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Dr. Sheila Pinette Director, Maine CDC Osteopathic physician Public Health Update May 2, 2013 In this update: Hepatitis Lyme disease Health equity Celiac Awareness Think Healthy. Swim Healthy. Be Healthy! Flu Snuggle ME Follow us Hepatitis In recognition of Hepatitis Awareness Month, Maine CDC is featuring a three-part series on viral hepatitis in public health updates released in May. Part 2: Hepatitis B Vaccination for Adults with Diabetes Mellitus CDC's Advisory Committee on Immunization Practices (ACIP) now recommends hepatitis B vaccination for all unvaccinated adults with diabetes who are younger than 60 years of age. Vaccination should occur as soon as possible after diagnosis of diabetes, and vaccination should also be given to adults diagnosed with diabetes in the past. Vaccination requires 3 doses at 0, 1, and 6 months, although other schedules are available. Longer intervals between doses are possible so that it is not necessary for patients to make extra medical visits for vaccination. However, longer intervals will leave adults with diabetes at risk for hepatitis B infection until the vaccination series is completed. On the basis of available information about hepatitis B virus (HBV) risk, morbidity and mortality, available vaccines, age at diagnosis of diabetes, and cost-effectiveness, ACIP recommends the following: • Hepatitis B vaccination should be administered to unvaccinated adults with diabetes mellitus who are aged 19 through 59 years (recommendation category A; evidence type • Hepatitis B vaccination may be administered at the discretion of the treating clinician to unvaccinated adults with diabetes mellitus who are aged ≥60 years (recommendation category B; evidence type For more information: • CDC Expert Commentary on Hepatitis B Vaccine for Adults with Diabetes at http://www.medscape.com/viewarticle/767207 • Use of Hepatitis B Vaccination for Adults with Diabetes Mellitus: Recommendations of the Advisory Committee on Immunization Practices (ACIP) at • www.mainepublichealth.gov/hep ---PAGE BREAK--- Lyme disease Lyme disease is the most common vectorborne disease in Maine. Ticks are already out, and we expect the number of Lyme disease cases to increase as the weather continues to get warmer. Anaplasma, Babesia, and other tickborne diseases are also increasing in Maine. Maine CDC has issued a health alert (available at http://go.usa.gov/Tmkd) to provide general information regarding ticks and Lyme disease; remind providers to report cases of Lyme disease; provide resources on diagnosis and treatment of Lyme disease; and remind providers about other tickborne diseases in Maine. Information about Lyme Disease Awareness Month is available at http://go.usa.gov/yTS For general information about Lyme disease, visit http://go.usa.gov/yTh Health equity The U.S. Department of Health and Human Services has released the Enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) along with a downloadable blueprint to offer guidance and implementation strategies: A Blueprint for Advancing and Sustaining CLAS Policy and Practice. The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities. For more information: http://go.usa.gov/TtHY Celiac Awareness May is National Celiac Disease Awareness Month. Celiac disease is an immune disease. People with this disease can’t eat gluten because it will damage their small intestine. Gluten is a protein found in wheat, rye, and barley. Gluten may also be used in products such as vitamin and nutrient supplements, lip balms, and some medicines. Other names for celiac disease are celiac sprue and gluten intolerance. Your body’s natural defense system, called the immune system, keeps you healthy by fighting against things that can make you sick, such as bacteria and viruses. When people with celiac disease eat gluten, their body’s immune system reacts to the gluten by attacking the lining of the small intestine. When this happens the body cannot get the nutrients it needs. Celiac disease is hereditary, meaning it runs in families. Adults and children can have celiac disease. As many as 1 out of every 133 Americans have celiac disease. Many people who have celiac disease may not know it. It can take up to 6 to 10 years to diagnose it. While there is no treatment for celiac disease can be managed or controlled by eating a lifelong gluten free diet. For more information about celiac disease go to National Digestive Disease Clearinghouse at http://digestive.niddk.nih.gov/index.aspx ---PAGE BREAK--- Think Healthy. Swim Healthy. Be Healthy! Recreational Water Illness and Injury Awareness Week (May 20–26) is a time to raise awareness about healthy and safe swimming. Every year, thousands of Americans get sick with recreational water illnesses (RWIs), which are caused by germs found in places where we swim. Poor swimmer hygiene leads to the contamination of recreational water and threatens swimmer health. Here are simple and effective steps swimmers can take to practice good hygiene: • Keep the poop and pee out of the water. • Check the chlorine and pH levels before getting into pools. • Don’t swallow the water you swim in. • Take children on bathroom breaks every 60 minutes or check diapers every 30–60 minutes. For additional information: • Pool safety: http://www.poolsafely.gov/ • Ocean, lake, and river safety: • To reduce the risk of drowning: http://www.cdc.gov/features/drowningprevention/index.html Flu Maine CDC issued a health alert on April 9 with information about human infections with novel influenza A (H7N9) viruses. So far, there is no evidence of ongoing human-to-human transmission. No cases have been identified in Maine; the health alert was issued for informational purposes. The health alert is available at: http://go.usa.gov/TDsR Maine CDC reported no seasonal flu activity for the week ending May 11. Snuggle ME Snuggle ME is a new resource with practice guidelines for the screening and treatment of pregnant women dependent upon alcohol or other prescribed or non- prescribed substances such as methadone, buprenorphine, and oxycontin for obstetrical and pediatric providers caring for pregnant women and their newborns in Maine. The resource was developed by the Maine Chapter of the American Academy of Pediatrics, in partnership with obstetric, pediatric, and substance abuse specialists across Maine, and Maine CDC. For more information: http://go.usa.gov/TtMR 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]