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Dr. Sheila Pinette Director, Maine CDC Osteopathic physician Public Health Update August 9, 2012 In this update: Pertussis (whooping cough) Third-hand smoke Six in 10 adults now get physically active by walking Human arbovirus update for health care providers Lyme disease Influenza Infectious disease conference Stay healthy this summer Animal rabies National Health Center Week Follow us Pertussis (whooping cough) More than 300 cases of pertussis have been reported in Maine so far this calendar year, more than four times the number of cases at the same time last year. Most reported cases have been in children ages 7 to 19. There have been 18 reported cases 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. Multiple factors have likely contributed to the increase in pertussis, including waning immunity, increased recognition, and improved diagnostic testing and reporting. In 2010, 27,550 pertussis cases were reported in the U.S. Year-to-date case counts from 2012 have surpassed those from the previous 5 years for the same period. Vaccines are still the safest and most effective tool we have for preventing pertussis. We continue to have additional evidence that pertussis vaccines are working well, no longer seeing 200,000 cases per year as we did in the pre-vaccine era. The majority of reported Maine cases have been in Cumberland, Somerset, and Penobscot counties. If pertussis is circulating in the community, there is a chance that a fully vaccinated person (of any age) can catch this very contagious disease. Maine’s pertussis surveillance data are limited with respect to information on vaccination coverage. We do know that among the cases that have been reported to us thus far in 2012, 79% were reported to have had at least one dose of pertussis-containing vaccine. However, we cannot say how many of them had age-appropriate vaccine coverage. As time passes after a person receives his or her last pertussis vaccine, protection can fade – this is known as waning of immunity (http://go.usa.gov/f6b). This is why we see fully vaccinated children and adults sometimes get the disease. When a fully vaccinated person gets pertussis, it doesn’t mean that pertussis vaccines don’t work. Most vaccines don’t protect everyone who gets them or last for a lifetime. Fortunately, the illness is typically milder in those who have been vaccinated, protecting them from severe disease. 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 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. US CDC, in collaboration with health departments from Washington and California, will study this further. ---PAGE BREAK--- 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. Preventing infant deaths from pertussis is our primary goal. US CDC recommends several strategies: Increase Tdap vaccination of pregnant women. Maintain high DTaP coverage rates among children and improve coverage with Tdap among adults to prevent the spread of disease and to protect the most vulnerable, particularly young infants. The latest data show that fewer than 10% of adults have received a Tdap booster shot. Promote cocooning, which is vaccinating everyone who comes into close contact with an infant. Focus efforts most on protecting those at high risk for severe disease (infants, immunocompromised, and pregnant women in third trimester) when antibiotics are given to protect people exposed to pertussis (prophylaxis). For more information, visit http://go.usa.gov/dCO Third-hand smoke Ever take a whiff of a smoker's hair and feel faint from the pungent scent of cigarette smoke? Or perhaps you have stepped into an elevator and wondered why it smells like someone has lit up when there is not a smoker in sight. Welcome to the world of third-hand smoke. “Third-hand smoke is tobacco smoke contamination that remains after a cigarette has been extinguished," says Jonathan Winickoff, a pediatrician at the Dana–Farber/Harvard Cancer Center in Boston and author of a study on the new phenomenon published in the journal Pediatrics. “Third-hand smoke," a term coined by Winickoff's research team, is a relatively new concept, but one that has worried researchers and nonsmokers for several years. Third-hand smoke refers to the tobacco toxins that build up over time—one cigarette will coat the surface of a certain room, a second cigarette will add another coat, and so on. The third-hand smoke is what remains after visible or "second-hand smoke" has dissipated from the air. The 2006 surgeon general's report says there is no risk-free level of tobacco exposure. There are more than 250 poisonous toxins found in cigarette smoke. For more information: http://www.cdc.gov/tobacco/data_statistics/sgr/2006/index.htm http://pediatrics.aappublications.org/content/123/1/e74.abstract http://www.portlandmaine.gov/hhs/phbreatheeasy.asp http://www.smokefreeforme.org Six in 10 adults now get physically active by walking Sixty-two percent of adults say they walked for at least once for 10 minutes or more in the previous week in 2010, compared to 56 percent in 2005, according to a new Vital Signs report from US CDC (http://go.usa.gov/Gof). However, less than half (48 percent) of all adults get enough physical activity to improve their health, according to data from the National Health Interview Survey. For substantial health benefits, the 2008 Physical Activity Guidelines for Americans recommends at least two and a half hours per week of moderate-intensity aerobic physical activity, such as brisk walking. This activity should be done for at least 10 minutes at a time. To learn more about Physical Activity Guidelines for Americans and ways to get active, visit www.cdc.gov/physicalactivity ---PAGE BREAK--- Human arbovirus update for health care providers There has been significant increase in regional arboviral activity in the last month. 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. The purpose of this health advisory is to alert clinicians to the potential for human disease activity in Maine, and to consider testing for arboviral disease in patients presenting with unexplained encephalitis, meningitis or high fever (≥100.4°F or 38°C) during the late summer and early fall. For more information, see the health alert Maine CDC issued Aug. 1: http://go.usa.gov/GoT Lyme disease Lyme disease is the most common vectorborne disease in Maine. Ticks are out and we expect the number of Lyme disease cases to increase in the warm weather. The 2011 Tick-borne Diseases Surveillance Report is now available at http://go.usa.gov/fAN. The 2011 Lyme disease surveillance report is available at http://go.usa.gov/VgS. Maine CDC issued an advisory on May 1 (http://go.usa.gov/V4q). For general information about Lyme disease, visit http://go.usa.gov/yTh Influenza The Vaccine Information Statements (VIS) for influenza for the 2012-2013 season are now available: http://go.usa.gov/fAK Multiple infections with variant influenza A (H3N2v) viruses have been identified in three states in recent weeks. From July 12 through August 3, 2012, 16 cases of H3N2v were reported and confirmed by US CDC. This virus was first detected in humans in July 2011. It has also been isolated in U.S. swine in many states. Since July 12, 2011, there have been 29 cases of H3N2v virus infection, including the 16 cases occurring in the last three weeks. Maine confirmed two cases of H3N2v influenza in 2011, but no new cases have been detected to date in 2012. Each of the 16 recent cases reported contact with swine prior to illness onset; in 15 cases, contact occurred while attending or exhibiting swine at an agricultural fair. While the viruses identified in these cases are genetically nearly identical, separate swine exposure events in each state were associated with human infections. Maine CDC and the Maine Department of Agriculture remind everyone to exercise good judgment while attending agricultural fairs (http://go.usa.gov/GoW). For recommendations and more information, see the health alert Maine CDC issued on Aug. 7 (http://go.usa.gov/Gog). 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/ ---PAGE BREAK--- Stay healthy this summer Maine CDC reminds people to stay healthy while enjoying outdoor activities this summer. Make sure you know what steps to take to protect your skin from the sun: http://go.usa.gov/fAZ Use good judgment for good health when attending Maine agricultural fairs (http://go.usa.gov/GoW): Do not attend a fair if you are ill. Always ask the owner for permission before you touch an animal. Before and after touching animals, wash your hands with soap and water or use alcohol hand gel. Before eating, wash your hands with soap and water or use alcohol hand gel. If you’ll be grilling outdoors this summer, check out this video from the Grill Sergeants with safety guidelines for safe grilling: http://go.usa.gov/fAb One in six Americans will get sick from food poisoning this year alone. FoodSafety.gov has a number of helpful at-a- glance food safety charts available at http://go.usa.gov/foq and other food safety information at http://go.usa.gov/fAJ Visit http://go.usa.gov/dOv for information about recreational water illnesses and how to avoid them. Be prepared to stay healthy even in extremely high temperatures this summer by reviewing our information on heat- related illness: http://go.usa.gov/dOd See this press release (http://go.usa.gov/dJS) for tips to avoid carbon monoxide poisoning. Maine Emergency Management Agency has tips for lightning safety: http://go.usa.gov/vzF For more information, visit http://www.cdc.gov/Features/KidsSafety/ Animal rabies CDC provides quarterly updates on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to inform pet owners and other members of the public about the risk of rabies in Maine and in their communities. The second quarter update (for the period April 1-June 30) is available at http://go.usa.gov/Goj National Health Center Week National Health Center Week is Aug. 5-11. For more than 45 years, community health centers have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay. During that time, community health centers have become the essential primary care medical home for millions of Americans, including some of the nation’s most vulnerable populations. For more information or to find a nearby health center, visit http://go.usa.gov/GoZ Follow us Follow Maine CDC on Social Media: 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://www.maine.gov/tools/whatsnew/rss.php?tid=1049. 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