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Dr. Sheila Pinette Director, Maine CDC Osteopathic physician Public Health Update October 3, 2013 In this update: SCC Briefed on Accreditation Status from Maine CDC and Portland Public Health Antibiotic resistance Breast cancer Meaningful use Mosquito-borne diseases Tick-borne diseases Flu Gluten-free standardization on food labels Pertussis (whooping cough) Rabies Upcoming events Follow us SCC Briefed on Accreditation Status from Maine CDC and Portland Public Health The Statewide Coordinating Council for Public Health (SCC) received an update at their September 19 meeting in Augusta. Shane Gallagher and Kate Marone, Accreditation Coordinators from Portland Public Health and Maine CDC respectively, provided a brief overview of Accreditation, followed by status updates from their agencies. Maine CDC continues to prepare to apply for Accreditation, and plans to submit its application in January 2014. Portland Public Health applied in late spring, and is now gathering the necessary documents to submit to the Public Health Accreditation Board (PHAB). The Accreditation process includes gathering and preparing several hundred documents in order to demonstrate how the organization is meeting the 32 Accreditation Standards. Both agencies hope to achieve national Public Health Accreditation status by the end of 2014. To request a copy of the presentation, or to learn more, please contact Maine CDC’s Accreditation Coordinator, Kate Marone, at [EMAIL REDACTED] ---PAGE BREAK--- Antibiotic resistance The use of antibiotics is the single most important factor leading to antibiotic resistance around the world. Antibiotics are among the most commonly prescribed drugs used in human medicine. However, up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary or inappropriate. Every year, more than two million people in the United States get infections that are resistant to antibiotics and at least 23,000 people die as a result, according to a new report issued by US CDC. The report, Antibiotic Resistance Threats in the United States, 2013, presents the first snapshot of the burden and threats posed by antibiotic-resistant germs having the most impact on human health. The threats are ranked in categories: urgent, serious, and concerning. To see the full report, please visit www.cdc.gov/drugresistance/threat- report-2013/. For more information about drug resistance and the serious impacts it has on human health, visit www.cdc.gov/drugresistance. Breast cancer During 2013, it is estimated that more than 1,150 women will be diagnosed with breast cancer and 190 women will die from the disease. As October marks National Breast Cancer Awareness month, Maine CDC reminds women that regular screening mammograms are critical in diagnosing and beginning treatment of the disease. A screening mammogram can detect breast cancer early, even before arise. The American Congress of Obstetricians and Gynecologists and the American Cancer Society recommend annual mammogram, starting at age 40. The US Preventive Services Task Force recommends screening every one to two years, starting at age 50. Women with a first degree relative with breast cancer may warrant testing prior to these age recommendations. All patients should enter into a personal discussion regarding their screening with their primary care physicians and decisions should be individualized. Women with hyper dense breast tissue may be at increased risk, as a mass may be masked by the dense tissue. Not all breast cancer is palpable as a lump on breast exam, which is why mammogram is so important. 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-[PHONE REDACTED]; TTY users call Maine Relay 711. More details can also be found at: http://go.usa.gov/DHJ5 ---PAGE BREAK--- Meaningful use The American Reinvestment & Recovery Act of 2009 includes many measures to modernize our nation's infrastructure, one of which is the "Health Information Technology for Economic and Clinical Health (HITECH) Act." The HITECH Act supports the concept of meaningful use of electronic health records. The Stage 2 measures for public health reporting state that an Eligible Hospital (EH) or Eligible Provider (EP) must register intent to submit ongoing submission of electronic data to the Public Health Authority (PHA) for the following types of reporting: • Immunization Registries • Surveillance • Reportable Lab Results • Cancer Registries • Specialized Registries The EH or EP must register with the PHA within 60 days of the start of the organization’s EHR reporting period, if they plan on attesting for such public health reporting for that period. Once registered, the EH or EP is immediately considered to be engaged in ongoing submission to the PHA. However, to remain engaged in ongoing submission the EH or EP must do the following: • Be ready to participate in the on-boarding process when the PHA is ready to engage. • Respond to any PHA written requests for actions. Note: The EH or EP does not meet the measure if there is a failure to respond to two written requests within 30 days on two separate occasions. For more information about meaningful use, visit http://go.usa.gov/DHhC. For Maine CDC’s Meaningful Use Stage 2 Registration page, go to http://go.usa.gov/DHS4. Mosquito-borne diseases Maine CDC has confirmed the presence of Eastern Equine Encephalitis (EEE) in more than 20 mosquito pools and has reported the death of a pheasant, an emu, and three horses from EEE. In addition, three mosquito pools have tested positive for West Nile virus (WNV). Maine CDC will update information on mosquito-borne disease surveillance in the state every Monday through September at http://go.usa.gov/jt6R EEE and WNV are viruses transmitted through the bite of an infected mosquito. Maine CDC recommends the following preventative measures to protect against mosquito-borne illnesses: • Use an Environmental Protection Agency-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; • Keep window and door screens down to keep mosquitoes out of the home; • Limit time outdoors at dawn and dusk when many species of mosquitoes are most active; • Remove containers holding water in and around the home, as water can attract mosquitoes. Information on pesticides and repellents is available at the Maine Board of Pesticides Control website at: http://go.usa.gov/jt6F ---PAGE BREAK--- Tick-borne diseases Babesiosis, is a parasitic infection transmitted the same tick that carries Lyme disease, is an emerging infection in Maine. A total of 31 cases of babesiosis have been reported since January, compared to a total of 10 cases in all of 2012. Most infections occur in the summer and fall months, so the number of 2013 cases is expected to rise. Other diseases are also carried by ticks in Maine, including anaplasmosis and Lyme disease. There have been 57 cases of anaplasmosis in Maine to date this year, compared to 43 in the same period last year. There have been 1,006 cases of Lyme so far this year, compared to 924 for the same period last year. (All data are as of Sept. 30.) For more information: • Info on tick-borne diseases: http://go.usa.gov/jtFJ • To order tick educational materials: http://go.usa.gov/jtMY • Aug. 15 health alert on babesiosis: http://go.usa.gov/jtMB • May 30 health alert on Lyme disease: http://go.usa.gov/bnhR Flu Maine CDC has updated its flu website for the 2013-2014 season at www.maineflu.gov. Weekly updates on flu activity will resume later this month at http://go.usa.gov/DHM6. 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 US CDC has published a summary of the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the 2013-2014 flu season at http://go.usa.gov/jdfB The Vaccine Information Statements (VIS) for this coming season’s vaccines are available at http://go.usa.gov/jdAC Gluten-free standardization on food labels The Food and Drug Administration (FDA) has finalized the definition of the term “gluten-free” and is regulating its use on food labels. No longer can manufacturers simply label foods as “gluten-free” without following proper guidelines. The term "gluten" refers to proteins that occur naturally in wheat, rye, barley and cross-bred hybrids of these grains. In people with celiac disease, an autoimmune digestive condition, foods that contain gluten trigger production of antibodies that attack and damage the lining of the small intestine. Such damage limits the ability of celiac disease patients to absorb nutrients and puts them at risk of other very serious health problems, including nutritional deficiencies, osteoporosis, growth retardation, infertility, miscarriages, short stature, and intestinal cancers. Here are the guidelines: According to the FDA, the term “gluten-free” now refers to foods that are either inherently gluten-free or foods that do not contain any ingredient that is: • A gluten-containing grain (e.g. spelt wheat) • Derived from a gluten-containing grain that has not been processed to remove gluten (e.g. wheat flour) • Derived from a gluten-containing grain that has been processed to remove gluten (e.g. wheat starch), if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food Foods that contain an unavoidable bit of gluten must keep that presence to less than 20 ppm. The guidelines are based on the smallest amount of gluten that can be detected using scientific analysis tools and are in line with the international bodies that set guidelines for food safety standards. Manufacturers have until Aug. 5, 2014, to comply with the rule. For more information, go to http://go.usa.gov/DHe2 ---PAGE BREAK--- Pertussis (whooping cough) Pertussis (whooping cough) is a cyclical disease that continues to affect a significant number of Maine residents. There have been 277 reported cases of pertussis so far this year in Maine. This is less than the 573 reported cases for the same period last year, but is more than the five-year median. Oxford county has the highest rate of pertussis in the state, and the majority of cases have occurred in people ages 7-19. 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 or see the update on statewide pertussis from July 30 at http://go.usa.gov/jdfe Rabies World Rabies Day was on Saturday, September 28. Why should Mainers know about this worldwide event? Because the rabies virus kills more than 55,000 people worldwide each year and is found in Maine’s wildlife. We have seen 38 animals with rabies so far this year. Maine’s Health and Environmental Testing Lab (HETL) confirmed rabies in the following animals: 18 raccoons, 11 skunks, five bats (big brown), and four foxes (1 gray, 3 red). One of the rabid skunks was from Washington County, which is concerning because it was the first report of a rabid animal in that county in six years. Last year, Maine confirmed its first rabid dog since 2003. For these reasons, it’s more important than ever to learn how to stay rabies-free. Before going on a brisk fall hike or hunting trip, read these simple tips for rabies prevention: • Avoid contact with wildlife and any animal you don’t know • Keep your pets up-to-date on rabies vaccination • Report exposures to Maine CDC at 1-[PHONE REDACTED] • Bat-proof your home For more tips, visit our website at www.mainepublichealth.gov/rabies. Upcoming events • Maine Public Health Association, American Lung Association of the Northeast, American Heart Association, American Cancer Society Cancer Action Network, Maine Medical Association, and Maine Osteopathic Association are co-hosting Public Health Policy & Advocacy: What You Really Want to Know but are Afraid to Ask from 12-4:30 p.m. Oct. 21 at the State House. For more information and to register: http://events.constantcontact.com/register/event?oeidk=a07e861d87l3db63a42 • Maine Public Health Association’s Fall Conference will be held from 8 a.m. to 4:30 p.m. Oct. 22 at the Augusta Civic Center. The theme of the conference is Health in All Policy: The Value of Public Health in Maine. For more information and to register: • Maine CDC’s 2013 Division of Infectious Disease Conference will be held from 8:15 a.m. to 4:15 p.m. Nov. 13 at the Augusta Civic Center. The conference website is available at http://www.cvent.com/d/pcqy5p The website includes a summary, agenda, conference brochure, information about fees, and the link to register. ---PAGE BREAK--- 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]