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Dr. Sheila Pinette Director, Maine CDC Osteopathic physician Public Health Update September 9, 2012 In this update: Healthy eating Food safety Mosquitoborne diseases Pertussis (whooping cough) Suicide prevention Infectious disease conference Teen immunizations Newborn Screening Awareness Month Watershed collaborative receives award Updated guidance Flu Increase in vibriosis Follow us Healthy eating September is both National Childhood Obesity Awareness Month and National Fruit and Veggies - More Matters Month. Childhood obesity is a major public health problem (http://go.usa.gov/ryuC). There is no single or simple solution to childhood obesity. It is influenced by many different factors, including a lack of access to healthy food and drinks, as well as limited opportunities for physical activity in the places where children live, play, and learn. Working together, states, communities, and parents can help make the healthy choice the easy choice for children and adolescents. Maine CDC is proud to highlight Maine’s annual Harvest Lunch Week and Farm to School efforts this month. These programs succeed in getting Maine youth to enjoy eating more fruits and veggies, which is important since only 1 in 4 Maine youth eat the recommended number of veggies and fruits each day (http://go.usa.gov/ryth). Studies show that fruit and vegetables are important to support growth, good health, and a healthy weight. Eating the recommended number of servings of fruits and vegetables can also help protect against high blood pressure, heart disease, type 2 diabetes, bone loss, and some cancers. Maine Harvest Lunch is a Farm to School activity that introduces students to local Maine grown veggies and fruits in their natural form. US CDC supports Farm to School as an obesity prevention strategy because it engages youth in learning about, preparing, and eating more veggies and fruits. Eating fruits and veggies prepared without added fat in place of higher calorie foods can help maintain a healthy weight. About 26% of Maine youth are overweight or obese. Fortunately, Maine has nearly 200 Farm to School programs with Maine farmers, teachers, and school food service personnel working together to improve the wellbeing of Maine’s youth and communities. Maine CDC’s Division of Population Health staff is part of the Maine Farm to School Workgroup that provides technical assistance, best practice guidelines, and support to local schools, farmers, and teachers working on Farm to School. The workgroup is made of partners from state agencies and nongovernment organizations. The Healthy Maine Partnerships have been working on Farm to School and Maine Harvest Lunch Week in their local service areas for years, which helps support Maine CDC’s efforts to reach the Healthy Maine 2020 goal of increasing Maine youth’s fruit and veggie consumption. To find out how many servings of fruits and veggies you need, go to http://go.usa.gov/ryz4 For more information about how to eat more fruits and veggies, visit ---PAGE BREAK--- Food safety Maine CDC’s Health Inspection Program attended the 2012 Northeast Region Annual Food Protection Seminar August 22-24, along with more than 85 attendees from academia, industry, and consulting as well as federal, state, and local health agencies. The 21 speakers discussed issues ranging from epidemiology, food safety, and seafood species authentication to the implementation of the 2009 FDA Food Code, wild mushroom harvesting, and foodborne outbreak response. A highlight of the seminar was the presentation by Gary Hirshberg, co-founder and chairman of Stonyfield Farm, who spoke about creating a “Win-Win-Win” future for consumers and farmers by shifting from traditionally-grown crops and foods to organic. The Health Inspection Program participated in a panel discussion of mobile units’ issues and emergency action plans. The next annual seminar is scheduled for August 2013 in Rhode Island. Mosquitoborne diseases Arboviral diseases, including Eastern equine encephalitis (EEE) and West Nile virus (WNV), are very serious infections that are transmitted by the bite of an infected mosquito. Although rare, these diseases have potentially severe and even fatal consequences for those who contract them. Mosquito pools (collections that contain between 1-50 mosquitoes) from York and Cumberland counties have tested positive for WNV. Maine CDC recommends the following preventative measures to protect against mosquitoborne illnesses: Use an EPA approved repellent when outdoors, especially around dawn and dusk – always follow the instructions on the product’s label Wear protective clothing when outdoors, including long-sleeved shirts, pants, and socks Use screens on your windows and doors to keep mosquitoes out of your home Avoid being outdoors at dawn and dusk when many species of mosquitoes are most active Practice household mosquito-source reduction: standing water should be removed from artificial water-holding containers in and around the house Maine CDC encourages providers to test for arboviral illness in patients presenting with unexplained encephalitis, meningitis, or fever greater than 100.4°F or 38°C during the late summer and early fall. For more information, see this health alert: http://go.usa.gov/GoT Pertussis (whooping cough) Pertussis cases continue to be reported at a rate of about 30 new cases per week. Most reported cases have been in children ages 7 to 19. More than 20 cases have been reported in children younger than 1 year old. Maine CDC issued a health alert on statewide pertussis July 31 (http://go.usa.gov/Gob). Weekly updates on pertussis in Maine are posted to www.mainepublichealth.gov on Thursdays. DTaP vaccine is recommended for all infants and children. In general, DTaP vaccines are 80-90% effective. Children who never got any doses of DTaP vaccine are at least eight times more likely to get pertussis than children who got all five doses of the vaccine before age seven. We expect some waning immunity (http://go.usa.gov/f6b) from DTaP vaccine, and study results reinforce the need for a routinely recommended booster dose of Tdap at age 11 or 12. Recent outbreak investigations have shown that Tdap vaccines are approximately 70% effective. Protection probably fades with time after getting the booster dose. Tdap vaccine is recommended for all preteens, teens, and adults. Currently a single dose is recommended for all teens and adults who have not previously received a dose. Since 2011, a Tdap dose is recommended for all pregnant women, preferably in the third or late second trimester, to protect newborn infants from severe pertussis. For more information, visit http://go.usa.gov/dCO ---PAGE BREAK--- Suicide prevention There are numerous efforts being to recognize and support World Suicide Prevention Day. In Maine, a number of events are planned: The Maine Suicide Prevention Program, a statewide suicide prevention initiative led by Maine CDC, in collaboration with the Departments of Education, Labor, Corrections, and Public Safety, is hosting a free training, “The Assessment and Management of Suicidal Clients,” from 9 a.m. to noon Sept. 10 at the University of Southern Maine in Portland. The goal of this workshop is to provide participants with the essential tools needed to assess suicide risks accurately and manage challenging scenarios effectively. The presenter is Dr. David Rudd, PhD, Dean of the College of Social and Behavioral Sciences at the University of Utah and Scientific Director for the National Center for Veterans Studies. Dr. Rudd is widely published and was recently elected a Distinguished Practitioner and Scholar of the National Academies of Practice in In addition to his clinical work, Dr. Rudd is an active researcher with more than 170 publications. Registration is required at http://www.ccsme.org/Events.htm Visit www.ccsme.org/train/suicideprevention to view the complete schedule of Suicide Prevention trainings for 2012-2013 and to register for these trainings. The Maine Suicide Prevention Program is also organizing its annual event to raise awareness of suicide prevention activities statewide and to recognize people and organizations that are making a difference through “Caring About Lives in Maine” awards. The event will be held from 1:30- 3:30 p.m. Sept. 18 at the Blaine House in Augusta. Registration is required. To register, please email Vincent Bryant at [EMAIL REDACTED] and include your email address and phone number. Infectious disease conference Maine CDC’s Infectious Disease Conference will be held from 7:45 a.m. to 4 p.m. November 13 at the Augusta Civic Center. This year’s meeting is dedicated to a review of emerging issues in the field of infectious diseases, particularly as they impact the Maine medical community. Issues presented will include challenges in controlling infectious diseases, information on responding to new disease threats, and clinical updates and approaches. The cost is $35 if registration is received on or before Oct. 24; $50 if registration is received Oct. 25 or later. For more information and to register: http://adcarecdc.neias.org/infectiousdisease/ Proposals for poster presentations at the conference are requested. Poster presentations will be displayed for the duration of the conference with a poster session from 1:45-2:15 p.m. Abstracts for posters must be submitted by Sept. 21 to [EMAIL REDACTED]. There is a preferred limit of 400 words for the body of the abstract. For more information, see http://go.usa.gov/Gtf Teen immunizations The 2011 National Immunization Survey-Teen (NIS-Teen) coverage data show that national vaccination rates in adolescents have continued to improve for tetanus-diphtheria-pertussis (Tdap) vaccine and for meningococcal conjugate vaccine (MCV4). National Tdap coverage rates for teens 13 through 15 years old met the Healthy People 2020 objective of 80 percent for the first time. While this is an important milestone, the more than 22,000 cases of pertussis seen in the United States through August 11th, 2012 remind us of how important it is to vaccinate all preteens with Tdap. Improving Tdap coverage in preteens and teens is especially important for protecting infants too young to be fully immunized. Most concerning however, is that HPV vaccination rates among girls continue to plateau and only half of U.S. girls are getting the human papillomavirus (HPV) vaccine. This is a life-saving vaccine that can protect them against cervical cancer. HPV vaccine coverage has not demonstrated the same strong and steady increases over time like the increases we have seen following the introduction of other vaccines. In fact, for the third year in a row, the increase in coverage for HPV vaccine is half of the increases seen for Tdap and MCV4 vaccine coverage. Parents, healthcare providers and immunization partners all have a role in preventing HPV-related cancers and disease in both girls and boys. For more information, visit http://go.usa.gov/ryFd ---PAGE BREAK--- 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. For more information, visit www.cdc.gov/features/ScreeningNewborns For information on newborn screening in Maine, visit http://go.usa.gov/ryse Watershed collaborative receives award The Salmon Falls Watershed Collaborative, an ambitious inter-state effort to protect drinking water supplies for more than 47,000 residents in Maine and New Hampshire, has been named a 2012 U.S. Water Prize award winner by The Clean Water America Alliance. To see the national prize video featuring the Collaborative and to learn more about the U.S. Water Prize visit http://www.cleanwateramericaalliance.org/u-s-water-prize/2012-prize-winners/ Members of the collaborative, including the Maine CDC Drinking Water Program, received the award at a reception in Washington D.C. on April 23. The Collaborative has many members, and the award itself has been rotating among them. The award recently came to the Maine CDC Drinking Water Program, which is celebrating National Protect Your Groundwater Day, on Sept. 11. To learn more about the Salmon Falls Collaborative or view the group’s Action Plan, please visit http://www.prep.unh.edu/sfwc.htm Pictured: front: Dr. Sheila Pinette, Director of Maine CDC; left to right: Andrews Tolman, Assistant Director, Maine CDC Drinking Water Program; Nancy Beardsley, Director, Maine CDC Division of Environmental Health; Roger Crouse, Director, Maine CDC Drinking Water Program. ---PAGE BREAK--- Updated guidance Maine CDC has posted updated norovirus resources for health care providers, including: Norovirus outbreak guidance for long term care: http://go.usa.gov/ryHV Norovirus outbreak checklist: http://go.usa.gov/ryHh For more information on norovirus, visit http://go.usa.gov/ryHx Maine CDC has posted guidelines to prevent transmission of HIV, hepatitis B, and hepatitis C through medical/dental procedures at http://go.usa.gov/ry64 Flu Weekly updates on flu activity 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 – find locations at www.flu.gov The Advisory Committee on Immunization Practices (ACIP) recommendations for the 2012-2013 flu season are available at: http://go.usa.gov/rkYd The Vaccine Information Statements (VIS) for influenza for the 2012-2013 season are available at http://go.usa.gov/fAK A disproportionately high number of children with neurologic disorders died from influenza-related complications during the 2009 H1N1 pandemic, according to a study by US CDC scientists. The report in the journal Pediatrics underscores the importance of influenza vaccination to protect children with neurologic disorders. US CDC is joining with the American Academy of Pediatrics, Families Fighting Flu, and Family Voices to spread the message about the importance of influenza vaccination and treatment in these children. For more information: http://go.usa.gov/ryud Increase in vibriosis Since July 1, ten infections with bacteria of the Vibrio genus (also called vibriosis) have been reported to Maine CDC; four in Maine residents and six in out of state residents. In 2011, only four cases were reported, all in Maine residents. The majority of vibriosis infections reported in Maine occur in the summer months. The median age of ill individuals is 70 years. All patients reported consuming some type of seafood during their exposure period. All cases are considered sporadic and not linked at this time. Multiple state agencies are involved in the investigation. For more information, see the health alert at http://go.usa.gov/rVPh Follow us Follow Maine CDC’s Social Media Updates: Facebook (www.facebook.com/MaineCDC) Twitter (http://twitter.com/MEPublicHealth) Blog (http://mainepublichealth.blogspot.com) You may subscribe to these updates for free through an RSS feed at http://go.usa.gov/G6u. In Internet Explorer and Firefox, you will be prompted to Subscribe to the Feed and then select the folder where feeds are stored. For clinical consultation and outbreak management guidance, call Maine CDC’s toll-free 24-hour phone line: 1-[PHONE REDACTED] For questions and potential exposure to poison, call the Poison Center’s 24-hour phone line: 1-[PHONE REDACTED]