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Dr. Sheila Pinette Director, Maine CDC Osteopathic physician Public Health Update November 1, 2012 In this update: West Nile virus Fungal infections outbreak Continuity of operations plan and exercise Up-to-date immunization rates Pertussis (whooping cough) Influenza Upcoming events Follow us West Nile virus Maine CDC has identified the presence of West Nile virus (WNV) neuroinvasive disease in a Maine resident from Cumberland County. This is Maine’s first ever locally-acquired case of WNV in a Maine resident. The patient, who is recovering at home, presented with including fever, encephalitis, meningitis, weakness, and double vision beginning on October 1. Maine CDC issued a health advisory Oct. 31 to alert clinicians of the presence of human WNV disease activity in Maine, and to remind clinicians to consider testing for arboviral disease in patients presenting with unexplained encephalitis, meningitis, or a febrile illness of unknown etiology through the end November. For more information, see the health alert: http://go.usa.gov/Yfhx Fungal infections outbreak There has been national news about a multistate outbreak of fungal meningitis and joint infections associated with contaminated steroid medications. Maine CDC issued a health alert related to this topic on Oct. 5: Meningitis and Stroke Associated with Potentially Contaminated Product (http://go.usa.gov/YRGe) and an update on Oct. 18: Update on Fungal Infections Outbreak and FDA Recall (http://go.usa.gov/YfRR). Maine did not receive any doses of the three lots of acetate PF 80 mg/ml injection initially recalled. Those lots of medication are: Lot # 05212012@68, BUD 11/17/2012 Lot # 06292012@26, BUD 12/26/2012 Lot# 08102012@51, BUD 02/06/2013 On Oct. 15, FDA released a MedWatch Safety Alert recalling all products from the New England Compounding Center (NECC), which is available at http://go.usa.gov/YR7H. FDA is requesting clinicians contact any patient who may have received any NECC product since May 21. US CDC has not confirmed any infections from medications other than the 3 initially recalled lots, but they are encouraging awareness out of an abundance of caution. For more information, visit this US CDC site: http://go.usa.gov/YRA4 ---PAGE BREAK--- Continuity of operations plan and exercise Maine CDC’s Infectious Disease Epidemiology Program recently completed a Continuity of Operations (COOP) Plan and underwent a two-week exercise to test it. The plan is intended to act as a guide in how to respond to all hazards that may threaten the Program’s ability to function in a normal capacity to investigate infectious diseases, respond to consults, and recommend public health control measures. The hazards may include pandemics, natural disasters, abrupt outages to power or essential systems, severe staff shortages, or large scale outbreaks. It was decided to test the newly developed COOP Plan to respond to an anticipated threat, specifically, the significant increase in pertussis statewide observed during 2012. From Sept. 24–Oct. 5, the Program conducted an exercise of the COOP Plan to conduct critical operations, while program resources were dedicated to responding to the pertussis outbreak. Nineteen staff members participated in this event. Members were split into two teams: one dedicated solely to pertussis and one team dedicated to all other business. On October 9, the Program reviewed the weaknesses, opportunities, and threats of this trial of the COOP Plan as applied to pertussis. A member of Public Health Emergency Preparedness also attended to provide insight and guidance. The final After Action Report/Improvement Plan (AAR-IP) is currently being finalized, but the trial appears to be successful. The AAR-IP will be used to help the Program apply the COOP Plan to future scenarios more efficiently and effectively. Up-to-date immunization rates Forty-seven practices have achieved an up-to-date (UTD) rate of at least 90% for the 2012 fourth quarter assessment of children 24-35 months of age in their practice following the 4DTaP, 3Polio, 1MMR, 3 HIB, 3 HepB, 1 Var, 4PCV immunization series. The practices were: Provider Name UTD Rate Provider Name UTD Rate ACADIA FAMILY HEALTH CENTER 100% SCOTT M CHASE DO 100% ARNOLD MEMORIAL MEDICAL CTR PA 100% SEARSPORT HEALTH CENTER 100% BREWER HEALTH CENTER 100% SEBASTICOOK FAMILY DOCTORS - PITTSFIELD 100% BUCKSPORT FAMILY MEDICINE 100% SMMC PRIMECARE PHYSICIAN SERVICES ROUTEONE 100% D.F.D. RUSSELL MEDICAL CENTER 100% ST JOHN VALLEY HEALTH CENTER 100% D.F.D. RUSSELL MEDICAL CENTER-LEEDS 100% STOCKTON SPRINGS REGIONAL HC 100% DEXTER FAMILY PRACTICE 100% TWIN CITY FAMILY PRACTICE 100% FAMILY PRACTICE & INTERNAL MEDICINE 100% WATERVILLE FAMILY PRACTICE PA 100% FISH RIVER RURAL HEALTH-EAGLE LAKE 100% MAINE DARTMOUTH FAMILY PRACTICE 96% FULL CIRCLE HEALTH CARE LLC 100% LOVEJOY HEALTH CENTER 95% HAMLIN PRIMARY CARE/BEN FISKE HLTH 100% BRIDGTON PEDIATRICS 94% HAN-MILLINOCKET PRIMARY CARE 100% MECHANIC FALLS FAMILY PRACTICE CTR 94% HARRINGTON FAMILY HEALTH CENTER 100% AROOSTOOK PEDIATRICS 93% HERMON FAMILY MEDICINE 100% MARTINS POINT HEALTH CARE 93% HORIZONS HEALTH SERVICES 100% WALDOBORO FAMILY MEDICINE 93% JEAN ANTONUCCI MD 100% MILBRIDGE MEDICAL CENTER 92% JUDY L WELCH MD 100% WESTERN MAINE PEDIATRICS 92% MICMAC SERVICE UNIT 100% CALAIS REGIONAL MEDICAL SERVICES 91% NEW HORIZONS MADISON 100% D.F.D. RUSSELL MEDICAL CENTER-TURNER 91% PASSAMAQUODDY HEALTH CENTER 100% FAMILY MEDICINE INSTITUTE 90% PINES HEALTH SERVICES - CARIBOU 100% HOULTON PEDIATRICS 90% RANGELEY FAMILY MEDICINE 100% KATAHDIN VALLEY HEALTH-HOULTON 90% REGIONAL MEDICAL CENTER 100% KENNEBEC PEDIATRICS 90% ROBERT M MERRILL MD 100% ---PAGE BREAK--- Pertussis (whooping cough) More than 580 cases of pertussis (whooping cough) have been reported in Maine this year; however, reported cases appear to be on a downward trend. Most reported cases have been in children ages 7 to 19. Close to 30 cases have been reported in children younger than 1 year old. Weekly updates on pertussis in Maine are posted to www.mainepublichealth.gov on Thursdays. DTaP vaccine is recommended for all infants and children. Tdap vaccine is recommended for all preteens, teens, and adults. For more information, visit http://go.usa.gov/dCO Influenza Maine CDC has not yet reported any flu activity for the 2012- 2013 season. Weekly updates on flu activity 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 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 Upcoming events 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 $50 if registration is received Oct. 25 or later. For more information and to register: http://adcarecdc.neias.org/infectiousdisease/ Upcoming Summit Meeting. Bridging Mental Health and Public Health Summit Meeting: A Focus on Local, State, and National Efforts will be held from 8 a.m. to 12:30 p.m. November 14 at Governor Hill Mansion, 136 State St., Augusta. The Summit Meeting is presented by the Maine Health Access Foundation; the Maine Department of Health and Human Services Chronic Disease Division; and the USM Muskie School of Public Service. For more information and to register: http://www.surveymonkey.com/s/QZ55T63 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]