Vermont's Smoke Free Law: Act 135

'Tis the season...

VT Department of Health: Ebola Update

Vermont Situation Update

The Vermont Department of Health continues to monitor a Vermonter who was voluntarily quarantined beginning on Oct. 27 after returning from West Africa. He is being monitored for fever or symptoms of Ebola.

Preparing for and responding to control the spread of disease is a core function of public health. Even though there is very low risk of Ebola in Vermont, the Health Department, hospitals, health care providers, and responders are preparing to safely respond and manage any suspected or confirmed cases of Ebola.

Related: Vermont is Carefully Montioring Travelers from Ebola-affected Regions (News release 10/8/14)

It's important to know:

• The risk of Ebola spreading in the U.S. and Vermont is very low.
• You can’t get Ebola from a person who has no symptoms.
• Ebola is spread through direct contact with blood and bodily fluids of a person who is sick with the disease.
• Ebola is NOT spread through the air, water, or food.

http://healthvermont.gov/prevent/ebola/index.aspx

CDC: Monitoring Symptoms and Controlling Movement to Stop Spread of Ebola

PURPOSE
The Centers for Disease Control and Prevention (CDC) updated their guidance on 10/27/2014 to help protect America from Ebola. This updated guidance focuses on strengthening how we monitor people who may have been exposed to Ebola and how medical professionals will oversee their care and, when warranted to protect the public health or our communities, limit their movement or activities. Through these changes, CDC and state and local health departments seek to support people who may have been exposed to Ebola, while also continuing to stop Ebola at its source in West Africa through the valor of our health care workers who serve. These changes will help ensure their symptoms are monitored and a system is in place to quickly recognize when they need to be routed to care. These actions will better protect potentially exposed individuals and the American public as a whole.

New risk levels were established and I have included the 'Low' and 'No' risk below. Please use the link at the bottom of this post for additional information about the updated guidance.

Low risk (but not zero)—

• having been in a country with widespread Ebola transmission within the previous 21 days and having no known exposure
• being in the same room for a brief period of time (without direct contact) with a person showing symptoms of Ebola
• having brief skin contact with a person showing symptoms of Ebola when the person was believed to be not very contagious
• in countries without widespread Ebola transmission: direct contact with a person showing symptoms of Ebola while wearing PPE
• travel on an airplane with a person showing symptoms of Ebola

No risk—

• contact with a person who is NOT showing symptoms AFTER that person was in contact with a person with Ebola
• contact with a person with Ebola BEFORE the person was showing symptoms
• having traveled to a country with Ebola outbreak MORE than 21 days ago
• having been in a country where there is no widespread Ebola transmission (e.g., the United States), and having no other exposures to Ebola

http://www.cdc.gov/media/releases/2014/fs1027-monitoring-symptoms-controlling-movement.html?s_cid=cs_021

Vermont Resident Enters Voluntary Quarantine [Ebola]

The man had been investigating the Ebola epidemic in West Africa.

Vermont Gov. Peter Shumlin announced Tuesday afternoon [10/28/2014] that a Vermont resident has entered voluntary quarantine after returning from West Africa where he was investigating the Ebola epidemic. The quarantine was announced during a 2:15 p.m. press conference.

Please use the below link to view the entire story:

http://www.necn.com/news/health/Vermont-Gov-to-Make-Important-Public-Health-Announcement-280669522.html

Vermont Department of Health - Letter to Parents/Guardians regarding Ebola

The Ebola Wars [The New Yorker - Online Article] (with some personal commentary)

Anyone who has been watching/reading/listening to the news knows that Ebola is a huge concern for the entire planet. I feel this article from The New Yorker does an excellent job of detailing the timeline for the most recent outbreak of Ebola, how the disease is transmitted and infects humans and what scientists are doing to find a cure. Sadly many healthcare workers have lost their lives helping infected patients; hopefully the lessons learned from these efforts will contribute to the eventual eradication of this disease.  I hope that you all find this article helpful. CSW, RN

"Ignorance more frequently begets confidence than does knowledge: it is those who know little, and not those who know much, who so positively assert that this or that problem will never be solved by science." -- Charles Darwin (The Descent of Man)

Vermont Dept. of Health Notice: Risk of Lead Poisoning from Cold Therapy

FDA warns parents and caregivers not to use “Bo Ying compound” manufactured  by Eu Yan Sang (Hong Kong) Ltd. due to the potential lead poisoning risk associated with the product.

FDA learned of this risk from the New York City Department of Health & Mental  Hygiene after the product was tested and found to contain high levels of lead. FDA has received one adverse event report of lead poisoning in an 18-month-old child who was given this product. The powdered product is marketed in retail outlets and online for use in infants and children for treatment of a variety of conditions including influenza, fever, sneezing, and nasal discharge. The product is labeled in Chinese and English.

Risk: Exposure to lead can cause serious damage to the central nervous system,  the kidneys, and the immune system. In children, chronic exposure to lead,  even at low levels, is associated with impaired cognitive function, including  reduced IQ, behavioral difficulties, and other problems.

Recommendations

• Consumers are advised to not purchase or use this product.
• Anyone using this product or providing it to a child should immediately consult a health care professional.

For More Information

• Safety Information<http://cirrus.mail-list.com/leadnet/81621366.html>
• Public Notification<http://www.fda.gov/Drugs/DrugSafety/ucm416220.htm>

Preventing Seasonal Flu Illness

What can I do to protect myself against the flu?

The single best way to protect against the flu is to get a flu vaccine each year. CDC recommends that everyone 6 months and older, especially people at high risk for developing serious complications from flu, get vaccinated each season. To learn more, see Key Facts about Flu Vaccine.

What are other steps that can be taken to prevent flu illness?

Take everyday preventive actions to stop the spread of germs.

• Try to avoid close contact with sick people.
• If you are sick with flu–like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. Your fever should be gone without the use of a fever-reducing medicine.
• While sick, limit contact with others as much as possible to keep from infecting them.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose and mouth. Germs spread this way.

Also, antiviral medications, which can treat flu illness, may be used in certain circumstances to prevent the flu.

Can herbal, homeopathic or other folk remedies protect against the flu?

There is no scientific evidence that any herbal, homeopathic or other folk remedies have any benefit against influenza.

How long can influenza viruses live on hard surfaces (such as books or doorknobs)?

Studies have shown that human influenza viruses generally can survive on surfaces between 2 and 8 hours.

What kills influenza viruses?

Influenza viruses can be destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics) and alcohols are effective against influenza viruses if used in proper concentrations for a sufficient length of time. For example, alcohol-based hand rubs can be used in the absence of soap and water for hand washing.

*What if soap and water are not available and alcohol-based products are not allowed in my facility?

If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.

http://www.cdc.gov/flu/about/qa/preventing.htm

States with Lab-confirmed Enterovirus D68

From mid-August to October 9, 2014, CDC or state public health laboratories have confirmed a total of 678 people from 46 states and the District of Columbia with respiratory illness caused by EV-D68. The 46 states are Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This indicates that at least one case has been detected in each state listed but does not indicate how widespread infections are in each state.

CDC is prioritizing testing of specimens from children with severe respiratory illness. Of the specimens tested by CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68.

In the upcoming weeks, more states will have confirmed cases of EV-D68 infection.

• The primary reason for increases in cases is that several states are investigating clusters of people with severe respiratory illness, and specimens are still being tested for EV-D68. It can take a while to test specimens and obtain lab results. That’s because the testing is complex and slower, and can only be done by CDC and a small number of state public health laboratories. As the backlog of specimens is processed, the number of states and confirmed cases will likely increase. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.
• Some of the increase will be from new EV-D68 infections since people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season.

http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-states.html

ISS Observation: When can I spot the International Space Station

Happy Tuesday Everyone!

As some of you are aware, I used to support base operations at NASA Wallops Flight Facility in Virginia. Although this post isn't medical in nature, sometimes taking a few minutes to go outside, look around and just take in the universe can be calming and rehabilitating (I know this because I actually did it last night). Below is a list of times that you can look up in your back yard and most likely see the ISS pass overhead. The times are for Waitsfield (05673) but if you go to the link at the bottom of this post you can input your own location. -- ENJOY!! CSW, RN

Observation of the International Space Station

The International Space Station (ISS) can easily be spotted with the naked eye. Because of its size (110m x 100m x 30m), it reflects a large amount of sunlight.

The best time to observe the ISS is when it is nighttime at your location, and the Space Station is sunlit. Often, such a viewing situation occurs in the morning before sunrise, or in the evening after sunset.

Visible passes

You find a list of the next sighting opportunities for your location below. The green bars indicate the brightness of the ISS on its pass.  The list contains all visible passes of the ISS during the next ten days. Please select a pass to get more details.

http://iss.astroviewer.net/observation.php?lon=-72.7798479&lat=44.1926386&name=05673

Tue, Oct. 07, 2014

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7:00:52 PM EDT

Dur.
3:56

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8:36:05 PM EDT

Dur.
1:35

Wed, Oct. 08, 2014

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7:46:47 PM EDT

Dur.
3:57

Thu, Oct. 09, 2014

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6:57:40 PM EDT

Dur.
5:58

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8:34:24 PM EDT

Dur.
2:05

Fri, Oct. 10, 2014

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7:44:48 PM EDT

Dur.
4:27

Sat, Oct. 11, 2014

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6:55:17 PM EDT

Dur.
6:34

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8:32:48 PM EDT

Dur.
1:56

Sun, Oct. 12, 2014

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7:43:03 PM EDT

Dur.
4:14

Mon, Oct. 13, 2014

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6:53:18 PM EDT

Dur.
6:14

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8:31:03 PM EDT

Dur.
1:33

Tue, Oct. 14, 2014

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7:41:17 PM EDT

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3:44

Wed, Oct. 15, 2014

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6:51:27 PM EDT

Dur.
5:41

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8:28:58 PM EDT

Dur.
1:14

Thu, Oct. 16, 2014

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7:39:17 PM EDT

Dur.
3:15

Fri, Oct. 17, 2014

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6:49:29 PM EDT

Dur.
5:16

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8:26:30 PM EDT

Dur.
1:09

First Vermont Case of EV-D68 Confirmed

For Immediate Release: October 2, 2014

CDC Confirms First Case of Enterovirus D68 in Vermont Child
Health Department Reminds Parents and Care Providers to be Watchful

BURLINGTON - The Vermont Department of Health today received the first confirmation from the Centers for Disease Control & Prevention that enterovirus D68 (EV-D68) is circulating in the state.

Of the two results received today, one was positive for EV-D68 and one was negative. The positive result was from a child younger than school age, who has since recovered.

"This confirms what we expected - that this particular virus is circulating in Vermont just as it is in most other states," said Patsy Kelso, state epidemiologist for infectious disease.

EV-D68 is one type of virus from a group of very common viruses called enterorviruses. The U.S. is currently experiencing a nationwide outbreak of EV-D68 associated with severe respiratory illness, but not all respiratory illnesses occurring now are caused by EV-D68.

"This is the season for respiratory illnesses - including enteroviruses - but we are not seeing any unusual increase or pattern of illness around the state," said Kelso. "We are reminding care providers and parents to be watchful and to get medical attention for anyone who is having difficulty breathing, or if symptoms are getting worse."

EV-D68 can cause infections with mild to severe respiratory illness, or no symptoms at all. Mild symptoms may include fever, runny nose, sneezing, coughing, and body and muscle aches. Severe symptoms may include wheezing and difficulty breathing.

Anyone can get infected with enteroviruses, but infants, children and teens who get infected are more likely to get sick. Children with asthma are at risk for severe symptoms from EV-D68 and other respiratory illnesses.

Enteroviruses, just like a cold or the flu, are spread through coughing or sneezing, contact with an infected person, or by touching objects or surfaces contaminated with the virus and then touching the mouth, nose or eyes. Not all clusters or outbreaks of respiratory illness occurring now are due to EV-D68.

To help keep illness from spreading:

*       Wash hands often and well with soap and water for 20 seconds

*       Avoid touching eyes, nose and mouth with unwashed hands

*       Avoid close contact such as kissing, hugging and sharing cups or eating utensils with people who are sick, or when you are sick

*       Cover your coughs and sneezes with a tissue or shirt sleeve - not your hands

*       Disinfect frequently touched surfaces, such as toys and doorknobs

*       Stay home and away from others when you are sick

There is no specific treatment for people with respiratory illness caused by EV-D68. It's important to stay as healthy as possible, and the Health Department advises anyone age 6 months and older to get vaccinated against the flu as early in the season as possible.

What We Know

States with Lab-confirmed EV‑D68 Infections

From mid-August to October 3, 2014, a total of 538 people in 43 states and the District of Columbia have been confirmed to have respiratory illness caused by EV-D68. Learn more about states with confirmed cases.

• EV-D68 infections have recently been documented across the United States.  
  • From mid-August to October 3, 2014, CDC or state public health laboratories have confirmed a total of 538 people in 43 states and the District of Columbia with respiratory illness caused by EV-D68. Learn about states with confirmed cases. This indicates that at least one case has been detected in each state listed but does not indicate how widespread infections are in each state.
  • Enteroviruses commonly circulate in summer and fall. We’re currently in middle of the enterovirus season, and EV-D68 infections are likely to decline later in the fall.
• Many state health departments have reported increases this year in cases of severe respiratory illness in children. 
  • This increase could be caused by many different viruses that are common during this time of year. EV-D68 appears to be the predominant type of enterovirus this year and may be contributing to the increases in severe respiratory illnesses.
  • Hospitals in Missouri and Illinois were the first to document this increase that was later identified to be caused predominantly by EV-D68 infection. Read more.
• CDC is prioritizing testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness. Of the specimens tested by the CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68. See map of states with lab-confirmed EV-D68 infections for more information.
• Almost all the confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing.
• EV-D68 has been detected in specimens from four* patients who died and had samples submitted for testing. The role that EV-D68 infection played in these deaths is unclear at this time; state and local health departments are continuing to investigate.

*Investigations are ongoing; CDC will review and update available data every Wednesday.

http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html

States with Lab-confirmed Enterovirus D68

From mid-August to September 30, 2014, CDC or state public health laboratories have confirmed a total of 472 people from 41 states and the District of Columbia with respiratory illness caused by EV-D68. The 41 states are Alabama, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This indicates that at least one case has been detected in each state listed but does not indicate how widespread infections are in each state.

CDC is prioritizing testing of specimens from children with severe respiratory illness. Of the specimens tested by CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68.

In the upcoming weeks, more states will have confirmed cases of EV-D68 infection.

• The primary reason for increases in cases is that several states are investigating clusters of people with severe respiratory illness, and specimens are still being tested for EV-D68. It can take a while to test specimens and obtain lab results. That’s because the testing is complex and slower, and can only be done by CDC and a small number of state public health laboratories. As the backlog of specimens is processed, the number of states and confirmed cases will likely increase. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.
• Some of the increase will be from new EV-D68 infections since people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season.

Mad Dash

Title Sponsor: Sugarbush Resort

Sunday, October 12, 2014, 10:00am
Meadow Road, Waitsfield, Vermont

A classic Vermont foot race benefiting the Mad River Path.
http://www.madriverpath.com/mad-dash.php

UPDATE: Enterovirus (EV-D68)

States with Lab-confirmed Enterovirus D68

http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html

From mid-August to September 22, 2014, a total of 175 people from 27 states were confirmed to have respiratory illness caused by EV-D68. The 27 states are Alabama, Arkansas, California, Colorado, Connecticut, District of Columbia, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Jersey, New York, North Dakota, Oklahoma, Pennsylvania, Virginia, Washington, and West Virginia. The cases of EV-D68 infection were confirmed by the CDC or state public health laboratories that notified CDC.

In the upcoming weeks, more states will have confirmed cases of EV-D68 infection.

·       The primary reason for increases in cases is that several states are investigating clusters of people with severe respiratory illness, and specimens are still being tested for EV-D68. It can take a while to test specimens and obtain lab results. That’s because the testing is complex and slower, and can only be done by CDC and a small number of state public health laboratories. As the backlog of specimens is processed, the number of states and confirmed cases will likely increase. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.

·       Some of the increase will be from new EV-D68 infections since people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season.

As investigations progress, we will have a better understanding of the trends for EV-D68 infections.