In 2014, national surveillance began for Acute Flaccid Myelitis (AFM). Peaks of cases were observed across the United States in 2014, 2016, and 2018. Given the observed biennial pattern, it was anticipated that there would be an increase in AFM cases in 2020; however, cases plateaued from 2019 through 2021. It is likely that methods of prevention for COVID-19 contributed to the deviation from the previously observed biennial pattern. AFM is still observed across the country; it is unknown if the biennial pattern will resume.

As of July 29, 2022, the Centers for Disease Control and Prevention (CDC) and state and local public health partners are reporting 5,189 cases of Monkeypox virus infections in the United States across 47 states, Washington, D.C., and Puerto Rico. CDC is also reporting multiple outbreaks of monkeypox have also been reported globally in 72 countries that do not normally report monkeypox activity. On Friday, July 22, CDC reported the first two cases of monkeypox in children in the United States during the current outbreak.

The purpose of this health advisory is to alert clinicians to the potential for human arboviral disease activity in Maine and to consider testing for mosquito-borne arboviruses in patients presenting with unexplained encephalitis, meningitis, or high fever (≤100.4°F or 38°C) during the summer and fall. Consider testing for Powassan virus year-round.

• Monkeypox testing is now available at several commercial laboratories. Providers should send specimens for monkeypox testing to commercial laboratories rather than Maine CDC's Health and Environmental Testing Laboratory (HETL). Requirements for specimen type may vary depending on the lab used.
• Jynneos, a vaccine to prevent monkeypox, is available in Maine. Supplies are prioritized for close contacts of confirmed monkeypox cases and for persons who might have had recent monkeypox exposures based on certain criteria.

COVID-19 remains a major health concern in Maine and across the United States. COVID-19 was the third leading cause of death in the U.S. in 2020 and 2021. New variants continue to emerge, some with higher transmissibility and an ability to cause breakthrough infections in those who have been vaccinated and in those with prior COVID-19 infection. Vaccination remains the best protection against infection, hospitalization, and death.

Ground-level ozone concentrations will be climbing in Maine late Saturday evening, dropping off overnight then building up again on Sunday along the coast of Maine from Kittery through Acadia NP and are expected to reach unhealthy levels on Sunday according to the Maine Department of Environmental Protection (DEP). Ozone levels have been at or near unhealthy levels in southern New England for days. Winds Saturday evening will turn toward Maine in the Gulf of Maine continuing into Sunday.

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform clinicians and public health departments that parechovirus (PeV) is currently circulating in the United States. Since May 2022, CDC has received reports from healthcare providers in multiple states of PeV infections in neonates and young infants. Parechoviruses are a group of viruses known to cause a spectrum of disease in humans.

Reporting of notifiable diseases and conditions is required under 22 M.R.S., Chapter 250, §802 and §822. Failure to report could result in preventable morbidity or mortality. Maine CDC is authorized to advise through publicly noticed Health Alerts the public health need for the temporary reporting of any disease or condition in the state of Maine in order to study and control any apparent outbreak or unusual occurrence of communicable diseases.

This Health Alert serves as notice for a temporary change to the Notifiable Diseases and Conditions List:

Since May 2022, monkeypox cases, which have historically been rare in the United States, have been identified in 18 states and territories among both persons returning from international travel and their close contacts domestically. Globally, more than 1,600 cases have been reported from more than 30 countries; the case count continues to rise daily. In the United States, evidence of person-to-person disease transmission in multiple states and reports of clinical cases with some uncharacteristic features have raised concern that some cases are not being recognized and tested.

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to update healthcare providers, public health departments, and the public on the potential for recurrence of COVID-19 or "COVID-19 rebound." Paxlovid continues to be recommended for early- stage treatment of mild to moderate COVID-19 among persons at high risk for progression to severe disease. Paxlovid treatment helps prevent hospitalization and death due to COVID-19.