if an exposure already occurred. A rabies exposure happens when a person or animal comes into contact with the saliva or tissue from the nervous system (brain or spinal cord) of a rabid animal. This contact can be from a bite or scratch, or if the animal’s saliva gets into a cut in the skin or in the eyes, nose, or mouth.

Rabies in people is very rare in the United States, with only one to two cases each year. The last human case of rabies in Maine was in 1937, but this does not mean that rabies is not a problem. Rabies in animals, especially wildlife, is common in most parts of the country, including Maine. The most commonly infected animals in Maine are raccoons, skunks, bats, and foxes. To date in 2011, 51 animals tested positive for rabies.

If you think that you have been exposed to rabies, wash the wound right away with soap and water. Then, call your doctor and the Maine CDC at 1-800-821-5821 to evaluate the need for animal testing and rabies shots. In addition, if you or your pet is exposed to a suspect rabid animal, call your veterinarian and local Animal Control Officer. If you or your pet is exposed to a wild animal, call your local Game Warden.

Follow these steps to prevent rabies:

• 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.

For more information about rabies, visit the Maine CDC website at www.mainepublichealth.gov/rabies.

Contagion

In the last two years, US CDC has sent scientists and doctors out more than 750 times to respond to health threats.

A new movie called Contagion is showing on screens nationwide. Although Contagion is a work of fiction, US CDC scientists were consulted for their help in making the movie as scientifically accurate as possible.

However, the film doesn’t provide a complete picture of the extensive role that state and local public health agencies would play in responding to a major disease pandemic. Over the last ten years, a major effort has been underway to strengthen the emergency response capabilities of state and local public health.

A quick overview of disease outbreak investigation is available from this Public Health Matters blog

Arsenic

There has been publicity recently over the amount of arsenic in the apple juice that many children drink. The Food and Drug Administration (FDA) has issued a statement that there is no evidence of any public health risk from drinking these juices and that FDA has been testing them for years.

Arsenic is a naturally occurring element found in water, air, food, and soil in organic and inorganic forms. Inorganic arsenic compounds can be harmful at high and long-term levels of exposure. Organic arsenic compounds are essentially harmless. Because both forms of arsenic have been found in soil and ground water, small amounts may be found in certain food and beverage products, including fruit juices and juice concentrates.

FDA has been tracking total arsenic contamination in apple and other juices for about six years, since foreign producers started gaining an increasing share of the juice market.

Most people ingest small amounts of arsenic each day from various foods, including rice products and shellfish. One of the big sources of arsenic exposure to be on the lookout for in Maine is arsenic in private well water. Half of Maine families get their drinking water from private wells, and 10% of these wells have arsenic levels above the current drinking water standard of 10 micrograms per liter. Only about 45% of families with wells have tested their well water for arsenic -- if you have a well, make sure you have tested it for arsenic.

For more information about arsenic, see this US CDC fact sheet.

National Newborn Screening Awareness Month

Newborn Screening saves lives, prevents disabilities and saves money. In the last five decades, newborn screening has become a well-defined, nationwide early identification program. Every year, 4 million infants born in the United States are screened shortly after birth for hearing loss and certain genetic, endocrine, and metabolic disorders. Each year, approximately 12,000 infants will be identified with one of these disorders.

The goal of newborn screening is to identify infants who appear healthy at birth, but who may have one of these disorders which can cause severe illness or death. Through early identification and treatment, newborn screening provides an opportunity for significant reductions in morbidity and mortality while reducing health care costs associated with treatment of lifelong debilitating conditions.

Phenylketonuria, or “PKU” as it is commonly referred to, was the first newborn screening test ever developed using dried bloodspots. Screening for PKU has been in place since the 1960s. Screening programs are now testing for 30 disorders, and this number is expected to increase in the future as science and technology continue to advance. The majority of disorders identified through newborn screening require lifelong treatment. The most commonly detected disorders are cystic fibrosis (CF), congenital hypothyroidism (CH), and congenital hearing loss.

For more information about newborn screening in Maine, visit the Maine Newborn Bloodspot Screening Program

Obesity

During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2010, no state had a prevalence of obesity less than 20%. Maine is one of 36 states with a prevalence of 25% or more.

There are a variety of online tools to help you stay active and eat healthier:

• My Fitness Pal lets you track your calories on their website or with free mobile apps: www.myfitnesspal.com
• Find safe environments in Maine to walk: www.healthymainewalks.org
• Learn more about portion size, balanced meals, and get healthy eating tips at www.choosemyplate.gov
• Search for low-cost health care resources in your area – including nutrition and wellness services – at www.keepmewell.org

For more information:

• Maine Physical Activity and Nutrition Program: http://www.maine.gov/dhhs/boh/hmp/panp/

• US CDC: http://www.cdc.gov/obesity/

Bath salts

Unregulated psychoactive substances marketed as “bath salts” are among the latest in a series of legal synthetic substances that, when used improperly, offer alternatives to illegal drugs. “Bath salts” are powerful stimulant drugs that are suspected to have been designed to avoid legal prosecution, and are commonly available on the Internet and in specialty smoke shops.

“Bath salt” products are known to produce certain side effects, some of which are quite severe. This MMWR describes emergency department visits in Michigan over the last year after use of “bath salts.”

In July, Maine enacted legislation to make it illegal to possess or sell any of the 21 different hallucinogenic drugs or stimulants that are sold and marketed as “bath salts.”

For more information, see this Fact Sheet from the state Office of Substance Abuse.

School-based flu vaccine clinics

Maine CDC has received a two-year, $1.25 million cooperative agreement award from US CDC to enhance the sustainability of school-located vaccination. School-located vaccination clinics (SLVC) were first broadly implemented in Maine in response to the 2009 H1N1 flu pandemic. Since then, schools and health care providers in many communities around the state have worked together to continue to offer influenza vaccine to students and staff members in the school setting. SLVC can provide low-cost and convenient opportunities for families to have their children vaccinated each year. In addition, achieving high immunization rates in schools can reduce the number of days that students and staff are absent during the flu season and improve the learning environment.

CDC now recommends that all people over six months of age receive an annual flu vaccine as the best way to prevent influenza. Unlike adults, children have few opportunities to get a flu shot, and primary care doctors may not be able to accommodate the high demand for vaccine in their offices. Maine’s influenza immunization rates among children for the 2010-11 season were well above the national average, but too many Maine children still go without an annual flu shot. Providing vaccines to children in the school setting is a strategy that can improve access and decrease financial barriers that some children may face in getting the flu vaccine.

Among the strengths that were noted in the review of this application were the success of previous years’ SLVC; the use of Maine’s immunization registry system, ImmPact2; and the strengths of the partnerships that have been developed at the local level.

In the 2010-11 school year, more than 350 SLVC were held statewide. Clinics were run by school nurses, hospitals, health centers, visiting nurses’ associations, and primary care practices. Maine CDC recognizes the many organizations and individuals who have worked hard at implementing school vaccination. Funds from this cooperative agreement will be used to further these efforts by:

1.) increasing and supporting SLVC over the next two years;

2.) improving mechanisms of insurance reimbursement to schools and health care providers who provide flu shots in the school setting; and

3.) evaluating the impact of school clinics and developing plans for long-term sustainability beyond the funding period.

More information on specific funding initiatives and opportunities related to this cooperative agreement will be forthcoming. General information on influenza in Maine is accessible at www.maineflu.gov.

An online toolkit for SLVC with registration forms, guidance documents, and sample materials has been posted at http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#schoolclinics

Hepatitis A Virus Cluster

Maine CDC is investigating a cluster of acute hepatitis A virus infections in Northern Lincoln County. Currently, 2 suspect and 3 confirmed cases have been identified. The first identified infected person had a history of recent international travel. The other four ill individuals were close contacts of the first case-patient.

Hepatitis A is an uncommon disease in Maine, with an average of 10 cases reported each year.

Illness caused by hepatitis A virus typically has an abrupt onset and can include fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice.

The average incubation period for hepatitis A is 28 days (range: 15-50 days). Individuals are considered infectious from 2 weeks before until 1 week after the onset of jaundice. The infectious periods for the persons in the Northern Lincoln County cluster range from early-July to mid-August. The virus is excreted in feces and is transmitted by the fecal-oral route or through the consumption of contaminated food or water. Good hand washing is key to limiting disease transmission.

For more information, see this Health Alert.

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 to medical practitioners throughout the state. This year’s conference will be held from 8:30 a.m. – 4:00 p.m. Nov. 15 at the Augusta Civic Center. Issues presented will include challenges in controlling infectious diseases, information on responding to new disease threats, and clinical updates and approaches. Registration fees, including the program, lunch, breaks, & CEUs, are $35 on or before 10/24/11 and $50 on or after 10/25/11. Space is limited.

The event brochure and agenda are available at: http://www.neias.org/mecdc/pdf/IDconferencebrochure_Final(3).pdf

For more information and to register: http://adcarecdc.neias.org/idhome/

Breastfeeding and obesity

Childhood obesity is an epidemic. In the US, 1 preschooler in 5 is at least overweight, and half of these are obese. Breastfeeding helps protect against childhood obesity. A baby's risk of becoming an overweight child goes down with each month of breastfeeding. In the US, most babies start breastfeeding, but within the first week, half have already been given formula, and by 9 months, only 31% of babies are breastfeeding at all. Hospitals can either help or hinder mothers and babies as they begin to breastfeed.

This month’s Vital Signs feature and related MMWR from US CDC focus on hospital support for breastfeeding.

US CDC’s Breastfeeding Report Card shows that Maine ranked third in the nation for percent of live births occurring at baby-friendly facilities and tied for third in the nation for State Maternity Practices in Infant Nutrition and Care scores from birthing facilities.

Rabies update

US CDC and the Maryland Department of Health and Mental Hygiene, with assistance from Montgomery County Department of Health and Human Services and Suburban Hospital-Johns Hopkins Medicine, have developed an online course to educate healthcare providers and public health professionals about rabies, the approach used in evaluating patients for rabies virus exposure, and the administration of rabies postexposure prophylaxis (PEP). There is no cost to view the course or to receive continuing education credit.

As a reminder to clinicians, PEP for rabies is reportable in Maine.

The second quarter animal rabies update for Maine is now available at http://www.maine.gov/tools/whatsnew/attach.php?id=277584&an=1

World Hepatitis Day

Today is World Hepatitis Day. This day was established to increase the awareness and understanding of viral hepatitis and the diseases that it causes. It provides an opportunity to focus on specific actions such as:

• strengthening prevention, screening and control of viral hepatitis and its related diseases;
• increasing hepatitis B vaccine coverage and integration into national immunization programmes; and
• coordinating a global response to hepatitis.

Hepatitis viruses A, B, C, D and E can cause acute and chronic infection and inflammation of the liver leading to cirrhosis and liver cancer.

For more information: http://www.who.int/csr/disease/hepatitis/world_hepatitis_day/en/index.html

Increase in pertussis

Between Jan. 1 and July 22, 72 pertussis cases were reported to Maine CDC, compared to 20 cases reported for the same period in 2010. Clusters of pertussis cases have been reported in schools, camps, sport teams, and workplaces with the largest number of clusters identified in Penobscot county. Cases range in age from 1 month to 79 years. One infant has recently been hospitalized with life-threatening symptoms.

Pertussis is a highly communicable, vaccine-preventable disease that can last for many weeks. It is transmitted through direct contact with the respiratory secretions of infected people. Symptoms include cough, paroxysms, whoop, and post-tussive vomiting. 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.

For more information and clinical guidance, please see this Health Alert.

Influenza Update 7/21/11

Maine CDC has issued a letter to health care providers who have registered with the Maine Immunization Program to offer state-supplied flu vaccine regarding vaccine availability.

For the 2011-12 season, Maine CDC plans to provide seasonal influenza vaccine for:

• All Maine children ages 6 months to 18 years-old
• Employees of schools that provide onsite vaccine clinics on school days
• Pregnant women and their partners (through health care providers who routinely care for pregnant women)
• Nursing home employees and residents
• Any underinsured or uninsured adult in any setting (for patients who do not have insurance or whose insurance does not cover vaccines)
• All individuals served by Tribal health centers and Municipal Health Departments

Information on the vaccine ordering process will be posted at www.maineflu.gov in August. Tools and resources for those conducting school-located vaccine clinics (SLVC) will also be updated in August.

FDA has approved the 2011-12 influenza vaccine formulation for all six manufacturers licensed to produce and distribute flu vaccine for the US.

US CDC has updated its online flu information, including:

• Key Facts about Influenza (Flu) and Flu Vaccine
• 2011-12 Seasonal Influenza Vaccine Updates Questions and Answers
• Children, the Flu, and the Flu Vaccine
  
• Questions and Answers about Seasonal Influenza

Stay cool the next couple of days

Maine CDC issued a heat advisory yesterday due to high temperatures forecast for today and tomorrow.

High temperatures are more common toward the end of July and into August in Maine. Everyone should take some simple measures to prevent heat-related illness. Some people are more likely to experience illness from heat and should take extra precautions to keep cool. These people include:

• Older adults (age 65 and older)
• Infants and young children
• People with a mental illness or who are under the influence of drugs or alcohol
• People who work outside
• People with heart conditions, kidney disease, diabetes, obesity, and high blood pressure
• People with mobility restrictions
• People living in poverty and who are homeless

More information on heat-related illness and ways to prevent it can be found at: http://www.maine.gov/dhhs/boh/heat/index.shtml

Colorectal cancer

In Maine’s total population, colorectal cancer is the second leading cause of new cancer cases and deaths. In 2009, almost 900 Mainers were diagnosed with colorectal cancer, and approximately 260 died from this disease.

This month’s US CDC Vital Signs and related MMWR focus on colorectal cancer.

The Maine Colorectal Cancer Control Program hopes to lessen the number of Mainers that are diagnosed with, or die from, colorectal cancer each year. The program focuses on helping all Mainers understand how important it is to be screened for colon cancer when they are age 50 and older, providing no-cost screening services for Mainers who do not have health insurance (or who have health insurance that does not pay for the costs of this important test), and connecting Mainers with the resources they need to prevent, detect, and survive colon cancer.

Lyme disease

Maine CDC held its second annual poster contest in conjunction with Lyme Disease Awareness Month in May. The winning posters by Jacob Carroll, Chloe Lawrence, Casey Pine, and Carrigan Eyrolles are now available at http://www.maine.gov/dhhs/boh/ddc/epi/vector-borne/lyme/index.shtml

Posters represented at least one of four ways to prevent Lyme disease:

1. Wear protective clothing
2. Use insect repellent
3. Perform a daily tick check
4. Use caution in tick infested areas

Most people get Lyme disease between the months of May and August. The best way to prevent Lyme disease and other tick-borne illnesses is to avoid contact with ticks – find out more steps you can take to avoid tick-borne diseases.

Maine Medical Center Research Institute, in partnership with Maine CDC, is expanding its efforts in northern and western Maine to track the spread of the ticks that may carry Lyme disease.

Summer health

Most people get Lyme disease between the months of May and August. The best way to prevent Lyme disease and other tick-borne illnesses is to avoid contact with ticks:

· Wear long sleeve shirts and pants. Light colored clothing makes it easier to spot ticks.

· Tuck your pants into your socks and tuck your shirt into your pants.

· Use insect repellent (with DEET) on your skin and apply permethrin to your clothes.

· Check your clothing and skin carefully after being outdoors and remove ticks immediately.

· If bitten by a tick, wash area of bite thoroughly with soap and water and apply an antiseptic to area of the bite.

· Mark on a calendar the date that you were bitten, and then watch for any changes in your health every day for the next month.

· Keep your lawn mowed, cut overgrown brush, and clear away leaf litter from your home.

· Inspect any pets daily and remove any ticks found.

Water, bugs, and the sun, are a few of the things kids experience more of in the summertime. See this US CDC feature on keeping kids safe and healthy this summer.

We’ve already experienced some severe weather. Know how to protect yourself in the event of thunderstorms and lightning. Power failures are common in severe summer storms. Check out this food safety video from the University of Maine Cooperative Extension to make sure you keep food safe after a power failure.

The US Food & Drug Administration (FDA) has established important new rules about sunscreen labels to reduce the risk of skin cancer.

This Cornell University video has helpful information about safe grilling practices.