Maine CDC Health Alert Network System (HAN)

Archived Alerts

AlertDateFile(s)

Chikungunya In A Maine Resident

July 14, 2014 Word  PDF
Maine CDC is reporting the first travel-acquired case of chikungunya in a Maine resident in 2014. Maine reported one travel related case of chikungunya in 2013. The current case travelled to the Dominican Republic, did not require hospitalization and is recovering. Several additional unrelated cases are under investigation. The purpose of this health alert is to provide updated testing options and remind providers to consider chikungunya in travelers to the Caribbean and other parts of the world.

Cyclosporiasis Cluster in Maine

July 8, 2014 Word  PDF
Four cases of cyclosporiasis were reported to Maine CDC from June 24-July 7th. The last known case reported in a Maine resident was in 2010, however cyclosporiasis is not a reportable condition in Maine. Tests are pending on two symptomatic contacts of one case. Onsets of illness for three cases occurred from May 27th – June 15th.

Human Arbovirus Update for Healthcare Providers

July 2, 2014 Word  PDF
Summer is here which means the mosquitoes are here as well. 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. Vermont has already detected EEE in a mosquito pool trapped in mid-June. 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 summer and early fall.

New Polio Vaccination Requirements for Travel

June 4, 2014 Word  PDF
On 5 May 2014, the Director-General of the World Health Organization (WHO) accepted the recommendations of an Emergency Committee, declaring the international spread of polio to be a public health emergency of international concern (PHEIC) under the authority of the International Health Regulations (IHR) (2005) and issued vaccination requirements for travelers in order to prevent further spread of the disease.

Statewide Pertussis

May 22, 2014 Word  PDF
Summer has arrived in Maine which brings many visitors especially school age campers from other states and countries. In Maine, the majority of reported cases have occurred among persons aged 7-19 years. During January 1 – May 22, 2014, 80 pertussis cases from 14 Maine counties have been reported. Lincoln has the highest rate in the state of 40.96 per 100,000 compared to the state’s case rate of 6.02 cases per 100,000. Maine’s number of pertussis cases to date exceeds the five year median of 49 pertussis cases. Pertussis is a highly communicable, vaccine-preventable disease that can last for many weeks. It is transmitted through direct contact with respiratory secretions of infected persons. Classic pertussis symptoms include paroxysmal cough, whoop, and posttussive vomiting. Pertussis can cause serious illness and can even be life-threatening, especially in infants. More than half of infants less than 1 year of age who get pertussis must be hospitalized. Maine CDC investigates all cases of pertussis to reinforce treatment guidelines and identify close contacts to assess whether prophylaxis is warranted. The following recommendations are highlighted to guide clinical management of suspect cases and persons reporting exposure to pertussis.

Second Confirmed MERS-CoV Case in United States

May 14, 2014 Word  PDF
The second case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United States, identified in a traveler, was reported to CDC by the Florida Department of Health (FDOH) on May 9, 2014, and confirmed by CDC on May 11. The patient is in a hospital in Florida after having flown from Saudi Arabia to Florida via London, Boston and Atlanta. The purpose of this HAN is to alert clinicians, health officials, and others to increase their index of suspicion to consider MERS-CoV infection in travelers from the Arabian Peninsula and neighboring countries.

Confirmed MERS-CoV Case in Indiana

May 5, 2014 Word  PDF
The first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United States, identified in a traveler, was reported to CDC by the Indiana State Department of Health (ISDH) on May 1, 2014, and confirmed by CDC on May 2. The patient is in a hospital in Indiana after having flown from Saudi Arabia to Chicago via London. The purpose of this HAN is to alert clinicians, health officials, and others to increase their index of suspicion to consider MERS-CoV infection in travelers from the Arabian Peninsula and neighboring countries.

2014 Lyme Disease Information

May 1, 2014 Word  PDF
Lyme disease is the most common vector-borne 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. May is Lyme Disease Awareness Month in Maine. The purpose of this advisory is to: provide general information regarding ticks and Lyme disease; remind providers to report cases of Lyme disease, including those diagnosed by erythema migrans; provide resources on diagnosis and treatment of Lyme disease; and remind providers that Anaplasma, Babesia and other tick borne diseases are also increasing in Maine.

Travel-Related Disease Conditions

February 5, 2014 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) investigated multiple cases of travel-related illness in 2013. Cases of chikungunya, dengue fever, and malaria have been reported to Maine CDC in persons who have recently traveled or have moved to Maine from another country. Maine residents frequently travel outside of the United States during school vacation weeks in February and April, often to warmer climates, putting them at risk for vector- and food-borne diseases.

Cold Weather Medical Emergencies and Cold Weather Advisory

January 24, 2014 Word  PDF
Maine CDC Director, Dr. Sheila Pinette, is warning people about the dangers associated with extremely cold weather resulting from exposure to sub-zero temperatures that could impact their health and safety. During extreme cold weather, the two most serious medical emergencies are frostbite and hypothermia. Knowing the signs, symptoms and treatment for cold weather related medical emergencies will help keep you safe and healthy this winter.

Maine Animal Rabies 4th Quarter Update

January 23, 2014 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) provides quarterly updates on animal rabies to veterinarians and other animal health professionals. This update is for the fourth quarter of 2013 (Oct. 1-Dec. 31).

Human Infection with Avian Influenza A (H5N1) Virus

January 17, 2014 Word  PDF
On January 8, 2014, the Public Health Agency of Canada reported the first confirmed case of human infection with avian influenza A (H5N1) virus identified in North America. The patient exhibited symptoms while returning from travel to Beijing, China, on December 27, 2013. For more information on this patient’s travel itinerary, please refer to a Public Health Agency of Canada technical briefing at http://www.phac-aspc.gc.ca/media/nr-rp/2014/2014_0108a-eng.php. The patient was hospitalized on January 1, 2014, and subsequently died on January 3, 2014. Investigations by Canadian public health officials are ongoing. Since avian influenza A (H5N1) viruses have only been rarely, and never sustainably, transmitted from person to person, there is a very low risk of subsequent related cases. To date, no cases of human infection with avian influenza A (H5N1) viruses have been reported in the United States.

Widespread Influenza Activity in Maine

January 8, 2014 Word  PDF
Influenza activity in Maine is widespread with laboratory confirmed influenza reported in all counties. Influenza A/pH1N1, Influenza A/H3, and influenza B have been confirmed in Maine indicating all three strains are circulating. Maine CDC has followed up on six outbreaks of influenza as of Tuesday, January 7th. Influenza vaccination is still strongly encouraged and is widely available, especially to protect those persons at risk of severe disease. The vaccine appears to be a good match to the circulating strains this year, and it is not too late to get vaccinated.

Carbon Monoxide Alert for Healthcare Facilities

December 26, 2013 Word  PDF
Over the past several days, four carbon monoxide poisoning incidents have been reported to the Maine Center for Disease Control. Carbon monoxide poisoning was made a notifiable condition in April 2008. All cases with clinical signs, symptoms, or known exposure consistent with diagnosis of carbon monoxide poisoning, and/or a carboxyhemoglobin level equal to or above 5%, are now reportable to the Maine CDC. Carbon monoxide poisoning is a Category II notifiable condition, and thus should be reported within 48 hours.

Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season

December 26, 2013 Word  PDF
From November through December 2013, CDC has received a number of reports of severe respiratory illness among young and middle-aged adults, many of whom were infected with influenza A (H1N1) pdm09 (pH1N1) virus. Multiple pH1N1-associated hospitalizations, including many requiring intensive care unit (ICU) admission, and some fatalities have been reported. The pH1N1 virus that emerged in 2009 caused more illness in children and young adults, compared to older adults, although severe illness was seen in all age groups. While it is not possible to predict which influenza viruses will predominate during the entire 2013-14 influenza season, pH1N1 has been the predominant circulating virus so far. For the 2013-14 season, if pH1N1 virus continues to circulate widely, illness that disproportionately affects young and middle-aged adults may occur. In Maine so far this influenza season, the majority of reported cases of influenza are influenza A, and of those that are typed, the far majority are influenza A (pH1N1). Vaccine is still widely available through providers, pharmacies, public clinics, and some schools.

Carbon Monoxide Alert for Emergency Departments

December 20, 2013 Word  PDF
With the potential for significant icing in the forecast for the weekend, power outages may affect many Maine households. Hospital emergency departments should be on alert for carbon monoxide poisonings due to improper placement and operation of gas-powered generators and other alternative cooking and power sources.

Update on Tick Borne Diseases in Maine

December 18, 2013 Word  PDF
Although the weather outside may be frightful, temperature alone is not enough to kill the ticks. The deer tick can remain active in its adult stage from fall to spring as long as the temperature is above freezing. The tick will remain alive, but inactive when temperatures are below 40 Fahrenheit.

Influenza Arrives in Maine - 2013

October 28, 2013 Word  PDF
Influenza has officially arrived in Maine. Maine’s Health and Environmental Testing Laboratory (HETL) detected the first positive influenza A virus by polymerase chain reaction (PCR) late last week. The patient was an unvaccinated adult from Kennebec County with multiple underlying conditions who did not have any recent travel, did not require hospitalization, and is recovering at home. The virus was typed as an Influenza A (2009 H1N1) strain. Influenza A (2009 H1N1), influenza A (H3), and influenza B are all currently circulating nationally. The 2013-2014 trivalent influenza vaccine contains components of all three strains (H1, H3 and B) and is likely to offer good protection. The 2013-2014 quadrivalent vaccine contains an additional B strain.

Acute Hepatitis and Liver Failure Following the Use of a Dietary Supplement Intended for Weight Loss or Muscle Building

October 15, 2013 Word  PDF
The Federal CDC recently sent out a Health Alert regarding a number of previously healthy individuals that developed acute hepatitis and sudden liver failure of unknown cause after using OxyELITE Pro, a dietary supplement marketed for weight loss and muscle gain. The most commonly reported symptoms included loss of appetite, light-colored stools, dark urine, and jaundice. Federal CDC recommends enhanced surveillance by public health agencies, emergency departments, and healthcare providers for patients who develop acute hepatitis or liver failure following use of a weight loss or muscle building nutritional supplement. Federal CDC also recommends that, as part of a comprehensive evaluation, clinicians evaluating patients with symptoms of acute hepatitis should ask about consumption of dietary supplements.

Post-exposure Prophylaxis for Individuals Exposed to Hepatitis A Virus

October 7, 2013 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) is investigating a case of acute hepatitis A virus infection in Cumberland County. The case prepared food for two group events held in Androscoggin County on Saturday, September 28: a fundraiser dinner at the Durham Friends Meetinghouse and a women’s group luncheon affiliated with the meetinghouse. Maine CDC attempted to contact most of the meal attendees, but the events were also open to the public. Individuals who consumed food at either event are recommended to receive post-exposure prophylaxis as soon as possible and up to 14 days after exposure. The last day of the prophylaxis period is Saturday, October 12, 2013. The case was also associated with a preschool in Cumberland County while infectious; however, the preschool exposure was outside the window of opportunity for prophylaxis to be effective. Persons associated with the preschool were provided with a letter and recommended to consult their primary care provider if they develop symptoms of hepatitis A.

2013 World Rabies Day: Rabies Post-Exposure Prophylaxis Recommendations

September 25, 2013 Word  PDF
World Rabies Day falls on September 28 this year and coincides with the anniversary of the death of Louis Pasteur, who helped to develop the first vaccine against the disease. To acknowledge this event, please review the current Advisory Committee on Immunization Practices (ACIP) recommendations for rabies post-exposure prophylaxis (PEP). Rabies PEP, combining wound treatment, local infiltration of human rabies immune globulin (HRIG), and vaccination is effective when appropriately administered. However, rabies has occasionally developed among humans when key elements of rabies PEP were omitted or incorrectly administered.

Air Quality Alert

August 20, 2013 Word  PDF
Ground-level ozone concentrations will be climbing in Maine Wednesday and are expected to reach unhealthy levels for the Southwest Coast and Mid-Coast regions according to the Maine Department of Environmental Protection (DEP). Unhealthy levels of ozone will continue into Thursday for the entire coastline. Ozone values for interior regions will likely reach the Moderate range Wednesday and possibly into Thursday.

Emerging Tick-borne Disease: Babesiosis

August 15, 2013 Word  PDF
Babesiosis is a parasitic infection that is carried by Ixodes scapularis (the deer tick), which is the same tick that also carries Lyme disease. Babesiosis is an emerging infection in Maine, and as of August 14, 2013, 17 cases have been reported to Maine CDC from 3 counties (Cumberland, Knox, and York). During 2012, a total of 10 cases were reported. Most infections occur during the summer and fall months, so the number of cases is expected to rise.

Eastern Equine Encephalitis Virus Positive Mosquito Pool

August 12, 2013 Word  PDF
Maine CDC has confirmed the presence of Eastern Equine Encephalitis virus (EEE) in mosquitoes collected in the state. One mosquito pool (a collection which contains between 1-50 mosquitoes) tested positive for EEE at Maine’s Health and Environmental Testing Laboratory (HETL) on August 9th, 2013. The positive pool of Culiseta melanura mosquitoes was collected on July 16th, 2013 in the town of Alfred in York county.

Diagnosing and Reporting Gastrointestinal Illness and Outbreaks

August 8, 2013 Word  PDF
Many health care providers that evaluate patients with GI illness (vomiting and/or diarrhea) do not take diagnostic specimens. It is important for healthcare to providers to consider collecting specimens to facilitate: 1) accurate diagnosis and treatment of the patient; 2) disease control recommendations for those patients with high risk for disease transmission (e.g., food service, healthcare, and childcare workers); and 3) recognition of emerging and unusual pathogens, disease clusters, and outbreaks.

Statewide Pertussis

July 30, 2013 Word  PDF
Pertussis continues to affect a significant number of Maine residents. During January 1 – July 26, 2013, 196 pertussis cases from 13 Maine counties have been reported. This number is less than the 333 reported pertussis cases during the same period in 2012, but exceeds the five year median of 60 pertussis cases. In Maine, the majority of reported cases have occurred among persons aged 7-19 years.

Maine Animal Rabies 2nd Quarter Update

July 29, 2013 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) provides quarterly updates on animal rabies to veterinarians and other animal health professionals. This update provides information on rabid animals for the second quarter of 2013 (Apr. 1-Jun. 30). Results are based on animals submitted and tested at the Health and Environmental Testing Laboratory (HETL) following exposure to a human or domestic animal. USDA APHIS Wildlife Services performs supplemental surveillance for rabid animals with no human or domestic animal exposure (Table 1). The number of rabid animals statewide may not be representative of the true incidence of animal rabies in Maine.

Maine CDC/DHHS Advises Caution as a Hot Week gets Hotter

July 18, 2013 Word  PDF
The National Weather Services has issued a Heat Advisory for Kennebec County, Cumberland County, Oxford County, Androscoggin County, and York County. High heat combined with high humidity will result in a “heat index” (a measure that describes how hot it feels) above 100 degrees for these areas on Friday. These conditions come after several days of continuous heat, with daily temperatures above 90 in some places and unusually warm overnight temperatures. Because nearly half of Maine homes do not have any air conditioning, many may find it difficult to get relief from the extreme heat on Friday.

Human Arbovirus Update for Healthcare Providers in Maine

July 8, 2013 Word  PDF
Summer is here and arboviral activity has already been detected in the New England region, with a mosquito collection testing positive for West Nile virus in Massachusetts. 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 during the summer and early fall.

Maine CDC/DHHS Advises Preparation for High Heat

July 5, 2013 Word  PDF
Parts of Maine are experiencing hot weather over the July 4 Holiday weekend. The high heat combined with high humidity will result in a “heat index” approaching 100 for some areas in southern and southwestern Maine. The “heat index” is a measure derived from both temperature and humidity that describes how hot it feels. These conditions may last well into the weekend, making it difficult for the many Mainers without air conditioning to get relief from the heat. Statewide, nearly a half of Maine homes do not have any air conditioning.

Exercise Good Judgment During the Agricultural Fair Season

June 28, 2013 Word  PDF
Maine’s fair season kicks off in July, with 24 licensed agricultural fairs throughout the state. Fairs offer visitors a unique opportunity to enjoy agricultural events, exhibits, food, amusement rides and other attractions. Fairs also may increase the risk of certain diseases, to both humans and animals. Influenza A H3N2v is associated with pig exposure, most commonly during fairs. Twelve cases were confirmed in 2011 from five states, including two in Maine. 309 cases of influenza A H3N2v were reported in 2012 from twelve states. Indiana has already reported 4 cases associated with a fair in June, 2013. Other diseases that may increase during fair season include Shiga toxin-producing E. coli infections (STEC), Salmonellosis, Cryptosporidiosis, and Campylobacteriosis. The risk of these diseases can be reduced through good hand hygiene.

Maine CDC/DHHS Advises Preparation for High Heat

June 24, 2013 Word  PDF
Parts of Maine will experience unusually hot weather over the next two days. High heat and humidity will affect the southern portion of the state, primarily interior York and Cumberland Counties. The hot weather today and tomorrow follows a stretch of relatively cool weather in the state, and Mainers may not yet be acclimated to the heat. Extreme heat can be dangerous, and the Maine CDC is advising healthcare and service providers and public health professionals to check on vulnerable individuals in their care, be ready to recognize and respond to heat illness, and give prevention guidance to patients and clients.

Situational Update and Guidelines for Evaluation of Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

June 20, 2013 Word  PDF
The Centers for Disease Control and Prevention (CDC) is working closely with the World Health Organization (WHO) and other partners to better understand the public health risk posed by Middle East Respiratory Syndrome Coronavirus (MERS-CoV), a novel coronavirus that was first reported to cause human infection in September 2012. No cases have been reported in the United States. The purpose of this HAN Advisory is to provide updated guidance to state health departments and health care providers in the evaluation of patients for MERS-CoV infection including expansion of availability of laboratory testing and, in consultation with WHO, expansion of the travel history criteria for patients under investigation from within 10 to 14 days for investigation and modification of the case definition. Please disseminate this information to infectious diseases specialists, intensive care physicians, internists, infection preventionists, as well as to emergency departments and microbiology laboratories.

Lyme Disease Update 2013

May 30, 2013 Word  PDF
Lyme disease is already on the rise. As the temperature is increasing, so is the number of reported Lyme disease cases in Maine. Maine had a record high number of Lyme disease cases reported in 2012, and we expect to see high numbers again in 2013.

2013 Lyme Disease Information

May 1, 2013 Word  PDF
Lyme disease is the most common vector-borne 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. May is Lyme Disease Awareness Month in Maine. The purpose of this advisory is to: Provide general information regarding ticks and Lyme disease; Remind providers to report cases of Lyme disease, including those diagnosed by erythema migrans; Provide resources on diagnosis and treatment of Lyme disease; Remind providers that Anaplasma, Babesia and other tick borne diseases are also increasing in Maine.

Measles Alert

April 25, 2013 Word  PDF
Measles is a highly contagious viral respiratory illness. On April 24, 2013 Maine CDC was notified of a confirmed case of measles in an out -of -state resident who visited several businesses and academic institutions throughout the state on April 16, 2013. Maine clinicians are asked to increase surveillance for rash illness suggestive of measles to identify early potential cases and prevent the spread of disease.

Maine Animal Rabies 1st Quarter Update (Jan. 1 - Mar. 31, 2013)

April 18, 2013 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) provides quarterly updates on animal rabies to veterinarians and other animal health professionals. This update provides information on rabid animals for the first quarter of 2013 (Jan. 1-Mar. 31). Results are based on animals submitted and tested at the Health and Environmental Testing Laboratory (HETL) following exposure to a human or domestic animal. USDA APHIS Wildlife Services performs supplemental surveillance for rabid animals with no human or domestic animal exposure (Table 1). The number of rabid animals statewide may not be representative of the true incidence of animal rabies in Maine.

Human Infections with Novel Influenza A (H7N9) Viruses

April 9, 2013 Word  PDF
As of April 8, 2013, Chinese public health officials have reported 24 cases of human infection with a novel avian influenza A (H7N9) virus, seven of which proved fatal. All 24 cases have occurred in eastern China. These are the first human infections identified with an avian influenza A (H7N9) virus infection. No person-to-person transmission or epidemiologic link between any of the cases has been identified. No cases have been identified in Maine, but we wanted to provide this information as the situation in China continues to unfold.

Fungal Infections Update

March 12, 2013 Word  PDF
CDC continues to receive new reports of fungal infection among patients who were given injections of contaminated methylprednisolone acetate (MPA1) from the New England Compounding Center (NECC) in Framingham, Mass. Most of these recent cases have been localized spinal or paraspinal infections (e.g., epidural abscesses) in patients, although new cases of meningitis or arachnoiditis also have been reported. Because many of these new cases are among patients with minimal symptoms, CDC is re- emphasizing the recommendation for clinicians to remain vigilant for fungal infections, especially in patients with mild or even baseline symptoms, and consider evaluation with magnetic resonance imaging (MRI) if clinically warranted. No Maine facilities received the contaminated lots of MPA, however small numbers of Maine residents received this medication in another state.

Carbapenem-Resistant Enterobacteriaceae

March 8, 2013 Word  PDF
Carbapenem-resistant Enterobacteriaceae (CRE) are untreatable or difficult-to-treat multidrug-resistant organisms that are emerging in the United States. CRE is seen in patients in acute care settings, especially ICUs, as well as long term care. Because of increased reports of these multidrug- resistant organisms, federal CDC is alerting clinicians about the need for additional prevention steps regarding CRE. Note that there are currently very few cases of CRE in Maine.

Carbon Monoxide Alert for Emergency Departments

February 8, 2013 Word  PDF
With high winds and snow expected for Maine Friday and Saturday, power outages may affect many Maine households. Hospital emergency departments should be on alert for carbon monoxide poisonings due to improper placement and operation of gas-powered generators and other alternative cooking and power sources. The most common presenting symptoms of carbon monoxide poisoning in a study of cases following the 1998 Ice Storm were headache (69% of cases), nausea (51%), dizziness (48%), fatigue (31%), vomiting (21%), chestpain (9%), shortness of breath (6%), and loss of consciousness (8%). These symptoms were associated with blood carboxyhemoglobin (COHb) levels ranging from 2 % to 50 %, with a median of 14 %. Some individuals with elevated COHb levels were asymptomatic, and were identified because another household member had symptoms. Carbon monoxide poisoning was made a notifiable condition in April 2008. All cases with clinical signs, symptoms, or known exposure consistent with diagnosis of carbon monoxide poisoning, and/or a carboxyhemoglobin level equal to or above 5% are now reportable to the ME-CDC. Use the same disease reporting lines as used for all notifiable conditions: 1-800-821-5821 (phone); 1-800-293-7534 (fax).

Maine Animal Rabies 4th Quarter Update (October 1 - December 31, 2012)

January 23, 2013 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) provides quarterly updates on animal rabies to veterinarians and other animal health professionals. This update provides information on rabid animals for the fourth quarter of 2012 (Oct. 1-Dec. 31). Results are based on animals submitted and tested at the Health and Environmental Testing Laboratory (HETL) following exposure to a human or domestic animal. USDA APHIS Wildlife Services performs supplemental surveillance for rabid animals with no human or domestic animal exposure. The count of positive animals statewide may not be representative of the true incidence of animal rabies in Maine.

Influenza Update

January 17, 2013 Word  PDF
Influenza activity in Maine remains widespread. All three strains of influenza are circulating, with influenza A/H3 as the predominant strain. Influenza activity is significantly higher than the 2011-2012 season with Maine CDC following up on 125 outbreaks as of Thursday January 17th. Many Maine residents are presenting to health care facilities for care, and influenza-related hospitalizations are still high. One pediatric death attributed to influenza was reported to Maine CDC in December. Vaccine is the best way to prevent disease, but early treatment with antiviral drugs can help reduce the severity of illness.

Influenza Update

January 8, 2013 Word  PDF
Influenza activity in Maine is widespread with all three strains of influenza circulating, with influenza A/H3 as the predominant strain. Influenza activity is significantly higher than the 2011-2012 season with Maine CDC following up on 65 outbreaks as of Tuesday January 8th. Many Maine facilities are reporting influenza related hospitalizations, and health care facilities are experiencing a surge of ill individuals presenting for care. One pediatric death attributed to influenza was reported to Maine CDC in December. Influenza levels are expected to remain high for the next several weeks. Influenza vaccination is still strongly encouraged and is widely available, especially to protect those persons at risk of more severe disease. The vaccine appears to be a good match to the circulating strains this year, and it is not too late to get vaccinated. Vaccine is the best way to prevent disease, but early treatment with antiviral drugs can help reduce the severity of illness.

Norovirus Gastroenteritis in Maine

January 3, 2013 Word  PDF
Since November 2012, Maine CDC has investigated 16 reports of gastroenteritis outbreaks (2 or more ill individuals) statewide. Norovirus Genotype II has been identified as the cause of 8 of the outbreaks. The southern part of the state has seen the majority of reported outbreaks – 56% in York County. Norovirus infections typically increase during the winter months. Public health partners are encouraged to consider norovirus when assessing clusters of gastroenteritis and to act promptly to prevent the spread of illness.

Widespread Influenza Activity in Maine

December 18, 2012 Word  PDF
Influenza activity in Maine has steadily increased in November and December. Influenza A/H3 and influenza B have been confirmed in Maine indicating both strains are circulating. Maine CDC has followed up on 13 outbreaks of influenza as of Tuesday December 18th. Influenza hospitalizations are also being reported, indicating the severity of illness this influenza season. One pediatric death attributed to influenza was reported to Maine CDC last week. Influenza vaccination is still strongly encouraged and is widely available, especially to protect those persons at risk of more severe disease. The vaccine appears to be a good match to the circulating strains this year, and it is not too late to get vaccinated.

Cluster of Invasive Group A Streptococcal Infections Associated with Injection of Bath Salts

December 6, 2012 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) is investigating a cluster of invasive Group A Streptococcal (GAS) infections in patients who have reported a history of injecting bath salts. Four cases of invasive GAS have been reported among persons aged 23-37 years, two of which resulted in Streptococcal Toxic Shock Syndrome (STSS). All cases reported injecting bath salts, all required hospitalization, one required intensive care, and one had necrotizing fasciitis. All four cases are from Aroostook and Penobscot counties.

Increased Gonorrhea Infection and Updated Treatment Recommendations

December 4, 2012 Word  PDF
Gonorrhea is a sexually transmitted disease caused by the Neisseria gonorrhoeae bacterium. Gonococcal infection is reportable to Maine CDC within 48 hours of recognition or strong suspicion of disease. In men, common symptoms include burning sensation when urinating or a white, yellow or green penile discharge. In women, symptoms are uncommon, but may include painful or burning sensation when urinating or increased vaginal discharge. Gonorrhea is a major cause of serious reproductive complications in females. Case reports of gonorrhea in Maine have been increasing in recent years from 96 cases in 2008 to 272 cases in 2011.

Influenza Arrives In Maine

November 5, 2012 Word  PDF
Influenza has officially arrived in Maine. The first two positive influenza A cases were detected by Affiliated Laboratory Inc. early last week. These cases were in a young adult from Aroostook county and a teenager from Penobscot county. Neither patient was vaccinated, had recent travel, or required hospitalization. A long term care facility in Penobscot reported an outbreak of influenza on October 31. Maine’s Health and Environmental Testing Laboratory (HETL) confirmed influenza A in an employee and a resident from the facility on Friday November 2. HETL typed all 4 samples as seasonal influenza A (H3). Influenza A (2009 H1N1), influenza A (H3), and influenza B are all currently circulating nationally. The current 2012-2013 influenza vaccine contains components of all three strains (H1, H3 and B) and is likely to offer good protection.

First Case of West Nile Virus in a Maine Resident

October 31, 2012 Word  PDF
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 symptoms including fever, encephalitis, meningitis, weakness, and double vision beginning on October 1st. The purpose of this health advisory is to alert clinicians to 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 (fever greater than or equal to 100.4 degrees Fahrenheit or 38 degrees Celsius) through the end November.

If the Power Goes Out, Generators Go Outside

October 29, 2012 Word  PDF
With high winds and heavy rains expected for Maine from Hurricane Sandy, the Maine Center for Disease Control and Prevention (MeCDC) is advising people to plan ahead to stay safe and healthy during and after the storm. “One of the things we worry about most during and after a big storm is people using gas-powered generators improperly when the power goes out,” said MeCDC Director, Dr. Sheila Pinette. After Tropical Storm Irene hit Maine and New England in August 2011, carbon monoxide (CO) poisoning was the cause of two deaths and four non-fatal poisonings in Maine. In each case, the carbon monoxide came from improper operation of generators during the power outages that followed the storm.

Update on Fungal Infections Outbreak and FDA Recall

October 18, 2012 Word  PDF
The U.S. Centers for Disease Control and Prevention (US CDC) and the Food and Drug Administration (FDA) are coordinating a multi-state investigation of fungal meningitis and septic arthritis among patients who received steroid injections with potentially contaminated methylprednisolone acetate, produced by New England Compounding Center (NECC) located in Massachusetts. As of October 17, 2012, 247 cases (including 2 peripheral joint infections) and 19 deaths have been reported in 15 states. Maine did not receive any medication from the 3 recalled lots.

Maine Animal Rabies 3rd Quarter Update (July 1 - September 30, 2012)

October 15, 2012 Word  PDF
Maine Center for Disease Control and Prevention (Maine 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.

Meningitis and Stroke Associated with Potentially Contaminated Product

October 5, 2012 Word  PDF
The Federal Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are coordinating a multi-state investigation of fungal meningitis among patients who received an epidural steroid injection. Several of these patients also suffered strokes that are believed to have resulted from their infection. As of October 4, 2012, five deaths have been reported. Fungal meningitis is not transmitted from person to person. These cases are associated with a potentially contaminated medication. Investigation into the exact source is ongoing; however, interim data show that all infected patients received injection with preservative-free methylprednisolone acetate (80mg/ml) prepared by New England Compounding Center, located in Framingham, MA. This particular medication was not distributed to Maine.

Eastern Equine Encephalitis Positive Pheasant

September 11, 2012 Word  PDF
On September 10, 2012 Maine’s Health and Environmental Testing Laboratory (HETL) confirmed Eastern equine encephalitis (EEE) in a pheasant flock from Lebanon in York County. Maine CDC and the Maine Department of Agriculture were notified of multiple deaths in a pheasant flock in the first week of September. The bird that tested positive died on September 6th as a result of the infection.

Increase in Vibriosis

September 6, 2012 Word  PDF
Since July 1st 2012, ten infections with bacteria of the Vibrio genus (also called vibriosis) have been reported to Maine CDC; four in Maine residents and six in out of state residents. In 2011, only four cases were reported, all in Maine residents. The majority of vibriosis infections reported in Maine occur in the summer months. Seven of the ten vibriosis infections reported in Maine this year were laboratory-confirmed Vibrio parahaemolyticus, one was Vibrio fluvialis, one was Grimontia hollisae (formerly Vibrio hollisae), and one is pending speciation. The median age of ill individuals is 70 years. All patients reported consuming some type of seafood during their exposure period. All cases are considered sporadic and not linked at this time. Multiple state agencies are involved in the investigation.

West Nile Virus Positive Mosquito Pool

August 20, 2012 Word  PDF
Maine CDC has confirmed the presence of West Nile virus (WNV) in mosquitoes in the state. One mosquito pool (a collection which contains between 1-50 mosquitoes) tested positive for WNV at Maine’s Health and Environmental Testing Laboratory (HETL) on August 17th, 2012. The pool of Culiseta melanura mosquitoes was collected on August 1, 2012 in the town of Lebanon.

Increase in Anaplasmosis - Maine 2012

August 9, 2012 Word  PDF
Anaplasmosis is a bacterial infection that is carried by Ixodes scapularis (the deer tick), which is the same tick that also carries Lyme disease. Anaplasmosis is an emerging infection in Maine, and as of August 8, 2012, 38 cases have been reported to Maine CDC from 8 counties (Androscoggin, Cumberland, Hancock, Kennebec, Knox, Lincoln, Somerset and York). During 2011, a total of 26 cases were reported. Most infections occur during the summer and fall months, so the number of cases is expected to rise.

Increase in Influenza A H3N2v Virus Infections in Three U.S. States

August 7, 2012 Word  PDF
Multiple infections with variant influenza A (H3N2v) viruses have been identified in 3 states in recent weeks. From July 12 through August 3, 2012, 16 cases of H3N2v were reported and confirmed by CDC. This virus was first detected in humans in July 2011. It has also been isolated in U.S. swine in many U.S. states. Since July 12, 2011, there have been 29 cases of H3N2v virus infection, including the 16 cases occurring in the last three weeks. All 29 cases were infected with H3N2v viruses that contain the matrix (M) gene from the influenza A (H1N1)pdm09 virus. This M gene may confer increased transmissibility to and among humans, compared to other variant influenza viruses. All cases have been laboratory-confirmed at CDC. Each of the 16 cases identified since July 12, 2012, 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. There is no indication that the cases in different states are epidemiologically related.

Human Arbovirus Update for Healthcare Providers

August 1, 2012 Word  PDF
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.

Statewide Pertussis

July 31, 2012 Word  PDF
Maine, like many other states, has been experiencing an increasing number of pertussis cases in the past year. During January 1 – July 26, 2012, 300 pertussis cases have been reported to Maine CDC from 13 Maine counties. This number far exceeds the 75 reported pertussis cases during the same period in 2011 and the total number of reported cases that year (205). In Maine, the majority of reported cases have occurred among persons aged 7-19 years. As of July 5, 2012, 37 states reported increases in pertussis compared with the same time period in 2011. As of July 19, 2012, nearly 18,000 cases have been reported to federal CDC. The national year-to-date case count for 2012 has surpassed case counts from the previous five years for the same period.

Maine Animal Rabies 2nd Quarter Update (April 1 - June 30, 2012)

July 24, 2012 Word  PDF
Maine Center for Disease Control and Prevention (Maine 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.

Air Quality Alert

July 12, 2012 Word  PDF
The Maine Department of Environmental Protection is urging the elderly, children and those with heart or lung diseases to reduce their exertion Friday as unhealthy air quality sets in along the state’s coast between Kittery and Acadia National Park due to elevated ground-level ozone concentrations. Meteorologists from the department’s Bureau of Air Quality are further forecasting that these unhealthy levels could linger though the weekend as the air mass remains largely unchanged through Sunday, but will issue an updated forecast by 3 p.m. on Friday on its website www.maine.gov/dep/air).

Maine CDC/DHHS Advises Caution in Heat

June 20, 2012 Word  PDF
Parts of Maine will experience unusually hot weather over the next two days. High heat and humidity will affect the southern half of the state, and the National Weather Service has issued a Heat Advisory for these areas for Wednesday. The hot weather will extend into Thursday, with warm overnight temperatures on Wednesday night. Extreme heat can be dangerous, and the Maine CDC is advising Mainers, healthcare providers, and public health professionals to take precautions to prevent heat illness.

Maine Animal Rabies 1st Quarter Update (Jan. 1 - Mar. 31, 2012)

May 24, 2012 Word  PDF
Maine Center for Disease Control and Prevention (Maine 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.

Increase in Pertussis

May 15, 2012 Word  PDF
Maine, like many other states, has been experiencing an increasing number of pertussis cases over the past year. During January 1–May 11, 2012, 55 pertussis cases have been reported to Maine CDC from 9 Maine counties. More than 200 cases of pertussis were reported to Maine CDC during 2011, far exceeding the 53 reported cases in 2010 and the 10-year average of 82 cases per year. Clusters of pertussis have occurred in schools, child care centers, camps, sport teams and workplaces. Pertussis is a highly communicable, vaccine-preventable disease that can last for many weeks. It is transmitted through direct contact with respiratory secretions of infected persons. Classic pertussis symptoms include paroxysmal cough, whoop, and posttussive vomiting. Pertussis can cause serious illness and can even be life-threatening, especially in infants. More than half of infants less than 1 year of age who get pertussis must be hospitalized.

Viral Hepatitis Awareness Month: Information for Clinicians

May 14, 2012 Word  PDF
May is Viral Hepatitis Awareness Month. Maine CDC urges clinicians to understand the burden of viral hepatitis in Maine and to follow key recommendations for testing and prevention. Viral hepatitis is a leading cause of liver cancer and the most common reason for liver transplantation among adults in the U.S. According to the U.S. Centers for Disease Control and Prevention, an estimated 4.4 million Americans are living with chronic hepatitis, and most do not know they are infected. The global burden of viral hepatitis is about 1 million deaths per year.

White Powder Letters Similar to Letters Sent in October 2010 and May 2011

May 9, 2012 PDF 
A series of “white powder letters” were received in the District of Columbia in October, 2010 and May, 2011. Similar letters were received at various locations around the country in March of this year. Today eight similar letters were reportedly received in Dallas, Texas area Head Start pre-schools. The letters were postmarked May 7 and additional letters may be in the mail system pending delivery. Specially trained response teams are prepared to investigate and collect any suspicious letters. The envelopes are postmarked Dallas, Texas and contain a letter and a white powder. They are typically addressed using a computer printed label. CONTEXTUAL RELEVANCE OR IMPACT TO MAINE: The Maine Information & Analysis Center has no specific information that any similar items have been sent to locations within Maine, or that we are targeted to receive any of the white powder mailings. This is general information of a possible threat and is provided for your knowledge and situational awareness only. Your continued vigilance and the consistent reporting of suspicious activity are critical. Please report suspicious behaviors or incidents to the MIAC at 207-624-7280 or by e-mail at intel.msp@maine.gov

Information For Providers On Lyme Disease

May 1, 2012 Word  PDF
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. May is Lyme Disease Awareness Month in Maine. The purpose of this advisory is to: provide general information regarding ticks and Lyme disease; remind providers to report cases of Lyme disease, including those diagnosed by erythema migrans; provide resources on diagnosis and treatment of Lyme disease; and remind providers that Anaplasma, Babesia and other tick borne disease are also increasing in Maine.

Norovirus Gastroenteritis in Maine

February 1, 2012 Word  PDF
Since the end of December 2011, Maine CDC has investigated 16 reports of gastroenteritis outbreaks statewide. Norovirus Genotype II has been identified as the cause of one of the outbreaks. Norovirus infections typically increase during the winter months, and Maine CDC routinely receives reports of suspected and confirmed norovirus outbreaks each year. Public health partners are encouraged to consider norovirus when assessing clusters of gastroenteritis and to act promptly to prevent the spread of illness.

Travel-Related Disease Conditions

January 30, 2012 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) investigated multiple cases of travel-related illness in 2011. Cases of hepatitis A, leishmaniasis, and malaria have been reported to Maine CDC in persons who have recently traveled or have moved to Maine from another country. During school vacation weeks in February and April, Maine residents frequently travel outside of the United States, often to warmer climates putting them at risk for vector-borne and food-borne diseases.

Maine Animal Rabies 4th Quarter Update (Oct. 1, 2011 - Dec. 31, 2011)

January 23, 2012 Word  PDF
Maine Center for Disease Control and Prevention (Maine 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.

Influenza Arrives in Maine

December 27, 2011 Word  PDF
Influenza has officially arrived in Maine. The first laboratory confirmed case of seasonal influenza was reported to Maine CDC on December 23rd, 2011. An adult from Lincoln County tested positive for influenza B at Maine’s Health and Environmental Testing Laboratory (HETL). The patient was not hospitalized, and had not recently traveled. Influenza A (2009 H1N1), influenza A (H3), and influenza B are all circulating nationally. Maine had previously detected two swine-origin novel strains of influenza A in October, but this is the first lab confirmed case of seasonal influenza in the state.

Increase in Legionellosis Cases in Maine

November 28, 2011 Word  PDF
Several New England states are seeing an increase in cases of legionellosis including Connecticut and Massachusetts. Parts of Canada are also seeing an increase in case counts in 2011. In Maine, 18 confirmed cases of legionellosis were reported to date, compared to 11 at the same time last year. The 5 year median is 10 cases. Cases range in age from 26 to 89 years, and have occurred in eight different counties. Maine saw 3 cases in the first half of 2011, but 15 in the last half of 2011. 12 of the 18 cases occurred in the last three months. No common exposure has been identified between any of the cases.

Increase In Pertussis In Maine: Reminder To Check Vaccination Status

November 14, 2011 Word  PDF
Pertussis (whooping cough) continues to increase in Maine and in many regions of the United States. The majority of reported pertussis infections have occurred in Penobscot County, but sporadic infections have occurred throughout the state. As of November 10, 2011, 163 persons infected with pertussis were reported to Maine CDC, compared to 53 reported for the entire year in 2010. Among the 163 persons reported to have pertussis in 2011, 105 (64%) were residents of Penobscot County. Clusters of pertussis have been reported in schools, camps, sport teams and workplaces.

Swine-Origin Novel Influenza A Case in Maine

October 19, 2011 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) is investigating a human case of novel influenza virus of swine origin. Federal CDC confirmed the novel strain in a child from Cumberland County earlier this week. A primary care provider evaluated the child, and provided treatment. The child was not hospitalized, and is recovering from the illness. Maine CDC has not identified any additional human cases. A joint investigation with the Maine Department of Agriculture and federal CDC is ongoing.

Maine Animal Rabies 3rd Quarter Update

October 12, 2011 Word  PDF
Maine Center for Disease Control and Prevention (Maine CDC) provides quarterly updates on animal rabies to veterinarians and other animal health professionals. These updates may be used as educational tools to inform pet owners and other members of the public about the risk of rabies in Maine and in their communities.

Rabies Post-Exposure Prophylaxis Reporting

September 28, 2011 Word  PDF
Rabies PEP is a reportable condition in Maine. The current notifiable condition reporting form is not conducive for reporting the administration of rabies PEP. Therefore, a new reporting form for rabies PEP has been developed to facilitate PEP reporting and is enclosed with this advisory.

Carbon Monoxide Poisoning: Notifiable Condition Reminder

August 30, 2011 Word  PDF
The Maine Center for Disease Control and Prevention has received reports of three incidents resulting in six carbon monoxide poisoning cases. All of these poisonings were caused by improper placement of generators as alternate power supplies during power outages associated with Hurricane Irene – either in attached garages or too close to windows. With nearly 90,000 Maine households still without power, the Maine CDC is reminding hospital emergency departments to report all cases with clinical signs, symptoms, or known exposure consistent with diagnosis of carbon monoxide poisoning, and/or a carboxyhemoglobin level equal to or above 5%. Prompt reporting from hospitals is essential to ensure appropriate follow-up, identify sources of exposure, and quickly tailor and deliver risk communication efforts intended to prevent future poisonings. Use the same disease reporting lines as used for all notifiable conditions: 1-800-821-5821 (phone); 1-800-293-7534 (fax).

Carbon Monoxide Alert for Emergency Departments

August 28, 2011 Word  PDF
With high winds and heavy rain expected for Maine from Hurricane Irene, power outages may affect many Maine households. Hospital emergency departments should be on alert for carbon monoxide poisonings due to improper placement and operation of gas-powered generators and other alternative cooking and power sources. The most common presenting symptoms of carbon monoxide poisoning in a study of cases following the 1998 Ice Storm were headache (69% of cases), nausea (51%), dizziness (48%), fatigue (31%), vomiting (21%), chest pain (9%), shortness of breath (6%), and loss of consciousness (8%). These symptoms were associated with blood carboxyhemoglobin (COHb) levels ranging from 2% to 50%, with a median of 14%. Some individuals with elevated COHb levels were asymptomatic, and were identified because another household member had symptoms. Carbon monoxide poisoning was made a notifiable condition in April 2008. All cases with clinical signs, symptoms, or known exposure consistent with diagnosis of carbon monoxide poisoning, and/or a carboxyhemoglobin level equal to or above 5% are now reportable to the ME-CDC. Use the same disease reporting lines as used for all notifiable conditions: 1-800-821-5821 (phone); 1-800-293-7534 (fax).

Storm Preparation Advisory: Carbon Monoxide Poisoning

August 26, 2011 Word  PDF
With high winds and heavy rains expected for Maine this weekend from Hurricane Irene, the Maine Center for Disease Control and Prevention is advising people to plan ahead to stay safe and healthy during and after the storm. “One of the things we worry about most during a big storm is people using gas-powered generators improperly when the power goes out. If used in the wrong way, they can cause carbon monoxide poisoning,” said state toxicologist, Dr. Andrew Smith.

Hepatitis A Virus Cluster, Northern Lincoln County

August 11, 2011 Word  PDF
The Maine Center for Disease Control and Prevention (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.

Increase In Pertussis

July 28, 2011 Word  PDF
During January 1- July 22, 2011, 72 pertussis cases were reported to Maine CDC, compared to 20 pertussis cases reported for the same time period in 2010. Clusters of pertussis cases have been reported in schools, camps, sport teams and workplaces with the largest number of clusters identified in Penobscot county. Cases range in age from 1 month to 79 years. One infant has recently been hospitalized with life threatening symptoms. Pertussis is a highly communicable, vaccine-preventable disease that can last for many weeks. It is transmitted through direct contact with respiratory secretions of infected persons. Symptoms include cough, paroxysms, whoop, and post-tussive vomiting. Pertussis can cause serious illness in infants, children and adults and can even be life-threatening, especially in infants. More than half of infants less than 1 year of age who get pertussis must be hospitalized.

Maine Animal Rabies 2nd Quarter Update

July 28, 2011 Word  PDF
Maine Center for Disease Control and Prevention (Maine 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.

Maine CDC/DHHS Extends Heat Health Alert

July 22, 2011 Word  PDF
This week’s heat wave is more extreme than originally forecast, and is reaching further into the state. The National Weather Service has issued an Extreme Heat Warning for York, Cumberland, Androscoggin, Kennebec, and Sagadahoc Counties, indicating that the heat index (a combination of heat and humidity that describes the felt temperature) will exceed 105. Less extreme but still dangerous heat will be felt in Oxford, Franklin, Somerset, and Lincoln Counties, as well as southern Penobscot, southern Piscataquis, and interior Hancock Counties. This heat will persist through Friday night, and some locations will continue to experience extreme heat on Saturday.

Maine CDC/DHHS Advises Caution in Heat

July 20, 2011 Word  PDF
Parts of Maine will experience unusually hot weather over the next two days. Heat and humidity will be highest on Thursday and persist through Friday in the southern and southwestern parts of the state, especially in York, Cumberland, and Oxford Counties. Nighttime temperatures will also be higher than usual. Extreme heat can be dangerous, and the Maine CDC is advising Mainers, health care providers, and public health professionals to take precautions to prevent heat illness. Please also note that the Maine Bureau of Air Quality is forecasting poor air quality on Thursday for coastal areas between Kittery and Acadia National Park, which could exacerbate heat-related illnesses, and may further restrict outdoor activities.

Human Arbovirus Update for Healthcare Providers

July 12, 2011 Word  PDF
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 during the late summer and early fall.

Ticks Submissions to Help Track Lyme Disease

June 23, 2011 Word  PDF
Maine Medical Center Research Institute (MMCRI), in partnership with the Maine Center for Disease Control and Prevention (Maine CDC), is expanding its efforts in northern and western Maine to track the spread of the ticks that may carry Lyme disease.

Measles Alert

June 13, 2011 Word  PDF
Measles is a highly contagious respiratory illness caused by a virus. United States is experiencing a surge of measles, and cases have been diagnosed as close as Massachusetts. The majority of measles cases reported in the United States in 2011 have been associated with importation, primarily from Europe and South-East Asia. Quebec has identified 208 new cases of measles since May 1, 2011. Maine clinicians are asked to increase surveillance for rash illness suggestive of measles to identify early potential cases and prevent the spread of disease in Maine.

Air Quality Alert

June 8, 2011 Word  PDF
The Maine Department of Environmental Protection is warning Mainers to expect unhealthy air quality today along the state’s southwest coast region between Kittery and Georgetown due to elevated ground-level ozone concentrations. Meteorologists from the department’s Bureau of Air Quality are further forecasting that these unhealthy levels are expected to expand up the coast from Kittery to Acadia National Park and possibly the state’s entire coastline on Thursday and remain until cleaner air arrives.

Shiga Toxin-producing E. coli O104

June 6, 2011 Word  PDF
A large outbreak of shiga toxin-producing E. coli O104 is occurring in Germany, with cases identified in travelers to Germany. This strain of E. coli is very rare and has not been seen in the United States prior to this outbreak. Please report any suspect cases of STEC in Maine residents with a history of travel to Germany immediately to the Maine Center for Disease Control and Prevention (Maine CDC) at 1-800-821-5821.

Maine State Police Investigating Death of Young Boy Found in South Berwick

May 16, 2011 Word  PDF
The Maine State Police are investigating the death of a young boy whose body was found in South Berwick.

Maine Animal Rabies 1st Quarter Update (January 1 – March 31, 2011)

May 13, 2011 Word  PDF
Maine Center for Disease Control and Prevention (Maine 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.

Viral Hepatitis Awareness Month: Information for Clinicians

May 11, 2011 Word  PDF
May is Viral Hepatitis Awareness Month. Viral hepatitis is a leading cause of liver cancer and the most common reason for liver transplantation among adults in the U.S. According to the federal Centers for Disease Control and Prevention, an estimated 4.4 million Americans are living with chronic hepatitis, and most do not know they are infected.

Information for Providers on Lyme Disease

May 2, 2011 Word  PDF
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. May is Lyme Disease Awareness Month in Maine. The purpose of this advisory is to: Provide general information regarding ticks and Lyme disease; Remind providers to report cases of Lyme disease, including those diagnosed by erythema migrans; Provide resources on diagnosis and treatment of Lyme disease; Remind providers that Anaplasma, Babesia and other tick borne disease are also increasing in Maine.

First Hantavirus Diagnosis in a Maine Resident

April 29, 2011 Word  PDF
Maine CDC has been notified of a diagnosis of hantavirus pulmonary syndrome (HPS) in a resident of Somerset County. This is the first documented case of HPS in a Maine resident. This resident had not recently traveled outside of Maine and was reported to have exposures known to be associated with hantavirus.

Widespread Influenza Activity In Maine

January 31, 2011 Word  PDF
Influenza activity in Maine has steadily increased in January 2011. Influenza A pH1N1 (pandemic strain that circulated widely in 2009 and 2010), influenza A/H3 and influenza B have been confirmed in Maine indicating several strains of influenza are circulating in Maine. Three long term care facilities reported outbreaks of influenza in January. Influenza vaccination is still strongly encouraged and is widely available, especially to protect those persons at risk of more severe disease.

Maine Animal Rabies 4th Quarter Update (Jan. 1 - Dec. 31, 2010)

January 24, 2011 Word  PDF
Maine Center for Disease Control and Prevention (Maine 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.

Increase In Pertussis

December 20, 2010 Word  PDF
Since November 1, 2010 there have been 13 cases of pertussis (whooping cough) reported to the Maine Center for Disease Control and Prevention (Maine CDC). Cases have been reported in Cumberland, Aroostook, Androscoggin, and Hancock counties with an identified cluster of cases in Penobscot county. Cases range in age from 7 years to 60 years. In 2009, for the same time frame, 7 cases of pertussis were reported. Pertussis is a highly communicable, vaccine-preventable disease that can last for many weeks. It is transmitted through direct contact with respiratory secretions of infected persons. Symptoms include cough, paroxysms, whoop, and post-tussive vomiting. Holiday activities bring individuals close together with an increased potential for transmission of this infection.

Bacterial Blood Infection in Cumberland County

December 10, 2010 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) is investigating a case of bacterial blood infection in a two year-old female from Cumberland County. A blood culture is pending however the clinical presentation was highly suspicious for meningococcal disease. The child attended a small daycare and participated in a number of overnight visits with family and friends. All known close contacts have been contacted directly by the Maine CDC for recommendations on antimicrobial chemoprophylaxis.

Norovirus Gastroenteritis in Maine

December 9, 2010 Word  PDF
Over the last 10 days, Maine CDC has investigated five reports of gastroenteritis outbreaks from Cumberland, Oxford, Kennebec and Hancock counties. Four outbreaks occurred in long term care facilities and one occurred in a school setting. Norovirus infections typically increase during the winter months, and Maine CDC routinely receives numerous reports of suspected outbreaks each year. Last winter season, December 2009-March 2010, there were 12 suspect and confirmed norovirus outbreaks reported, compared to 56 reported during the same time period the year before. Public health partners are encouraged to consider norovirus when assessing clusters of gastroenteritis and to act promptly to prevent the spread of illness. All of the above facilities have implemented preventive measures to control further spread of illness.

Increase in Early Syphilis in Maine

November 15, 2010 Word  PDF
Since mid July 2010, health care providers in Maine have diagnosed 19 cases of early syphilis, ages 19-56, in Cumberland, Penobscot, Waldo and York Counties. Eleven (11) cases were primary syphilis, 5 cases were secondary syphilis and 3 cases were early latent syphilis. All 19 cases were among men who have sex with men (MSM). Eight of the 19 individuals (42%) are known to be HIV positive. Since January 2010, 33 total cases of early syphilis have been reported.

Influenza Arrives in Maine

November 9, 2010 Word  PDF
Influenza has officially arrived in Maine. The first laboratory case of influenza was confirmed by Maine CDC this week. An adult from Sagadahoc County tested positive for influenza B at a national reference laboratory. The patient was not immunized and had recently traveled to the southern United States. Influenza A (2009 H1N1 pandemic strain), influenza A (H3N2), and influenza B are all circulating nationally. Now that influenza is reported in Maine, it is important to try to limit its spread. The best way to prevent influenza is by getting vaccinated. The U.S. CDC recommends all individuals older than 6 months be immunized, even if they got a seasonal or 2009 H1N1 vaccine last season. All high risk individuals should be vaccinated as soon as possible.

2010 - 2011 Influenza Season

October 14, 2010 Word  PDF
The 2010-2011 influenza season officially started October 3, 2010. The purpose of this Health Alert is to provide information and guidance for the upcoming influenza season.

Maine Animal Rabies 3rd Quarter Update (Jan. 1 - Sep. 30, 2010)

October 7, 2010 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) provides quarterly updates on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

Pertussis In Maine: Advisory For Parents and Clinicians

September 6, 2010 Word  PDF
Pertussis is still an important concern in Maine and throughout the U.S. To date in 2010, Maine has seen 32 confirmed cases of pertussis with 11 of those reported in the past month. The majority of people identified are younger than 13 years of age. Half are not up to date on their vaccines or their vaccine status is not known. This advisory provides information on pertussis for the public and clinicians as well as a reminder about required vaccines for school attendance.

Air Quality Alert

August 31, 2010 Word  PDF
The Maine Department of Environmental Protection is warning people that the air quality in Maine over the next several days will likely be the worst we have seen in several years. Ground-level ozone concentrations are expected to reach unhealthy levels along the entire coast of Maine beginning tomorrow (Wednesday). The high levels will continue into Thursday and likely move inland.

Eastern Equine Encephalitis (EEE) Update

August 25, 2010 Word  PDF
Eastern equine encephalitis (EEE) is a very serious viral infection that is transmitted by the bite of an infected mosquito. Although rare, this disease has potentially extremely severe consequences for those who contract it. All people and many organizations in Maine need to be aware of the health risks and protect themselves and those they serve from mosquito bites.

Hepatitis A Cluster in Waldo County, Maine

August 12, 2010 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) is investigating a third case of acute hepatitis A. All three are residents of Waldo County and at least one attended a number of social functions in different areas of Maine while infective which included attendees from across the state. We therefore believe other people may be at risk for contracting the illness and may be showing signs and symptoms of it in the coming days and weeks.

Seasonal Influenza A (H3N2) Virus Infections

August 5, 2010 Word  PDF
Influenza A (H3N2) virus infections have been recently detected in people in a number of states across the U.S., including two small localized outbreaks. Sporadic cases of influenza and localized summer outbreaks from seasonal influenza viruses are detected each summer. Clinicians are reminded to consider influenza as a possible diagnosis when evaluating patients with acute respiratory illnesses, including pneumonia, even during the summer months. Treatment decisions should not be made on the basis of a negative rapid influenza diagnostic test result since the test has only moderate sensitivity. False positive results also can occur, particularly at times when overall influenza prevalence is low. For patients for whom laboratory confirmation is desired, or to confirm initial influenza cases in a community in which cases have been tested by rapid influenza diagnostic tests, it is recommended that reverse transcriptase -polymerase chain reaction (RT-PCR), and/or viral culture is utilized. Clinicians should use empirical treatment with influenza antiviral medications for persons hospitalized with suspected influenza, and for suspected influenza infection of any severity in high-risk individuals, regardless of influenza immunization status. Early initiation of treatment provides more optimal clinical responses, although treatment of moderate, severe, or progressive disease begun after 48 hours of symptoms can still provide benefit.

Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas

August 2, 2010 Word  PDF
Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics. Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF). The Centers for Disease Control and Prevention (CDC) strongly advises that health care providers in the United States should: 1) consider DF and DHF when evaluating patients returning from dengue-affected areas--both domestic and abroad--who present with an acute febrile illness within two weeks of their return, 2) submit serum specimens for appropriate laboratory testing, and 3) report all presumptive and confirmed cases of DF and DHF to their local or state health department.

Air Quality Alert

July 27, 2010 Word  PDF
Ground-level ozone concentrations are expected to reach unhealthy levels for the Southwest Coastal region (Kittery through Boothbay Harbor) on Wednesday according to the Maine Department of Environmental Protection (DEP). Interior areas (Sanford through Bangor) and the Mid-Coast (Pemaquid through Acadia) are expected to have Moderate levels of ozone. Further away from the coast air quality should remain in the Good range.

Maine Animal Rabies 2nd Quarter Update (Jan. 1 - Jun. 30, 2010)

July 19, 2010 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) provides quarterly updates on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

Human Arbovirus Update for Healthcare Providers in Maine

July 13, 2010 Word  PDF
Arboviral infections including Eastern equine encephalitis (EEE) and West Nile Virus (WNV) are very serious viral 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. Because both of these diseases are seen primarily in the later summer and fall, and have been detected in animals here in Maine, the purpose of this health advisory is to alert clinicians to the potential for human disease activity.

Paralytic Shellfish Poisoning (Red Tide) Reminder

July 8, 2010 Word  PDF
With elevated levels of paralytic shellfish poisoning (PSP, also known as red tide poisoning) causing many areas of the coastline to be closed to commercial harvesting for some shellfish, and with especially high levels detected recently in the Downeast area of the state, Maine CDC in the Department of Health and Human Services and the Maine Department of Marine Resources are reminding Mainers and tourists of recommendations for the safe consumption of shellfish.

Maine CDC/DHHS Advises Caution In Heat

July 7, 2010 Word  PDF
High heat and humidity, such as what Maine is experiencing this week, make for hazardous conditions, especially when experienced for a prolonged period (3 days or more) in a geographical area such as New England where such conditions are rare and especially for people who are most susceptible to heat-related illnesses. Getting susceptible people to air conditioned space is the single most important strategy to prevent heat illness when high heat and humid conditions are expected for 3 days or more.

Heat Advisory

July 1, 2010 Word  PDF
With Maine heading into summer and a possible hot spell forecast for this upcoming weekend into next week, this is a reminder that it is important for all of us to prevent heat-related problems and to recognize the signs of heat illness early. Heat-related illnesses and deaths are preventable, yet over the past 30 years more people have died in this country from heat than from hurricanes, lightning, tornadoes, floods, and earthquakes combined.

Pertussis In Maine: Advisory For Clinicians

June 21, 2010 Word  PDF
Pertussis is still a problem in Maine and clinicians should consider the possibility of pertussis when evaluating a person with a chronic cough. So far in 2010 Maine has seen 11 confirmed cases of pertussis with 8 of those reported in the past month. The most recent cases range from 2 years to 36 years of age and 7 of the 8 cases are younger than 14 years old. Of these 8 cases 4 reside in Cumberland, 3 in Penobscot and 1 in Lincoln County. This advisory provides recommendations for the evaluation and management of pertussis.

An Update for Healthcare Providers on the Potential for Q Fever Infection Among Travelers Returning from Iraq and the Netherlands

June 4, 2010 Word  PDF
The U.S. CDC recently issued a Health Advisory on the potential for Q fever infection among travelers returning from Iraq and the Netherlands.

Healthcare Professionals Warned Not To Use Certain Intravenous Metronidazole, Ondansetron, and Ciprofloxacin Due To Potential Contamination

June 3, 2010 Word  PDF
The U.S. Food and Drug Administration (FDA) is alerting healthcare professionals not to use certain intravenous (IV) bags of metronidazole, ondansetron, and ciprofloxacin because of potential contamination. FDA has received reports of floating matter in IV bags manufactured by Claris Lifesciences Limited, in Ahmedabad, India. Microbiological analysis identified the matter in one of the bags as a Cladosporium mold. Molds of this type can cause infections in susceptible patients, such as immunocompromised individuals. At this time, FDA is not aware of any reports of injuries due to administration of these products. Affected products include any metronidazole, ondansetron, and ciprofloxacin manufactured by Claris Lifesciences Limited and sold under the following labels: Claris, Sagent Pharmaceuticals, Pfizer, West-Ward Pharmaceuticals.

Air Quality Alert Due to Smoke from Wildfires

June 2, 2010 Word  PDF
It has been reported that a number of fires are burning in the Province of Quebec, Canada. As a result, on Wednesday, ground-level Particle Pollution concentrations are expected to reach unhealthy levels in many parts of Maine according to the Maine Department of Environmental Protection. As long as fires continue to burn in Quebec, smoke will be an issue for the foreseeable future. When the winds are right smoke and the resulting high Particle Pollution values will be brought to Maine, at times reaching unhealthy levels.

Maine Animal Rabies 1st Quarter Update (Jan. 1 - Mar. 31, 2010)

May 6, 2010 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

Information for Clinicians on Lyme Disease

May 4, 2010 Word  PDF
Lyme disease is the most common vector-borne disease in Maine and the second most commonly reported reportable infectious disease in Maine. Ticks are already active, and we expect the number of Lyme disease cases to increase as the weather continues to get warmer. May is Lyme Disease Awareness Month in Maine.

Use of a Reduced (4-dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies

April 30, 2010 Word  PDF
The Advisory Committee on Immunization Practices (ACIP) has updated previous recommendations for postexposure prophylaxis (PEP) to prevent human rabies. Previously, ACIP recommended a 5-dose rabies vaccination regimen. The new ACIP recommendations call for a 4-dose rabies vaccination regimen with HDCV or PCECV on days 0, 3, 7, 14 (not 28) for PEP for previously unvaccinated persons. ACIP recommendations for use of human rabies immune globulin (HRIG) remain unchanged. As before, all PEP should begin with immediate thorough cleansing of all wounds with soap and water. Persons with altered immunocompetence should still receive the 5-dose rabies vaccination regimen for PEP.

Information for Clinicians on Increased Gonorrhea in Maine

April 22, 2010 Word  PDF
In the first quarter (January - March) of 2010, 60 individuals have been diagnosed with gonorrhea and a majority of these cases were in Androscoggin and Cumberland counties. Eighty-two percent (82%) of cases were in individuals ages 15-29. These numbers represent an increase of 54% since the last quarter (October - December) of 2009, and an increase of 93% when compared to the first quarter of 2009.

Increase in Mumps in the Northeast - March 2010

March 31, 2010 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) has been informed of a multi-state mumps outbreak in the Northeast. As of January 29, 2010, a total of 1,521 cases had been reported, with onset dates from June 28, 2009, through January 29, 2010. The outbreak began in New York and has spread to surrounding northeast states and Canada. The Hasidic (Jewish) population was first affected but the outbreak has expanded to the general population. Maine has no confirmed cases mumps related to this outbreak. Holiday and school vacations that occur during March and April may offer opportunities for travel and potential exposure to the mumps virus.

Seasonal Influenza Vaccine for 2010/2011

March 29, 2010 Word  PDF
This health advisory provides information on Maine CDC’s plans for offering seasonal influenza vaccine for the upcoming fall. Maine CDC is pleased to announce that for the 2010/2011 influenza season we plan on providing seasonal influenza vaccine for: all Maine children ages 6 months to 18 years-old; employees of schools that provide onsite vaccine clinics on school days; pregnant women and their partners (through health care providers who routinely care for pregnant women); nursing home employees and residents; high risk adults in limited public health settings, the scope and number of such settings determined by our vaccine supply.

Tuberculosis Among the Homeless in Cumberland County, Maine

March 25, 2010 Word  PDF
Maine CDC is investigating two cases of TB among persons associated with homelessness in Cumberland County. These two cases were identified within 6 months of each other. Laboratory testing indicates the M. tuberculosis bacteria are genetically identical. Two linked cases of TB is considered an outbreak in Maine. The purpose of this notice is to make health care providers aware of the outbreak and to recommend increased surveillance of TB.

Maine CDC H1N1 Feedback Survey

March 19, 2010 Word  PDF
As many of you know, we are in the process of conducting numerous in-person debriefings across the state with stakeholders on the H1N1 efforts. We hope you have had a chance to participate in these. However, we recognize some are unable to attend these forums, and even if you have been able to, certain types of feedback are easier to provide by responding to a survey. Therefore, we are providing the link below to a Survey Monkey as a mechanism to provide us confidential feedback on the H1N1 efforts. We encourage you to participate in this survey, which should take no longer than 15 - 30 minutes. Additionally, we ask that you forward it to other stakeholders. We are eager to have as many people as possible fill it out so we can obtain as broad feedback as possible.

Travel-Related Disease Conditions, Maine - 2010

February 22, 2010 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) has investigated multiple cases of travel related illness in 2010. Cases of dengue fever, typhoid fever, cryptosporidiosis, salmonellosis and giardiasis have been reported to Maine CDC in persons who have recently traveled or have moved to Maine from another country. During school vacation weeks in February and April Maine residents travel outside of the United States, often to warmer climates putting them at risk of mosquito borne diseases, especially dengue fever.

Maine Animal Rabies 4th Quarter Update (Jan. 1 - Dec. 31, 2009)

February 10, 2010 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

Increase in Invasive Group A Streptococcal and STSS Infections

January 22, 2010 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) is investigating an increase in the number and severity of invasive Group A Streptococcal (GAS) infections in the first 3 weeks of January compared to previous years. Several cases reported in January, 2010 have led to Streptococcal Toxic Shock Syndrome (STSS) and death.

Early Treatment For Influenza-like Illness

January 11, 2010 Word  PDF
The purpose of this health advisory is to reinforce recommendations for early treatment of patients with increased risk of complications from influenza. Early treatment for influenza may prevent secondary bacterial infections. During the past two weeks, an increase in cases of invasive Streptococcal pneumoniae has been observed. Cases of severe H1N1 influenza that have required hospitalization have also been reported. Circulation of influenza viruses is expected to continue through the winter months when invasive bacterial infections are also common.

H1N1 Update for January 7, 2010

January 7, 2010 Word  PDF
Flu activity in Maine has decreased enough to be classified as "regional" instead of "widespread." However, people are still being hospitalized due to H1N1, and it is important to be aware that flu comes in waves. Vaccination is the best protection for yourself and the people you care about.

H1N1 Update for December 30, 2009

December 31, 2009 Word  PDF
Flu continues to decline in Maine and the rest of the United States, but it is important to be aware that flu comes in waves. Protect yourself and those you care about by getting vaccinated before the next wave. No new deaths due to H1N1 have been reported this week. The 17 H1N1-related deaths since August have occurred in people with underlying health conditions, the vast majority with multiple serious underlying conditions. People with underlying health conditions should seek vaccine at their primary care providers, specialty providers, or at public clinics listed at www.maineflu.gov and 211. Anyone with underlying health conditions who experiences flu-like symptoms should contact his or her health care provider immediately to receive a prescription for antiviral medications (such as Tamiflu).

H1N1 Update for December 23, 2009

December 23, 2009 Word  PDF
Data indicate that H1N1 flu has been relatively mild in Maine compared with other states, and continues to decline. There have been no new deaths since the last update. There were 9 new hospitalizations last week, down from 11 last week, and across all age groups. There were no new admissions to intensive care. Individuals were hospitalized in Cumberland, Franklin, Kennebec, Oxford, Penobscot, Washington, and York counties. Outbreaks were reported in one long term care facility and two K-12 schools. The outbreaks occurred in Penobscot, Somerset, and York counties.

Agranulocytosis/Severe Neutropenia in Cocaine Users

December 17, 2009 Word  PDF
The Substance Abuse and Mental Health Services Administration (SAMHSA) has learned of several cases of agranulocytosis, a serious, acute blood disease characterized by low white blood cell counts, among cocaine users. The Maine Center for Disease Control and Prevention (Maine CDC) is working with federal CDC to investigate the incidence of agranulocytosis among persons who use cocaine.

Non-Safety Related Voluntary Recall of Certain Lots of Sanofi Pasteur H1N1 Pediatric (0.25 mL, for 6-35 month olds) Vaccine in Pre-Filled Syringes

December 15, 2009 Word  PDF
As part of its quality assurance program, Sanofi Pasteur, Inc., performs additional routine, ongoing testing of influenza vaccines after the vaccine has been distributed to health care providers to ensure that vaccines continue to meet required specifications. In recent testing of the amount of antigen in its influenza A (H1N1) monovalent vaccine, Sanofi Pasteur found four distributed lots of single-dose, pre-filled syringe pediatric (0.25 mL.) vaccine with antigen content lower than required potency levels. The manufacturer is conducting a non-safety related voluntary recall of these affected lots of vaccine.

H1N1 Vaccine Encouraged for All Mainers

December 14, 2009 Word  PDF
Based on recent demand and a large recent increase in H1N1 vaccine supply, Maine CDC is now recommending that H1N1 vaccine be offered to anyone who wishes to receive it.

H1N1 Vaccine and Treatment Update

December 4, 2009 Word  PDF
The vaccine supply continues to increase, and more substantially this week and into next week. By Monday we expect to have about 390,000 doses in Maine, which is enough for a little more than 1 dose per 2 people in the high priority groups and 1 dose per 3 people in the general population. Our distribution this past two weeks has focused on getting vaccine to many more health care facilities and practices, who now number into the hundreds. If you are a health care provider and have not received vaccine yet, there is a good chance you will this coming week. However, we still need to be vigilant about the vaccine supply since there still are over 300,000 people in high priority groups in Maine who have not had any access to vaccine.

H1N1 Update for November 20, 2009

November 20, 2009 Word  PDF
H1N1 continues to expand and worsen amid increasing vaccine shortages relative to demand for it as well as under-utilization of antiviral medicines. There have been a total of 143 schools with reported high absentee rates, including 44 this past week; ER visits for flu account for about 1 in 6 ER patients; there have been 50 hospitalizations this week, with half of them among children; and there have been 2 deaths (both previously reported), for a total of 5 since August. Vaccine administered appears to be very under-reported by health care providers, with only about 45% of doses distributed having been reported as administered. Flu infections can make people more likely to develop pneumococcal infections, which can cause serious complications, including death. All children younger than 5, all people between ages 5 and 64 with certain high risk conditions, and all people age 65 and older should receive a pneumococcal vaccine. Information on treatment with intravenous antiviral medicines is available.

H1N1 Update for November 13, 2009

November 13, 2009 Word  PDF
As expected, H1N1 continues to expand and worsen. In the last several days there have been 65 school outbreaks, 19 hospitalizations, 2 deaths (for a total of 3 since August), and about 1 in 6 emergency room visits are for flu. There is also evidence that antiviral medicines continue to be under-utilized. The vaccine supply continues to slowly improve. There is sufficient vaccine now for 1 in 4 people in high priority groups and 1 in 8 of all Maine people. An estimated 95% of schools are expected to complete their vaccinations by the end of next week. Increasing amounts of vaccine are being distributed to pediatric health care providers for preschool aged children and older children not reached by the school clinics. Vaccine is also being distributed to health care providers who care for high-risk adults, though this supply is still relatively small but expected to improve a great deal this next two weeks. Feel free to join us every Monday at 12 noon for a conference call with Q&A. Call-in information is at the end of this advisory.

H1N1 Update for Friday, November 6, 2009

November 6, 2009 Word  PDF
This health advisory serves to update health care providers and others on the H1N1 situation in Maine as well as access to vaccine and antiviral medications. H1N1 CONTINUES TO SPREAD AND WORSEN IN MAINE As anticipated, H1N1 continues to expand and worsen. Outpatient visits for influenza, the numbers of schools reporting high absenteeism, and hospitalizations have all increased substantially this past week. Maine has also recorded its second death due to H1N1 this week – a young adult with serious underlying conditions from Penobscot County. 25 schools have reported high (>15%) absentee rates this week, and they range from Aroostook to York County and from Washington to Oxford County. 10 people were hospitalized this past week due to H1N1. Four of them were previously healthy children, including one child admitted to an IUC. Every county has had confirmed cases of H1N1.

Treatment and Prophylaxis with Antivirals Maine Stockpile Available for Uninsured and Underinsured Outpatients and Inpatients

October 31, 2009 Word  PDF
With H1N1 increasingly becoming widespread in Maine, with the disease expected to continue to expand and worsen, and with very limited vaccine supplies, it is critical that health care providers know the importance of treating and providing prophylaxis for those patients at high-risk for complications with antiviral medicines. A significant portion of the state stockpile has been available to inpatients for several months, and has now also been distributed for outpatients who do not have adequate insurance covering these medicines. It is important that people at risk for complications from influenza with symptoms or exposure have easy access to antiviral medications, especially since vaccine is in such short supply. This health advisory provides information on accessing the stockpile and the importance of treatment and prophylaxis with antiviral medications.

Maine School-Located Influenza Vaccine Funding for K-12 Schools

October 25, 2009 Word  PDF
In collaboration with the Maine Center for Disease Control and Prevention (Maine CDC) in the Maine Department of Health and Human Services we enter into this agreement to offer seasonal influenza and H1N1 influenza vaccines in K-12 schools. This partnership sets the foundation not only to protect the health of school children and the school community, but also to protect the health of the entire community, including siblings, parents, and the elderly. Since children are major transmitters of influenza, vaccinating them provides protection throughout the community. Additionally, offering vaccines in schools will help reduce the impact of large scale vaccination clinics on the health care system, which may be overstretched by a surge in H1N1 and/or seasonal influenza during the time in which many people will need and be seeking vaccination.

Widespread Influenza Activity in Maine

October 23, 2009 Word  PDF
Influenza activity in Maine has increased during the past week. Additionally, this week laboratory confirmed seasonal influenza H3 and influenza B were reported, indicating seasonal variants of influenza are also present in Maine. The purpose of this health advisory is to request that health care partners report cases of laboratory-confirmed 2009 H1N1 influenza and any cases of influenza (seasonal or 2009 H1N1) among patients who are hospitalized, have died, and/or are associated with an outbreak.

Maine CDC/DHHS Update on Novel Influenza A (H1N1) Virus

October 22, 2009 Word  PDF
The 2009 novel H1N1 influenza virus is the predominant influenza virus in circulation in most countries worldwide. The vast majority of the U.S. is seeing widespread influenza, with nearly all of it being the 2009 novel H1N1 influenza strain. Outpatient visits for influenza-like illness (ILI) increased in much of New England. Maine continues to see overall increases in outpatient visits for ILI.. Much of this is most likely due to novel H1N1. The vast majority of people with ILI are not being tested, and do not need to be. People with confirmed H1N1 are primarily children and young adults. The first confirmed person with H1N1 in Aroostook County was reported in the northern part of that county this week. Gould Academy has had 3 students confirmed with H1N1 as well as 2 other students and 2 staff with the symptoms. Two cases of seasonal influenza have been confirmed this last week in Maine, in individuals in Cumberland and Androscoggin counties. The vast majority of cases in Maine – as well as across the country – are novel H1N1.

Maine Animal Rabies 3rd Quarter Update

October 9, 2009 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities. This update is for rabid animals for the third quarter of 2009 or January 1 – September 30, 2009 (Table). Visit the Maine CDC rabies prevention website for more information, including rabies testing data updated regularly: http://www.maine.gov/dhhs/boh/ddc/epi/zoonotic/rabies.shtml The count of positive animals statewide may not be representative of the true incidence of animal rabies. Results are based on only those animals submitted for testing due to contact with a human or domestic animal.

Updated Clinical Testing and Management Guidance for ILI

October 9, 2009 Word  PDF
This advisory provides an updated algorithm for health care providers in Maine for testing and management of influenza-like illness (ILI). Health care providers and other public health partners are asked to report to Maine CDC influenza infection among patients who: • Are hospitalized; • Have died; and/or • Are associated with a suspected outbreak. Health care providers with questions on influenza can contact the Maine CDC at 1-800-821-5821 24 hours a day, 7 days a week.

Update on H1N1 and Seasonal Influenza Vaccine

October 7, 2009 Word  PDF
There is a lot of new information contained in the health advisory below, especially: new information on the anticipated distribution of H1N1 vaccine; resulting guidance on the administration of the H1N1 vaccine; ongoing delays in seasonal flu vaccine distribution; and emergency rules related to health care and some other facilities offering H1N1 vaccine to direct patient staff similar to what they are now required to do for seasonal influenza vaccine. We anticipate information to continue to change rapidly, so please stay informed. We at Maine CDC are greatly appreciative to all Maine health care providers, schools, emergency management, public health, and many other stakeholders for being patient and flexible and for your continued dedication to effectively addressing this pandemic.Approximately 14,800 doses of H1N1 nasal spray (LAIV=live attenuated influenza vaccine) is arriving in Maine this week. We are ordering about another 20,000 doses of H1N1 vaccine this week, both injectable and nasal spray. This additional supply should arrive in Maine next week, for a total of about 35,000 doses in the state. While this may seem like a lot of vaccine, it is not, when one considers there are 1.3 million people in Maine.

Update on H1N1 and Seasonal Influenza Vaccine

October 7, 2009 Word  PDF
There is a lot of new information contained in the health advisory below, especially: new information on the anticipated distribution of H1N1 vaccine; resulting guidance on the administration of the H1N1 vaccine; ongoing delays in seasonal flu vaccine distribution; and emergency rules related to health care and some other facilities offering H1N1 vaccine to direct patient staff similar to what they are now required to do for seasonal influenza vaccine. We anticipate information to continue to change rapidly, so please stay informed. We at Maine CDC are greatly appreciative to all Maine health care providers, schools, emergency management, public health, and many other stakeholders for being patient and flexible and for your continued dedication to effectively addressing this pandemic. Approximately 14,800 doses of H1N1 nasal spray (LAIV=live attenuated influenza vaccine) is arriving in Maine this week. We are ordering about another 20,000 doses of H1N1 vaccine this week, both injectable and nasal spray. This additional supply should arrive in Maine next week, for a total of about 35,000 doses in the state. While this may seem like a lot of vaccine, it is not, when one considers there are 1.3 million people in Maine.

First Orders of H1N1 Vaccine to Be Submitted This Week

September 30, 2009 Word  PDF
Maine CDC is placing orders with U.S. CDC for the first shipments of H1N1 vaccine this week, starting Wednesday, September 30th. The first shipments are not expected to arrive until later next week (the week of October 5th) and will consist of only a limited number of one type of H1N1 vaccine, the H1N1 LAIV (Live Attenuated Intranasal Vaccine). This nasal formulation is limited to healthy non-pregnant 2 – 49 year olds. In terms of the high-risk populations for H1N1, this vaccine is most appropriate for young healthy children and household contacts of young infants. Maine CDC urges pediatric and obstetrical health care providers to register and submit orders for H1N1 vaccine as soon as possible.

Updated Pediatric Antiviral Dosing Information for Seasonal and H1N1 Vaccine

September 25, 2009 Word  PDF
As of September 25, 2009 influenza activity is increasing in the United States with 26 states reporting widespread influenza activity. So far, ninety-nine percent of all subtyped influenza viruses being submitted to CDC are 2009 influenza A (H1N1) viruses. The current situation will likely affect pharmacies as a greater number of people than usual seek to fill prescriptions for influenza antiviral drugs or antibiotics to treat secondary bacterial infections, in addition to seeking advice on over-the-counter flu medications. This may affect supplies and availability of antiviral medications and other materials that may be needed to fill prescriptions. Pharmacists and physicians who care for pediatric patients should be aware of two issues: (1) the possible need to compound Tamiflu® on site if commercially manufactured pediatric oral suspension formulation is not available, and (2) the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match.

Varicella (Chickenpox) Outbreak in Penobscot County

September 24, 2009 Word  PDF
The Maine Center for Disease Control and Prevention has received notification of four cases of clinically confirmed varicella (chickenpox) among young adults in a residential post-secondary institution in Penobscot County. The vaccination status of all four individuals is unknown. The purpose of this advisory is to alert providers in the area to an active varicella outbreak, recommend varicella vaccination, and to report new cases of varicella to Maine CDC at 1-800-821-5821.

Seasonal Influenza Vaccine Supply Delay

September 21, 2009 Word  PDF
Based on national guidance from the Centers for Disease Control and Prevention (CDC) and in preparation for H1N1 flu vaccine arriving in October, the Maine CDC/DHHS asked health care providers to begin vaccinating with seasonal influenza vaccine as soon as it became available in August and September. We asked schools receiving state-supplied vaccine to schedule the majority of their seasonal flu clinics in September and early October. Unfortunately, we have recently learned from both the CDC and the vaccine manufacturers that the scheduled delivery for the remaining doses of seasonal flu vaccine will not be as accelerated as originally anticipated, due to prioritization of H1N1 vaccine and other challenges. This delay is being felt across the country, and other states are in the process of postponing large scale seasonal flu vaccine clinics.

Register to be a H1N1 Flu Vaccine Distribution Site

September 17, 2009 Word  PDF
This health alert is to update health care providers on the availability of the ability to order H1N1 vaccine. As you may know, pregnant women, children and young adults are being disproportionately affected by novel H1N1 influenza virus (“swine flu”). We expect to start receiving H1N1 vaccine in Maine by mid-October. If you are a health care provider licensed to administer vaccine, we ask that you consider registering to receive the H1N1 vaccine. We also encourage you to become involved with the initiative to offer all children seasonal and H1N1 vaccines in Maine schools. This will assure all Maine children are offered vaccine as quickly and as efficiently as possible while also not overburdening the health care system. If you are interested in becoming involved, please contact your local schools, or call the Maine CDC at 1-888-257-0990, or check the school-located vaccine website at www.maineflu.gov. Thank you ahead of time for your consideration in this important public health effort to keep our communities and schools healthy!

Human Risk for Eastern Equine Encephalitis (EEE)

September 15, 2009 Word  PDF
Eastern equine encephalitis (EEE) is a very serious viral infection that is transmitted by the bite of an infected mosquito. Although rare, this disease has potentially severe consequences for those who contract it. All people in Maine need to be aware of the health risk and protect themselves from mosquito bites.In recent days and weeks EEE has killed horses in York, Cumberland, Kennebec, Waldo, and Penobscot Counties. These horses mean infected mosquitoes posing a risk to people are present. Although the risk of contracting the disease from one particular mosquito bite is very small, since any one mosquito is unlikely to be infected, the risk is much more widespread geographically than previously thought. This risk for contracting EEE virus is highest at dusk to dawn and when temperatures are above 50 degrees (and especially above 60 degrees), since these are the conditions when mosquitoes are most actively biting. The risk is also likely to continue through next year. As a result, all Mainers, schools, and communities should take action.

Eastern Equine Encephalitis (EEE)

September 4, 2009 Word  PDF
The Maine CDC and the Maine Department of Agriculture’s Animal Health and Industry Division announced today that a total of five horses in Maine have died of confirmed Eastern Equine Encephalitis (EEE) and three more are suspicious, awaiting test results. These horses are from the counties of York, Cumberland, Waldo, and Penobscot. Although the risk of contracting EEE from one mosquito bite is very small, these recent cases indicate that the risk for contracting EEE is much more widespread geographically in Maine than previously thought. Information contained in this health advisory is on the human and equine health issues related to EEE, testing information for EEE, as well as resources related to mosquito control.

Update: Hepatitis A Cluster, Swans Island, ME

September 4, 2009 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) is continuing to investigate a cluster of acute hepatitis A associated with one household on Swans Island in Hancock County. Currently, nine cases have been identified. There has been one death; one other individual was hospitalized. All cases are among out-of-state residents. The cases are residents of Nebraska, Maryland, Virginia and West Virginia. The age range is 13 years to 69 years of age. The onset date of the first case was July 7. The most recent case became ill on September 2. This case prepared food at a potluck dinner on August 22 at a church on the island. Because of the time interval since the potluck, prophylaxis with vaccine or immune globulin is not recommended at this time for persons who attended the dinner.

Hepatitis A Cluster, Swans Island, Maine

August 27, 2009 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) is investigating a cluster of acute hepatitis A associated with one household on Swans Island, Hancock County, Maine. Currently, six cases have been identified; 4 confirmed and 2 probable cases. There has been one death and one other individual is hospitalized. All cases identified are among out of state residents. All cases of suspected viral hepatitis should be reported immediately by phone to the Maine CDC at 1-800-821-5821. Epidemiologists are available to provide guidance on post-exposure prophylaxis with either hepatitis A vaccine or immune globulin. To be effective, post exposure prophylaxis needs to be given as soon as possible, but not later than 14 days after last exposure.

Air Quality Advisory for Monday and Tuesday

August 17, 2009 Word  PDF
(AUGUSTA)-- Ground-level ozone concentrations are expected to reach unhealthy levels in the Southwest Coastal Region and the High Elevations of Acadia on Monday according to the Maine Department of Environmental Protection (DEP). Unhealthy levels of ozone are expected to continue and include more of the coast on Tuesday. Meanwhile, particle pollution levels are expected to be in the Moderate Range for both days. The combination of multiple pollutants in addition to the heat and humidity will likely cause health problems for children, the elderly and anyone with a heart or lung disease. Everyone is encouraged to limit outdoor exertion.

Maine CDC Update on Novel H1N1

August 12, 2009 Word  PDF
The purpose of this health advisory is to provide information on four important novel H1N1 updates recently issued by U.S. CDC. They are: changes to the recommended isolation period for people recovering from an influenza-like-illness; updated guidance for K-12 schools to respond to H1N1 influenza; H1N1 vaccine recommendations; and informational resources for those planning vaccination clinics. Additionally, this health advisory provides a list of strategies to keep informed about H1N1, which is especially important given the likelihood of pandemic escalation over the fall and winter.

Human Arbovirus Update for Healthcare Providers in Maine

August 11, 2009 Word  PDF
This health advisory provides a brief update on the epidemiology and natural history of West Nile virus (WNV) and Eastern Equine Encephalitis (EEE) infections, a summary of surveillance findings in Maine, and guidance for obtaining and submitting clinical diagnostic specimens to the Maine Center for Disease Control (Maine CDC), where tests will be performed free of charge. Testing for mosquito-borne infections should be performed routinely for every person diagnosed with aseptic meningitis or encephalitis during the summer and fall months. Maine CDC will also test physician-submitted serum specimens for persons with other severe and/or persistent unexplained febrile illnesses.

H1N1 Preparations for Residential Schools

August 4, 2009 Word  PDF
The purpose of this health advisory is to provide some guidance for residential schools on how to prepare for H1N1, based on preliminary lessons we have learned from the recent outbreaks in summer residential camps.

Salmonella Outbreak Identified in 3 Maine Counties

July 31, 2009 Word  PDF
Six cases of an unusual type of Salmonella have been identified in Androscoggin, Cumberland and Sagadahoc Counties since the end of June. Four of the individuals were adults and two were children. The adults were associated with an outbreak involving 10 other individuals in a center for developmentally disabled persons. The source of the infection has not yet been identified. The epidemiologic investigation is ongoing.

Conference Call on Testing and Management of Novel Influenza A Virus (H1N1)

July 29, 2009 Word  PDF
A conference call by the Maine CDC on testing and management of H1N1 for health care providers is scheduled from noon to 1 pm on Monday, August 3. The call in number is 1-800-914-3396. The participant code is 473623. Health care providers with questions on H1N1 can contact the Maine CDC at 1-800-821-5821 24 hours a day, 7 days a week.

Testing and Management of Novel Influenza A (H1N1)

July 28, 2009 Word  PDF
This advisory provides an updated algorithm for health care providers in Maine for testing and management of novel influenza A (H1N1). Testing and treatment for influenza-like illness is indicated for persons who are hospitalized or at high-risk for severe disease.

Maine H1N1 Influenza Preparedness Summit

July 17, 2009 Word  PDF
Maine CDC/DHHS, Maine Emergency Management Agency, and Maine Department of Education are co-sponsoring an H1N1 Influenza Preparedness Summit to promote vigilance, preparation, and a sharing of responsibility to mitigate the effects of H1N1 and to offer H1N1 immunization to all people in Maine later this year. A registration of $15 is required with scholarships by request. For more information contact MCD Meeting Services at conferences@mcd.org or 207-622-7566, ext 232.

Ten Action Steps for Novel H1N1 Influenza Planning

July 16, 2009 Word  PDF
It is critical to assure that medical offices and other outpatient facilities (e.g., outpatient/ambulatory clinics, outpatient surgery centers, urgent care centers, physical therapy/rehabilitation offices or clinics) that provide routine, episodic, and/or chronic healthcare services can manage an increased demand for services in the midst of a novel H1N1 influenza outbreak. Ensuring a sustainable community healthcare response will be important for a likely recurrence of novel H1N1 flu in the fall.

Paralytic Shellfish Poisoning (Red Tide) Reminder

July 15, 2009 Word  PDF
With elevated levels of paralytic shellfish poisoning (PSP, also known as red tide poisoning), causing much of the coastline to be closed to commercial harvesting for some shellfish, Maine CDC in the Department of Health and Human Services and the Maine Department of Marine Resources are reminding Mainers and tourists of recommendations for the safe consumption of shellfish.

Clinicians Advised to Halt Use of Propofol from Tainted Lots

July 14, 2009 Word  PDF
The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have been investigating recent cases of febrile reactions among patients undergoing endoscopy in the United States. This investigation has revealed that all of the case-patients received the anesthetic propofol from 100 ml vials manufactured by Teva Pharmaceuticals. Testing done by the FDA has found that two lots of this product that were in use in facilities reporting febrile reactions were positive for elevated levels of endotoxin. The lots are 31305429B and 31305430B. Teva Pharmaceuticals is initiating a voluntary recall for these lots, and clinicians are advised to immediately stop using these lots of Teva Pharmaceuticals propofol. CDC, FDA and Teva Pharmaceuticals are continuing to investigate this issue. To date, all case-patients have recovered. As additional information about the recall becomes available, an updated Health Alert Notice will be provided.

Maine CDC/DHHS Update on Novel Influenza A (H1N1) Virus

July 11, 2009 Word  PDF
Although very few people in Maine with H1N1 need to be or are being tested, Maine CDC has tested and confirmed a total of 203 cases as of July 10th. 114 are Maine residents, and 89 are out of state residents, mostly either summer residents or residential youth campers. Maine residents with confirmed H1N1 are concentrated in the southern half of the state, where there appears to be widespread transmission in many areas. A total of 10 have been hospitalized, including 2 out of state residents. About 60% of Maine resident cases are under the age of 24. Weekly updates with demographic data, including county breakdowns, can be found at: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml. H1N1 is widespread in much of the rest of New England, has been detected in all 50 states and 122 countries. 24 states have had deaths due to H1N1 (a total of 211 on July 10).

Maine CDC Operations during State Closure Days

July 3, 2009 Word  PDF
Maine CDC will operate in very limited capacity during state government closure days. The state budget legislation for the current biennium has a provision which requires most executive branch departments, agencies, and offices to be closed for 10 days in fiscal year 2009-2010. Please note that several state closure days are situated near state holidays and will result in 4-day weekends. This will affect both handling of telephone inquiries to Maine CDC Division of Infectious Disease and testing availability and turn-around-time at the Maine CDC Health and Environmental Testing Laboratory (HETL).

Guidance for Camps to Address Novel H1N1 Virus

June 25, 2009 Word  PDF
This health advisory provides guidance on suggested means to reduce the spread of the novel influenza A (H1N1) virus in day, residential, or overnight camp settings based on current knowledge of the H1N1 pandemic. Summary of Current Situation: At least 12 states have seen camp-associated outbreaks among staff and/or campers, and some camps, such as those sponsored by the Muscular Dystrophy Association, have been cancelled because of the very high risk for complications of those specific campers. Maine has seen outbreaks in 5 residential camps in 5 counties (Androscoggin, Cumberland, Lincoln, Oxford, and York) involving 10 confirmed cases in counselors. Other possible outbreaks involving camps are currently being investigated. No campers so far have been reported with H1N1.

Pregnant Women and Novel Influenza A H1N1

June 24, 2009 Word  PDF
This advisory is intended to provide guidance for the diagnosis and management of pregnant women with influenza like illness (ILI) during the current outbreak of novel influenza A H1N1 in Maine. Pregnant women are known to be at higher risk for complications from infection with seasonal influenza viruses, and severe disease among pregnant women was reported during past pandemics. An excess of influenza-associated deaths among pregnant women was reported during the pandemics of 1918–1919 and 1957–1958. Adverse pregnancy outcomes have been reported following previous influenza pandemics, with increased rates of spontaneous abortion and preterm birth reported, especially among women with pneumonia. Case reports and several epidemiologic studies conducted during inter-pandemic periods also indicate that pregnancy increases the risk for influenza complications for the mother and might increase the risk for adverse perinatal outcomes or delivery complications.

Maine CDC Update on Novel Influenza A Virus (H1N1)

June 21, 2009 Word  PDF
The purpose of this health advisory is to provide an update on H1N1 in Maine in the areas of surveillance, mitigation, vaccination, and communication. H1N1 continues to spread in Maine, especially in the southern half of the state, and Maine is one of 11 states reporting widespread influenza activity. Although we have an overall total of 61 cases identified by testing in Maine (50 among Maine residents and 11 among those visiting or staying in Maine) it is important to note that individual case data are useful only in that they are markers of the presence of H1N1 and community transmission in a given county or geographical area. Most people with H1N1 do not need testing (such as symptomatic close contacts of confirmed cases or people with mild illness), and their illness is not reflected in the case counts. Counties or regions with no reported cases may still be affected.

Rabies Vaccine Available for Pre-exposure Rabies Prophylaxis

June 19, 2009 Word  PDF
Novartis announces sufficient RabAvert® rabies vaccine to resume pre-exposure prophylaxis for groups at risk for rabies virus exposure. Since early 2008, rabies vaccine has been in decreased supply in the United States. Previously, due to the limited supply, pre-exposure vaccination was suspended for groups at risk for rabies exposure. Please see archived HAN’s from October 23, 2008 and September 15, 2008 at http://www.maine.gov/tools/whatsnew/index.php

Maine CDC Update on Novel Influenza A (H1N1)

June 13, 2009 Word  PDF
The purpose of this health advisory is to provide an update on H1N1 as well as links to new or focused planning and clinical resources. H1N1 continues to spread in Maine, especially in the southern and Mid Coast areas. Although we have an overall total of 44 cases confirmed by testing in Maine (35 among Maine residents and 9 among those visiting or staying in Maine) it is important to note that individual case data are useful only in that they are markers of the presence of H1N1 in a given county or geographical area. Many people with H1N1 are not tested (such as symptomatic close contacts of confirmed cases or people with mild illness), and their illness is not reflected in the case counts. Counties or regions with no reported cases may still be affected.

WHO Declares Pandemic Phase 6 for H1N1

June 11, 2009 Word  PDF
World Health Organization (WHO) Declaration of Pandemic Phase 6 for Novel H1N1 Influenza.The WHO phases are based on the geographical spread of a novel influenza virus. As “pandemic” means worldwide epidemic, a WHO Phase 6 means that the virus is spreading across the globe. What the WHO phases do not do is predict the severity of the virus. The move to Phase 6 is really an alert that the spread of the H1N1 virus is now expected to traverse the globe and those nations where the virus has yet to arrive should expect to eventually see cases and be prepared to respond.

Seasonal Influenza Vaccine Opportunities for Schools and Communities

June 11, 2009 Word  PDF
Maine CDC is working with the Maine Department of Education (Maine DOE) to provide communities an opportunity for their schools to offer seasonal influenza vaccine this fall for their students and possibly other children. Below is a slightly abridged version of the communication that was sent to all schools earlier this week. We are now sending it through the Health Alert Network so that interested community members, especially those working in health care, public health, emergency management, and other related fields can contact their local schools or school districts to partner on this effort. Doing so may not only help protect the health of the entire community but also ready the community for large scale vaccine clinics for H1N1.

Novel Influenza A (H1N1) in Maine

June 3, 2009 Word  PDF
Maine CDC has identified a total of 17 cases of H1N1 (14 confirmed and 3 probable) among Maine residents, along with an additional 4 out of state residents who were ill and tested while staying in Maine, for an overall total of 21. This total includes 7 additional cases this week, 5 in Cumberland County and 2 in York County. One of the two new York County residents is hospitalized. One of the new Cumberland County residents is a Brunswick High School student. Four recent cases are residents of the Brunswick area, indicating possible clustering in that area, and include 3 children or youth.

Pertussis Outbreak in Penobscot County, Maine

June 2, 2009 Word  PDF
In the past month seven cases of pertussis has been reported in individuals ranging from 9 months to 42 years of age in the Brewer, Hampden and Holden areas of Penobscot County. Ill individuals are associated with three different schools. A number of symptomatic contacts have been identified in Penobscot County and are undergoing diagnostic testing. Pertussis is a highly communicable, vaccine-preventable disease that can last for many weeks. It is transmitted through direct contact with respiratory secretions of infected persons. Symptoms include cough, paroxysms, whoop, and post-tussive vomiting.

Shiga-toxin positive E. coli O157:H7 (STEC) cluster

May 28, 2009 Word  PDF
Maine CDC is investigating a cluster of 7 shiga toxin positive E.coli O157:H7 (STEC) cases in Cumberland and York counties that occurred among residents over the past month (case onset dates of April 17 to May 17). This is double the usual number of STEC cases reported this time of year (n=3). The median age of cases was 26 years (age range 14 years to 65 years). As of May 28, 6 of the 7 cases have been confirmed shiga positive E. coli O157:H7 by the Health and Environmental Testing Laboratory (HETL). Of these, 4 cases match by Pulse-Field Gel Electrophoresis (PFGE) and are considered part of a national cluster. At this time, the investigation is ongoing although we have not identified any common venues, events or foods based on case interviews.

Maine CDC H1N1 Update

May 28, 2009 Word  PDF
This Maine CDC Health Advisory is providing an update on the H1N1 situation in Maine as well as some important updates from U.S. CDC. Although Maine CDC has identified and conducted case investigations on 10 people with either confirmed or probable H1N1, other nearby states are seeing much more of the infection, resulting in some school closures and hospitalizations. For instance, Massachusetts has over 400 confirmed cases of H1N1, mostly in the Greater Boston area, with 90% of them in people under 40 years of age. There are currently 27 people hospitalized with the infection, and about a dozen schools have closed due to H1N1 in Massachusetts. (http://publichealth.blog.state.ma.us/h1n1-swine-flu/). New York has also seen several hundred confirmed cases, mostly among young people, and has had several dozen schools closed. New Hampshire has 31 confirmed cases, with all but two under age 50 (http://www.dhhs.state.nh.us/DHHS/DHHS_SITE/swineflu.htm).

Air Quality Advisory for Ozone in Southwest Coast, Mid-Coast, and Western Interior of Maine

May 21, 2009 Word  PDF
Ground-level ozone concentrations are expected to reach the unhealthy for sensitive groups level today for the Southwest Coast, Mid-Coast and Western Interior according to the Maine Department of Environmental Protection (DEP). The U.S. Environmental Protection Agency (EPA) recently revised the national ozone standard from 84 parts per billion (ppb) to 75 ppb. At the same time, the Air Quality Index (AQI) for ozone was revised to reflect the new more protective standard. If Maine has a typical summer this year, the DEP will likely be encouraging you to take precautions to protect your health more often than usual because of this revised standard. For more information call DEP's toll free ozone hotline at 1-800-223-1196 or visit DEP’s air quality web site by going to MaineDEP.com and select ‘Maine Air Quality Forecast.

Maine H1N1 Update

May 8, 2009 Word  PDF
As of the morning of May 8th, Maine has identified 12 people with H1N1 through testing, including 7 adults, 1 young adult, and 4 children or youth. They reside in York (5), Cumberland (3), Kennebec (3), and Penobscot (1) Counties. Three of the identified patients are students – one at the Lunt Elementary School in Falmouth, one at Bridgton Academy, and one early identified patient at the Kennebunk Elementary School. A recently identified patient is a young adult (with chronic underlying illness) who is hospitalized. 4 of the 12 test results have been confirmed by U.S. CDC; all 4 are in York County. 6 out of the 12 patients traveled to an area with confirmed H1N1. Of the 6 who did not travel out of state, 5 have no known contact with an identified case. Out of the over 1,000 influenza tests that have been conducted by the Maine CDC’s laboratory since April 27th, 12 have been positive for un-subtypeable H1N1, and 24 have been positive for seasonal influenza, mostly type A Influenza viruses (and mostly known subtypes of H1 or H3).

Updated Guidance on Laboratory Testing of Persons with Suspected Novel Influenza A (H1N1) Virus

May 6, 2009 Word  PDF
Maine CDC issues the following updated guidance on laboratory testing of persons with suspected novel influenza A (H1N1) virus. These guidelines are current as of May 6, 2009. Maine is now considered an affected area. On 5/4/09, one case patient was confirmed as novel influenza A (H1N1) by Federal CDC. At this time, Maine CDC is maintaining case finding activities to better understand the spread of this virus across the state.

Maine Update and New School Closure Guidelines

May 5, 2009 Word  PDF
Based on revised guidance on school closings from the U.S. Centers for Disease Control and Prevention and in consultation with the Maine Center for Disease Control, Maine Education Commissioner Susan Gendron advised Kennebunk Elementary School to reopen on Wednesday, a day earlier than previously recommended. In the new guidelines issued Tuesday afternoon, the U.S. CDC no longer recommends that schools with probable cases of H1N1 influenza be closed. Instead, it recommends a focus on “keeping all student, faculty and staff with symptoms of influenza out of schools and childcare facilities during their period of illness and recuperation, when they are potentially infectious to others.” The Kennebunk Elementary School was closed starting last Thursday for an expected seven days after a student was found to have a probable case of H1N1. The Maine CDC continues to test possible cases of H1N1. No new cases were identified on Monday or Tuesday. Totals as of Tuesday, May 5 include: two adults in Kennebec County, three adults and one youth in York County, and one youth in Penobscot County. U.S. CDC has confirmed one of the adults in York County as testing positive for H1N1. All are recovering. Four of the cases had an out of state travel history, though no travel to Mexico. One was a contact of the original four. The epidemiological investigation continues for the other two.

Update on H1N1 in Maine

May 2, 2009 Word  PDF
In light of H1N1’s arrival in Maine with cases in 3 counties (Kennebec, Penobscot, and York) as of early morning of May 2nd, and the resulting closure of a school, this health advisory provides a brief review of informational resources and strategies as well as the most recently updated guidance for schools and child care facilities in affected areas from U.S. CDC.

Updated Guidance for Communities with Confirmed H1N1 Influenza A Virus

April 30, 2009 Word  PDF
In light of H1N1’s arrival in Maine and the resulting closure of at least one school and day care, this health advisory is to review the major steps we ask that people and organizations in Maine take. The most important strategies to minimize swine flu’s impact in Maine are those of vigilant respiratory hygiene: covering coughs and sneezes with sleeves or a tissue; washing hands frequently; and staying home if ill, especially with a fever. Additionally, everyone should stay informed since this event is rapidly changing and resulting guidance is as well. The U.S. CDC’s website has updated national information and guidance, and can be found at: http://www.cdc.gov/swineflu/. Maine CDC’s website has updated Maine-specific information, including daily updates starting later today, as well as links to federal information. It can be located at: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml or found on the Maine CDC’s homepage: www.mainepublichealth.gov. Importantly, everyone should also make preparations. These preparations include activating a pandemic influenza plan. Every hospital, other health care institution, emergency management agency, school business, agency or organization should activate their pandemic influenza plan. Every individual and family should also activate their plan. If one does not exist, then preparation check lists for a variety of settings including individuals, homes, businesses, and schools can be found at: http://www.pandemicflu.gov/plan/checklists.html. These plans generally call for such measures as ensuring adequate critical supplies are on hand and preparing for higher than normal absenteeism. Health care providers should call Maine CDC’s 24-hour clinical consultation line (1-800-821-5821) to report a suspected case and obtain testing information including expediting the transportation of samples for testing. Maine CDC’s Health and Environmental Testing Laboratory (HETL) will perform influenza RT-PCR tests and subtyping for influenza A positive specimens. Instructions on collecting and submitting laboratory diagnostic specimens for H1N1 influenza testing are available at http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm.

Three Probable H1N1 Influenza ("Swine Flu") Cases Identified in Maine

April 29, 2009 Word  PDF
As of 12:30 PM April 29, 2009, 3 probable cases of H1N1 Influenza (“Swine Flu”) were identified in Maine. Two of the individuals are residents of Kennebec County and the third is a resident of York County. All are non-elderly adults. Samples from the three were tested this morning at Maine CDC’s Health and Environmental Testing Laboratory (HETL). The samples will be submitted to the US Centers for Disease Control and Prevention for final confirmation, which is highly likely. The cases are currently being investigated by Maine CDC infectious disease epidemiologists. The most important strategies to minimize swine flu’s impact in Maine are those of vigilant respiratory hygiene: covering coughs and sneezes with sleeves or elbows; washing hands frequently; and staying home if ill, especially with a fever. Additionally, everyone should stay informed since this event is rapidly changing and resulting guidance is as well. The U.S. CDC’s website has updated national information and guidance, and can be found at: http://www.cdc.gov/swineflu/. Maine CDC’s website has updated Maine-specific information, including daily updates starting later today, as well as links to federal information. It can be located at: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml or found on the Maine CDC’s homepage: www.mainepublichealth.gov.

H1N1 Influenza (“Swine Flu”) and New Clinical Guidance on Treatment of Children and Pregnant Women

April 29, 2009 Word  PDF
It is announced on the news wires this morning the death of a 23-month old in Texas from H1N1 (“swine flu”). Maine does not have any confirmed cases yet of H1N1 influenza. The Maine CDC’s Health and Environmental Testing Laboratory (HETL) tested about three dozen samples on Tuesday April 28th. A number of tests are being conducted today. The most important strategies to minimize swine flu’s impact in Maine are those of vigilant respiratory hygiene: covering coughs and sneezes with sleeves or elbows; washing hands frequently; and staying home if ill, especially with a fever. Additionally, everyone should stay informed since this event is rapidly changing and resulting guidance is as well. The U.S. CDC’s website has updated national information and guidance, and can be found at: http://www.cdc.gov/swineflu/. Maine CDC’s website has updated Maine-specific information, including daily updates starting later today, as well as links to federal information. It can be located at: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml or found on the Maine CDC’s homepage: www.mainepublichealth.gov. Importantly, everyone should also make preparations. These preparations include activating a pandemic influenza plan. Every hospital, other health care institution, emergency management agency, school business, agency or organization should activate their pandemic influenza plan. If one does not exist, then preparation check lists for a variety of settings including homes, businesses, and schools can be found at: http://www.pandemicflu.gov/plan/checklists.html. Health care providers should call Maine CDC’s 24-hour clinical consultation line (1-800-821-5821) to report a suspected case and obtain testing information including expediting the transportation of samples for testing. Maine CDC’s Health and Environmental Testing Laboratory (HETL) will perform influenza RT-PCR tests and subtyping for influenza A positive specimens. Instructions on collecting and submitting laboratory diagnostic specimens for H1N1 influenza testing are available at http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm.

Interim CDC Guidance for Nonpharmaceutical Community Mitigation

April 28, 2009 Word  PDF
While Maine has not yet identified any people confirmed with swine influenza A (H1N1), there are several people being tested, and a large number of Mainers who have recently returned from traveling in areas where swine influenza is found. The most important strategies to minimize swine flu’s impact in Maine are those of respiratory hygiene: covering coughs and sneezes with sleeves or elbows; washing hands frequently; and staying home if ill, especially with a fever. Additionally, everyone should stay informed since this event is rapidly changing and resulting guidance is as well. The U.S. CDC’s website has updated national information and guidance, and can be found at: www.cdc.gov/swineflu . Maine CDC’s website has updated Maine-specific information, including daily updates starting later today, as well as links to federal information. It can be located at: www.maine.gov/dhhs/boh/swine-flu-2009.shtml or found on the Maine CDC’s homepage: www.mainepublichealth.gov . Importantly, everyone should also make preparations. These preparations include activating a pandemic influenza plan. If one does not exist, then preparation check lists for a variety of settings including homes, businesses, and schools can be found at: www.pandemicflu.gov/plan/checklists.html . This health advisory contains an update from U.S. CDC including new interim guidance on community mitigation strategies, such as isolation, quarantine, school and day care closures, and the social distancing strategies of cancelling mass gatherings. People and organizations in Maine need to prepare now for those possible strategies to be implemented.

Updated Guidance from Maine CDC for Laboratory Testing of Persons with Suspected Swine Influenza A (H1N1) Virus

April 27, 2009 Word  PDF
Situation Update: No cases of swine influenza (H1N1), known as swine flu, have been detected in Maine as of April 26, 2009. Maine CDC urges health care providers to increase surveillance for acute febrile respiratory illness to identify early any cases of swine influenza (H1N1) in Maine. As part of their ongoing investigation into the outbreak, CDC yesterday announced confirmation of an additional 13 human cases of infection with swine flu in the U.S, bringing the total number of cases to 21 so far. At this time, cases of swine influenza have been confirmed in California, Kansas, New York City, Ohio and Texas. Based on the rapid spread of the virus thus far, public health officials believe that more cases will be identified over the next several weeks. Case counts are updated daily and available at http://www.cdc.gov/swineflu/investigation.htm. Yesterday the Acting Secretary of the U.S. Department of Health and Human Services declared a public health emergency in the United States. U.S. CDC and Maine CDC’s goals are to reduce transmission and illness severity, and provide information to assist health care providers and the public in addressing the challenges posed by this newly identified influenza virus. To this end, U.S. CDC has issued a number of guidance documents in the past 24 hours. In addition, U.S. CDC’s Division of the Strategic National Stockpile (SNS) is releasing one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak. Maine CDC is working closely with U.S. CDC to arrange for these materials to be delivered to and distributed in Maine, primarily for the care of hospitalized patients seriously ill with swine flu. Additionally, Maine CDC’s laboratory, the Health and Environmental Testing Laboratory, has increased its capacity to test for swine influenza. Maine CDC senior and epidemiology staff have been in close and frequent contact with U.S. CDC and other New England states, making preparations to address this expanding outbreak.

Surveillance for Swine Influenza A (H1N1) Virus in School and Childcare Settings

April 27, 2009 Word  PDF
Guidance for School and Childcare Settings At this time, Maine CDC recommends that schools and childcare settings increase education on respiratory hygiene and monitor attendees for acute febrile respiratory illness. Staff and children (as developmentally appropriate) should all be taught and asked to follow these steps that prevent the transmission of infections such as influenza: 1.Cover your coughs and sneezes. 2.Avoid touching your eyes, nose and mouth. 3.Wash hands frequently, especially after coughing or sneezing. 4.Stay home if you’re sick, especially with a fever. School or childcare participants with acute febrile respiratory illness, regardless of travel history, should be sent home according to facilities-established procedures with instructions to stay at home until 24-48 hours after their symptoms resolve. Instructions should be given to seek medical care with worsening of symptoms. At this time, exclusion is not recommended for school or childcare participants who have recently traveled to an affected area and who do not have symptoms. Disease Reporting and Consultation To contact Maine CDC to report suspected cases of swine influenza, outbreaks of influenza like illness, or to request other clinical consultation please call the 24/7 Disease Reporting and Consultation Line at 1-800-821-5821.

Swine Influenza Screening and Laboratory Testing Guidance for Health Care Providers

April 25, 2009 Word  PDF
The US CDC has identified eight new cases of a novel swine influenza A (H1N1) virus first identified on April 17 in two children in southern California. The six additional cases were reported in San Diego County (three cases) and Imperial County, California (one case), and in Guadalupe County, Texas (two cases). The average age of these confirmed cases is 16, and all have fully recovered. In addition, US CDC has confirmed that the same unique strain of swine influenza A (H1N1) virus has been isolated among specimens from patients in Central Mexico, where there appears to be an emerging outbreak. No cases of swine flu have been reported in Maine or New England. Although seasonal influenza continues to be detected in Maine, influenza activity has been declining and is currently sporadic. Maine CDC health officials have been in close contact with officials at U.S. CDC the past few days as well as increasing capacity to further address the situation, including increasing influenza tracking and public health laboratory capacity (Maine CDC’s Health and Environmental Testing Laboratory=HETL) to perform rapid typing of influenza.

Invasive Haemophilus Influenzae, tybe b in an under-vaccinated 3 year old

March 9, 2009 Word  PDF
The Maine Department of Health and Human Services’ Maine Center for Disease Control and Prevention, (Maine CDC) is issuing an advisory regarding meningitis and bacteremia from Haemophilus influenzae type b (Hib) in a 3 year old under-vaccinated child. In late February 2009, a 3 year old child from midcoast Maine developed Hib bacteremia and meningitis. The child received the 2 and 4 month immunizations, though did not complete the Hib vaccine series with the 6 month and 12-15 month vaccines. The child was hospitalized in intensive care, and is currently recovering. The child’s household members, including an unvaccinated infant, have been given prophylaxis with Rifampin antibiotic to prevent additional cases of invasive Hib.

Questions and Answers about Bisphenol-A and Formula

March 3, 2009 Word  PDF
In response to a number of questions on BPA (Bisphenol-A), especially from local WIC agencies and clients, the Maine CDC has developed a fact sheet on this subject that we hope will help provide some guidance for parents of young children. The Maine CDC is not promoting either the liquid concentrate or powder formula (we formerly preferentially promoted the liquid concentrate) provided by WIC. We are asking that clients make the choice of the feeding method that is best for them using this additional information and talking with their baby’s doctor if questions remain.

Update on Norovirus Gastroenteritis Outbreaks in Maine

February 28, 2009 Word  PDF
During December 1, 2008 – February 20, 2009, Maine CDC has investigated 28 confirmed or suspected norovirus gastroenteritis outbreaks from counties across the state. The majority of outbreaks reported occurred in long term care facilities or assisted living centers (23); however outbreaks have also occurred at acute care facilities (3), schools (1), and office settings (1). Norovirus infections typically increase during the winter months, and Maine CDC routinely receives reports of suspected norovirus outbreaks each year. Surveillance data suggests that norovirus circulation is more widespread this year. Public health partners are encouraged to consider norovirus when assessing clusters of gastroenteritis and to act promptly to prevent the spread of illness.

Carbon Monoxide (CO) Poisoning Warning

February 23, 2009 Word  PDF
A number of Maine communities are experiencing power outages due to the recent storm. It is estimated that over 80,000 households are without power. Outbreaks of carbon monoxide (CO) poisonings have been associated with storm-related power outages due to improper placement and operation of gas-powered generators and other alternative heating and power sources. A study of a CO poisoning outbreak in the aftermath of the January 1998 Ice Storm found that improper placement of a gasoline generator, such as in a basement or garage, could increase the risk of CO poisoning by 20 to 300-fold. Using a kerosene heater in a room without any doors to other rooms opened, or failing to crack a window, also put people at increased risk for CO poisoning. CO is an odorless colorless gas emitted when burning most fuels. Improper operation or placement of alternative heating or power sources can result in poisoning when CO gas builds-up in enclosed spaces.

Information for Veterinarians regarding Pets and the Peanut Butter Recall

February 18, 2009 Word  PDF
CDC has been investigating the current Salmonella Typhimurium outbreak in humans in coordination with the Food and Drug Administration (FDA) and state and local health departments. In addition to human illness, animals may also have been affected. One laboratory-confirmed case of Salmonella in a dog from an Oregon household was reported, and further characterization of this Salmonella isolate is pending. Salmonella resembling the outbreak strain was isolated by a private laboratory from recalled peanut butter flavored dog biscuits from this dog’s household. At least three states have reported incidents of dogs that have shown gastrointestinal signs consistent with Salmonella infection, and those animals have been known to have consumed peanut butter products on the FDA recall list.

REVISED Widespread Influenza Activity in Maine

February 17, 2009 Word  PDF
In February, influenza activity has become widespread in Maine, with all three of the major seasonal influenza variants circulating. Outbreaks of influenza are occurring in schools and in long term care facilities across the state. The influenza vaccine is a good match for both influenza A strains, and matches approximately 30% of the influenza B strains currently circulating. Influenza vaccination is still strongly encouraged, especially to protect those persons at risk of more severe disease. Interim recommendations for chemoprophylaxis and treatment of influenza have been issued in response to the high resistance of influenza A H1N1 strains to oseltamivir (Tamiflu) in national studies.

Maine Animal Rabies 4th Quarter Update

February 11, 2009 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities. This update is for the forth quarter of 2008 or January 1 – December 31, 2008 (Table). Visit the Maine CDC rabies prevention website for more information, including rabies testing data updated regularly: www.maine.gov/dhhs/boh/ddc/rabies_surveillance.htm

Pertussis Outbreak Reported in Hancock County

January 29, 2009 Word  PDF
Since January 9, 2009, eight cases of pertussis have been reported in individuals ranging from 9 to 50 years of age in the Blue Hill and Brooklin areas of Hancock County. The outbreak involves an elementary school, a middle school, and a worksite. A number of symptomatic contacts have been identified in Hancock County and are undergoing diagnostic testing. There is no evidence that this outbreak is directly related to the recent outbreak of pertussis reported in York County.

Outbreak of Salmonella Typhimurium Infections - United States

January 18, 2009 Word  PDF
CDC, in collaboration with public health officials in many states and the U.S. Food and Drug Administration (FDA), is investigating a multistate outbreak of human infections caused by Salmonella serotype Typhimurium. As of January 16, 2009, 9PM EST, 474 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 43 states. Infection may have contributed to 6 deaths. Of persons for whom data was available, 107 (23%) were hospitalized.

Pertussis Outbreak in York County

January 16, 2009 Word  PDF
A cluster of four cases of pertussis has been reported in girls 8 to 10 years of age in the Biddeford –Saco area. The ill children attend three different schools, but have common exposures at an after school program and an athletic facility. A number of symptomatic contacts have been identified in York, Cumberland and Aroostook counties and are undergoing diagnostic testing. Pertussis is a highly communicable, vaccine-preventable disease that can last for many weeks. It is transmitted through direct contact with respiratory secretions of infected persons. Symptoms include cough, paroxysms, whoop, and post-tussive vomiting.

Outbreaks of Norovirus Gastroenteritis in Maine

January 13, 2009 Word  PDF
During December 1, 2008 – January 13, 2009, Maine CDC has investigated 14 reports of confirmed or suspected norovirus gastroenteritis outbreaks from six counties. Seven of these reports have been laboratory-confirmed. Eleven outbreaks occurred in long term care facilities or assisted living centers, two were associated with acute care facilities, and one occurred at an office holiday party. Noroviruses are the principal cause of viral gastroenteritis in the United States. Circulation of norovirus infections typically increases during the winter months, and outbreaks are currently being reported also in other areas of the nation. The Federal CDC estimates that 23 million cases of acute gastroenteritis per year are due to norovirus infection.

December 22, 2008-CDC Issues Interim Recommendations for the Use of Influenza Antiviral Medications

December 22, 2008 Word  PDF
Although influenza activity is low in the United States to date, preliminary data from a limited number of states indicate that the prevalence of influenza A (H1N1) virus strains resistant to the antiviral medication oseltamivir is high. Therefore, CDC is issuing interim recommendations for antiviral treatment and chemoprophylaxis of influenza during the 2008-09 influenza season. When influenza A (H1N1) virus infection or exposure is suspected, zanamivir or a combination of oseltamivir and rimantadine are more appropriate options than oseltamivir alone. Local influenza surveillance data and laboratory testing can help with physician decision-making regarding the choice of antiviral agents for their patients. The 2008-09 influenza vaccine is expected to be effective in preventing or reducing the severity of illness with currently circulating influenza viruses, including oseltamivir-resistant influenza A (H1N1) virus strains. Since influenza activity remains low and is expected to increase in the weeks and months to come, CDC recommends that influenza vaccination efforts continue.

Influenza arrives in Maine

December 18, 2008 Word  PDF
Influenza has officially arrived in Maine. The first laboratory confirmed cases of influenza were reported this week. A young adult from Androscoggin County tested positive for influenza A (H1). This young adult was unimmunized and has no record of recent travel. A youth from Cumberland County also tested positive for influenza A (H1). No medical history was available for this patient. Now that we know influenza is officially in Maine, it is important that we make every effort to try to limit its spread. The best way to prevent getting influenza is getting vaccinated. Influenza vaccine has been widely distributed in Maine and appears to be still available in most places. New recommendations advise all children aged 6 months to 18 years be immunized this influenza season. All high risk individuals should be vaccinated as soon as possible.

Carbon Monoxide Poisoning Advisory

December 13, 2008 Word 
A number of Maine communities are experiencing power outages due to the recent storm. It is estimated that over 200,000 households are without power. Outbreaks of carbon monoxide (CO) poisonings have been associated with storm-related power outages due to improper placement and operation of gas-powered generators and other alternative heating and power sources. A study of a CO poisoning outbreak in the aftermath of the January 1998 Ice Storm found that improper placement of a gasoline generator, such as in a basement or garage, could increase the risk of CO poisoning by 20 to 300-fold. Using a kerosene heater in a room without any doors to other rooms opened, or failing to crack a window, also put people at increased risk for CO poisoning. CO is an odorless colorless gas emitted when burning most fuels. Improper operation or placement of alternative heating or power sources can result in poisoning when CO gas builds-up in enclosed spaces. We are receiving reports of CO poisoning in the aftermath of Friday’s storm.

Domestic Violence and Sexual Assault Health Advisory for the General Public

December 9, 2008 Word  PDF
Driven by recent domestic violence-related homicides, the Maine CDC is issuing a public health advisory. Domestic violence and sexual assault are public health problems that are unacceptable in any form. All Mainers can play a role in preventing further violence, especially since important resources exist for everyone.

Domestic Violence and Sexual Assault Health Advisory for Health Care Providers

December 9, 2008 Word  Pdf
Driven by recent domestic violence-related homicides, the Maine CDC is issuing a public health advisory. Domestic violence and sexual assault are public health problems that are unacceptable in any form. All Mainers, including health care providers, can play an important role in preventing further violence.

2008-2009 Winter Heating Advisory

December 2, 2008 Word  PDF
The heating and economic crises can have a significant impact on Mainers’ health. A recent survey found that 10% of Maine households report not having sufficient funds to heat their homes this winter. About 2/3 of Maine households use oil as a primary source for heating their homes, with Mainers having one of the highest dependencies on oil heat in the nation. Mainers report a number of planned energy and monetary conservation strategies such as supplementing with wood heat and electric space heaters, turning down the thermostat and water heater, buying fewer groceries and other necessities such as medicines.

Revised - Maine Animal Rabies Third Quarter Report Jan.1 - Sept. 30, 2008

November 25, 2008 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

November 19, 2008 - Update on Hepatitis A in the Kennebunk Area

November 19, 2008 Word  PDF
Five cases of hepatitis A have been reported among students at Consolidated School in Kennebunkport. The first two cases were part of a family cluster identified in September. The other three cases were reported in late October/early November and were unrelated to the family cluster. For the last three cases, it is believed that transmission occurred in the school setting after exposure to the first two ill students.

Update: Hepatitis A in the Kennebunk Area

November 7, 2008 Word  PDF
In mid to late September 2008 a cluster of six cases of hepatitis A was reported in a family in the Kennebunk area. Two of the children in the family attended Consolidated School in Kennebunkport. Since late October four additional cases of illness have been identified. Two of these cases were in members of the extended family diagnosed in September. The other two cases were in students at Consolidated School; these two students were unrelated to the extended family with hepatitis A. The average incubation period of hepatitis A is 30 days with a range from 15 to 50 days. Given the time interval since the initial family cluster, these newly identified cases most likely represent a second generation of infection. With the two new ill students, it is likely that transmission occurred in the school setting.

Hepatitis A in the Kennebunk Area

October 30, 2008 Word  PDF
In mid to late September 2008 a cluster of six cases of hepatitis A was reported in a family in the Kennebunk area. This week three additional cases have tentatively been identified. Two of the cases are in members of the extended family. The third case is in an unrelated child. The average incubation period of hepatitis A is 30 days with a range from 15 to 50 days. Given the time interval since the initial family cluster, these newly identified cases most likely represent a second generation of infection. An investigation of the most recent cases is underway.

Rubella on a Ship

October 28, 2008 Word  PDF
On October 18, 2008 a crew member of a cruise ship had onset of fever and rash. The crew member worked in the kitchen and reportedly did not have direct contact with passengers. The illness was subsequently confirmed to be rubella. The ship visited Bar Harbor on October 15 and October 19.

Eastern Equine Encephalitis in Massachusetts Resident

October 27, 2008 Word 
On October 22, 2008, Maine Center for Disease Control and Prevention (Maine CDC) was notified of a Massachusetts resident that tested positive for Eastern Equine Encephalitis (EEE). The 73 year old man from northeast Massachusetts developed symptoms of illness on September 21, 2008 while vacationing in Maine. After several weeks of hospitalization, he was transferred to a facility in Massachusetts where his prognosis remains guarded.

Human Rabies Vaccine Supply Update

October 24, 2008 Word  PDF
There is currently a rabies vaccine supply shortage in the United States. Novartis (produces RabAvert®) now has adequate supply to deliver post-exposure prophylaxis (PEP) vaccine upon request and without restriction. Sanofi Pasteur (IMOVAX®) has PEP vaccine available on a limited basis with a password requirement. It is anticipated that a vaccine supply shortage will continue through 2009.

Eastern Equine Encephalitis: Update for Maine Clinicians

October 9, 2008 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) within the Maine DHHS is reporting that a pool of mosquitoes, collected on September 30, 2008 from the town of Arundel in York County, has tested positive for Eastern Equine Encephalitis (EEE). Test results for additional pools from this location are currently pending. Numerous other mosquito pools previously collected this year from Arundel and York County have come back negative for both EEE and West Nile virus (WNV).

Eastern Equine Encephalitis: Update for Maine Clinicians, September, 2008

September 19, 2008 Word  PDF
A horse has recently died and tested positive for Eastern Equine Encephalitis (EEE) in Lebanon, in York County, Maine. An emu also recently tested positive in nearby Barnstead, NH. Because there is a risk of human transmission of EEE from infected mosquitoes to people in the area of positive animals, Maine CDC within the Maine Department of Health and Human Services and the Maine Department of Agriculture are alerting physicians, veterinarians, and other health care providers of this EEE activity, and providing laboratory testing criteria and guidelines. For further questions or concerns, please contact Maine CDC for the medical epidemiologist on call at: 1-800-821-5821.

Continued Decrease in Human Rabies Vaccine

September 15, 2008 Word  PDF
Rabies vaccine for humans in the United States is provided by two manufacturers: Sanofi Pasteur produces IMOVAX® and Novartis produces RabAvert®. It is anticipated that a vaccine supply shortage will continue through mid-to-late 2009.

Temporary Decrease in Human Rabies Vaccine Supplies

August 27, 2008 Word  PDF
Because of limited existing supplies, CDC strongly recommends that health-care providers, state and local public health authorities, animal control officials, and the public take immediate steps to ensure appropriate use of human rabies biologics.

Human Arbovirus Update for Healthcare Providers in Maine, August 2008

August 6, 2008 Word  PDF
This health advisory provides a brief update on the epidemiology and natural history of West Nile virus (WNV) and Eastern Equine Encephalitis (EEE) infections, a summary of surveillance findings in Maine, and guidance for obtaining and submitting clinical diagnostic specimens to the Maine Center for Disease Control (Maine CDC), where tests will be performed free of charge. Testing for mosquito-borne infections should be performed routinely for every person diagnosed with aseptic meningitis or encephalitis during the summer and fall months. Maine CDC will also test physician-submitted serum specimens for persons with other severe and/or persistent unexplained febrile illnesses

Temporary Decrease in Human Rabies Vaccine Supplies

July 30, 2008 Word  PDF
Rabies vaccine for humans in the United States is provided by two manufacturers. Sanofi Pasteur produces IMOVAX and Novartis produces RabAvert. Both manufacturers are currently having problems meeting the demand for their products.

Paralytic Shellfish Poisoning (Red Tide) Advisory Update

July 30, 2008 Word  PDF
With an incident of paralytic shellfish poisoning (PSP, also known as red tide poisoning) being reported earlier this month and recent test results showing high levels of PSP in the tomalley of some lobster, the Maine CDC/DHHS is updating its recommendations on safe shellfish consumption to include a reminder about not eating tomalley.

Red Tide Press Release for LHOs

July 8, 2008 Word  PDF
Over the weekend of July 5th three people from Washington County were hospitalized with symptoms of paralytic shellfish poisoning, also known as red tide poisoning. This occurred several hours after they shared a meal of mussels. Samples of the mussels were highly contaminated with the toxin that causes paralytic shellfish poisoning. All three people were discharged the day after admission, and are expected to fully recover.

Paralytic Shellfish Poisoning in Washington County (medical provider version)

July 8, 2008 Word  PDF
Over the weekend of July 5, 2008 three people from Washington County were hospitalized with symptoms of paralytic shellfish poisoning, also known as red tide poisoning. This occurred several hours after they shared a meal of mussels. Samples of the mussels were highly contaminated with the toxin that causes paralytic shellfish poisoning. All three people were discharged the day after admission, and are expected to fully recover.

Air Quality Alert for the Southwest Coast, Mid-Coast, Western Interior, and Eastern Interior regions of Maine

July 7, 2008 Word  PDF
On Tuesday, ground-level ozone concentrations are expected to reach the “unhealthy for sensitive groups” level for the Southwest Coast, Mid-Coast, Western Interior and Eastern Interior regions while “unhealthy” levels are expected for the high elevations of Acadia National Park, according to the Maine Department of Environmental Protection (DEP). The coastal regions are likely to record higher levels of ozone than interior regions so everyone, not just sensitive groups, should take precautions.

Syphilis in Maine 2008

June 30, 2008 Word  PDF
Since March 5, 2008 health care providers in Maine have diagnosed syphilis in nine individuals, ages 25-59, in Cumberland, Kennebec, and York Counties. Three individuals had primary syphilis, three had secondary syphilis, and three had early latent syphilis. Eight of the nine individuals with syphilis were men who have sex with men (MSM); the remaining person with syphilis was a male to female transgendered (MTF) individual. Three of the nine individuals are known to be HIV positive.

Air Quality Alert for Mid-Coast Region of Maine

June 26, 2008 Word  PDF
Ground-level ozone concentrations are expected to reach unhealthy levels for sensitive groups for the mid-coast region and high elevations of Acadia (Port Clyde through Mt. Desert) according to the Maine Department of Environmental Protection (DEP).

June 9, 2008 – Maine CDC Advises Caution in Heat

June 9, 2008 Word  PDF
With Maine heading into summer, it is important for all of us to prevent heat-related problems and to recognize the signs of heat illness early. Heat-related illnesses and deaths are preventable, yet over the past 30 years more people have died in this country from heat than from hurricanes, lightning, tornadoes, floods, and earthquakes combined.

Hepatitis B Screening and Vaccination of the Foreign-Born

May 27, 2008 Word  PDF
May is Viral Hepatitis Awareness Month. Maine has an estimated 5,000 chronic hepatitis B virus (HBV) carriers; many of whom are foreign-born from regions with high endemicity of HBV infection. The Maine Center for Disease Control and Prevention (Maine CDC) is reminding health care providers about the need for screening of all foreign-born persons from high risk countries for hepatitis B virus infection. Hepatitis B vaccination should be offered to all susceptible patients. Chronic hepatitis B carriers require counseling and medical management to reduce their risk for developing chronic liver disease; their household, sex, and needle-sharing contacts also should also be tested, and if susceptible, vaccinated against hepatitis B.

Measles in the United States Jan.1 to April 25, 2008

May 16, 2008 Word  PDF
From January 1 through April 25, 2008, CDC received a total of 64 reports of confirmed measles cases in the U.S. This is the highest number reported for the same time period since 2001.

Multi-Dose Medication and Reuse of Syringes

April 25, 2008 Word  PDF
The purpose of this advisory is to notify you of a potential threat to patient safety if your facility uses parenteral medications for multiple patients with unsafe injection practices.

Animal Rabies 1st Quarterly Update January 1 – March 31, 2008

April 22, 2008 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

Cereal recalled due to contamination with Salmonella

April 10, 2008 Word  PDF
On April 5, 2008 the Malt-O-Meal Company of Minnesota announced a recall of unsweetened puffed rice and unsweetened puffed wheat cereals. In addition to Malt-O-Meal’s own brand, these cereals are sold under multiple labels including the store brands for Hannaford and Shaw’s Supermarkets. The other brands being recalled are Acme, America’s Choice, Food Club, Giant, Jewel, Laura Lynn, Pathmark, ShopRite, Tops, and Weis Quality. The products recalled include “Best if used by” codes between April 8, 2008 (APR0808) and March 18, 2009 (MAR1809). The entire list of products included in the recall is available at: http://www.malt-o-meal.com/recallinfo/. The reason for the recall was contamination with Salmonella.

Influenza Activity in Maine

February 26, 2008 Word  PDF
In February, influenza activity has become widespread in Maine, with all 3 of the major seasonal influenza variants circulating. Outbreaks of influenza are occurring in schools and in long term care facilities across the state. Although there is a decrease in the relative efficacy of this year’s vaccine against two of the three circulating strains, influenza vaccination is still strongly encouraged, especially to protect those persons at risk of more severe disease. Chemoprophylaxis and treatment of influenza with osteltamivir (Tamiflu) or zanamivir (Relenza) continues to be recommended in spite of low levels of oseltamivir resistance noted among influenza A (H1N1) in national studies. Influenza-related deaths in persons aged less than 18 years and outbreaks of influenzalike illnesses in long term care facilities should be immediately reported to Maine CDC at 1-800-821-5821.

Hepatitis B

February 6, 2008 Word  PDF
An increase in acute Hepatitis B Virus (HBV) was noted in 2006 when 26 cases of infection were identified in Maine. This was a substantial increase from the annual average of 10 cases per year for the preceding six years (2000-2005) (range 5-14 cases per year). Preliminary data from 2007 indicate that the number of cases of acute HBV infection remains elevated (n=18).

Norovirus Gastroenteritis

February 6, 2008 Word  PDF
Since December 1, 2007, the Maine CDC has investigated seven reports of confirmed or suspected norovirus gastroenteritis outbreaks from six counties. Four of these reports have been laboratory-confirmed. Five outbreaks occurred in long term care facilities and two in elementary schools. Noroviruses are the principal cause of viral gastroenteritis in the United States. Circulation of norovirus infections typically increases during the winter months, and outbreaks are currently being reported also in other areas of the nation. The Federal CDC estimates that 23 million cases of acute gastroenteritis per year are due to norovirus infection.

Rabies 4th Quarter Update

January 29, 2008 Word  PDF
The Maine Center for Disease Control and Prevention provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

Erratum Mumps Outbreak in Maine

November 21, 2007 Word  PDF
In the November 19, 2007 Health Alert Network Advisory "Mumps Outbreak in Maine" errors occurred. On page 2, under laboratory diagnosis, the second sentence of the second paragraph should read, " The diagnosis of mumps in persons with suggestive clinical presentation can be confirmed through viral culture of urine or saliva, by identifying mumps IgM antibody in serum, or through polymerase chain reaction (PCR) testing of saliva to amplify mumps nucleic acid early in the acute illness." In addition, updates were made to the text under laboratory diagnosis, third paragraph, number 2. See below for the corrected text.

Mumps Outbreak in Maine

November 19, 2007 Word  PDF
Since late September, Maine CDC has confirmed seven people with mumps in central and southern Maine, and is awaiting the results of laboratory testing on other patients with clinicallysuspected illnesses. Confirmed patients reside in Cumberland, Androscoggin, Oxford, and Somerset Counties and range in age from late teens to late fifties. Mumps exposures at two acute care hospitals have resulted in serological testing for immunity and/or expedited vaccine boosting of a significant number of health care workers. Although no formal epidemiological link has been made, it is likely that these infections may be associated with an ongoing outbreak of mumps in New Brunswick and Nova Scotia. The epidemiology of recent outbreaks in North America, including the current situation in Canada, suggests that college and university students and health care workers should be priority populations for vaccination initiatives.

Outbreak of Atypical Pneumonia in College Students, Brunswick

November 6, 2007 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) is working closely with the Bowdoin College Health Services to investigate and control an outbreak of 32 cases of atypical pneumonia that have occurred over a two month period at the college. Initial diagnostic testing has identified Mycoplasma pneumoniae (M. pneumoniae), the most common agent of pneumonia in adolescents and young adults, as the probable cause of this outbreak. Epidemiological and laboratory investigations are ongoing. Students at the college have been encouraged to practice cough hygiene measures, to minimize contact with others during acute illness, and to visit the infirmary for medical evaluation if they have fever or cough illnesses. There is no evidence that this outbreak is currently affecting college employees or residents of surrounding communities.

Information on MRSA for Maine Schools

October 31, 2007 Word  PDF
The Maine Center for Disease Control and Prevention (Maine CDC) has received many recent inquiries related to Methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a bacterial infection that is easily spread and can be prevented through increased personal hygiene and environmental cleaning.

Outbreak of Salmonella Infections in Cumberland County

October 25, 2007 Word  PDF
The Maine CDC is currently investigating a cluster of Salmonella infections that have been reported among persons residing in Cumberland County in the last month. As of October 24, 2007, we have identified a total of 10 cases that are associated with this outbreak; eight (8) are culture-confirmed and two (2) are probable cases (i.e. epidemiologically-linked cases without culture confirmation). Symptom onset dates range from September 13 to October 2 and ages range from 23 to 64 years. The investigation of this outbreak is ongoing.

Mumps

October 18, 2007 Word  PDF
Since September 27, Maine CDC has received reports of three people with laboratory-confirmed mumps in central and southern Maine. Three people of unknown vaccination status in their 30s-40s are infected in York and Cumberland Counties. Two were hospitalized and are now recovering at home. All are expected to fully recover. These are the first confirmed people infected with indigenous mumps in Maine in more than ten years. In addition, Maine CDC is currently investigating the possibility of two people infected in Kennebec County. We are also investigating any common exposures these individuals might have had to mumps.

Maine Animal Rabies 3rd Quarter Update

October 2, 2007 Word  PDF
The Maine Center for Disease Control and Prevention provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

Shiga toxin positive E.coli 0157:H7 (STEC)

September 19, 2007 Word  PDF
Maine CDC is investigating a cluster of six hemorrhagic shiga toxin positive E.coli O157:H7 (STEC) cases in mid-coast and central Maine that occurred among residents over the past 3 weeks (case onset dates of August 22 to September 13 and ages range 9 months to 75 years). As of September 19, four of the six have been confirmed shiga-positive E.coli O157:H7 by the Health and Environmental Testing Laboratory (HETL). Two other specimens are pending and one other suspect case is under investigation. All patients had bloody diarrhea and one (adult) was hospitalized. At this time, the investigation is ongoing although we have not identified any common venues, events or foods based on case interviews.

Lyme Disease in Maine: Answers to Frequently-Asked Questions from Health Professionals

September 12, 2007 Word  PDF
Although the Maine Center for Disease Control and Prevention does not provide clinical consultation on the management of individual cases of Lyme disease, the Medical Epidemiology Section in the Division of Infectious Disease receives frequent requests from health professionals for Lyme disease-related information to assist in patient assessment and care. This Health Advisory includes answers to some of the more frequently asked questions that we receive, and is not intended in any way to be comprehensive.

Pertussis Cluster in Portland Area

September 7, 2007 Word  PDF
Maine CDC is investigating a household cluster of pertussis cases in the Portland area, following the diagnosis of pertussis in an infant who was admitted to a hospital critical care unit over the weekend. Although there are no other persons currently hospitalized or seriously ill, this health advisory is being distributed because of the large number of children who were likely to have been exposed to pertussis during the past several weeks and for whom antibiotic prophylaxis and evaluation of respiratory illnesses is being recommended. Exposures occurred over the past 2-3 weeks in several settings including a childcare center and two children’s sports teams. Parents of children who have been identified as case contacts are being notified and will be likely to be calling their medical provider offices over the next few days. It should be noted that there is no evidence of a wider community outbreak of pertussis in southern Maine at this time.

Syphilis in Maine

August 30, 2007 Word  PDF
Since January 1, 2007 health care providers in Maine have diagnosed 9 cases of syphilis all among males, ages 22-63, in Androscoggin, Cumberland, Oxford, and York Counties. Three cases were primary syphilis, two cases were secondary syphilis and four cases were early latent syphilis. Eight of the 9 cases were among men who have sex with men (MSM). Two of the 8 individuals are known to be HIV positive.

Outbreak of Botulism Associated with Canned Chili

August 28, 2007 Word  PDF
Public health officials in Indiana, Texas, and at CDC are investigating an outbreak of botulism associated with canned hot dog chili sauce manufactured by Castleberry’s Food Company.

More Toys Recalled Because of Lead Paint

August 16, 2007 Word  PDF
The Department of Health and Human Services’ Maine Center for Disease Control (Maine CDC) wants to remind Maine parents what they can do about common toys that have been recently recalled because they contain lead.

Human Arbovirus Update for Healthcare Providers in Maine

August 16, 2007 Word  PDF
This health advisory provides a brief update on the epidemiology and natural history of West Nile virus (WNv) and Eastern Equine Encephalitis (EEE) infections, a summary of surveillance findings in Maine, and guidance for obtaining and submitting clinical diagnostic specimens to the Maine Center for Disease Control (Maine CDC), where tests will be performed free of charge. Testing for mosquito-borne infections should be performed routinely for every person diagnosed with aseptic meningitis or encephalitis during the summer and fall months. Maine CDC will also test physician-submitted serum specimens for persons with other severe and/or persistent unexplained febrile illnesses

Maine Paralytic Shellfish Poisoning (Red Tide) Illnesses - Washington County

August 1, 2007 Word  PDF
Four persons from a Washington County fishing household were hospitalized with symptoms of paralytic shellfish poisoning (PSP) on the evening of July 31th within several hours of sharing a meal of mussels. Preliminary testing of mussels taken from the home were highly contaminated with the toxin that causes paralytic shellfish poisoning. These preliminary tests show toxin levels 200 times the threshold level used to close shellfish beds in Maine. Maine CDC is now assisting the Maine Department of Marine Resources (DMR) to determine the source of the implicated mussels and to assure that any harvested shellfish available to the public continue to be safe to eat. Early information indicates the probable source of the mussels was a drifting barrel found by the lobsterman off the Washington County coast; not from a mussel bed. This information also indicates the mussels taken off the barrel were for the lobsterman’s personal use.

Maine Animal Rabies 2nd Quarter Update - January 1 - June 30 2007

July 9, 2007 Word  PDF
The Maine Center for Disease Control and Prevention provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

Toys Recalled Because of Lead Based Paint

June 15, 2007 Word  PDF
The Department of Health and Human Services’ Maine Center for Disease Control (Maine CDC) wants Maine parents to know what to do about common toys that have been recently recalled because they contain lead.

Federal CDC Health Advisory: Early Report of Serious Eye Infections Associated with Soft Contact Lens Solution

May 29, 2007 Word  PDF
The Centers for Disease Control and Prevention (CDC), collaborating with the Food and Drug Administration, state and other partners, has identified an outbreak of a serious but rare eye infection called Acanthamoeba keratitis (AK). This infection is caused by a free-living ameba (Acanthamoeba) a microscopic organism found everywhere in nature. Infections can result in permanent visual impairment or blindness. AK primarily affects otherwise healthy people, most of whom wear contact lenses. In the United States, an estimated 85% of cases of this infection occur in contact lens users. The incidence of the disease in the U.S. is approximately one to two cases per million contact lens users.

Mumps Outbreak in Eastern Canada - Alert for Maine Clinical Providers

May 18, 2007 Word  PDF
Increased mumps activity is currently being reported in three Canadian provinces (Nova Scotia, New Brunswick, and Prince Edward Island), and has recently also spread to Ontario. As of May 11th, 2007, 271 confirmed cases of mumps had been reported from the four affected provinces. Approximately 90% and 25% of the mumps cases in Nova Scotia and New Brunswick respectively, are associated with university settings. The viral strain in these outbreaks is the same genotype (G) detected from the 2005-06 Nova Scotia outbreaks, the United States' multi-state outbreak in 2006, and the United Kingdom epidemic between 2004 and 2006

New Federal CDC Treatment Guidelines for Gonorrhea

May 4, 2007 Word  PDF
As of April 13, the federal Centers for Disease Control and Prevention (CDC) no longer recommends the use of fluoroquinolones for the treatment of gonococcal infections and associated conditions such as pelvic inflammatory disease (PID). This is due to widespread fluoroquinolone resistance in Neisseria gonorrhoeae in the United States. CDC now recommends only one class of antibiotics, cephalosporins, for the treatment of gonorrhea. All providers in Maine are strongly encouraged to follow the updated guidelines.

Carbon Monoxide Poisoning Warning

April 19, 2007 Word  PDF
A number of Maine communities continue to experience power outages due to the recent storm. Outbreaks of carbon monoxide (CO) poisonings have been associated with storm-related power outages due to improper placement and operation of gas-powered generators and other alternative heating and power sources. A study of a CO poisoning outbreak in the aftermath of the January 1998 Ice Storm found that improper placement of a gasoline generator, such as in a basement or garage, could increase the risk of CO poisoning by 20 to 300-fold. Using a kerosene heater in a room without any doors to other rooms opened, or failing to crack a window, also put people at increased risk for CO poisoning. CO is an odorless colorless gas emitted when burning most fuels. Improper operation or placement of alternative heating or power sources can result in poisoning when CO gas builds-up in enclosed spaces.

Maine Animal Rabies Quarterly Update - 1st Quarter, 2007

April 3, 2007 Word  PDF
The Maine Center for Disease Control and Prevention provides a quarterly update on animal rabies to veterinarians and other animal health professionals. This update may be used as an educational tool to increase the understanding of pet owners and other members of the public regarding the risk of rabies in Maine and in their communities.

Salmonella Infections Associated with Peanut Butter

February 16, 2007 Word  PDF
The Food and Drug Administration (FDA) is warning consumers not to eat certain jars of Peter Pan peanut butter or Great Value peanut butter due to risk of contamination with Salmonella Tennessee.

Outbreaks of Norovirus Gastroenteritis in Maine

January 12, 2007 Word 
Since December 1, 2006, the Maine CDC has investigated eight reports of confirmed or suspected norovirus gastroenteritis outbreaks from seven counties. Four of these reports have been laboratory-confirmed. Six outbreaks occurred in long term care facilities and one in an elementary school. One outbreak associated with a gathering of families and friends was reported from a hospital emergency department.

Influenza Arrives in Maine

January 3, 2007 Word 
Cases of both influenza A and influenza B among Maine residents have now been confirmed by laboratory diagnostic testing in several communities, marking the beginning of our influenza season.

Influenza B in Maine

December 16, 2006 Word 
Laboratory-confirmed influenza B has been reported in Maine for the first time this season. Medical providers should continue to promote influenza immunization, especially for persons at risk of complications. Rapid influenza diagnostic tests may be useful as clinicians begin to see individuals with influenza-like illnesses in their practices. Providers should review updated guidelines for the use of antiviral drugs for prevention and chemoprophylaxis of influenza. Links to detailed CDC recommendations on vaccination, testing, and antivirals are provided below.

Hepatitis B Outbreak

December 5, 2006 Word 
An outbreak of acute Hepatitis B Virus (HBV) began in the Bangor area in June 2006. The Maine CDC has continued to receive reports of cases throughout the summer and fall. Currently, there are seven cases in Penobscot County and one case in Hancock County. (For comparison, only 12 cases of acute hepatitis B are reported statewide during an average year.) Each case has undergone one or more in-depth interviews. Sexual exposure has been identified as a major risk factor in this outbreak.

Updated Treatment Guidelines for Lyme Disease

October 31, 2006 Word 
The infectious Disease Society of America (IDSA) recently issued new guidelines for the diagnosis and treatment of Lyme disease, ehrlichiosis and babesiosis.

Pertussis Outbreaks in Western and Southern Maine

October 13, 2006 Word 
Maine CDC has been notified of a possible cluster of suspected Pertussis cases in a high school in Portland, Maine. In the past two months, Maine CDC was also notified of small clusters in some daycares in western and southern Maine.

Multiple States Investigating a Large Outbreak of E. coli 0157:H7 Infections

September 15, 2006 Word 
Public health officials in multiple states, with the assistance of the Centers for Disease Control and Prevention, are investigating a large outbreak of E. coli O157:H7 infections. Thus far, 50 cases with matching pulsed-field gel electrophoresis (PFGE) pattern have been reported from CT (1), ID (3), IN (4), MI (3), OR (5), NM (2), UT (11), WI (20). Eight patients developed the hemolytic uremic syndrome (HUS) and one patient died. Most cases are recent: for those with known illness onset, the range of onset is 08/25/2006 to 09/03/2006. The outbreak is likely ongoing.

Hepatitis B Cluster, September 2006

September 14, 2006 Word 
The Maine Center for Disease Control and Prevention (Maine CDC) has continued to receive reports of acute hepatitis B (HBV) from the Bangor area. During the summer a total of five cases were reported. Only 12 cases of acute hepatitis B are reported statewide during an average year. The cases in the Bangor area are males, 55 to 77 years of age, with no apparent risk factors or links to each other. An investigation for possible common exposures is ongoing.

Guidance for Laboratory Testing of Persons with Suspected Infection with Avian Influenza A (H5N1) Virus in the United States

July 20, 2006 Word 
This update provides revised interim guidance for testing of suspected human cases of avian influenza A (H5N1) in Maine and is based on the current state of knowledge regarding human infection with H5N1 viruses. The epidemiology of H5N1 human infections has not changed significantly since February 2004. Therefore, federal CDC recommends that H5N1 surveillance in the United States remain at the enhanced level first established at that time. However, this revised interim guidance provides an updated case definition of a suspected H5N1 human case for the purpose of determining when testing should be undertaken and also provides more detailed information on laboratory testing. Effective surveillance will continue to rely on health care providers obtaining information regarding international travel and other exposure risks from persons with specified respiratory symptoms as detailed in the recommendations below. This guidance will be updated as the epidemiology of H5N1 changes. Note: Federal CDC is revising its interim guidance for infection control precautions for avian influenza A (H5N1). These will be issued as soon as they are available.

Hepatitis B Cluster, July 2006

July 14, 2006 Word 
The Maine Center for Disease Control and Prevention (Maine CDC) has received 3 reports of acute hepatitis B (HBV) in the month of June from the Bangor area. Only 12 cases of acute hepatitis B are reported statewide during an average year. The cases are 56 to 77 years of age, diabetic, and have no apparent risk factors or links to each other. An investigation for possible common exposures is ongoing.

Risk of Salmonella Infectious from Chicks and Other Poultry, June 2006

July 5, 2006 Word 
The Maine Center for Disease Control and Prevention (Maine CDC) alerts healthcare providers to the risks of Salmonella infection associated with exposure to chicks. The Maine CDC further advises healthcare providers to educate patients and families about the risks of Salmonella and other enteric diseases from contact with chicks and other poultry.

New Recommendations for Mumps Prevention in Maine

June 20, 2006 Word 
Federal CDC, and state and local health departments across the nation are still coping with an outbreak of mumps that began in Iowa in December 2005 and involved at least 12 additional states. To date, Maine CDC has not received any reports of confirmed mumps in Maine. Nationally, the CDC reported 4,016 confirmed, probable, or suspect cases of mumps as of June 14, 2006.

Human Arbovirus Update for Healthcare Providers in Maine, June 2006

June 13, 2006 Word 
In 2005, two horses, one bird, and one mosquito pool tested positive for Eastern Equine Encephalitis (EEE) in Maine, all in York County. In the same year, eight birds tested positive for West Nile virus (WNV). These results are the latest indication that there is a real risk of EEE and WNV transmission from infected mosquitoes to Maine residents. As the warm season approaches, the Maine CDC is alerting physicians and other healthcare providers of the risk of acquired human EEE and WNV infections, and providing laboratory testing criteria and guidelines

Community-associated MRSA and Tattoos

May 30, 2006 Word 
The Division of Infectious Disease has received an increasing number of reports of skin and soft tissue infections (SSTI) among persons that recently received tattoos or piercing. Several patients were subsequently diagnosed with community-associated methicillin-resistant Staphylococcal aureus (CA MRSA). Additionally, secondary cases of CA MRSA have been identified among household members.

Syphilis Increase in Maine

May 25, 2006 Word 
Since January 1, 2006, health care providers in Maine have diagnosed 9 cases of syphilis among seven males and two females, ages 24-48, in Cumberland, Kennebec, Waldo and Somerset Counties. Two cases were primary syphilis, two cases were secondary syphilis and five cases were early latent syphilis. Three of the cases were among males with HIV infection.

Avian and Pandemic Influenza: What Mainer's Need to Do

May 18, 2006 Word 
The current circulating strain of H5N1 avian influenza, more commonly referred to as bird flu, could very likely appear in the United States in the near future, at least among birds. This virus also has the potential to mutate and start infecting a large number of humans, possibly even becoming a pandemic (global epidemic). However, the detection of H5N1 in the United States in birds does not signal the start of a human pandemic

Potent substance probably sold as heroin is causing overdoses - may be or may contain methyl fentanyl

April 21, 2006 Word 
Three states, New Jersey, Maryland and Illinois, are reporting an increase in opioid overdoses, supposedly heroin, requiring significant amounts of antidote

Mumps Outbreak in Iowa - Air Travel Exposure

April 14, 2006 Word 
The state of Iowa has been experiencing a large mumps outbreak that began in December 2005. As of April 10, 2006, a total of 515 possible mumps cases have been reported to the Iowa Department of Public Health (IDPH) during 2006. This outbreak has spread across Iowa, and mumps activity, possibly linked to the Iowa outbreak, is under investigation in six neighboring states, including Illinois (n = four), Kansas (n = 33), Minnesota (n = one), Missouri (n = four), Nebraska (n = 43), and Wisconsin (n = four) (CDC, unpublished data, April 10, 2006). The reasons for this outbreak are under investigation.

Widespread Influenza Activity

April 6, 2006  
After an initial peak in activity in late-December, Maine’s influenza sentinel surveillance providers reported an increasing number of outpatient visits for influenza-like illness during the past 3 weeks. Laboratory surveillance data from the state laboratory and two reference laboratories indicate an increasing number of specimens submitted for influenza testing and number of specimens positive for influenza A and B. During the past 3 weeks, over 20 outbreaks of influenza have been reported in long-term and acute care facilities and schools.

Pertussis in Maine

March 7, 2006 PDF 
Maine has seen significant increases in the incidence of pertussis (whooping cough) in recent years. Ten cases were recently reported from Hancock County. This advisory provides recommendations for the evaluation and management of pertussis.

Meningococcal Chemoprophylaxis

March 7, 2006 PDF 
Maine Center for Disease Control and Prevention (Maine CDC) recently received reports of meningococcal disease in which large numbers of persons were placed on chemoprophylaxis. The purpose of this health advisory is to make health care providers aware of national guidelines for chemoprophylaxis of meningococcal disease.

CDC Recommends against the use of Amantadine and Rimandatine for the treatment or prophylaxis of influenza in the United States during the 2005-06 influenza season.

January 18, 2006 Word 
CDC Recommends against the Use of Amantadine and Rimandatine for the Treatment or Prophylaxis of Influenza in the United States during the 2005–06 Influenza Season Recent evidence indicates that a high proportion of currently circulating Influenza A viruses in this country are resistant to these medications

Varicella Outbreak in a Brunswick Elementary School

January 10, 2006 Word 
During the week of December 19th Maine CDC (formerly Bureau of Health) received a report of an outbreak of varicella (chickenpox) among 12 students at Longfellow School in Brunswick, Maine. The school also reported that during the holiday season 14 children developed chickenpox. This brought the number of chickenpox cases in the school since the end of October to more than 30. The school is a K-5th grade elementary school with a student population of 354.

Public Health Update on Influenza in Maine

December 13, 2005 Word 
The purpose of this Health Advisory is to provide recommendations on:
  1. Influenza in Maine
  2. Influenza vaccine availability
  3. Anti-viral medications
  4. Laboratory testing for influenza
  5. Influenza surveillance activities

Maine Frequently Asked Questions on Avian and Pandemic Influenza

November 2, 2005 Word  PDF
Bird flu is an infection caused by avian (bird) influenza (flu) viruses, normally a subtype of a type A influenza virus. Occurring naturally among birds, these viruses are often carried by wild birds in their intestines, causing few if any symptoms. However, they can cause some domestic birds, including chickens, to be very ill and even die. Although bird flu viruses do not usually infect humans, occasionally some strains can. Symptoms of bird flu in humans depend on the subtype and strain of bird flu, but can range from conjunctivitis to typical flu-like symptoms to severe respiratory disease and sometimes even death.

Eastern Equine Encephalitis: Update for Maine Clinicians

October 4, 2005 Word  PDF
Two horses and one bird have recently tested positive for Eastern Equine Encephalitis (EEE) in Maine, all in York County. Because there is a risk of human transmission of EEE from infected mosquitoes to people in that area, Maine Health and Human Services’ Public Health is alerting physicians and other health care providers of this EEE activity, and providing laboratory testing criteria and guidelines. For further questions or concerns, please contact Public Health for the medical epidemiologist on call at: 1-800-821-5821.

Imported Mumps Cases in Maine Summer Camps, June-July 2005

July 15, 2005 Word 
The Bureau of Health (Maine Center for Disease Control and Prevention) is currently investigating two confirmed cases of mumps among campers and staff members at two Maine youth summer camps. Both individuals are non-U.S. residents here for the camping season. The cases are not linked to each other. No secondary transmission has been identified as of July 14 th.

Community-Associated MRSA Update

June 8, 2005 Word 
Over the past 3 years, outbreaks of community-associated Methicillin-resistant Staphylococcus aureus (MRSA) have become a well-documented problem in correctional facilities across the United States. During the week of May 30th, officials at two Maine correctional facilities reported outbreaks of skin and soft tissue infections caused by CA-MRSA affecting a total of 11 inmates. None of the inmates were critically ill and there is no evidence that the two outbreaks were directly connected. No infections have been reported among correctional officers or other staff.

Community-Associated MRSA Infections in a Correctional Facility

May 26, 2005 Word  PDF
This week the Cumberland County Jail reported an outbreak among inmates of skin infections caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). This outbreak is currently limited to a very small number of inmates, and control measures have been initiated in collaboration with the DHHS Bureau of Health and Portland Public Health. The problem of CA-MRSA, however, is growing and becoming a bigger public health concern across Maine and the nation. Health professionals should be aware of some of the basic issues in recognition, management, and prevention of these infections.

Bureau of Health Update on Influenza

November 3, 2004 Word 
Influenza vaccine supply in Maine continues to be extremely limited, and no outbreaks of flu are evident yet in the State. The Bureau of Health’s goal is to minimize influenza’s impact by: assuring influenza vaccine access for high-priority Mainers; promoting measures that will minimize transmission of influenza; and improving Maine’s health system preparedness for influenza. We expect to evolve our recommendations as this situation continues to change.

Updated Guidance on Influenza

October 20, 2004 Word 
The purpose of this Health Advisory is to provide:
  1. An update on influenza vaccine supplies in Maine;
  2. Vaccine guidelines for Maine;
  3. Revisions to the recommendations for vaccinating healthy health care workers; and
  4. Influenza-related infection control measures for health care settings that should be implemented as soon as possible.

Maine Health Advisory on Influenza to Health Providers

October 13, 2004 Word 
Due to recently announced loss of half the nation’s expected influenza vaccine supply for the 2004 – 2005 season, vaccine availability continues to be extremely limited. At this time the supply is insufficient to provide flu vaccine to all persons for whom it is recommended.

Interim Influenza Vaccination Recommendations 2004-05 Influenza Season

October 6, 2004 Word 
We are forwarding to you a Health Advisory from CDC on the sudden shortage of flu vaccine and their recommendations. Here in Maine, Maine Department of Health and Human Services, Bureau of Health is working to assess the influenza vaccine supply (both the supply ordered by the Bureau of Health as well as that ordered by health care providers privately). Maine typically does not experience influenza activity prior to late November/early December.

Outbreak of Pertussis Cases at a Southern Maine High School

May 13, 2004 Word  PDF
The Bureau of Health is currently investigating an outbreak of pertussis at Cheverus High School, an institution in Portland which enrolls students from across southern and midcoastal Maine. Bureau epidemiologists are working with the school administration and nursing staff to ensure that close contacts of cases are referred for appropriate antibiotic prophylaxis and that individuals with clinical illnesses compatible with pertussis are referred for diagnostic testing and antibiotic treatment. Student families and staff members have received advisories instructing them to contact their primary care medical providers if they are symptomatic or are close contacts of confirmed cases. This advisory is intended to alert area clinicians who may see such patients and to provide an update on current recommendations in evaluation and preventive management of pertussis. If you are involved in evaluation or treatment of suspect pertussis cases or their exposed contacts, please review this advisory and contact the Division of Disease Control at 1-800-821-5821.
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