HEALTH ALERT: Eastern Equine Encephalitis (EEE) and Schools

HEALTH ISSUE ALERT: Eastern Equine Encephalitis (EEE) and Schools

TO: Superintendents, Heads of Private Schools, School Nurses
FROM: Angela Faherty, Ph.D., Commissioner and Dora Anne Mills, MD, MPH, Director of Maine CDC/DHHS
DATE: September 10, 2010
RE: HEALTH ALERT: Eastern Equine Encephalitis (EEE) and Schools

As we did last year at about this time, at the request of the Maine Center for Disease Control and Prevention (Maine CDC), the Department is sharing this important guidance to schools regarding Eastern Equine Encephalitis (EEE). The information and guidance in this letter were developed by the Maine CDC, the lead agency in public health initiatives that involve schools.

EEE is a very serious viral infection transmitted to people from the bite of an infected mosquito. One-third of those identified with EEE will die of the disease, and half of the survivors suffer from permanent brain damage. The disease is especially severe in children (as well as adults over 50). The transmission cycle of EEE virus is most common in and near areas of wetlands, especially salt marshes and freshwater hardwood and cedar wetlands. There is no vaccine or effective treatment for humans. Therefore, prevention strategies are critical.

EEE virus was first detected in Maine in a bird in York County in 2001. A man spending time in Cumberland County in the fall of 2008 died of the disease. In 2009 the virus killed animals (including horses, pheasants and a llama) in York, Cumberland, Kennebec, Waldo, and Penobscot Counties. Three-quarters of these cases were in Waldo and York Counties. EEE has also been detected in nearby Canadian provinces (Nova Scotia, Quebec, and Ontario) and so far this year in New Hampshire, Massachusetts, Rhode Island, Connecticut, and New York.

The 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 felt to be higher in areas with previously-identified EEE and/or in areas near wetlands such as freshwater hardwood, red maple, and cedar wetlands as well as saltwater marshes.

Schools play an important role in preventing EEE. Maine CDC and its consulting experts recommend:

Cover up outdoors. Children and others on outdoor field trips and participating in other outdoor activities for a significant amount of time when the temperature is above 50 degrees should be encouraged to:

Cover up: Cover up with long sleeve shirts, pants, and socks; and/or
Use repellent: Use a US CDC-recommended effective insect repellent containing DEET, picaridin, IR3535, or oil of lemon eucalyptus on exposed skin and/or clothing. The repellent/insecticide permethrin can be used on clothing and can be effective through several washes. Always follow the package directions. For details on recommended repellents see: http://www.cdc.gov/ncidod/dvbid/westnile/qa/insectrepellent.htm

Permission required: School employees and volunteers must have written permission from parents or guardians before applying repellants to minor children. Please see Maine Board of Pesticides backgrounder on administering pesticides with children:
http://www.maine.gov/agriculture/pesticides/laws/documents/policies/BPC-policyInsect-Repellents10-2-09.doc

Limit/reschedule evening outdoor activities or use insect repellent. Unless the dusk temperature is forecast to be less than 50 degrees, limit and even reschedule outdoor group evening activities such as school athletic events so people are able to go indoors by one hour before sunset, or make sure participants and spectators know to use insect repellent.

Implement Integrated Pest Management strategies. Since we anticipate the risk from EEE to continue, schools should consider implementing an Integrated Pest Management program with comprehensive mosquito control strategies that include public and school wide education and the hiring of a licensed commercial pesticide applicator company in order to assess a property, set up a mosquito surveillance program, and advise on mosquito control options. A list of licensed companies can be found at: http://www.maine.gov/agriculture/pesticides/public/mosquitocontrollist.htm .

All these recommendations are especially true in those areas with previously-identified EEE or in areas near wetlands such as freshwater hardwood, red maple, and cedar wetlands as well as saltwater marshes. However, the lack of identified EEE in an area of the state does not mean there is no risk.
Fact sheet for parents. Maine CDC has also created a one-page fact sheet for parents which we encourage you to send home with students, share by email, and/or post on your school website(s), as you deem appropriate. You can access the fact sheet here:
http://www.maine.gov/dhhs/boh/ddc/epi/vector-borne/eee/EEE-Fact-Sheet-Parents.doc
Resources to learn more about EEE and mosquito control:

Maine CDC: 800-821-5821 for consultation or
http://www.maine.gov/dhhs/boh/ddc/epi/vector-borne/index.shtml
Board of Pesticide Control: 207-287-2731 or www.thinkfirstspraylast.org (information on pesticide regulations, licensed applicators, pesticide effects)
Maine Department of Environmental Protection (Maine DEP): 287-3901 or 800-452-1942 http://www.maine.gov/dep/blwq/topic/westnile/ (info on pesticides and wetlands)
University of Maine Cooperative Extension at 800-287-0279
US CDC EEE Website http://www.cdc.gov/EasternEquineEncephalitis/index.html

Maine Department of Education and Maine CDC continue to work very closely together and are greatly appreciative of your assistance in keeping Maine’s children and school communities healthy.
For more information contact Maine CDC at 800-821-5821.