The Centers for Disease Control and Prevention (U.S. CDC) is issuing this Health Alert Network (HAN) Health Advisory to alert healthcare providers to low vaccination rates against influenza, COVID-19, and RSV (respiratory syncytial virus). Low vaccination rates, coupled with ongoing increases in national and international respiratory disease activity caused by multiple pathogens, including influenza viruses, SARS-CoV-2 (the virus that causes COVID-19), and RSV, could lead to more severe disease and increased healthcare capacity strain in the coming weeks.

Hospital emergency departments, emergency medical services, and outpatient providers should be on alert for carbon monoxide (CO) poisonings. The Maine Center for Disease Control and Prevention (Maine CDC) is investigating 18 reports of CO poisoning from eight separate incidents linked to improper generator use after the recent storm. CO poisoning is a reportable condition in Maine and these events have been reported to the Maine CDC. The Maine CDC investigates cases of suspected CO poisoning to identify exposure risk factors and improve outreach efforts to prevent further poisonings.

The Centers for Disease Control and Prevention (U.S. CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify healthcare providers and the public about an outbreak of Rocky Mountain spotted fever (RMSF) among people in the United States with recent travel to or residence in the city of Tecate, state of Baja California, Mexico. RMSF is a severe, rapidly progressive, and often deadly disease transmitted by the bite of infected ticks, although many patients do not recall being bitten by a tick. Doxycycline is the treatment of choice for patients of all ages.

The Centers for Disease Control and Prevention (U.S. CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and health departments about the occurrence, geographic spread, and sexually associated human-to-human transmission of Clade I Monkeypox virus (MPXV) in the Democratic Republic of the Congo (DRC). MPXV has two distinct genetic clades (subtypes), and cases of Clade I MPXV have not been reported in the United States at this time (a clade is a broad grouping of viruses that has evolved over decades and is a genetic and clinically distinct group).

Maine continues to see a record-breaking burden of human tickborne disease. As of December 7, 2023, Maine reported 2,706 cases of Lyme disease, 738 cases of anaplasmosis, 173 cases of babesiosis, 12 cases of hard tick relapsing fever, and five cases of Powassan. The Maine Center for Disease Control and Prevention (Maine CDC) reported record numbers of Lyme disease and Powassan surpassing the 2,652 Lyme disease cases and four Powassan cases reported in 2022.

In Maine, cases of tuberculosis (TB) disease have increased in 2023 throughout the state, and the number of contact investigations at schools, health care settings and other facilities has also increased. Many individuals exposed to TB are now seeking screening for latent tuberculosis infection (LTBI). Health care providers in all parts of Maine should know how to screen close contacts of individuals with TB disease, manage LTBI treatment, and recognize the differences between LTBI and TB disease.

The purpose of this health advisory is to alert clinicians and professionals who work with animals that could be rabid that, effective November 27, 2023:

1. Turnaround times for animal rabies testing at the Health and Environmental Testing Laboratory (HETL) may take up to three business days, and
2. HETL will no longer be accepting live animal submissions.

Please review this information from U.S. CDC on potential risk of lead exposure from certain recalled fruit puree pouches sold in the United States. Maine CDC is not aware of children in Maine with blood lead levels of 5 g/dL or higher (Maine's threshold for investigating sources of lead exposure) related to consumption of these products. Families should not buy the recalled products and should discard any products they may have already purchased.

Influenza, COVID-19, and respiratory syncytial virus (RSV) are three viral respiratory infections that cause the majority of respiratory-related hospitalizations and deaths in our communities. Influenza and RSV cause seasonal epidemics with timing that varies year to year; COVID-19 burden continues to rise and fall with no seasonality. U.S. CDC's initial respiratory season outlook indicated that, with COVID-19, seasonal influenza, and RSV, even an average respiratory season can place substantial strain on the health care system; U.S.

In the wake of Wednesday night's mass shooting event in Lewiston, these resources may be helpful to our clinical partners and your patients as we all struggle to cope with the events unfolding in our state.