All Health Advisories

Alert	Date	File(s)
COVID-19 Testing, Vaccines, Treatment, Reporting, Guidance, and Resources	May 22, 2023	Advisory (PDF)
COVID-19 infections, hospitalizations, and deaths have decreased substantially in recent months. SARS-CoV-2, the virus that causes COVID-19, continues to circulate worldwide and new variants are expected to continue to appear. Vaccines continue to provide the best protection against infection and severe illness. Medications that reduce progression to severe disease are widely available for people at highest risk for severe disease. The U.S. Public Health Emergency ended on May 11, 2023, resulting in changes to reporting requirements and availability of certain metrics guiding certain healthcare infection control and individual- and community-level prevention practices. U.S. CDC and Maine CDC remain dedicated to preventing severe disease and death from COVID-19, particularly for populations at higher risk, and will continue working to reduce the negative impact of COVID-19.
U.S. CDC: Outbreak of Suspected Fungal Meningitis in U.S. Patients who Underwent Surgical Procedures under Epidural Anesthesia in Matamoros, Mexico	May 18, 2023	Advisory (PDF)
The U.S. Centers for Disease Control and Prevention (U.S. CDC) is issuing this Health Alert Network Health Advisory about an outbreak of suspected fungal meningitis among U.S. patients hospitalized in Texas after undergoing cosmetic procedures under epidural anesthesia in the city of Matamoros, state of Tamaulipas, Mexico. It is currently unknown which organism(s) is causing the outbreak. A fungal etiology is suspected based on elevated cerebrospinal fluid (CSF) levels of the fungal biomarker (1,3)-beta-D-glucan in at least one patient. As of May 12, 2023, five patients have been diagnosed with suspected fungal meningitis; all have been hospitalized, and one has died. All these patients received epidural anesthesia and underwent cosmetic procedures. Affected patients underwent procedures in at least two clinics in Matamoros, Mexico, including River Side Surgical Center and Clinica K-3. Other facilities might be identified through further investigation.
U.S. CDC: Potential Risk for New Mpox Cases	May 15, 2023	Advisory (PDF)
Please review this important information from U.S. CDC regarding ongoing risks for mpox in the United States and recommendations for clinicians. Testing for mpox is available at several commercial laboratories and is available at Maine's Health and Environmental Testing Laboratory. Maine CDC strongly encourages clinicians to use commercial labs for mpox testing. There are no commercially available tests available for people without any visible lesions. Patients tested for mpox should also be tested for other sexually transmitted infections (STIs), per the 2021 CDC STI Treatment Guidelines, including HIV, syphilis, gonorrhea, and chlamydia.
2023 Lyme and Other Tickborne Disease Information	May 8, 2023	Advisory (PDF)
Ticks are already active this year. As the weather continues to get warmer into the spring and summer months, Maine expects the number of Lyme and other tickborne disease case reports to increase. The purpose of this advisory is to provide healthcare providers with useful information on how to assess and care for patients with possible tickborne disease infections. May is Lyme Disease Awareness Month in Maine and Maine CDC encourages all Mainers to stay "Tick Free ME."
Measles Exposure in Maine	May 5, 2023	Advisory (PDF)
Maine's Health and Environmental Testing Laboratory has notified Maine CDC of a positive PCR test for measles in a child. The individual is now isolated at home. Potentially exposed individuals should check their immunization status and monitor for symptoms. The best protection against measles is vaccination. Maine CDC is asking clinicians to increase surveillance for rash illness suggestive of measles to identify early potential cases and prevent the spread of disease and to promptly see any patients seeking post-exposure prophylaxis.
Health Risks from Browntail Moths	April 13, 2023	Advisory (PDF)
The browntail moth is an invasive species of both forest and human health concern. Maine is the only state in the U.S. currently experiencing widespread problems with this moth. The microscopic hairs found on browntail moth caterpillars, shed skins, and cocoons can cause skin reactions and breathing problems.
Marburg Virus Disease Outbreaks in Equatorial Guinea and Tanzania	April 7, 2023	Advisory (PDF)
The U.S. Centers for Disease Control and Prevention (U.S. CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform clinicians and public health departments in the United States about two confirmed outbreaks of Marburg virus disease (MVD)-one in Equatorial Guinea and one in Tanzania. Currently, there is no evidence to suggest that these two outbreaks are related; most experts agree that these represent two independent animal-to-human spillover events. To date, no confirmed cases of MVD related to these outbreaks have been reported in the United States or other countries outside Equatorial Guinea and Tanzania. This Health Advisory provides information about these outbreaks to increase awareness of the risk of imported cases in the United States. It also summarizes U.S. CDC's recommendations for case identification, testing, and clinical laboratory biosafety considerations in the United States.
Pertussis Circulating in Maine	April 6, 2023	Advisory (PDF)
Cases of pertussis are on the rise in Maine. It is important for healthcare providers to be able to recognize the signs and symptoms of pertussis, test for pertussis, treat pertussis, determine who should receive prophylaxis, and vaccinate patients against pertussis.
Diagnosis and Treatment of Syphilis in Pregnant People	March 30, 2023	Advisory (PDF)
Maine CDC recently received notification of a case of congenital syphilis (CS). This is the second case of CS reported to Maine CDC in the past three months. Prior to December 2022, there had not been a case of CS reported in Maine in nearly 30 years. Syphilis rates in the United States have been rising since 2012. From 2012 through 2021, the rate of syphilis cases increased by 224% in the U.S. and by 405% in Maine. In 2022, 23/112 (21%) of syphilis cases in Maine were women between the ages of 15 and 44 years (preliminary data). Preliminary 2021 data for the U.S. include 2,677 cases of CS, an increase of 702% from 2012.
Think. Test. Treat Tuberculosis (TB) in Maine	March 24, 2023	Advisory (PDF)
March 24 is World TB Day. World TB Day is a time to recognize achievements and to renew our commitment to ending tuberculosis (TB) in the United States. Recognize the signs and symptoms of TB disease, test for TB infection, and treat latent TB infection (LTBI) and TB disease. Consider TB disease in patients with symptoms such as hemoptysis, fatigue, loss of appetite, weight loss, night sweats, fever, and cough for more than 3 weeks, regardless of presence/absence of risk factors for TB disease. TB testing is recommended for patients with risk factors for becoming infected with TB such as foreign-born persons from countries with elevated rates of TB and history of working or living in a congregate setting (i.e., homeless shelters, correctional facilities, detention centers, and long-term care facilities). Timely completion of TB treatment is critical. Treatment for both LTBI and TB disease should be initiated early to avoid disease progression and further spread of TB. Make sure patients take all doses as prescribed to prevent severe disease and death, decrease risk of developing multi-drug resistance, and mitigate spread of TB to others.
U.S. CDC: Increased Chikungunya Virus Activity in Paraguay and Associated Risk to Travelers	March 7, 2023	Advisory (PDF)
Please review this advisory on the potential for chikungunya infection after travel to Paraguay. Consider testing for chikungunya in patients with unexplained encephalitis, meningitis, fever, or polyarthralgia. Chikungunya is a serious arboviral infection transmitted from the bite of an infected mosquito. Maine does not have mosquitoes that transmit this virus and there is no risk of local transmission. Most people are infected while travelling abroad to an area with known chikungunya activity. This disease has potentially severe and even fatal consequences for those who contract it. Maine's Health and Environmental Testing Laboratory (HETL) can test for chikungunya. If you suspect chikungunya infection, you may submit serum and CSF samples to HETL for arboviral testing. Chikungunya is a reportable disease. All suspect cases and positive lab reports should be reported to Maine CDC by phone to the 24/7 disease reporting and consultation line at 1-800-821-5821 or by fax to 1-800-293-7534.
U.S. CDC: Measles Exposure at a Large Gathering in Kentucky (February 2023) and Global Measles Outbreaks	March 6, 2023	Advisory (PDF)
Please review this information regarding a large group event in Kentucky last month leading to measles cases across the country. Measles is a reportable condition: cases should be reported immediately to Maine CDC at 800-821-5821 on recognition or strong suspicion of disease. Labs should submit isolates and clinical specimens to Maine CDC for confirmation. Antibody and PCR testing can be performed at some commercial laboratories. PCR testing can be performed at Maine's Health and Environmental Testing Laboratory (HETL). If a commercial laboratory is used, Maine CDC may request that clinical specimens be sent to HETL for confirmational testing. Maines MMR vaccination coverage is higher than the national average (96.7% of kindergarteners have 2+ doses compared to 93.6% nationally). Unvaccinated individuals, especially children under 5 years old, pregnant people, and individuals with compromised immune systems are more likely to suffer from measles complications.
Increase in Extensively Drug-Resistant Shigellosis in the United States	March 2, 2023	Advisory (PDF)
Please take a moment to review this information from U.S. CDC that includes key recommendations for health providers, laboratories, and the general public. The United States has seen a rise in extensively drug-resistant shigellosis. In 2022, Maine CDC identified 11 cases of shigellosis (preliminary data as of February 28, 2023). Shigellosis is a reportable disease in the State of Maine. All Shigella isolates and specimens are required to be sent to the Maine Health and Environmental Testing Laboratory.
Updates on Mpox Surveillance, Testing, Treatment, and Vaccination in Maine	February 28, 2023	Advisory (PDF)
As of February 15, 2023, a total of 30,193 cases of mpox and 32 deaths have been reported nationwide as part of the 2022 mpox outbreak. Mpox case counts have fallen in recent months, from an average of over 400 cases a day in August 2022 to less than five per day in February 2023. Thirteen mpox cases were reported in Maine residents in 2022 (preliminary data as of February 28, 2023) and no cases have been reported so far in 2023. In the current outbreak, most people have been infected during sexual activity from contact with mpox lesions on the skin or mucosal surfaces, such as the throat, anus, or rectum, of a person with mpox. Gay, bisexual, and other men who have sex with men make up the majority of cases. Anyone, regardless of sexual orientation or gender identity, can become infected with mpox if they have close or intimate contact with someone who is pre-symptomatic for or has symptoms of mpox.
Gonorrhea with Resistance or Reduced Susceptibility to Multiple Antibiotics Identified in Massachusetts	February 7, 2023	Advisory (PDF)
Massachusetts recently identified a novel strain of multidrug-non-susceptible Neisseria gonorrhoeae (N. gonorrhoeae) with resistance or reduced susceptibility to all drugs that are recommended for treatment in the U.S. The novel strain, identified in Massachusetts, showed reduced susceptibility to ceftriaxone, cefixime, and azithromycin and showed resistance to ciprofloxacin, penicillin, and tetracycline. This is the first isolate identified in the U.S. showing resistance or reduced susceptibility to all drugs that are recommended for treatment. This strain has the same sequence type recently identified in the United Kingdom and previously reported as circulating in Asia-Pacific countries. Identification of this novel strain is a reminder that N. gonorrhoeae is becoming less responsive to a limited arsenal of antibiotics. While no cases of this novel strain have been reported in Maine as of today's date, gonorrhea continues to be a concern, with cases rising nationally and in Maine. Cases of gonorrhea in Maine increased 34% between 2021 (n=462) and 2022 (n=620). In 2022, rates of gonorrhea were highest for Black and African Americans, males, and persons aged 15-34 years; one-third of cases reported male-to-male sexual contact (2022 data as of February 2, 2023). The highest rate of gonorrhea in Maine was in Androscoggin County (122.5 cases per 100,000 population).
Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears	February 3, 2023	Advisory (PDF)
Please review this national alert regarding a healthcare product contaminated with extensively drug-resistant Pseudomonas aeruginosa. Maine has not identified any cases linked to this outbreak. Removing contaminated artificial tears from healthcare facilities and homes will avoid actual tears caused by infections. Carbapenemase-producing organisms, like the organism identified in this investigation, are a reportable condition in Maine.
Evusheld No Longer Authorized for Emergency Use in the U.S.	January 26, 2023	Advisory (PDF)
The U.S. Food and Drug Administration (FDA) announced on January 26, 2023, that the Emergency Use Authorization (EUA) for Evusheld (tixagevimab co-packaged with cilgavimab) has been revised and based on this revision, Evusheld is not currently authorized for use in the U.S. This is because it is unlikely to be active against more than 90% of the SARS-CoV-2 variants currently circulating in the U.S. based on the latest CDC data. However, people who have used Evusheld still have options to increase their protection against the most serious consequences of COVID-19, including hospitalization and death.
Case of Congenital Syphilis in Maine	January 18, 2023	Advisory (PDF)
Syphilis rates in the United States (U.S.) have been increasing since 2012. From 2012 through 2021, the rate of syphilis cases increased by 224% in the U.S. and by 405% in Maine. In 2022, 112 cases of syphilis were reported in Maine, 20.5% of whom were women between the ages of 15 and 44 years (preliminary data). Maine CDC recently received notification of a case of probable congenital syphilis (CS). This is the first case of CS reported in a Maine resident in nearly 30 years. In 2021, there were 2,677 cases of CS reported in the U.S., an increase of 702% from 2012. In 2021, the highest rates of CS were among birthing persons who were non-Hispanic American Indian or Alaska Native (364 cases per 100,000 live births), non-Hispanic Native Hawaiian or other Pacific Islander (221 cases per 100,000 live births), and non-Hispanic Black or African American (153 cases per 100,000 live births). CS occurs when a pregnant person with syphilis passes the infection to the fetus during pregnancy. This can happen during any stage of syphilis and any trimester of pregnancy; the risk of transmission is highest if the pregnant person has been infected recently. Approximately 40% of babies born to persons with untreated syphilis can be stillborn or die from the infection as a newborn. CS can lead to preterm labor and newborn/childhood illness including hydrops fetalis; hepatosplenomegaly; rashes; fevers; failure to thrive; deformity of the face, teeth, and bones; blindness; and deafness. Adequate and timely treatment of syphilis in pregnant persons is 98% effective in preventing CS. During 2017 through 2021, the majority of missed prevention opportunities among persons delivering babies with CS in the U.S. were those with no timely prenatal care or syphilis testing (38% of cases) and those with timely syphilis testing but no adequate treatment of the pregnant person (34% of cases).
U.S. CDC: Increase in Pediatric Invasive Group A Streptococcal Infections	January 5, 2023	Advisory (PDF)
The United States has seen a rise in invasive Group A Streptococcal infections. From November 1 to December 31, 2022, Maine CDC identified 25 cases, one of which was in a pediatric patient. This is higher than seen in this time frame in the last 5 years (average of 12 cases in November and December). Please remember that invasive Group A Strep is a reportable condition in the State of Maine. Please take a moment to review this information from US CDC that includes key recommendations for health providers, laboratories, and the general public.
Important Updates on COVID-19 Therapeutics for Treatment and Prevention	December 22, 2022	Advisory (PDF)
Most COVID-19 deaths are preventable with currently available treatments, yet many patients miss the opportunity to get treated in the outpatient setting while symptoms are mild. A recent U.S. CDC study found that only 28% of people eligible for treatment actually get treated. Paxlovid (ritonavir-boosted nirmatrelvir), Veklury (remdesivir), and Lagevrio (molnupiravir) remain effective against all currently circulating variants. Please review this latest U.S. CDC information on COVID-19 treatment. For further information about who to treat for COVID-19, medications, and training videos on treatment, please visit https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus/covid19-treatment.shtml.
Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir	December 16, 2022	Advisory (PDF)
This Health Alert Network (HAN) Health Advisory provides clinicians and public health officials with guidance for prioritizing oseltamivir for treatment and information on other influenza antivirals that are recommended for treating influenza in areas where oseltamivir is temporarily unavailable.
Increase in Syphilis in Maine	December 15, 2022	Advisory (PDF)
Syphilis cases have been increasing in Maine over the past several years, particularly among women. The increase in syphilis cases among women of reproductive age is concerning because of the potential risk of congenital syphilis if she is pregnant. All pregnant persons at the first prenatal visit, and retest at 28 weeks gestation and at delivery if at high risk Maine CDC recommends testing for syphilis in all patients who are obtaining any sexually transmitted infection (STI) testing. Providers should presumptively treat if a patient is symptomatic, is a contact to a syphilis case, belongs to a high-risk group, or if follow-up is uncertain. Report all cases of syphilis to Maine CDC at 1-800-821-5821.
Elevated Influenza Activity in Maine	December 8, 2022	Advisory (PDF)
Influenza activity is increasing in all 16 counties in Maine. Maine CDC's Health and Environmental Testing Laboratory (HETL) has confirmed that influenza A/pH1N1, influenza A/H3, and influenza B/Victoria are currently circulating in Maine. Influenza vaccination is the best way to prevent illness. It is not too late to get influenza vaccine. Vaccination is strongly encouraged throughout the season, and vaccines are widely available.
Deauthorization of Bebtelovimab Treatment for COVID-19	November 30, 2022	Advisory (PDF)
FDA today revoked the emergency use authorization for bebtelovimab, a monoclonal antibody therapy. Accordingly, bebtelovimab may no longer be used for COVID-19 treatment in the U.S. With the continued appearance of new variants, COVID-19 infection is now likely to be due to variants resistant to all monoclonal antibody therapies. Healthcare facilities offering COVID-19 monoclonal antibody treatment should explore offering Veklury to patients who cannot receive Paxlovid and should retain outpatient infusion capacity for COVID-19 monoclonal antibody therapies that could be authorized later.
U.S. CDC: Update on Managing Monkeypox in Patients Receiving Therapeutics	November 21, 2022	Advisory (PDF)
Monkeypox remains an emerging threat across the US. Maine has seen a small number of patient infections with monkeypox reported to public health, mostly among men who have sex with men. Healthcare providers should be aware of updated information on monkeypox treatment. Please take a moment to review this information from U.S. CDC regarding treatment of monkeypox.
Elevated Rates of Hepatitis A Infection Linked to Ongoing Person-to-Person Transmission	November 15, 2022	Advisory (PDF)
The purpose of this advisory is to inform healthcare providers and community-based organizations that: Maine continues to have an outbreak of hepatitis A across the state. Hepatitis A vaccination is recommended for, and should be offered to, patients with risk factors for infection (persons reporting drug use, homelessness, incarceration, and men who have sex with men) or patients with severe outcomes associated with hepatitis A infection such as those with chronic liver disease. Providers at facilities serving at-risk populations such as syringe service programs and substance use treatment facilities should recommend and administer hepatitis A vaccine to their clients. Programs without health care providers should provide education about hepatitis A and refer to care.
U.S. CDC: Update on Ebola Virus Disease (Sudan ebolavirus) Outbreak in Central Uganda	November 10, 2022	Advisory (PDF)
Maine CDC encourages healthcare providers and facilities to review this information from U.S. CDC regarding the current U.S. federal response to the Ebola outbreak in Uganda. All confirmed and suspected patients with Ebola virus disease must be reported immediately to Maine CDC by phone at 800-821-5821. All hospitals should prepare to identify and assess patients with signs/symptoms and exposures concerning for Ebola. Hospital readiness assessment tools are available on the Maine CDC website at https://www.maine.gov/dhhs/mecdc/infectious-disease/hai/resources.shtml. Maine CDC can provide further guidance at that time regarding how to send specimens to public health for testing for Ebola, malaria, and influenza, and regarding transfer to an Ebola assessment or treatment facility if appropriate.
Change to Guidelines for Specimen Collection Tubes for Venous Whole Blood Lead Analyses	November 9, 2022	Advisory (PDF)
The purpose of this advisory is to inform clinical laboratories and health care providers in Maine about changes to guidelines for submitting venous whole blood lead specimens to the Maine CDC's Health and Environmental Testing Laboratory (HETL). HETL is updating its guidelines given concerns, recently identified in Maine and nationally, that some lavender-top specimen collection tubes may be contaminated with lead, potentially producing falsely elevated results.
CDC: Increased Respiratory Virus Activity, Especially Among Children, Early in the 2022-2023 Fall and Winter	November 7, 2022	Advisory (PDF)
Please take a moment to review this information from U.S. CDC regarding increased respiratory virus activity in the U.S., including in Maine. The information provided here also addresses current trends of respiratory syncytial virus (RSV), seasonal influenza, COVID-19, and enterovirus/rhinovirus (EV/RV). Individual laboratory reports of positive RSV and influenza tests are not required to be reported to Maine CDC. Influenza-associated hospitalization (lab-confirmed) and influenza-associated pediatric death are reportable conditions. Additionally, any school, daycare, or healthcare facility with any sudden increase in respiratory illness should notify Maine CDC by phone at 800-821-5821 or by fax at 800-293-7534.
US CDC: Outbreak of Ebola virus disease (Sudan ebolavirus) in Central Uganda	October 7, 2022	Advisory (PDF)
Please see the attached HAN Health Advisory from U.S. CDC about an emerging outbreak of Ebola in Uganda. Further information is available on U.S. CDC's webpage on the September 2022 Uganda, Mubende District (https://www.cdc.gov/vhf/ebola/outbreaks/uganda/2022-sep.html) page.
U.S. CDC: Severe Manifestations of Monkeypox among People who are Immunocompromised Due to HIV or Other Conditions	October 3, 2022	Advisory (PDF)
The purpose of this U.S. Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN) Health Advisory is to inform healthcare providers that 1) Severe manifestations of monkeypox have been observed in the United States in the current outbreak. 2) People who are immunocompromised due to HIV or other conditions are at higher risk for severe manifestations of monkeypox than people who are immunocompetent. 3) Because people with HIV-associated immunocompromise are at risk for severe manifestations of monkeypox, the HIV status of all sexually active adults and adolescents with suspected or confirmed monkeypox should be determined. 4) There are diagnostic and clinical management strategies that may help address severe manifestations of monkeypox.
Severe Respiratory Illnesses Associated with Rhinoviruses and/or Enteroviruses Including EV-D68	September 19, 2022	Advisory (PDF)
Healthcare providers and hospitals in several regions of the United States notified the Centers for Disease Control and Prevention (U.S. CDC) during August 2022 about increases in pediatric hospitalizations in patients with severe respiratory illness who also tested positive for rhinovirus (RV) and/or enterovirus (EV). RVs and EVs can have clinically similar presentations and are indistinguishable from one another on multiplex assays often used in clinical settings. Upon further typing, some specimens have been positive for enterovirus D68 (EV-D68). Concurrently, pediatric acute respiratory illness sentinel surveillance sites are reporting a higher proportion of EV-D68 positivity in children who are RV/EV positive compared to previous years. Although it primarily causes acute respiratory illness, EV-D68 has been associated with acute flaccid myelitis (AFM), a rare but serious neurologic complication involving limb weakness. The purpose of this Health Alert Network (HAN) Health Advisory is to 1. Notify healthcare providers, laboratories, infection control specialists, and public health departments about recent increases in severe respiratory illness requiring hospitalization in children, 2. Urge healthcare providers to consider EV-D68 as a possible cause of acute, severe respiratory illness (with or without fever) in children, 3. Advise of the potential for an increase in AFM cases in the upcoming weeks, and 4. Provide U.S. CDC and Maine CDC recommendations to healthcare providers, laboratories, infection preventionists, and the public.
Influenza Arrives in Maine	September 13, 2022	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) has received several reports of positive influenza laboratory results during recent weeks. Maine CDC is requesting that laboratories send respiratory specimens from influenza confirmed or suspect patients to Maine's Health and Environmental Testing Laboratory (HETL) for subtyping, especially in the beginning of influenza season. Subtyping allows Maine CDC to determine which influenza viruses are circulating this season and detect novel influenza virus infections. Novel influenza A viruses cause human infection but are different from current seasonal human influenza A viruses that circulate among people. In August 2022, U.S. CDC reported 5 cases of human variant virus infection, or viruses that typically circulate in swine, and avian influenza H5N1 continues to circulate in wild and domestic birds. Though the risk to humans remains low, healthcare providers should be aware and test symptomatic patients with risk factors such as swine, agriculture, and avian exposures for influenza. HETL is the only laboratory in Maine that can identify novel influenza, therefore, all influenza A positive specimens from people with these exposures should be sent to HETL for further evaluation.
Updates on Monkeypox Testing, Vaccination, and Treatment in Maine	September 7, 2022	Advisory (PDF)
The global outbreak of monkeypox continues to grow in Maine and across the United States. Most cases have been identified in urban areas in other states. More cases are expected in Maine. Nationwide, the outbreak remains largely confined to gay, bisexual, or other men who have sex with men and transgender, gender non-conforming, or non-binary individuals who have sex with men, although some infections have been identified in other people. This health advisory provides updates on three key areas for clinicians: testing, vaccination, and treatment.
Varicella Testing and Reporting Recommendations	September 6, 2022	Advisory (PDF)
In 2021, providers reported 63 cases of varicella in Maine residents to Maine CDC, compared to just 33 cases reported in 2020. The decrease in widespread COVID-19 social distancing practices likely played a role in the increase in varicella cases. Varicella is a notifiable condition in Maine, and all confirmed or suspected cases should be reported to Maine CDC by telephone, fax, or electronic lab report within 48 hours of recognition or strong suspicion of disease.
Reminder to Report Cases of Acute Flaccid Myelitis to Maine CDC	August 29, 2022	Advisory (PDF)
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. The U.S. Centers for Disease Control and Prevention (U.S. CDC) reported eight confirmed cases of AFM from January 2022 through June 2022. Enteroviruses, particularly EV-D68, are thought to be a likely cause of the condition. AFM is rare in Maine, with four confirmed cases reported since 2014. Common symptoms include respiratory or gastrointestinal illness, rapid onset of limb weakness in one or more limbs (more proximal), loss of muscle tone and reflexes in the affected limb or limbs, facial or eyelid droop and difficulty swallowing or speaking. In severe cases, AFM can lead to respiratory failure or neurologic life-threatening complications. The condition progresses rapidly and can lead to respiratory failure, so early detection and hospitalization are critical.
Maine CDC Monkeypox Clinician Update Call TODAY + US CDC Update on Monkeypox in High-Risk Groups	August 4, 2022	Advisory (PDF)
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. This Health Alert Network (HAN) Health Update serves to alert clinicians to clinical considerations for preventing, diagnosing, and managing monkeypox in people with HIV, children, adolescents, and people who are pregnant or breastfeeding.
Arbovirus Update for Healthcare Providers	August 3, 2022	Advisory (PDF)
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. Eastern Equine Encephalitis virus (EEE), Jamestown Canyon virus (JCV), and West Nile virus (WNV) are serious arboviral infections that are transmitted by the bite of an infected mosquito. Maine reported one human case of JCV in 2021. Additionally, Powassan virus (POW) is an arboviral disease transmitted by the bite of an infected tick. Maine identified three cases of POW in 2021 and four more cases to date in 2022. Two of the POW cases in 2022 died. Although rare, these diseases have potentially severe and even fatal consequences for those who contract them.
Monkeypox Updates: Testing at Commercial Laboratories, Vaccination	July 28, 2022	Advisory (PDF)
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. Vaccine is not yet available for the general population.
COVID-19 Treatment Updates: Training Videos for Prescribers, Clinical Considerations, Prescribing Paxlovid, and Using Bebtelovimab	July 27, 2022	Advisory (PDF)
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. Vaccines are available for people 6 months and older and boosters are available for people 5 years and older; additional doses and other pre-exposure prophylaxis for people with moderate/severe immunocompromise. People should keep up to date on COVID-19 vaccination. Getting vaccine doses now will not preclude receiving additional vaccine doses in the fall or beyond. Maine continues to see COVID-19 hospitalizations and deaths, largely among younger, unvaccinated adults and older, vaccinated adults. In people with mild or moderate COVID-19 illness who are at high risk for severe disease, treatment can sharply reduce the risk of progressing to hospitalization or death. Outpatient treatment of COVID-19 is the standard of care for eligible patients. Health care providers, particularly those in primary care specialties, should become familiar with these therapeutics and how to prescribe them for appropriate patients.
A DEP Air Quality Alert is in Effect for Sunday Along the Coast of Maine	July 23, 2022	Advisory (PDF)
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. This will allow transport of ozone and its precursors from upwind sources such as southern New England and beyond to Maine. Meanwhile, particle pollution levels will likely be in the moderate range in southern portions of Maine.
U.S. CDC: Recent Reports of Human Parechovirus (PeV) in the United States	July 18, 2022	Advisory (PDF)
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. Clinicians are encouraged to include PeV in the differential diagnoses of infants presenting with fever, sepsis-like syndrome, or neurologic illness (seizures, meningitis) without another known cause and to test for PeV in children with signs and symptoms compatible with PeV infection (see below). Commercial laboratory assays, multiplex platforms for meningitis and encephalitis, and testing through state public health laboratories (SPHLs) are available to test cerebrospinal fluid (CSF) for PeV to confirm a diagnosis. CDC laboratory support is also available for testing and typing patient specimens.
Monkeypox Now a Reportable Condition in Maine	July 15, 2022	Advisory (PDF)
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: - Any confirmed case of **monkeypox** is immediately reportable to Maine CDC within 24 hours; and - All **monkeypox** or **non-variola orthopoxvirus** test results (positive or negative) are reportable to Maine CDC within 24 hours.
U.S. CDC: Updated Case-finding Guidance: Monkeypox Outbreak	June 16, 2022	Advisory (PDF)
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.
COVID-19 Rebound After Paxlovid Treatment	May 26, 2022	Advisory (PDF)
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. COVID-19 rebound has been reported to occur between 2 and 8 days after initial recovery and is characterized by a recurrence of COVID-19 symptoms or a new positive viral test after having tested negative. A brief return of symptoms may be part of the natural history of SARS-CoV-2 (the virus that causes COVID-19) infection in some persons, independent of treatment with Paxlovid and regardless of vaccination status. Limited information currently available from case reports suggests that persons treated with Paxlovid who experience COVID-19 rebound have had mild illness; there are no reports of severe disease. There is currently no evidence that additional treatment is needed with Paxlovid or other anti-SARS-CoV-2 therapies in cases where COVID-19 rebound is suspected.
Maine CDC and US CDC: Monkeypox Virus Infection in the United States and Other Non-endemic Countries	May 23, 2022	Advisory (PDF) | Monkeypox Information Sheet for Healthcare Facilities
Monkeypox is a zoonotic viral infection endemic to several Central and West African countries. Prior to May 2022, cases outside of Africa were reported either among people with recent travel to Nigeria or contact with a person with a confirmed monkeypox virus infection. In May 2022, several patients were confirmed with monkeypox in England; at least six were among persons without a history of travel to Africa and the source of these infections is unknown.
Updated Information on Availability and Use of Treatments for Outpatients with Mild to Moderate COVID-19 Who are at Increased Risk for Severe Outcomes of COVID-19	May 11, 2022	Advisory (PDF)
The U.S. Centers for Disease Control and Prevention (U.S. CDC) is issuing this Health Alert Network (HAN) Health Advisory to update healthcare providers, public health departments, and the public about the availability and use of recommended therapies for COVID-19 and to advise against using unproven treatments that have known or potential harms for outpatients with mild to moderate COVID-19. For patients with mild to moderate COVID-19 who are not hospitalized and who are at increased risk for severe COVID-19 outcomes, several treatment options, including antiviral medications and monoclonal antibodies, are now widely available and accessible.
2022 Lyme and Other Tickborne Disease Information	May 9, 2022	Advisory (PDF)
Lyme disease is the most common vectorborne disease in Maine. May is Lyme Disease Awareness Month in Maine and we want to encourage Mainers to stay tick free by being "Tick Wise." Ticks are already active, and the Maine CDC expects the number of Lyme disease and other tickborne disease cases to increase as the weather continues to get warmer.
Health Risks from Browntail Moths	May 2, 2022	Advisory (PDF)
The browntail moth is an invasive species of both forest and human health concern. Maine is the only state in the U.S. currently experiencing widespread problems with this moth. The microscopic hairs found on browntail moth caterpillars, shed skins, and cocoons can cause skin reactions and breathing problems.
Recommendations for Adenovirus Testing/Reporting of Children with Acute Hepatitis of Unknown Origin	April 22, 2022	Advisory (PDF)
The U.S. Centers for Disease Control and Prevention (U.S. CDC) issued a Health Advisory to notify clinicians and public health authorities of a cluster of children identified with hepatitis and adenovirus infection. In November 2021, clinicians at a large children's hospital in Alabama notified U.S. CDC of five pediatric patients with significant liver injury, including three with acute liver failure, who also tested positive for adenovirus. All children were previously healthy. None had COVID-19. Case-finding efforts at this hospital identified four additional pediatric patients with hepatitis and adenovirus infection for a total of nine patients admitted from October 2021 through February 2022; all five that were sequenced had adenovirus type 41 infection identified. In two patients, plasma samples were negative for adenovirus by quantitative polymerase chain reaction (qPCR), but both patients were positive when retested using whole blood. Two patients required liver transplant; no patients died. A possible association between pediatric hepatitis and adenovirus infection is currently under investigation. Cases of pediatric hepatitis in children who tested negative for hepatitis viruses A, B, C, D, and E were reported earlier this month in the United Kingdom, including some with adenovirus infection. This Health Advisory serves to notify clinicians who may encounter pediatric patients with hepatitis of unknown etiology to consider adenovirus testing and to elicit reporting of such cases to state public health authorities and to U.S. CDC. Nucleic acid amplification testing (NAAT, e.g., PCR) is preferred for adenovirus detection and may be performed on respiratory specimens, stool or rectal swabs, or blood.
Increase in HIV Cases in Kennebec County, Maine	April 7, 2022	Advisory (PDF)
Human Immunodeficiency Virus (HIV) cases in Kennebec County, Maine, have increased from 1 case in 2020 to 5 cases in 2021 (see Figure 1). Of the 5 cases diagnosed in 2021, 4 were diagnosed when severely ill and hospitalized; 3 were diagnosed with AIDS (Acquired Immune Deficiency Syndrome) at the same time as their HIV diagnosis. The Maine CDC has not identified an epidemiological link among these cases at this time. Individuals who are diagnosed later in their HIV infection course are more likely to transmit HIV to others, and also have a poorer prognosis than those diagnosed earlier.
Increasing Access to COVID-19 Therapies for Non-Hospitalized Patients	March 23, 2022	Advisory (PDF)
COVID-19 transmission continues to occur in Maine. In recent weeks, new cases have dropped under 1,000 cases/day and, in recent days, under 500 cases/day. This is a sharp drop from the recent surge of Omicron-variant infections in Maine in January and February, yet it does not mean we are in the clear. Over 30 COVID-19 deaths were reported to Maine CDC in the first half of March. The daily census of hospitalized COVID-19 patients, over 400 through much of January, just recently dipped below 100. Recent reports from European countries and elsewhere suggest the BA.2 subvariant is likely to cause a resurgence in cases, hospitalizations, and deaths in coming weeks. Many hospitalizations and deaths could be averted through early access to COVID-19 testing and COVID-19 outpatient treatment.
Increase of Legionnaires' Disease Cases in York County	March 4, 2022	Advisory (PDF)
Maine Center for Disease Control and Prevention is investigating an increase in cases of Legionnaires' disease, a potentially fatal pneumonia, in persons who live in, work in, or visit York County. Providers should consider the possibility of Legionnaires disease in patients presenting with respiratory illness, particularly if the patient reports spending time in York County in the 14 days prior to the onset of symptoms. Providers should perform testing using both urine antigen and sputum/respiratory culture and consider using empiric treatment with activity against Legionella.
Expanded Eligibility for COVID-19 Pre-exposure Prophylaxis for Patients with Moderate/Severe Immunocompromise	February 24, 2022	Advisory (PDF)
This health alert provides updates on patient eligibility for EVUSHELD, a long-acting monoclonal antibody that is available under U.S. Food and Drug Administration Emergency Use Authorization for pre-exposure prophylaxis to prevent COVID-19 infection in persons with moderate to severe immunocompromise. Additional groups of people in Maine are now eligible to get pre-exposure prophylaxis. For the latest information regarding the patient conditions that determine eligibility for EVUSHELD and the locations in Maine where this medication is available, visit the Maine CDC COVID-19: Healthcare Providers page at https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus/providers.shtml#prophylaxis
Highly Pathogenic Avian Influenza Guidance and Recommendations	February 23, 2022	Advisory (PDF)
The United States Department of Agriculture (USDA) has confirmed highly pathogenic avian influenza (HPAI) A(H5N1) in a backyard bird flock in Knox County. This is the first time Maine has detected HPAI in the State. Though HPAI can cause illness in humans, no human cases with this specific viral strain have been detected in the United States to date. Healthcare providers evaluating patients with respiratory symptoms should ask about recent exposures to wild and domestic birds and should consider influenza infection, including HPAI infection, as a possibility. Respiratory specimens collected from individuals with symptoms of influenza-like illness and bird exposures should be sent directly to Maine's Health and Environmental Testing Laboratory (HETL) for influenza testing.
Accessing COVID-19 Treatments for Non-hospitalized Patients	February 11, 2022	Advisory (PDF)
This health alert provides important updates regarding COVID-19 therapeutics for non-hospitalized patients, including new information on which patients to prioritize for some or all of these medications. It also includes information on locations in the State where patients can get tested, evaluated, and treated with these medications. The approach outlined in this health advisory is subject to change. Vaccination remains the best way to prevent COVID-19 infection, hospitalization, and death. However, infections, hospitalizations, and deaths continue to occur in unvaccinated individuals and, to a lesser extent, in vaccinated individuals. Several oral and intravenous medications are now available in Maine to prevent progression of COVID-19 infection to hospitalization and death. However, lack of knowledge among patients, supply shortages of several of these medications, and other considerations such as transportation and insurance remain substantial barriers.
COVID-19 Pre-exposure Prophylaxis for Patients with Moderate/Severe Immunocompromise	February 7, 2022	Advisory (PDF)
This health alert provides an update on patient eligibility for EVUSHELD, a long-acting monoclonal antibody that is available under U.S. Food and Drug Administration Emergency Use Authorization for pre-exposure prophylaxis to prevent COVID-19 infection in persons with moderate to severe immunocompromise. Vaccination for COVID-19 remains the best protection against infection, hospitalization, and death. However, individuals with immunocompromising conditions, or taking certain immunocompromising medications, may be less likely to mount an appropriate immune response to COVID-19 vaccination, leaving them at elevated risk for COVID-19 infection, hospitalization, and death. Many such persons are already at elevated risk for severe disease from COVID-19 due to their existing health conditions. Pre-exposure prophylaxis is now available for certain individuals who have been vaccinated against COVID-19 but remain highly susceptible to this infection and subsequent severe disease.
COVID-19 Reporting Requirements	January 27, 2022	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) relies on health care providers and laboratorians to report the occurrence of notifiable diseases. Without such surveillance data, Maine cannot accurately monitor trends, detect and respond to unusual occurrences of diseases (such as outbreaks), and evaluate the effectiveness of control and prevention activities. COVID-19 is a reportable disease in Maine as stated in Maine CDC's Notifiable Diseases and Conditions List and Rules. Reporting of notifiable diseases and conditions is required under 22 M.R.S., Chapter 250, 802 and 822. Health care providers and facilities, medical laboratories, childcare facilities, correctional facilities, educational institutions, administrators, and health officers are all required reporters.
Expanded U.S. FDA Approval of Remdesivir for COVID-19 Treatment	January 24, 2022	Advisory (PDF)
On January 21, 2022, the U.S. Food and Drug Administration (FDA) granted full approval to the antiviral drug remdesivir (Veklury) to treat non-hospitalized patients 12 years of age and older with mild-to-moderate COVID-19 disease who are at high risk of hospitalization. This expanded approval provides another treatment option to reduce the risk of hospitalization in high-risk patients. The use of remdesivir was previously limited to patients requiring hospitalization, and treatment outside the hospital was off-label. Remdesivir's manufacturer, Gilead Sciences, Inc., indicates that it has been able to meet demand for this drug. In vitro data suggest that remdesivir remains active against the Omicron variant of SARS-CoV-2. The expanded indication allows remdesivir to be administered in qualified outpatient settings that can administer daily intravenous (IV) infusions over three consecutive days. The FDA also expanded remdesivirs pediatric Emergency Use Authorization (EUA) to include non-hospitalized pediatric patients younger than 12 years of age (over 3.5 kg) who are at high risk of disease progression.
Update to Standing Order for COVID-19 Testing	January 21, 2022	Advisory (PDF)
On January 14, 2022, Maine CDC issued a revised Standing Order ("Order"), effective date January 21, 2022, that authorizes health care providers or other trained personnel at a health care facility or medically supervised COVID-19 collection site (collection site) in the state to collect and submit specimens of SARS-CoV-2 for molecular or antigen-based testing.
COVID-19 Surveillance Definition Changes	January 19, 2022	Advisory (PDF)
As of January 2, 2022, the Maine Center for Disease Control and Prevention (Maine CDC) is using updated definitions for COVID-19 outbreaks and COVID-19-associated deaths. COVID-19 outbreak criteria will now depend on facility type. In pre-K-12 schools, an outbreak of COVID-19 will now be defined as greater than or equal to 15% absenteeism among students or staff in a single day, where the majority of those absent are due to COVID-19 illness. For all other facility types, including but not limited to long-term care, hospital, outpatient healthcare, higher education, and businesses, an outbreak of COVID-19 is now defined as 5 or more people who have been in-person at a facility with confirmed or probable COVID-19 within a 14-day period.
Update on COVID-19 Therapeutics	January 7, 2022	Maine CDC - Evusheld Tiers and Contacts | Advisory (PDF)
This health alert provides updates on (1) the use of monoclonal antibody therapies and (2) the availability of oral antivirals and infusion therapies for outpatients with COVID-19. This alert also contains information on how healthcare providers and patients can access oral antivirals and infusion therapies, which must be started in the first few days after symptom onset. Finally, this alert provides information on a long-acting monoclonal antibody therapy for pre-exposure prophylaxis in immunocompromised patients. In short, given the increasing prevalence of the SARS-CoV-2 Omicron variant in the State, Maine CDC recommends healthcare providers suspend use of two monoclonal antibody therapies, bamlanivimab/etesevimab ("bam-ete") and casirivimab/imdevimab (REGEN-COV). A third monoclonal antibody therapy, sotrovimab, remains effective against the Omicron variant and should continue to be offered to patients meeting criteria. With respect to oral antiviral therapies, Paxlovid and molnupiravir, Maine CDC is working with two pharmacy chains, Walmart and Hannaford, to make these therapies available across the State. More information will follow soon describing how to determine which patients should receive these therapies in the setting of limited availabilities.
US CDC: Using Therapeutics to Prevent and Treat COVID-19	January 3, 2022	Advisory (PDF)
The SARS-CoV-2 Omicron variant has quickly become the dominant variant of concern in the United States and is present in all 50 states. The Centers for Disease Control and Prevention (CDC) recommends that eligible individuals receive all vaccines and booster shots as the best preventive measure available against severe disease, hospitalizations, and death due to COVID-19. Therapeutics are also available for preventing and treating COVID-19 in specific at-risk populations. These therapeutics differ in efficacy, route of administration, risk profile, and whether they are authorized by the U.S Food and Drug Administration (FDA) for adults only or adults and certain pediatric populations. Some therapeutics are in short supply, but availability is expected to increase in the coming months. This Health Alert Network (HAN) Health Advisory serves to familiarize healthcare providers with available therapeutics, understand how and when to prescribe and prioritize them, and recognize contraindications.
Rapid Increase of Omicron Variant Infections in the United States: Management of Healthcare Personnel with SARS-CoV-2 Infection or Exposure	December 27, 2021	Advisory (PDF)
Due to the increased transmissibility of the SARS-CoV-2 Omicron variant and concerns about potential impacts on the healthcare system, the U.S. Centers for Disease Control and Prevention (CDC) and the Maine CDC are updating recommendations to enhance protection for healthcare personnel, patients, and visitors, and ensure adequate staffing in healthcare facilities. The guidance is based on the limited information currently available about the Omicron variant and will be updated as needed as new information becomes available.
Reporting Urgent Notifiable Conditions by Telephone	December 9, 2021	Advisory (PDF)
Maine CDC would like to remind providers and laboratories to immediately report all Urgent Notifiable Conditions on recognition or strong suspicion of disease by phone to Maine CDC at 1-800-821-5821. The sustained ongoing challenges posed by the COVID-19 response elevates the importance of immediately reporting Urgent Notifiable Conditions by phone and not relying on electronic laboratory reports or faxing. This includes ALL conditions with a phone icon next to them on the Notifiable Diseases and Conditions list EXCEPT for novel Coronavirus. Positive COVID-19 cases DO NOT need to be called in to Maine CDC. All other disease conditions are reportable within 48 hours of recognition or strong suspicion of disease.
U.S. CDC: Increasing Seasonal Influenza A(H3N2) Activity, Especially Among Young Adults and in College and University Settings, During SARS-CoV-2 Co-Circulation	November 30, 2021	Advisory (PDF)
The attached HAN message titled Increasing Seasonal Influenza A(H3N2) Activity, Especially Among Young Adults and in College and University Settings, During SARS-CoV-2 Co-Circulation was sent by US CDC on November 24, 2021. Maine CDC is forwarding this federal HAN message to ensure widest visibility.
Tickborne Illness Risk Remains High Amid Record Numbers of Reported Anaplasmosis and Babesiosis Cases	November 23, 2021	Advisory (PDF)
Maine CDC would like to alert clinicians that the tick season in Maine continues to be very active this year, posing increased risk of tickborne disease. Maine CDC reported record numbers of anaplasmosis and babesiosis cases, surpassing the record number of cases reported in 2019. As of November 23, 2021, Maine reported 1,276 cases of Lyme disease, 748 cases of anaplasmosis, 184 cases of babesiosis, eight cases of Borrelia miyamotoi, and three cases of Powassan encephalitis.
Expanded Eligibility of COVID-19 Vaccine Booster Shots for All Adults 18 and Up	November 17, 2021	Advisory (PDF)
Based on sustained COVID-19 community transmission rates, Maine CDC has concluded that all individuals are at high risk for COVID-19 exposure. Accordingly, effective immediately, all Mainers age 18 years or older who received the Pfizer or Moderna vaccine are eligible for a booster dose at least six months after the second dose of their primary series. Those who received the single-dose J&J vaccine remain eligible for a booster dose at least two months after their initial dose.
Pertussis and Other Childhood Respiratory Illnesses Circulating in Maine	November 15, 2021	Advisory (PDF) | Common Respiratory Illnesses Chart
Childhood respiratory illnesses like pertussis, respiratory syncytial virus (RSV), and influenza are circulating in Maine and should be considered in addition to COVID-19. Schools and childcare programs should be aware of exclusion recommendations specific to pertussis. The most effective approaches to preventing and reducing transmission of pertussis include ensuring children are up-to-date on recommended vaccines (and maintaining vaccination records) and ensuring symptomatic staff and children stay home if they are sick with pertussis-like symptoms. Healthcare providers should be aware of pertussis or other alternative diagnoses for patients presenting with respiratory symptoms and should test appropriately.
Extending the Use of Rapid Antigen Testing Supplies	November 12, 2021	Advisory (PDF)
During the COVID-19 pandemic, various components of the testing supply chain (e.g., test kits, reagents, swabs) have been in short supply. Though the testing supply chain has stabilized, it remains vulnerable to increases in COVID-19 transmission, such as the one Maine is experiencing now.
Influenza Arrives in Maine	November 4, 2021	Advisory (PDF)
Influenza has arrived in Maine. Multiple Maine facilities reported influenza positive rapid results in recent weeks, and Maine's Health and Environmental Testing Laboratory (HETL) has just confirmed two cases using real-time reverse transcription-polymerase chain reaction (real time-RT PCR) testing. Both specimens tested positive for influenza A/H3. These individuals are adults who were not hospitalized. One patient was unvaccinated, and the vaccine status remains unknown for the other. The 2021-2022 influenza surveillance season officially began on October 3, 2021. Though seasonal influenza activity in the United State remains low, both Influenza A and B viruses are currently circulating nationally. It is not too late to get vaccinated.
Booster Doses of Pfizer-BioNTech COVID-19 Vaccine	September 24, 2021	Advisory (PDF)
This week, the U.S. Food and Drug Administration authorized, and the U.S. Centers for Disease Control and Prevention (CDC) recommended, administration of a booster dose of the Pfizer-BioNTech COVID-19 vaccine for certain individuals.
US CDC: Rapid Increase in Ivermectin Prescriptions and Reports of Severe Illness Associated with Use of Products Containing Ivermectin to Prevent or Treat COVID-19	August 27, 2021	Advisory (PDF)
This Health Advisory from the US Centers for Disease Control and Prevention is being posted by Maine CDC to ensure widest visibility.
Increased Respiratory Syncytial Virus (RSV) Activity in Maine	August 16, 2021	Advisory (PDF)
Respiratory syncytial virus (RSV) is circulating in Maine at a higher rate than usual for this time of year. Health care providers should consider testing patients with acute respiratory illness for RSV. To prevent transmission of RSV and other respiratory viruses, people with respiratory symptoms should refrain from in-person work, school, or daycare while acutely ill. This recommendation applies even if they have tested negative for SARS-CoV-2, the virus that causes COVID-19.
Use of an additional mRNA COVID-19 vaccine dose after an initial 2-dose primary mRNA COVID-19 vaccine series for immunocompromised people	August 14, 2021	Advisory (PDF)
On August 12, 2021, the U.S. Food and Drug Administration modified the Emergency Use Authorizations (EUAs) for the Pfizer-BioNTech and Moderna COVID-19 vaccines to allow for administration of an additional dose (i.e., a third dose) of an mRNA COVID-19 vaccine after an initial 2-dose primary mRNA COVID-19 vaccine series for certain immunocompromised people. On August 13, 2021, the U.S. CDC's Advisory Committee on Immunization Practices ("ACIP") reviewed the data for use of an additional dose of mRNA COVID-19 vaccine for immunocompromised people. ACIP made an interim recommendation for use of an additional dose of Pfizer-BioNTech COVID-19 vaccine (for persons aged 12 years) or Moderna COVID-19 vaccine (for persons aged 18 years) after an initial 2-dose primary mRNA COVID-19 vaccine series for moderately to severely immunocompromised people.
Maine DEP Issues Air Quality Alert for Thursday, August 12th	August 12, 2021	Advisory (PDF)
This message from the Maine Department of Environmental Protection is being forwarded by the Maine Center for Disease Control and Prevention to ensure widest visibility. Ground-level ozone concentrations will be climbing in Maine on Thursday and are expected to reach unhealthy levels for the Southwest Coast and the high elevations of Acadia NP according to the Maine Department of Environmental Protection (DEP). Ozone levels in southern New England began ramping up on Wednesday with transport of ozone and its precursors toward Maine later today and tomorrow. Meanwhile, some smoke is expected to combine with regional particle pollution to push particle pollution to moderate levels statewide tomorrow.
Health Risks from Extreme Heat this Week	August 11, 2021	Advisory (PDF)
Maine will experience extremely hot and humid weather this week. The Maine CDC would like to remind health care providers, caregivers, and public health professionals to identify those in their care at increased risk and advise them to take precautions to prevent heat illness. Health care providers should remind patients and their caregivers about the importance of seeking medical attention for heat-related illnesses and discuss prevention methods. Residential care facilities should monitor their residents carefully for signs of heat illness, especially if the facility is not air conditioned.
Cluster of Legionellosis Cases - Greater Bangor Area	August 5, 2021	Advisory (PDF)
In the greater Bangor area, Penobscot County, Maine, physicians have reported 4 confirmed cases of legionellosis from July 1, 2021 to July 31, 2021, 3 of which required intubation. Cases range in age from 38 to 67 years old. Maine CDC has not identified a common exposure among cases.
Varicella Testing and Reporting Recommendations	August 3, 2021	Advisory (PDF)
Maine CDC is seeing a rise in the number of reported cases of varicella (chickenpox). Varicella is a notifiable condition in Maine, and all confirmed or suspect cases of varicella should be reported to Maine CDC. The number of reported cases of varicella decreased in 2020, likely due to reduced person-to-person transmission because of COVID-19 restrictions. Since January 1, 2021, Maine has identified 46 cases of varicella from all 16 counties (data as of 07/29/2021), including two outbreaks in child care facilities.
Standing Order for COVID-19 Testing	July 1, 2021	Advisory (PDF)
On July 1, 2021, Maine CDC issued a revised Standing Order ("Order") that authorizes health care providers or other trained personnel at a health care facility or medically supervised COVID collection site (collection site) in the state to collect and submit specimens of SARS-CoV-2 for molecular or antigen-based testing. The Order is a physician's order that authorizes lab testing for COVID-19 for any individual in Maine at least 12 months of age or older. The Order is not meant to replace existing patient-provider relationships or provider-laboratory relationships. It can assist people who believe that they have been exposed or have an elevated risk of exposure and who do not have a primary care provider, cannot discuss this exposure in a timely way with their health care provider, or are visiting Maine from another state, as examples. The Order also authorizes the collection site that submitted the specimen for SARS-CoV-2 molecular or antigen testing under this Order to receive the results of the test directly from the testing laboratory. The Order further authorizes the laboratory that performed the test for SARS-CoV-2 to provide test results directly to the individual who was tested, with the individuals consent.
Human Powassan Case and Arbovirus Update for Healthcare Providers in Maine	June 29, 2021	Advisory (PDF)
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 arboviruses in patients presenting with unexplained encephalitis, meningitis or high fever (100.4F or 38C) during the summer and fall. Maine CDC identified a human case of Powassan encephalitis in a Maine resident who resides in midcoastal Maine. The individual was symptomatic in late June and hospitalized. CDC Fort Collins confirmed the Powassan result in this individual by neutralization testing. This individual likely acquired this Powassan encephalitis infection in the state of Maine. There are two types of Powassan virus in the United States. The first type, often called lineage 1 Powassan virus is associated with Ixodes cookei or the woodchuck tick. Lineage 2 POW, sometimes called Deer tick virus, is associated with Ixodes scapularis or the deer tick. Both can cause human disease. Powassan encephalitis is a member of the flavivirus genus which includes arboviruses like Dengue virus, West Nile virus (WNV), Yellow Fever virus, and Zika virus. Arboviral diseases, including Eastern equine encephalitis (EEE), Jamestown Canyon virus (JCV), and WNV, are serious infections that are transmitted by the bite of an infected mosquito. Maine reported one human case of WNV in 2020. Additionally, Powassan virus is an arboviral disease transmitted by the bite of an infected tick. Maine identified one case of Powassan virus disease in residents during 2020. Although rare, these diseases have potentially severe and even fatal consequences for those who contract them.
Changes to HETL COVID-19 Testing Operational Schedule	June 21, 2021	Advisory (PDF)
On Monday, June 28, 2021, the hours of operation for the clinical microbiology section at the Maine CDC Health and Environmental Testing Laboratory (HETL) will shift to 7 a.m. to 5 p.m., Monday through Friday. As a result, HETL will not conduct COVID-19 PCR testing on Saturday or Sunday. Submitters should be aware that samples are only viable for testing within 72 hours after collection. Samples beyond that 72-hour window cannot be tested. Before 5 p.m. on Friday, HETL staff will freeze any sample that would expire because it is more than 72 hours post collection. HETL staff will then test that sample during the next business period. If HETL is not able to verify that an unfrozen sample was collected within 72 hours, the sample will not be tested. Facilities should plan to deliver COVID-19 samples before 5 p.m. on Friday. Samples delivered after 5 p.m. on Friday may exceed the 72-hour period of viability prior to Monday. Samples received on Saturday or Sunday will be processed during the next business period, provided that the sample has not exceeded the 72-hour period of viability.
Maine DEP Issues Air Quality Alert for Monday, June 7, 2021	June 7, 2021	Advisory (PDF)
[This message from the Maine Department of Environmental Protection is being forwarded by the Maine Center for Disease Control and Prevention to ensure widest visibility.] Ground-level ozone concentrations will be climbing in Maine on Monday June 7th and are expected to reach unhealthy levels according to the Maine Department of Environmental Protection (DEP). Ozone levels have been high upwind since June 2nd. High levels began around Lake Michigan and have been slowly migrating eastward. By Saturday June 5th southern New England had very high levels of ozone even reaching into the Unhealthy (red) category. Transport winds are expected to direct the higher values to Maine on Monday. The unhealthy levels of ozone are possible along the entire coastline and the Eastern Interior. Meanwhile Particle Pollution levels are expected to be in the Moderate range. At elevated ozone levels, children, healthy adults who exert themselves, and individuals suffering from a respiratory disease such as asthma, bronchitis or COPD can experience reduced lung function and irritation. When this happens, individuals may notice a shortness of breath, coughing, throat irritation, and/or experience an uncomfortable sensation in their chest.
Acute Hepatitis A Case in a Food Service Worker in Eastport, Maine	May 27, 2021	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) has identified a case of acute hepatitis A virus infection in an Eastport, Maine, food service worker. The individual handled food in the deli at the R&M IGA at 88 Washington Street in Eastport, Maine, while infectious on the following dates in 2021: May 3-6, May 8, May 10-13, May 15, and May 18-20. Deli food items purchased on May 3-22 should be discarded or cooked thoroughly. Epidemiological assessment of the employee's illness determined that patrons of the establishment may be at risk for hepatitis A infection. Maine CDC recommends that anyone who ate food prepared in the R&M IGA deli from May 13-22, 2021, receive hepatitis A vaccine within 14 days of their potential exposure. There is a 14-day window during which prophylaxis is effective after exposure. Anyone who ate food prepared at or who worked at this establishment from May 3-12, 2021, is outside the window for which prophylaxis is recommended. Those individuals are advised to watch for symptoms and seek medical attention should they develop symptoms (see below). Health care providers are encouraged to remain vigilant for hepatitis A infection in persons with consistent symptoms and should ask individuals with such symptoms about consumption of prepared food from this establishment or who worked at this establishment during this period.
Cases of Myocarditis/Pericarditis Following COVID-19 Vaccination	May 26, 2021	Advisory (PDF)
The U.S. Centers for Disease Control and Prevention is aware of reports of myocarditis and pericarditis after receipt of a COVID-19 vaccine. The reports appear to be rare, given the number of vaccine doses administered to date. U.S. CDC is investigating whether there is any causal association or an increase of such events relative to the background rates. Myocarditis is an inflammation of the heart muscle and pericarditis is the inflammation of the lining outside the heart. In both cases, the body's immune system causes an inflammation in response to an infection or some other trigger. While myocarditis can be serious, it is frequently mild and self-limited. Symptoms can include abnormal heart rhythms, shortness of breath, or chest pain. Myocarditis is often caused by a viral infection, but it can result from a reaction to a drug or as part of a more general inflammatory condition. Myocarditis itself not a notifiable condition in Maine. Maine CDC has received reports of cases of myocarditis occurring in Maine residents after receipt of an mRNA COVID-19 vaccine. Since there is usually an increase in myocarditis at this time of year, it is not known if these cases are associated with receipt of the vaccine. Vaccination for COVID-19 remains strongly recommended. U.S. CDC will continue to evaluate reports of myocarditis/pericarditis occurring after COVID-19 vaccination and will share more information as it becomes available.
2021 Lyme and Other Tickborne Disease Information	May 3, 2021	Advisory (PDF)
Lyme disease is the most common vectorborne 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 and we want to encourage Mainers to stay tick free using "Stop. Check. Prevent."
Health Risks from Browntail Moths	April 28, 2021	Advisory (PDF)
The browntail moth is an invasive species of both forest and human health concern. Maine and Massachusetts are the only states in the U.S. experiencing problems with this moth. The microscopic hairs found on browntail moth caterpillars, shed skins, and cocoons can cause skin reactions and breathing problems.
Cases of Cerebral Venous Sinus Thrombosis with Thrombocytopenia after Receipt of the Johnson & Johnson COVID-19 Vaccine	April 13, 2021	Alert (PDF)
Maine CDC is forwarding this HAN message from US CDC to ensure widest visibility. Maine CDC is not aware of any reports of these cases in Maine residents. The State of Maine is advising that providers pause administration of the Johnson & Johnson vaccine until the US CDC's scientific advisory committee has further reviewed the safety data. Maine CDC is working with administration partners to provide an alternative supply of the mRNA vaccines to clinics already scheduled so they can continue operations. As of April 12, 2021, approximately 6.85 million doses of the Johnson & Johnson (J&J) COVID-19 vaccine (Janssen) have been administered in the United States. The Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) are reviewing data involving six U.S. cases of a rare type of blood clot in individuals after receiving the J&J COVID-19 vaccine that were reported to the Vaccine Adverse Events Reporting System (VAERS). In these cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia). All six cases occurred among women aged 18-48 years. The interval from vaccine receipt to symptom onset ranged from 613 days. One patient died. Providers should maintain a high index of suspension for symptoms that might represent serious thrombotic events or thrombocytopenia in patients who have recently received the J&J COVID-19 vaccine. When these specific type of blood clots are observed following J&J COVID-19 vaccination, treatment is different from the treatment that might typically be administered for blood clots. Based on studies conducted among the patients diagnosed with immune thrombotic thrombocytopenia after the AstraZeneca COVID-19 vaccine in Europe, the pathogenesis of these rare and unusual adverse events after vaccination may be associated with platelet-activating antibodies against platelet factor-4 (PF4), a type of protein. Usually, the anticoagulant drug called heparin is used to treat blood clots. In this setting, the use of heparin may be harmful, and alternative treatments need to be given. CDC will convene an emergency meeting of the Advisory Committee on Immunization Practices (ACIP) on Wednesday, April 14, 2021, to further review these cases and assess potential implications on vaccine policy. FDA will review that analysis as it also investigates these cases. Until that process is complete, CDC and FDA are recommending a pause in the use of the J&J COVID-19 vaccine out of an abundance of caution. The purpose of this Health Alert is, in part, to ensure that the healthcare provider community is aware of the potential for these adverse events and can provide proper management due to the unique treatment required with this type of blood clot.
Acute Hepatitis A Case in a Food Service Worker in Orono, Maine	March 24, 2021	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) has identified a case of acute hepatitis A virus infection in an Orono, Maine, food service worker. The individual handled food while infectious on the following dates: March 6-9, March 13-16, and March 20-21, 2021. Epidemiological assessment of the employee's illness determined that patrons of the establishment may be at risk for hepatitis A infection. Maine CDC recommends that anyone who ate food prepared at or who worked at the Circle K at 2 Stillwater Avenue in Orono, Maine, from March 13 through 16 and March 20 through 21 receive hepatitis A vaccine within 14 days of their potential exposure. There is a 14-day window during which prophylaxis is effective after exposure. Anyone who ate food prepared at or who worked at this establishment from March 6 through 9, 2021, is outside the window for which prophylaxis is recommended. Such individuals are advised to watch for symptoms and seek medical attention should they develop symptoms (see below). Health care providers are encouraged to remain vigilant for hepatitis A infection in persons with consistent symptoms and should ask individuals with such symptoms about consumption of food from or working at this establishment during this period.
Notifiable Diseases and Conditions Rule Update, Re-Instatement of Requirement to Submit SARS-CoV-2 Samples	February 17, 2021	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) has updated its Rules for the Control of Notifiable Diseases and Conditions. The new rule goes into effect today, February 17, 2021. One of the most significant parts of the rule is the Notifiable Diseases and Conditions List, which states the diseases and conditions required to be reported to the state. The Rules for the Control of Notifiable Diseases and Conditions were first drafted in 1976 by the Department of Health and Human Services. The last revision to the rules occurred in 2015.Maine CDC has updated the Rules for the Control of Notifiable Diseases and Conditions to better align with new and emerging diseases and more efficient methods of reporting that are being adopted nationally. The updated rules reinforce the requirements for electronic laboratory reporting of notifiable diseases as well as compliance with provider reporting.
Campylobacteriosis Outbreak Associated with Raw Milk from New Hampshire Farm	February 12, 2021	Advisory (PDF)
The New Hampshire Department of Health and Human Services (DHHS) has notified the Maine Center for Disease Control and Prevention (Maine CDC) of multiple individuals with gastrointestinal illness associated with recent purchases of unpasteurized/raw milk from Brandmoore Farms in Rollinsford, NH. In subsequent investigations, Maine and New Hampshire public health officials have identified multiple cases of campylobacteriosis in residents of both states. Maine has identified at least 30 cases of campylobacteriosis among Maine residents associated with this outbreak. At least two Maine residents have been hospitalized. Maine CDC and New Hampshire DHHS are warning consumers that they should not consume Brandmoore Farm retail raw milk with best-by dates through February 5, 2021. Anyone who consumed this raw milk has an elevated risk of enteric diseases, including campylobacteriosis. Brandmoore Farm distributes raw milk from its retail store located in Rollinsford, NH, as well as at Heron Pond Farm in South Hampton, NH and Dog Rose Farm in Lee, NH. Customers who still have Brandmoore Farms raw milk are advised not to drink it and to dispose of the product. Anyone symptomatic should be evaluated by a medical provider, tested, and treated as appropriate.
UPDATED: COVID-19 Updates: Quarantine and Testing	February 2, 2021	Advisory (PDF) | Updates and Clarifications to “COVID-19 Updates: Quarantine and Testing” Advisory from 1/27/21
With Maine's increased COVID-19 infection rates and rollout of COVID-19 vaccinations, Maine CDC is updating its guidance regarding: - quarantine of individuals who are identified as close contacts of a COVID-19 case, and - use of antigen testing. 1/27/21: Original Advisory Posted 2/2/21: PLEASE SEE "UPDATES AND CLARIFICATIONS" DOCUMENT FOR ADDITIONAL INFORMATION.
Influenza Arrives in Maine	February 1, 2021	Advisory (PDF)
Maine CDC's Health and Environmental Testing Laboratory (HETL) recently confirmed the first case of influenza B by PCR in Maine this season. Although multiple Maine health care facilities have reported influenza-positive antigen results in recent weeks, this is the first PCR-confirmed case. The individual is an adult who was not hospitalized, was unvaccinated, and had no recent travel history. It is not too late to vaccinate patients against influenza. Influenza vaccination can flatten the curve of influenza illnesses, and it also can help save medical resources for care of patients with COVID-19. Though influenza activity is currently lower than usual for this time of year, it may increase in the coming months. The 2020-2021 quadrivalent influenza vaccine contains components of both A subtypes (H1 and H3) as well as two B lineages (Yamagata and Victoria).
Adverse Event Related to Vaccination with Pfizer-BioNTech COVID-19 Vaccine	December 24, 2020	Advisory (PDF)
Nationwide distribution of the first COVID-19 vaccine started December 14, 2020. U.S. CDC has since received reports that some people have experienced severe allergic reactions -- also known as anaphylaxis -- after receiving a COVID-19 vaccine. An allergic reaction is considered severe when a person needs to be treated with epinephrine or an EpiPen or if they must go to a hospital for emergent care. On Tuesday, December 22, 2020, Maine Medical Center reported an instance of a severe allergic reaction in an individual who had just received the Pfizer-BioNTech COVID-19 vaccine. The individual's past medical history was significant for severe allergic reactions and eosinophilic asthma. The individual experienced nausea, diaphoresis, and a dry cough that progressed to shortness of breath. The individual received epinephrine, was transported to the Maine Medical Center ED for monitoring, and is doing well.
Influenza Testing Reminder	December 23, 2020	Advisory (PDF)
Maine CDC has recently received an increase in reported positive influenza antigen tests. Some specimens have been sent to Maine's Health and Environmental Testing Laboratory (HETL) for further analysis, but none have been confirmed. This is a reminder that providers are asked to send their first ten positive influenza specimens to HETL for confirmation and subtyping. This helps to determine where and which type of influenza is circulating in Maine. Instructions on submitting specimens for influenza testing can be found at: https://www.maine.gov/dhhs/mecdc/public-health-systems/health-and-environmental-testing/micro/submitting-samples.shtml. Influenza-related hospitalizations, influenza-like illness outbreaks, and influenza-associated pediatric deaths are required to be reported to Maine CDC. Though all other cases of influenza are not required to be reported, Maine CDC does appreciate reports of these as well. The best way to prevent influenza is by getting vaccinated. Maine CDC and national authorities recommend all individuals older than 6 months be immunized, even if they were vaccinated for influenza last season. It is not too late to get vaccinated.
COVID-19 Vaccination Training and Education	December 14, 2020	Advisory (PDF)
As part of the State's response to COVID-19, Maine DHHS is offering a series of educational sessions for Maine clinicians on the COVID-19 vaccine(s) and to support efforts to build the knowledge and trust needed to ensure a successful vaccination effort statewide. Given busy clinician schedules, Maine DHHS is offering a series of short (30min) "COVID-19 Vaccine Info Sessions" that will be hosted twice a week starting Tuesday, Dec 15, 2020. The sessions will occur twice a week for the next several months at the following times: - Tuesdays at 7:30AM - 8:00AM - Fridays at 12:00PM - 12:30PM The sessions will offer brief didactic overviews on the vaccine development and approval process, followed by time for questions & discussions. Clinicians are welcome to attend one or multiple sessions.
Changes to Maine CDC's Quarantine Policy	December 4, 2020	Advisory (PDF)
On December 2, 2020, the U.S. Centers for Disease Control and Prevention ("CDC") released a Scientific Brief on Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing, based on a review of new epidemiological and modeling data. As noted in this Scientific Brief, local public health authorities determine and establish the quarantine options for their jurisdictions. Based on recent modeling and local circumstances and resources, U.S. CDC has provided data on options to shorten the previous 14-day quarantine period. Considering these data, Maine CDC is changing the quarantine period for individuals known to be close contacts of cases of COVID-19 to 10 days. It is important to note that a shorter quarantine period carries a risk that an exposed individual could become positive and potentially transmit COVID-19 to others after quarantine.
Acute Hepatitis A Case in a Food Service Worker in Dover-Foxcroft	November 19, 2020	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) has identified a case of acute hepatitis A virus infection in a Dover-Foxcroft, Maine, food service worker. The case handled food while infectious on November 11, 2020. Epidemiological assessment of the employee's illness determined that restaurant patrons may be at risk for hepatitis A infection. Maine CDC is recommending that anyone who may have eaten food prepared at or who worked at Pats Pizza in Dover-Foxcroft on November 11, 2020 receive hepatitis A vaccine by November 25, 2020 as there is a 14-day window during which prophylaxis is effective. This recommendation includes anyone who may have had dine-in, take-out, delivery, or curbside pickup of food from the restaurant. These recommendations are based on the best information available at this time. Health care providers are encouraged to remain vigilant for hepatitis A infection in persons with consistent symptoms and should ask individuals with such symptoms about consumption of food from this establishment during this period.
Acute Hepatitis A Case in a Food Service Worker in Bangor, Maine	November 3, 2020	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) has identified a case of acute hepatitis A virus infection in a Bangor, Maine, food service worker. The case handled food while infectious on October 16-18, 20, 22-25, 27 and 29. Epidemiological assessment of the employee's illness determined that restaurant patrons may be at risk for hepatitis A infection. Maine CDC is recommending that anyone who may have eaten food prepared at or who worked at the Texas Roadhouse in Bangor on the dates listed above between October 20th through October 29th receive hepatitis A vaccine within 14 days of their last exposure as there is a 14-day window during which prophylaxis is effective. This recommendation includes anyone who may have had dine-in, take-out, delivery, or curbside pickup of food from the restaurant. Anyone who visited the restaurant from October 16th through October 19th, 2020, is outside the window for which prophylaxis is recommended, but is advised to watch for symptoms and seek medical attention should they develop symptoms. These recommendations are based on the best information available at this time. Health care providers are encouraged to remain vigilant for hepatitis A infection in persons with consistent symptoms and should ask individuals with such symptoms about consumption of food from this establishment during this period.
Cryptosporidiosis Outbreak Linked to Raw Milk from Maine Farm	October 22, 2020	Advisory (PDF)
Maine Center for Disease Control and Prevention (Maine CDC) has identified an outbreak of cryptosporidiosis in individuals who consumed unpasteurized/raw milk from Roux Farm in Shapleigh, Maine, within the last two months. Epidemiologists identified at least four individuals who became ill and tested positive for cryptosporidiosis. Anyone who consumed raw milk (regular or any flavor) from Roux Farm produced before October 18, 2020, may be at elevated risk of cryptosporidiosis. Raw milk from the farm was sold through a variety of stores in the state.
Flavivirus Case in a Maine Resident	October 21, 2020	Advisory (PDF)
Maine CDC identified a human case of neuroinvasive Flavivirus infection in an adult who resides in Cumberland County. The individual became ill in early September and is currently hospitalized. Serum samples collected September 5th and September 13th tested positive for West Nile virus (WNV) antibodies at a commercial laboratory. Per established protocols, Maine's Health and Environmental Testing Laboratory (HETL) sent the samples to the U.S. CDC for further confirmation. Plaque reduction neutralization test (PRNT) testing results from the U.S. CDC indicated evidence of cross-reactive Saint Louis Encephalitis virus (SLEV) and WNV flavivirus neutralization antibodies, although the specific virus could not be identified. This is the first identification of a flavivirus in a Maine resident since 2018.
Acute Hepatitis A Case in a Food Service Worker in Rockwood, Maine	September 30, 2020	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) has identified a case of acute hepatitis A virus infection in a Rockwood, Maine, food service worker. The case handled food while infectious from September 2, 2020, through September 22, 2020. Epidemiological assessment of the employee's illness determined that restaurant patrons may be at risk for hepatitis A infection. Maine CDC is recommending that anyone who may have eaten food prepared at or worked at The Birches Resort Restaurant in Rockwood on September 16, 2020, through September 22, 2020, receive hepatitis A vaccine within 14 days of their potential exposure as there is a 14-day window during which prophylaxis is effective after exposure. This recommendation includes anyone who may have had dine-in, take-out, delivery, or curbside pickup of food from the restaurant. Anyone who visited the restaurant from September 2, 2020 through September 15, 2020, is outside the window for which prophylaxis is recommended, but are advised to watch for symptoms and seek medical attention should they develop symptoms. Health care providers are encouraged to remain vigilant for hepatitis A infection in persons with consistent symptoms and should ask individuals with such symptoms about consumption of food from this establishment during this period.
COVID-19 Testing Updates - September 2020	September 8, 2020	Advisory (PDF)
- Persons who test positive for SARS-CoV-2, the virus that causes COVID-19, using a molecular amplification test and have not had a previous positive test, should be considered infected at the time of testing, regardless of any subsequent negative test results. Molecular amplification tests include Polymerase Chain Reaction (PCR) and Nucleic Acid Amplification Tests (NAAT). - Maine Center for Disease Control and Prevention (Maine CDC) continues to recommend that ALL persons who were in close contact with a person infected with COVID-19 (defined as being within 6 feet for at least 15 minutes) should be tested, regardless of symptoms. - Maine's Health and Environmental Testing Laboratory (HETL) is working with all submitting facilities to convert to the Lab Web Portal for electronic test ordering and reporting.
Acute Hepatitis A Case in a Food Service Worker in Saco, Maine	September 1, 2020	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) has identified a case of acute hepatitis A virus infection in a Saco, Maine food service worker. The case handled food while infectious from August 5, 2020 through August 21, 2020. While this employee was not in charge of preparing food, this employee had access to food in the kitchen. Maine CDC is making these recommendations out of an abundance of caution.
Changes to U.S. CDC COVID-19 Guidance	July 24, 2020	Advisory (PDF)
Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a Symptom-Based Strategy. Except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue isolation and precautions. See https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
Human Arbovirus Update for Healthcare Providers in Maine	July 20, 2020	Advisory (PDF)
The purpose of this health advisory is to alert clinicians to the potential for human arboviral disease activity in Maine as summer progresses and to consider testing for arboviral disease in patients presenting with unexplained encephalitis, meningitis or high fever (100.4F or 38C) during the summer and fall when mosquitoes are most active. Arboviral diseases, including Eastern equine encephalitis (EEE), Jamestown Canyon virus (JCV), and West Nile virus (WNV), are serious infections that are transmitted by the bite of an infected mosquito. Maine reported no cases of locally acquired mosquito-borne infection in residents in 2019. Additionally, Powassan virus is an arboviral disease transmitted by the bite of an infected tick. Maine identified two cases of Powassan virus disease in residents during 2019. Although rare, these diseases have potentially severe and even fatal consequences for those who contract them.
Serious Adverse Health Events Associated with Methanol-based Hand Sanitizers	July 7, 2020	Advisory (PDF)
Most commercially available alcohol-based hand sanitizers or rubs (ABHSR) contain either ethanol or isopropanol as active ingredients. On June 19, 2020, the U.S. Food and Drug Administration (FDA) advised consumers not to use any hand sanitizer manufactured by "Eskbiochem SA de CV" in Mexico, due to the potential presence of methanol, a toxic alcohol, as an active ingredient, which can cause blindness and/or death when absorbed through the skin or when swallowed. Since then, FDA has identified additional ABHSR products that contain methanol and is working with manufacturers and distributors on a voluntary recall of these products (https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitzers-methanol).
COVID-19 Testing at HETL	June 30, 2020	Advisory (PDF)
The Maine CDC Health and Environmental Testing Laboratory ("HETL") has received several specimens for COVID-19 testing that do not have the appropriate paperwork attached. Federal rules under CLIA require HETL to only run tests that are accompanied by complete paperwork.
Hepatitis A Increase in Maine	June 19, 2020	Advisory (PDF)
Maine has seen an increase in hepatitis A cases in Penobscot, Somerset, and York counties over the past four months, with the number of reported cases climbing from zero in January and February to 13 in Penobscot, 7 in Somerset, and 6 in York counties in March through today. Twenty-one of the 26 cases had risk factors of injection drug use or housing insecurity. Historically Maine had 7 to 10 cases of hepatitis A per year over the past decade. In 2019, Maine CDC identified 45 cases. This increase was driven by a restaurant-associated outbreak and cases related to injection drug use or homelessness. Since January 1, 2020, Maine CDC has identified 39 cases of hepatitis A. Recent case investigations, however, have not identified a source of the infections. The increase of hepatitis A in Maine mirrors an increase of cases seen across the country.
Acute Hepatitis A Case in a Food Service Worker in Saco, Maine	June 5, 2020	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) has identified a case of acute hepatitis A virus infection in a Saco, Maine, food service worker. The case handled food while infectious from May 12, 2020, thru May 23, 2020. Epidemiological assessment of the employee's illness determined that restaurant patrons may be at risk for hepatitis A infection. Maine CDC is recommending that anyone who may have eaten food prepared at or worked at the Sea Salt Lobster Restaurant in Saco on May 22, 2020, and May 23, 2020, receive hepatitis A vaccine by Saturday, June 6, 2020, as there is a 14-day window during which prophylaxis is effective after exposure. This recommendation includes anyone who may have had take-out, delivery, or curbside pickup of food from the restaurant. Anyone who visited the restaurant from May 12, 2020, thru May 21, 2020, is outside the window for which prophylaxis is recommended, but are advised to watch for symptoms and seek medical attention should they develop symptoms. Health care providers are encouraged to remain vigilant for hepatitis A infection in persons with consistent symptoms and should ask individuals with such symptoms about consumption of food from this establishment during this period.
Universal Testing in Congregate Living Settings	May 23, 2020	Advisory (PDF)
Maine CDC has adopted the attached recommendations regarding universal testing in congregate living settings. This policy may be updated as scientific understanding of COVID-19 evolves.
Increased COVID-19 Testing Capacity at Maine CDC Laboratory	May 18, 2020	Advisory (PDF)
On March 25, 2020, Maine met U.S. CDC's criteria for a Moderate level of community transmission for coronavirus disease 2019 (COVID-19). Since then Maine's testing capacity has been inhibited by the limited national supply of laboratory materials and testing equipment. To preserve specimen collection and testing supplies for patients who may develop severe COVID-19 illness, Maine CDCs Health and Environmental Testing Laboratory (HETL) has, until now, had to prioritize testing for individuals in high-risk categories. Maine CDC has expanded its capacity for COVID-19 testing. This expansion results largely from a partnership with IDEXX (Westbrook, Maine) to use the OPTI SARS-CoV-2 RNA PCR Test Kit, which recently received US FDA Emergency Use Authorization. The test kit is based on real-time reverse transcription polymerase chain reaction (RT-PCR), which provides detection of the viral RNA in the sample.
2020 Lyme and Other Tickborne Disease Information	May 13, 2020	Advisory (PDF)
Lyme disease is the most common vectorborne 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 and we want to encourage Mainers to use the "Tick Tock" strategies to stay tick free.
Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19	May 11, 2020	Advisory (PDF)
A pediatric multi-system inflammatory syndrome, recently reported by authorities in the United Kingdom, is also being observed among children and young adults in New York and elsewhere in the United States. Clinical features vary, depending on the affected organ system, but have been noted to include features of Kawasaki disease or features of shock; however, the full spectrum of disease is not yet known. Only severe cases may have been recognized at this time. This inflammatory syndrome may occur days to weeks after acute COVID-19 illness. This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated (CRP, troponin etc.), and fever and abdominal symptoms may be prominent. Rash also may be present. Myocarditis and other cardiovascular changes may be seen. Some patients have developed cardiogenic or vasogenic shock and required intensive care. Patients with this syndrome who have been admitted to pediatric intensive care units have required cardiac and/or respiratory support.
Health Risks from Browntail Moths	May 5, 2020	Advisory (PDF)
The browntail moth is an invasive species of both forest and human health concern. Maine and Massachusetts are the only states in the U.S. experiencing problems with this moth. The tiny, microscopic hairs found on browntail moth caterpillars, shed skins, and cocoons can cause skin reactions.
Testing for COVID-19 - Antibody Testing	May 1, 2020	Advisory (PDF)
Antibody-based tests for the detection of antibodies against coronaviruses are now available through commercial laboratories. Only a select few of these tests are specific for SARS-CoV-2, the virus that causes COVID-19. Providers should review the COVID-19 Antibody Testing Primer from the Infectious Disease Society of America (IDSA) about serology-based tests for COVID-19.
Temporary Updates to the Notifiable Diseases and Conditions List - SARS CoV-2 and COVID-19 Deaths	April 22, 2020	Advisory (PDF)
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 two temporary changes to the Notifiable Diseases and Conditions List.
Updated Guidance for COVID-19: Prioritization of Testing and Discontinuation of Home Isolation	March 19, 2020	Advisory (PDF)
US CDC's guidelines on Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission define Moderate community transmission as, "Widespread and/or sustained transmission with high likelihood or confirmed exposure within communal settings with potential for rapid increase in suspected cases." According to US CDC, at that level and when testing capacity is limited, public health control activities may require prioritization of testing to high-risk individuals. Maine now meets US CDCs criteria for a Moderate level of community transmission. At present, a limited national supply of laboratory materials inhibits Maines testing capacity. Maine may also need to limit testing if such shortages continue. Therefore, consistent with US CDC guidelines, Maine is now creating a prioritization system to test to individuals in high-risk categories.
Updated Guidance for COVID-19 Testing	March 16, 2020	Advisory (PDF)
On March 15, 2020, the U.S. Centers for Disease Control and Prevention (U.S. CDC) and the U.S. Food and Drug Administration (FDA) issued new guidance for collection, handling, and testing clinical specimens from persons for Coronavirus Disease 2019 (COVID-19). These new guidance can be found at https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.htm and https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2. Key Messages: - U.S. CDC is now recommending collecting a single nasopharyngeal (NP) swab in viral transport media. Throat (OP) swabs are no longer required. If both swabs are used, they should be combined at collection in to a single vial. - FDA has expanded options for specimen transport media. - The Maine Health and Environmental Testing Laboratory (HETL) will no longer be running a respiratory viral panel with all submitted COVID-19 specimens.
Actions to Take Now for Community Transmission of COVID-19	March 15, 2020	Advisory (PDF)
As of March 15, 2020, there are 7 confirmed and 5 presumptive positive COVID-19 cases in Maine. Community transmission is occurring in Cumberland County. The Maine Center for Disease Control and Prevention (Maine CDC) expects to see community transmission in other areas of Maine, possibly in the coming days. Such transmission will likely mean large numbers of patients needing medical care at the same time, stressing health care providers, hospitals, and other health care facilities. Critical systems, including emergency medical services, are likely to be affected, and should plan accordingly. Social distancing strategies should be implemented, even though they may impact daily activities and disrupt scheduled events.
First Presumptive COVID-19 Case in Maine	March 12, 2020	Advisory (PDF)
On Thursday, March 12, 2020, Maine's Health and Environmental Testing Laboratory (HETL) reported out the first presumptive positive COVID-19 test result on a Maine resident. Currently, all positive COVID-19 results from state public health laboratories are considered presumptive until they are confirmed at the U.S. Center for Disease Control and Prevention (U.S. CDC). Health care providers should immediately notify infection control personnel at their health care facility if they suspect a patient of having COVID-19. Providers and health care facilities do not need to notify Maine CDC if they suspect their patient of having COVID-19, and do not need authorization to send samples to HETL. Providers should work with their health care facilities to determine the best location and method for specimen collection.
COVID-19 Updated U.S. CDC Guidance	March 12, 2020	Advisory (PDF)
On March 10, 2020 the U.S. Centers for Disease Control and Prevention (U.S. CDC) released the following new or revised guidance in response to concerns around national and local shortages in Personal Protective Equipment (PPE) supplies, particularly N95 respirators: - Infection Prevention and Control - Emergency Medical Services (EMS) - Long-Term Care Facilities Other guidance issued includes - Guidance for Based Precautions and Disposition of Hospitalized Patients - People at risk for serious illness from COVID-19. Maine CDC is also providing additional guidance to providers seeking COVD-19 testing at Maine's Health and Environmental Testing Laboratory (HETL): - Providers no longer need to call Maine CDC for authorization prior to submitting a sample for testing - Nasopharyngeal (NP) and throat (oropharyngeal) swabs no longer need to be sent in separate viral transport media. NP and OP swabs can be submitted in a single container of viral transport media
Preparing for Community Transmission of COVID-19 in Maine	March 9, 2020	Advisory (PDF)
As of March 9, 2020, U.S. states have reported over 500 cases of the novel coronavirus disease (COVID-19). Widespread sustained transmission has also been reported in China, Iran, Italy, and South Korea. Community spread has been reported in several other countries, including parts of the U.S. (California, Oregon, Washington). Community spread in Washington state led to the first death in the U.S. from COVID-19, the first reported case of COVID-19 in a health care worker, and the first outbreak in a long-term care facility. Widespread transmission of COVID-19 in the U.S. may occur, including within Maine. Such transmission could mean large numbers of patients needing medical care at the same time, stressing health care providers and hospitals/other health care facilities. Critical systems, including emergency medical services, are likely to be affected, and should plan accordingly. Various degrees of social distancing may be required, which could impact daily activities and disrupt scheduled events. There are no confirmed cases of COVID-19 in Maine at this time. Testing for COVID-19 is available at Maine's Health and Environmental Testing Laboratory. Health care workers caring for patients with COVID-19, close contacts of persons with COVID-19, and travelers returning from affected locations where community spread is occurring are at higher risk. The situation is rapidly evolving. For updates on the situation in Maine, visit https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus.shtml The clinical spectrum of COVID-19 disease is not fully known, but reported illnesses have ranged from mild to severe. Available information suggests most patients with COVID-19 have mild illness, with severe illness occurring in only 15-20% of patients. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, dyspnea). Risk factors for serious disease associated with COVID-19 include older age and co-morbidities (e.g., heart disease, lung disease, and diabetes). No vaccine to prevent COVID-19 is currently available, nor are there FDA-approved medications for treatment of COVID-19.
Updated COVID-19 Testing Criteria	March 5, 2020	Advisory (PDF)
On Wednesday, March 4, 2020, the U.S. Centers for Disease Control and Prevention (U.S. CDC) expanded the Coronavirus Disease 2019 (COVID-19) testing criteria to a wider group of symptomatic patients. A patient who is suspected of having COVID-19 must wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available. Health care personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). If providers suspect their patient of having COVID-19, they should immediately notify their health care facility's infection control personnel and Maine CDC at 1-800-821-5821. In the case of a patient suspected of having COVID-19, specimens must be sent to Maine Health and Environmental Testing Laboratory (HETL). Health care providers should remind all patients being tested for COVID-19 to remain isolated until test results are back and are negative.
Updated COVID-19 Patients Under Investigation (PUI) Criteria	February 28, 2020	Advisory (PDF)
U.S Centers for Disease Control and Prevention (U.S. CDC) updated the Coronavirus Disease 2019 (COVID-19) criteria for Patients Under Investigation (PUI) on Thursday, February 27, 2020. A person who meets the PUI criteria must wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available. Health care personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield). If providers suspect a patient meets the PUI criteria, they should immediately notify their healthcare facility's infection control personnel and Maine CDC at 1-800-821-5821. Currently, testing for COVID-19 is not yet available in Maine. In the case of a PUI, specimens must be sent to HETL who will facilitate sending them to U.S. CDC for COVID-19 testing. There are no confirmed cases of COVID-19 in Maine at this time; therefore, the risk of community spread remains low.
Influenza-Associated Pediatric Death	February 19, 2020	Advisory (PDF)
Maine CDC received notification of an influenza-associated pediatric death on Tuesday, February 18, 2020. The child, a southern Maine resident under 5 years old, was unvaccinated and tested positive for influenza B. This is the first influenza-associated pediatric death in Maine during the 2019-20 influenza season. Influenza activity in Maine remains elevated. Influenza vaccination is strongly encouraged, and vaccine is still widely available. Vaccination can reduce illness and prevent hospitalization and death.
Maine CDC Encourages Providers to Obtain Vaccine and Vaccinate At-Risk Populations for Hepatitis A	February 13, 2020	Advisory (PDF)
In 2019, Maine saw a nearly five-fold increase in hepatitis A cases over the five-year average number of cases, increasing from 9 in 2018 to 45 in 2019. A quarter of the cases in 2019 had risk factors such as injection drug use or homelessness. Maine CDC recommends that healthcare providers and facilities that provide services to at-risk populations obtain hepatitis A vaccine and offer vaccination to their clients to prevent further spread of hepatitis A. - Screen patients for risk factors (e.g., drug use, homelessness, incarceration, MSM, and chronic liver disease). - Recommend and administer hepatitis A vaccine to at-risk patients, regardless of the original presenting complaint or the type of clinical facility. In particular, the emergency department may be an individual's only interaction with the healthcare system and is an important opportunity for prevention. - Record immunizations in the state immunization information system (registry). - Consider hepatitis A as a diagnosis in anyone with jaundice, elevated liver enzymes, or clinically compatible symptoms. Order an acute hepatitis panel to include hepatitis A IgM on these patients. Rapidly report all persons diagnosed with hepatitis A to the health department to ensure timely case investigation and follow-up of contacts.
Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV)	February 4, 2020	Advisory (PDF)
The Centers for Disease Control and Prevention (federal CDC) continues to closely monitor an outbreak of respiratory illness caused by a novel coronavirus (2019-nCoV) that was initially detected in Wuhan City, Hubei Province, China in December 2019. This federal CDC Health Alert Network (HAN) Update provides a situational update and interim guidance to state and local health departments that supersedes guidance in federal CDC's HAN 426 distributed on January 17, 2020. - As of February 4, 2020, no cases of 2019-nCoV have been identified in Maine. - If a patient meets the PUI criteria, the provider should contact Maine CDC immediately, by calling 1-800-821-5821, to determine if this patient needs to be considered a PUI for 2019-nCoV and be tested for infection.
Increase in Suspected Unintentional Overdoses in Cumberland County	February 1, 2020	Advisory (PDF)
On Saturday, February 1st, the Northern New England Poison Control Center notified Maine CDC of ten individuals who potentially overdosed unintentionally over the weekend. All ten individuals received emergency assistance in Cumberland County. Cases were reported from multiple facilities. Some of these individuals may have thought that they were using cocaine, but the cocaine may have been contaminated with opioids. At least one individual indicated they purchased the cocaine from a new dealer. Several individuals were seriously impaired and required naloxone to recover, some needing multiple doses. The intent of this HAN is to alert Emergency Medical Services, health care facilities and providers, and law enforcement to a potentially contaminated product that is leading to severe adverse outcomes.
Updated Definition for Patients Under Investigation (PUI) for 2019 Novel Coronavirus (2019-nCoV)	January 31, 2020	Advisory (PDF)
Imported cases of 2019-nCoV infection in people have been detected in the U.S. While person-to-person spread among close contacts has been detected with this virus, this virus is NOT currently spreading in the community in the United States. At this time, Maine does not have any confirmed cases and has no patients under investigation (PUI). U.S Centers for Disease Control and Prevention (U.S. CDC) updated the 2019 Novel Coronavirus (2019-nCoV) definition for patients under investigation (PUI) on Friday, January 31, 2020.
Update and Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV)	January 21, 2020	Advisory (PDF)
The Centers for Disease Control and Prevention (CDC) continues to closely monitor an outbreak of a 2019 novel coronavirus (2019-nCoV) in Wuhan City, Hubei Province, China that began in December 2019. CDC has established an Incident Management System to coordinate a domestic and international public health response. Coronaviruses are a large family of viruses. Some cause illness in people; numerous other coronaviruses circulate among animals, including camels, cats, and bats. Rarely, animal coronaviruses can evolve and infect people and then spread between people such as has been seen with Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) (https://www.cdc.gov/coronavirus/mers/index.html) and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (https://www.cdc.gov/sars/index.html).
Lead Poisonings Requiring Medical Chelation Treatment	January 16, 2020	Advisory (PDF)
Between July and December 2019, four children ages 12 to 24 months were identified with blood lead levels ranging from 45 to 57 mcg/dL. Blood lead levels of 45 mcg/dL or higher are typically treated with medical chelation therapy to reduce blood lead levels. These are the first chelation cases identified in Maine since 2016. The children resided in Androscoggin, Cumberland, and York counties.
Widespread Influenza Activity in Maine	January 7, 2020	Advisory (PDF)
Influenza activity in Maine is now widespread with providers reporting laboratory-confirmed influenza in all sixteen counties. Maine's Health and Environmental Testing Laboratory (HETL) confirmed influenza A/pH1N1, influenza A/H3, influenza B/Victoria, and influenza B/Yamagata are all circulating in Maine. Maine CDC has followed up on nine (9) outbreaks of influenza as of Tuesday, January 7, 2020. With increased influenza activity, it is not too late to get vaccinated. Influenza vaccination is the best way to prevent illness. Vaccination is strongly encouraged throughout the season and is still widely available.
Vaping-associated Pulmonary Illness - Reporting Now Required	October 3, 2019	Advisory (PDF) | Disease Reporting Form
The purpose of this health advisory is to inform clinicians that, effective immediately, and pursuant to 22 M.R.S. 802(1)(B), pulmonary disease associated with e-cigarette use is now temporarily added to the list of Notifiable Conditions that are required to be reported to Maine CDC. Summary: There has been an increase in the number of cases of significant lung illness related to e-cigarette use in Maine. As of Wednesday, October 2, four additional cases of lung illness related to e-cigarette use have been confirmed, bringing Maine's total to five cases. No deaths from this illness have been reported in Maine. Recommendations: Consider e-cigarette-associated illness with patients who present with respiratory illness of unclear etiology and who have vaped or dabbed within the past 90 days. Clinicians should ask about and document extent of use, type of instrument used, type of vaping liquid used (i.e. nicotine, THC), place of purchase, and if the patient still has the vaping liquid they used. Clinicians should also complete a respiratory viral panel and test for influenza to rule out a possible viral cause of illness. Reporting: Clinicians should report cases with onset on or after May 1, 2019, that meet the criteria of (1) significant respiratory illness of unclear etiology and (2) a history of vaping. All suspect cases should be reported by phone to Maine CDCs 24/7 disease reporting and consultation line at 1-800-821-5821 or by fax to 1-800-293-7534 using the Disease Reporting Form (attached). Attention: On October 9, 2019, Maine CDC will be hosting a live webinar to discuss pulmonary illness associated with e-cigarette use. More information to follow.
Influenza Arrives in Maine	September 27, 2019	Advisory (PDF)
Influenza has officially arrived in Maine. Multiple Maine facilities reported influenza positive lab results in the last week, including a PCR confirmed case, which tested positive for influenza A and was typed at Maine's Health and Environmental Testing Lab (HETL) as influenza A/H3. This individual is an adult who was not hospitalized, was unvaccinated, and had recent travel history. The 2019-2020 influenza season officially begins on September 29, 2019. Individuals should NOT wait to get vaccinated as influenza is already present in the state. Both Influenza A and B strains are currently circulating nationally. The 2019-2020 quadrivalent influenza vaccine contains components of both A strains (H1 and H3) as well as two B strains (Yamagata and Victoria). Quadrivalent vaccine is recommended for optimal protection, however if only trivalent vaccine is available the recommendation is not to wait and obtain the vaccine as soon as possible.
"Start of Influenza Season" Conference Call Agenda	September 23, 2019	Agenda
The agenda for the upcoming 2019 "Start of Influenza Season" conference call.
Maine Reports a Case of Lung Illness Related to E-Cigarette Use	September 20, 2019	Advisory (PDF)
The purpose of this health advisory is to alert clinicians to the first case in Maine of severe pulmonary disease linked to e-cigarette product use, or "vaping". Clinicians should consider vaping-associated pulmonary illness in the evaluation of patients with significant respiratory illness and a history of vaping. Patients presenting with significant respiratory illness of unclear etiology should be asked about their use of vaping products. For patients who have used vaping products, clinicians should ask about the extent of use, the type of instrument used, the type of vaping liquid used, and the place of purchase. Patients should also be asked if they still have the vaping liquid they used. If so, Maine CDC can assist with arranging laboratory testing of the liquid. Reporting: Maine CDC asks that clinicians report cases that meet the criteria of (1) significant respiratory illness of unclear etiology and (2) a history of vaping. All suspect cases should be reported by phone to Maine CDC's 24/7 disease reporting and consultation line at 1-800-821-5821 or by fax to 1-800-293-7534 using the Disease Reporting Form.
Eastern Equine Encephalitis Positive Horse	September 3, 2019	Advisory (PDF)
The purpose of this health advisory is to alert clinicians to the potential for human Eastern Equine Encephalitis (EEE) disease activity in Maine and to consider testing for EEE in patients presenting with unexplained encephalitis, meningitis or high fever (100.4F or 38C) during the summer and early fall. Maine Department of Agriculture, Conservation, and Forestry notified Maine CDC of a case of Eastern Equine Encephalitis (EEE) in a horse from York County late Friday August 30th. The Animal Health Diagnostic Center at Cornell University in New York confirmed the EEE result in this horse. Maine has not detected EEE to date in mosquito collections. However, public health officials in other Northeast states have seen significant increases in EEE activity this year. Massachusetts has reported four human cases and one human death, as well as four animal deaths from EEE. New Hampshire has reported one animal death from EEE. Maine has not identified a human case of EEE since 2015. EEE is a rare, but potentially fatal arboviral disease. It is the most severe arboviral infection found in the United States. EEE virus is transmitted to humans through the bite of an infected mosquito. Signs and symptoms can include fever, headache, myalgias, vomiting, weakness, confusion, seizures, and memory loss. In more serious cases, the illness may progress to encephalitis, coma, and death. The case-fatality rate for infected individuals is approximately 33% and up to 50% for those who show symptoms. Most survivors are left with significant and long-term brain damage. Symptoms can begin anytime from four to ten days after the mosquito bite, and usually last one to two weeks. It is possible some people will not show any signs of EEE illness. There is no specific treatment, but people with severe EEE illness often need to be hospitalized.
Severe Pulmonary Disease Associated with Using E-Cigarette Products	August 30, 2019	Advisory (PDF)
In an ongoing effort to provide the most up-to-date information on respiratory illnesses related to e-cigarette use, the Maine Center for Disease Control and Prevention is sharing this advisory from the federal Centers for Disease Control and Prevention. There have been no confirmed cases of vaping-related respiratory illness in Maine as of Friday, August 30, 2019. Maine CDC continues to ask that clinicians report cases of severe pulmonary disease of unclear etiology and a history of e-cigarette product use within the past 90 days to Maine CDC's 24/7 disease reporting and consultation line at 1-800-821-5821 or by fax to 1-800-293-7534 using the Disease Reporting Form.
Vaping-associated Pulmonary Illness - Call for Cases	August 21, 2019	Advisory (PDF)
The purpose of this health advisory is to alert clinicians to reports of severe pulmonary disease linked to e-cigarette product use, or "vaping". As of August 15, 2019, 94 possible cases of severe lung illness associated with vaping have been reported in 14 states since June 28, 2019. Clusters are occurring in multiple states, including Wisconsin, Illinois, California, Indiana and Minnesota, primarily among adolescents and young adults. Additional states have alerted federal CDC to possible (not confirmed) cases and investigations into these cases are ongoing. There is no conclusive evidence that an infectious disease is causing the illnesses. While some cases in each of the states are similar and appear to be linked to e-cigarette product use, more information is needed to determine the etiology. Clinicians should consider vaping-associated pulmonary illness in the evaluation of patients with significant respiratory illness and a history of vaping. Patients presenting with significant respiratory illness of unclear etiology should be asked about their use of vaping products. For patients who have used vaping products, clinicians should ask about the extent of use, the type of instrument used, the type of vaping liquid used, and the place of purchase. It is not yet known if similar cases are occurring in Maine.
Cases of Varicella (Chickenpox) Associated with the Portland Expo Center	August 3, 2019	Advisory (PDF)
Maine CDC is aware of cases of varicella (chickenpox) in individuals who are staying at the Portland Expo Center. Varicella is a contagious viral disease that can spread easily to individuals who have not had varicella and have not gotten the varicella vaccine. There are several diseases that can cause a febrile rash in children, so Maine CDC encourages laboratory testing when assessing patients when possible. If diagnosed with varicella, patients may return to their congregate living setting if clinically stable and indicated by a provider. Individuals staying at the Portland Expo are already considered exposed. Providers should encourage patients to practice good hand and respiratory hygiene and stay away from non-immune individuals as much as possible.
Human Powassan Case	July 24, 2019	Advisory (PDF)
The purpose of this health advisory is to alert clinicians to the potential for human Powassan encephalitis disease activity in Maine and to consider testing for Powassan in patients presenting with unexplained encephalitis, meningitis or high fever (100.4F or 38C) during the summer and early fall. Maine CDC was notified of a human case of Powassan encephalitis (POW) in a Maine resident who resides in southern Maine. The individual was symptomatic in late June and hospitalized. CDC Fort Collins confirmed the Powassan result in this individual. Powassan virus is transmitted to humans through the bite of an infected Ixodes tick. Signs and symptoms can include fever, headache, vomiting, weakness, confusion, seizures, and memory loss. Long-term neurologic problems may occur. Symptoms can begin anytime from one week to one month after the tick bite. There is no specific treatment, but people with severe Powassan virus illness often need to be hospitalized.
Increase in Legionellosis Cases - Greater Bangor Area, Penobscot County	July 12, 2019	Advisory (PDF)
In the greater Bangor area, Penobscot County, Maine, physicians have reported 6 confirmed cases of legionellosis from November 2018 to the present. This is an increase from the 5-year median of 3.2 cases for Penobscot County. Cases range in age from over 50 to under 85 years old. Maine CDC is actively investigating the cases and has not identified a common exposure among cases. Health care providers should be aware of this increase in legionellosis cases and consider legionellosis in the differential diagnosis of any pneumonia case. Although urinary antigen assay is an adequate diagnostic test for Legionella, given the recent increase in number of cases, Maine CDC recommends respiratory specimen culture, particularly for patients who live in the greater Bangor area. Culture specimens can detect all species and serogroups of Legionella and may aide in exposure identification. Maine CDC requests Legionella isolates grown from respiratory specimens be sent to the Maine Health and Environmental Testing Laboratory (HETL) for further analysis.
Maine CDC Update on Portland Expo Operations	July 3, 2019
Maine CDC continues to support the City of Portland in connection with asylum seekers residing at The Expo. The response has involved conducting health screenings, providing vaccinations, and offering assistance through the Women, Infants and Children (WIC) program.
Human Arbovirus Information for Healthcare Providers in Maine	July 2, 2019	Advisory (PDF)
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 arboviral disease in patients presenting with unexplained encephalitis, meningitis or high fever (100.4F or 38C) during the summer and early fall. Arboviral diseases, including Eastern equine encephalitis (EEE), Jamestown Canyon virus (JCV), and West Nile virus (WNV), are serious infections that are transmitted by the bite of an infected mosquito. Maine reported a fatal case of JCV infection, a relatively rare arboviral disease carried by mosquitoes, in a resident in 2018. Additionally, Powassan virus is an arboviral disease transmitted by the bite of an infected tick. Maine identified zero cases of Powassan virus disease in residents during 2018. Although rare, these diseases have potentially severe and even fatal consequences for those who contract them.
Maine CDC Hepatitis A Update	June 28, 2019	Update (Doc)
Maine Center for Disease Control and Prevention (Maine CDC) is providing this update on hepatitis A cases in the state in 2019. Providers or labs reported 24 cases of acute hepatitis A to date this year in Maine. Of these cases, six occurred last week and one case is currently under investigation in an out-of-state resident tested in Maine. Nine cases are linked to exposures at a restaurant in Caribou, and five cases are linked to an ongoing outbreak in New Hampshire. The remaining cases are sporadic.
Maine CDC Hepatitis A Update	June 21, 2019	Update (Doc)
The Maine Center for Disease Control and Prevention (Maine CDC) has identified three additional cases of hepatitis A virus infection in Aroostook County since the last update on June 18, 2019. There is now a total of nine confirmed hepatitis A cases in Aroostook County since May 17, 2019. All nine cases are linked to exposures at a restaurant in Caribou. There is no ongoing risk to the public from eating at this restaurant, nor is there any ongoing risk to the public as a result of the original case.
Maine CDC Hepatitis A Update	June 18, 2019	Update (Doc)
The Maine Center for Disease Control and Prevention (Maine CDC) has identified three additional cases of hepatitis A virus infection in Aroostook County over the past week. There are now six confirmed hepatitis A cases in Aroostook County since May 17, 2019. All six cases are linked to exposures at a restaurant in Caribou. There is no ongoing risk of hepatitis A to the public from eating at this restaurant.
Acute Hepatitis A Case in a Food Service Worker in Presque Isle, Maine	June 14, 2019	Advisory (PDF)
Maine Center for Disease Control and Prevention (Maine CDC) identified additional cases of acute hepatitis A virus infection in Aroostook County. Close contacts at risk are already being notified. The only risk to the public identified by Maine CDC at this time involves a Presque Isle food service worker. The Presque Isle case served food and drink while infectious on May 26, 2019 and June 2, 2019. Maine CDC recommends the hepatitis A vaccine as post-exposure prophylaxis to anyone who ate or worked at the Mai Tai Restaurant in Presque Isle, Maine between 11:00am and 4:30pm on June 2, 2019. Exposed persons can receive post-exposure prophylaxis up to 14 days from exposure, after which the treatment is no longer effective. Anyone who visited the restaurant between 11:00am and 4:30pm on May 26, 2019 is outside the window for which prophylaxis is recommended, but they should watch for symptoms and seek medical attention should they develop symptoms. Health care providers are encouraged to remain vigilant for hepatitis A infection in persons with consistent symptoms. All cases of hepatitis are reportable in Maine. Providers with suspected cases should report them to Maine CDC at 1-800-821-5821.
Meningococcal Disease Case at Wiscasset Middle High School	June 12, 2019	Advisory (PDF)
The Maine Center for Disease Control and Prevention (Maine CDC) is reporting a case of meningococcal disease in a student who attends Wiscasset Middle High School. Lab tests confirmed the case on June 11, 2019. Maine CDC has informed Wiscasset Middle High School as well as local medical facilities of the case, and is working with them to notify exposed individuals. The student attended two public events during their infectious period: the Wiscasset Middle High School Alumni Banquet on Saturday, June 1st and the Wiscasset Middle High School Graduation on Thursday, June 6th. There are no specific recommendations for students, staff, or visitors to the school, alumni banquet, or graduation. Most cases of meningococcal disease are sporadic, with fewer than 5% associated with secondary cases. Maine CDC is asking clinicians to be aware of potential exposures and increase surveillance for illness suggestive of meningococcal disease.
Maine CDC Health Update	June 11, 2019
No new cases of Measles or Hepatitis A	June 5, 2019	Advisory (DOC)
Health Risks from Browntail Moths	May 29, 2019	Advisory (PDF)
The browntail moth is an invasive species of both forest and human health concern. Maine and Massachusetts are the only states in the U.S. experiencing problems with this moth. The tiny, microscopic hairs found on browntail moth caterpillars, shed skins, and cocoons can cause skin reactions.
Confirmed Measles Case in Maine	May 21, 2019	Advisory (PDF)
Maine Center for Disease Control and Prevention is reporting the first case of measles in Maine this year. Maine CDC confirmed the case on May 20th, 2019. The case involves a school aged child from Somerset County. The child was vaccinated, did not have any serious complications, and is fully recovered from the disease. Maine CDC is working with the family and clinicians to identify exposed contacts and to assess contacts for evidence of immunity. Measles is a highly contagious respiratory illness caused by a virus. Maine clinicians are asked to encourage vaccination and increase surveillance for rash illness suggestive of measles to identify early potential cases and prevent the spread of disease in Maine.
Hepatitis A in Caribou Update	May 21, 2019
On Friday, May 17, the Maine Center for Disease Control and Prevention (Maine CDC) alerted Mainers to a confirmed case of acute hepatitis A in a food worker in Caribou. The case was infectious and handled food at Burger Boy restaurant from April 24 to May 13. In response to this case, Maine CDC issued guidance for those who visited the restaurant during the infectious period, and for health providers in this area.
Acute Hepatitis A Case in a Food Service Worker in Caribou, Maine	May 17, 2019	Advisory (PDF)
Maine Center for Disease Control and Prevention (Maine CDC) identified a case of acute hepatitis A virus infection in a Caribou, Maine food service worker. The case prepped food while infectious from April 24, 2019 thru May 13, 2019. A public health assessment of the employee's illness determined that restaurant patrons may be at risk for hepatitis A infection.
2019 Lyme and other Tickborne Disease Information	May 7, 2019	Advisory (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 and we want to encourage Mainers to use the "Tick Aware and Tick Alert" strategies to stay tick free.
Viral Hepatitis Awareness Month: Information for Clinicians	May 7, 2019	Advisory (PDF)
May is Viral Hepatitis Awareness Month. Maine CDC urges clinicians to understand the burden of hepatitis B and C in Maine and to follow key recommendations for testing and prevention. All persons at risk for hepatitis B and C should be tested and those who are susceptible should be vaccinated for hepatitis A and hepatitis B.
MMR Guidance	May 3, 2019	Advisory (PDF)
Over the past few weeks, multiple news outlets have reported on the MMR vaccine, previous vaccine recommendations, and the potential for some adults to need additional doses of MMR vaccine. This HAN message contains the most current MMR vaccine recommendations from the federal Centers for Disease Control and Prevention (CDC).
Influenza-Associated Pediatric Death	April 9, 2019	Advisory (PDF)
Maine CDC received notification of an influenza-associated pediatric death on Monday, April 8, 2019.
Influenza Season Continues with Widespread Activity in Maine	April 4, 2019	Advisory (PDF)
Influenza activity remains elevated and widespread in Maine and throughout the United States.
Measles Exposure in Two Healthcare Offices in Maine	April 2, 2019	Advisory (PDF)
On April 1, 2019 Maine CDC was notified of a confirmed case of measles in an out of state resident who visited two businesses in Maine while traveling in the state on Wednesday, March 27, 2019.
Rabies Positive Bat in Bangor Potentially Exposes Several Individuals	March 22, 2019	Advisory (PDF)
Maine Center for Disease Control and Prevention is investigating the circumstances surrounding a rabid bat in the general area outside the Shaw House in Bangor on the weekend of March 16 and 17.
Confirmed Mumps Case in Maine	March 15, 2019	Advisory (PDF)
Maine CDC is investigating a confirmed case of mumps in an unvaccinated student in York County.
Measles Recommendations and Current Situation in Maine	March 8, 2019	Advisory (PDF)
The purpose of this advisory is to provide health care providers with the most current information on measles prevention and assessment of suspect cases, should they arise.
Widespread Influenza Activity in Maine	January 30, 2019	Advisory (PDF)
Influenza activity in Maine is now widespread with providers reporting laboratory confirmed influenza in all sixteen counties.
Confirmed Hepatitis A Case in an Individual Who Stayed in Portland Shelters	October 29, 2018	Alert (PDF) | Fact Sheet (PDF)
Maine CDC offers free vaccines to those at highest risk as a precaution following confirmed hepatitis A case in Portland shelter.
Maintaining Vigilance for Acute Flaccid Myelitis Cases	October 25, 2018	Advisory (PDF)
Maine CDC advises clinicians to maintain vigilance for AFM and report patients who meet clinical criteria for AFM to the Maine CDC.
Pertussis Update in Maine	October 24, 2018	Advisory (PDF)
Maine sees increase in pertussis cases in York and Waldo counties, and an increase in infant cases.
Early Start to Influenza Season in Maine	September 7, 2018	Advisory (PDF)
Influenza has officially arrived early in Maine. Individuals should not wait to get vaccinated.
Dramatic Increases in Cases of Syphilis and Gonorrhea	September 5, 2018	Advisory (PDF)
Maine CDC recommends screening for all at-risk people and appropriate treatment for infected individuals as cases continue to rise.