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Dr. Sheila Pinette Director, Maine CDC Public Health Update August 18, 2011 In this update: School-based flu vaccine clinics Bath salts Affordable Care Act Hepatitis A Virus Cluster Bullying Electronic Death Records Health Alert Network Coming Up: Infectious Disease Conference Obesity Other updates Follow Us School-based flu vaccine clinics Maine CDC has received a two-year, $1.25 million cooperative agreement award from US CDC to enhance the sustainability of school-located vaccination. School-located vaccination clinics (SLVC) were first broadly implemented in Maine in response to the 2009 H1N1 flu pandemic. Since then, schools and health care providers in many communities around the state have worked together to continue to offer influenza vaccine to students and staff members in the school setting. SLVC can provide low-cost and convenient opportunities for families to have their children vaccinated each year. In addition, achieving high immunization rates in schools can reduce the number of days that students and staff are absent during the flu season and improve the learning environment. CDC now recommends that all people over six months of age receive an annual flu vaccine as the best way to prevent influenza. Unlike adults, children have few opportunities to get a flu shot, and primary care doctors may not be able to accommodate the high demand for vaccine in their offices. Maine’s influenza immunization rates among children for the 2010-11 season were well above the national average, but too many Maine children still go without an annual flu shot. Providing vaccines to children in the school setting is a strategy that can improve access and decrease financial barriers that some children may face in getting the flu vaccine. Among the that were noted in the review of this application were the success of previous years’ SLVC; the use of Maine’s immunization registry system, ImmPact2; and the of the partnerships that have been developed at the local level. In the 2010-11 school year, more than 350 SLVC were held statewide. Clinics were run by school nurses, hospitals, health centers, visiting nurses’ associations, and primary care practices. Maine CDC recognizes the many organizations and individuals who have worked hard at implementing school vaccination. Funds from this cooperative agreement will be used to further these efforts by: increasing and supporting SLVC over the next two years; improving mechanisms of insurance reimbursement to schools and health care providers who provide flu shots in the school setting; and evaluating the impact of school clinics and developing plans for long-term sustainability beyond the funding period. More information on specific funding initiatives and opportunities related to this cooperative agreement will be forthcoming. General information on influenza in Maine is accessible at www.maineflu.gov. An online toolkit for SLVC with registration forms, guidance documents, and sample materials has been posted at ---PAGE BREAK--- Bath salts Unregulated substances marketed as “bath salts” are among the latest in a series of legal substances that, when used improperly, offer alternatives to illegal drugs. “Bath salts” are powerful stimulant drugs that are suspected to have been designed to avoid legal prosecution, and are commonly available on the Internet and in specialty smoke shops. “Bath salt” products are known to produce certain side effects, some of which are quite severe. This MMWR describes emergency department visits in Michigan over the last year after use of “bath salts.” In July, Maine enacted legislation to make it illegal to possess or sell any of the 21 different hallucinogenic drugs or stimulants that are sold and marketed as “bath salts.” The full text of the Maine law is available at For more information, see this Fact Sheet from the state Office of Substance Abuse: http://www.maine.gov/governor/lepage/issues/bath%20salts.pdf Affordable Care Act The US Departments of Health and Human Services (HHS), Labor, and the Treasury have proposed new rules under the Affordable Care Act that will enable consumers to easily understand their health coverage and determine the best health insurance options for themselves and their families. The proposed rules will also assist employers in finding the best coverage for their businesses and employees. New forms, which will provide clear, consistent and comparable information about health plan benefits and coverage, are scheduled to be available in 2012. For more information, see this press release: http://www.hhs.gov/news/press/2011pres/08/20110817a. html Earlier this week, HHS Secretary Kathleen Sebelius announced $49 million in grants awarded to all 50 states, partly supported by the Affordable Care Act, to improve the quality of health care and strengthen the public health infrastructure. Maine CDC received almost $700,000 for Epidemiology and Laboratory Capacity, about $71,000 for Healthcare Associated Infections, and $35,000 for Immunization Research. For more information, see this press release: http://www.hhs.gov/news/press/2011pres/08/20110815a. html Hepatitis A Virus Cluster Maine CDC is investigating a cluster of acute hepatitis A virus infections in Northern Lincoln County. Currently, 2 suspect and 3 confirmed cases have been identified. The first identified infected person had a history of recent international travel. The other four ill individuals were close contacts of the first case-patient. Hepatitis A is an uncommon disease in Maine, with an average of 10 cases reported each year. Illness caused by hepatitis A virus typically has an abrupt onset and can include fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice. The average incubation period for hepatitis A is 28 days (range: 15-50 days). Individuals are considered infectious from 2 weeks before until 1 week after the onset of jaundice. The infectious periods for the persons in the Northern Lincoln County cluster range from early- July to mid-August. The virus is excreted in feces and is transmitted by the fecal-oral route or through the consumption of contaminated food or water. Good hand washing is key to limiting disease transmission. For more information, see this Aug. 11 Health Alert: http://www.maine.gov/tools/whatsnew/attach.php?id=28 3879&an=1 ---PAGE BREAK--- Bullying Bullying is a form of youth violence and can result in physical injury, social and emotional distress, and even death. Victimized youth are at increased risk for mental health problems, such as depression and anxiety; complaints, such as headaches; and poor school adjustment. Youth who bully others are at increased risk for substance use, academic problems, and violence later in adolescence and adulthood. For more information, visit http://www.cdc.gov/ViolencePrevention/ Electronic Death Records The Maine Electronic Death Registration System (EDRS) is a Web-based system that registers Maine death records. We encourage all stakeholders, including medical certifiers, to use the EDRS. Corrections, completions and amendments will be generated electronically. This will ensure that the correct information is released to the public and ensure consistency among municipal offices and the state. Because the EDRS is an online, Web-based system, the only software needed by a facility is a standard web- browser. For training, contact Theresa Roberts: [EMAIL REDACTED] The EDRS team will be presenting the Electronic Death Registration system at the Maine Medical Association’s INNOVATIONS conference on September 9. For more information, visit http://www.maine.gov/dhhs/boh/phs/odrvs/vital- or contact the EDRS Team at [EMAIL REDACTED] Health Alert Network The Maine Health Alert Network (MaineHAN) is a consortium of key public health officials who are responsible for protecting the public in the event of a natural disaster, infectious disease outbreak, or bioterrorism attack. Members of the MaineHAN receive emergency and routine message traffic from a number of different sending authorities within the state. Maine CDC generates alerts, advisories, and updates intended for a statewide audience, while more localized messaging is handled by various MaineHAN member organizations. Joining the MaineHAN is as simple as contacting the HAN Help Desk at [EMAIL REDACTED] or 287-6551. The information you need to provide in order to become a member of the MaineHAN is minimal — your first and last name, e-mail address, work phone number, and the name of your organization are all that are required. Once your account has been created, you will receive an e- mail containing your username and password, as well as a guide for new members to help you get started setting up your profile. Coming Up: Infectious Disease Conference Since 1983, Maine CDC’s Division of Infectious Disease has organized an annual infectious disease conference targeting public health issues of emerging concern to medical practitioners throughout the state. This year’s conference will be held from 8:30 a.m. – 4:00 p.m. Nov. 15 at the Augusta Civic Center. Issues presented will include challenges in controlling infectious diseases, information on responding to new disease threats, and clinical updates and approaches. Registration fees, including the program, lunch, breaks, & CEUs, are $35 on or before 10/24/11 and $50 on or after 10/25/11. Space is limited. For more information and to register: http://adcarecdc.neias.org/idhome/ ---PAGE BREAK--- Obesity During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2010, no state had a prevalence of obesity less than 20%. Maine is one of 36 states with a a prevalence of 25% or more. There are a variety of online tools to help you stay active and eat healthier: • My Fitness Pal lets you track your calories on their website or with free mobile apps: www.myfitnesspal.com • Find safe environments in Maine to walk: • Learn more about portion size, balanced meals, and get healthy eating tips at www.choosemyplate.gov • Search for low-cost health care resources in your area – including nutrition and wellness services – at www.keepmewell.org For more information: • Maine Physical Activity and Nutrition Program: http://www.maine.gov/dhhs/boh/hmp/panp/ • US CDC: http://www.cdc.gov/obesity/ Other updates • Maine CDC has produced a short video encouraging people to take small steps to live healthier. See the One campaign video here: M • The US Food & Drug Administration (FDA) has approved the second all-in-one fixed-dose combination tablet for people living with HIV. For more information: http://www.fda.gov/ForConsumers/ByAudience/F orPatientAdvocates/HIVandAIDSActivities/ucm26 7592.htm • US CDC has launched Health Communication Science Digest, a collection of journal links which provides easy access to recently published articles and reports in diverse disciplinary areas such as advertising, communication, epidemiology, marketing, and public health. It is designed to enhance awareness of emerging health communication and marketing scientific knowledge which is particularly relevant for the health communication and social marketing community. For more information, see http://www.cdc.gov/healthcommunication/Scienc eDigest/index.html?source=govdelivery Follow Us Follow Maine CDC’s Social Media Updates: • Facebook (www.facebook.com/MaineCDC) • Twitter (http://twitter.com/MEPublicHealth) • Blog (http://mainepublichealth.blogspot.com) • YouTube (www.youtube.com/mainepublichealth) You may subscribe to these updates for free through an RSS feed at http://www.maine.gov/tools/whatsnew/rss.php?tid=1049. 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]