Department of Health and Human Services Commissioner’s Office

221 State Street 11 State House Station

Augusta, Maine 04333-0011 Tel.: (207) 287-3707; Fax: (207) 287-3005

TTY Users: Dial 711 (Maine Relay)

Vaccine-Preventable Diseases & Norovirus

Vaccine-preventable disease information included in this packet is pertussis (whooping cough), varicella (chicken pox), and influenza. Maine CDC continues to see cases of pertussis across the state and the majority of cases are in children ages 7 to 19 years old. Pertussis in schools can be problematic because it is highly contagious and fully vaccinated children are less likely to have the classic symptoms, making it difficult to diagnose. Varicella cases also continue to be seen in Maine and can spread in schools, especially among children that are not fully vaccinated. Influenza arrived early in Maine and greatly affects children.

Norovirus includes a group of viruses that cause “stomach flu” or gastroenteritis in people and are the most common cause of foodborne outbreaks. People with norovirus become sick with acute vomiting and diarrhea lasting 1-2 days. These viruses are extremely contagious and outbreaks are common in school/daycare settings.

Maine CDC recommends:

1. Reminding parents that they should not send a child to school if they are sick. 2. Encouraging good hand and respiratory hygiene. 3. Getting an annual influenza vaccination as soon as possible, including school faculty, children, and

families. 4. Encouraging kids with prolonged cough to seek medical attention. Remind them to tell their provider

that pertussis is in the school (if applicable) and stress the importance of testing. 5. Reminding parents of the importance of vaccination and verifying school/daycare vaccine records. 6. Reviewing Maine CDC’s monthly pertussis surveillance report, which indicates what counties the cases

are in and what ages are affected. These can be found at http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vaccine/pertussis.shtml#reports.

7. Not having people prepare food with gastrointestinal (GI) symptoms and for 2-3 days after they recover.

8. Reporting pertussis and varicella cases to Maine CDC. 9. Reporting outbreaks to Maine CDC with more than 15% absenteeism due to illness.

The materials in this section include:

• Posters: pertussis, varicella, influenza • Fact sheets: pertussis, varicella, influenza, & norovirus • Checklists: flu symptoms for families, schools experiencing a GI outbreak • School closure guidance for influenza absenteeism

To report a disease or outbreak, please call Maine CDC’s 24-hour Disease Reporting Hotline at 1-800-821-5821 or contact Maine CDC by email at disease.reporting@maine.gov. This email is not secure and personal information should not be sent. Epidemiologists are available to help you if you have any questions relating to vaccine preventable diseases or norovirus.

Whooping Cough:Experiencing symptoms? Been exposed?

Help stop the spread.Get tested.Get treated early.

Preventing the spread of whooping coughstarts with you.

www.MainePublicHealth.gov

Do you suspect Varicella

Think it? Confirm it. Report it.Varicella is caused by the varicella zoster virus. It is spread by coughing, sneezing, and contact witha skin lesions. An infected person can spread the disease up to 2 days before symptoms start and until all lesions are crusted. Persons with varicella should remain out of school or work until all lesions are crusted. Varicella can be prevented through vaccination.

Think about varicella when seeing persons with rash illness. Report all varicella cases to Maine CDC at 800-821-5821.

800-821-5821maine.gov/idepi

(chickenpox)

1. wash your hands

2. cover your cough

4. get vaccinated

3. stay home when you’re sick

Pertussis Fact Sheet

What is pertussis? Pertussis, or whooping cough, is caused by bacteria called Bordetella pertussis. Pertussis can be very serious, especially in infants. It mainly affects the breathing. What are the signs of pertussis? The first signs of pertussis are similar to a cold (sneezing, runny nose, low-grade fever, and a cough). These signs start 5 to 21 days after exposure. After one or two weeks of illness, the cough gets worse with symptoms that may include:

A sudden, uncontrollable cough where one cough follows the next without a break for breath.

A high-pitched whooping sound when breathing in after a coughing episode. Whooping is less common in infants and adults.

Vomiting after coughing

Exhaustion

Over time, coughing spells become less frequent, but may continue for several weeks or months.

How do you catch pertussis? Pertussis is spread from person to person through the air. A person has to breathe in droplets from an infected person to get sick. For example, a person may catch pertussis by standing close (less than 3 feet away) to an infected person who is coughing or sneezing. When and for how long can a person spread pertussis? Pertussis is most likely to spread to others early in the illness. Persons with pertussis can no longer spread the disease once they have completed 5 days of treatment with antibiotics. However, persons with pertussis who do not take antibiotics can spread the disease during the first 21 days they are sick. What are the complications? Severe pertussis is more likely in infants than in older children or adults. The most common complication of pertussis is pneumonia. Seizures,

swelling of the brain and death are rare but possible. Who gets pertussis? People of all ages can get pertussis, even people who have been vaccinated or have had pertussis infection in the past. It is most common in school-aged children and teenagers, but cases in adults also occur. Older children and adults usually have less severe illness, but they can still spread the disease to infants and young children. Is there any treatment? Pertussis can be treated with antibiotics. Treatment should be started early to prevent the spread to others and can lessen the symptoms of illness. A cough may continue for many weeks after treatment especially if treatment wasn’t started until late in the illness. Pertussis bacteria die off naturally after three weeks of coughing. Antibiotics are not recommended if a person has already been coughing for 21 days or more. Why did my healthcare provider tell me or my child to stay home for 5 days? You can still spread pertussis to others until you take 5 days of antibiotics. Disease can spread quickly in schools or the workplace. What will happen if I do not want to take the antibiotics? If you do not take the antibiotics, you will need to stay away from others for 21 days after you start to become sick. This includes staying home from daycare, school, work or events. Is there a lab test for pertussis? Yes. To test for pertussis, your healthcare provider may insert a swab (like a long q-tip) into your nose. The lab will test the material on the swab to see if they can find the bacteria that causes pertussis.

Created on 8/10/07. Updated 06/09/2016. Sources of Information: Centers for Disease Control and Prevention (accessed 9/10/2013)

Is there a vaccine for pertussis? Yes, there are vaccines. The childhood vaccine is called Dtap, and the Pertussis booster for adolescents and adults is called Tdap. People who catch pertussis after being vaccinated have milder illness and are much less likely to be hospitalized or die from the disease. Vaccines prevent 200,000 cases of pertussis each year in the US. Talk to your healthcare provider about getting vaccinated against pertussis. How can pertussis be prevented? Vaccinate all children on time. Speak with your healthcare provider to see if you should get a booster vaccine. This is the best way to prevent pertussis. Other ways to prevent pertussis are to:

Avoid close contact with others who are sick or coughing

Wash your hands often

Stay at home if you are ill

Cover your cough with a tissue or cough into your sleeve

Use routine cleaners and disinfectants to remove these bacteria from surfaces or objects.

See your healthcare provider if you have signs of pertussis or have been in close contact with someone who has pertussis.

Where can I get more information? For more information contact your healthcare provider or local health center. Infectious Disease Epidemiology website: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/index.shtml The federal Centers for Disease Control and Prevention website - http://www.cdc.gov – is another excellent source of health information.

Updated: 8/14/2015

Varicella (Chickenpox) Fact Sheet

What is Varicella? It is an infection caused by the varicella zoster virus. Who can get it? Anyone who is un- or under vaccinated or not immune from previous infection.

What are the symptoms? The most common symptoms are a skin rash on the face, scalp, and trunk. Most people have a fever, which develops just before rash appears.

Are there complications? Yes, skin infections, swelling of the brain, and pneumonia can occur. Adolescents and adults are more at risk for severe disease.

How soon do symptoms appear? Symptoms typically appear 14-16 days after infection, but can range from 10-21 days.

How is chickenpox spread? It can be spread by coughing and sneezing, direct contact, and contact with tiny liquid droplets from skin lesions. Surfaces of items like toys can also spread the virus if someone who is sick touches them without washing their hands, and someone else then touches the same surface and then rubs their eyes, mouth, or nose.

How long is an infected person able to spread the disease? An infected person can spread the disease up to 5 days before starting symptoms, but more commonly 1-2 days prior to onset of rash. The infected person remains contagious until all lesions are crusted (usually 5 days after start of symptoms).

What is the treatment for chickenpox? Infected persons who were otherwise healthy will not need specific treatment.

Do not use aspirin or products containing aspirin to relieve your child’s fever, as this has been known to cause Reye’s syndrome, a potentially fatal disease affecting all organs, but most seriously affecting the liver and brain. Use only non-aspirin medicines. Persons with poor immune systems from disease or drugs should contact their doctor immediately if they are exposed to or develop chickenpox. If you are pregnant and are either exposed to or develop chickenpox, you should immediately discuss your options with your doctor.

How do I protect myself and my family? Vaccine is the best prevention. Washing hands well and often with soap and teaching children to do the same is also important. Eating utensils should not be shared and surfaces that are frequently touched (toys, doorknobs, tables, counters, etc.) should also be regularly cleaned with soap and water or with cleaning wipes. Where can I get more information? Your healthcare provider or local health center will have additional information. You can also contact Maine Center for Disease Control and Prevention by calling 1-800-821-5821 or visiting the website http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vaccine/varicella.shtml. The federal Centers for Disease Control and Prevention website http://www.cdc.gov/varicella is another excellent source of health information.

Influenza Fact Sheet What is influenza (flu)? _____- Influenza, commonly called "the flu," is caused by the influenza virus, which infects the nose, throat, and lungs. Unlike many other viruses such as the common cold, the flu causes severe illness and life-threatening complications in many people.

What are the symptoms of the flu? Flu is a respiratory illness. Symptoms of flu include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. Children can have additional symptoms, such as nausea, vomiting, and diarrhea, but these symptoms are uncommon in adults. Although the term "stomach flu" is sometimes used to describe vomiting, nausea, or diarrhea, these illnesses are caused by other viruses, bacteria, or possibly parasites, and are rarely related to the flu.

When is the flu season in Maine? The flu season is generally from October through May, although flu may be found year round. Maine Center for Disease Control and Prevention (Maine CDC) monitors flu activity and provides reports each week from October through May.

How does the flu spread? _________ The main way the virus is spread is from person to person in droplets of coughs and sneezes. When a person coughs or sneezes the droplets can travel up to 3 feet and land on the mouth or nose of others. It is also possible to get the flu from touching a surface that has flu virus on it, and then touching your own mouth or nose (or someone else’s mouth or nose) before washing your hands.

Does the flu have complications? Yes. Some of the complications caused by flu include bacterial pneumonia, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes. Children may get sinus problems and ear infections after getting the flu. Those aged less than five years, 65 years and older and persons of any age with chronic medical conditions are at highest risk for serious complications of flu.

How can I prevent getting the flu? The single best way to prevent the flu is to get a flu vaccine each year. There are two types of vaccines:

The "flu shot" – an inactivated vaccine (containing killed virus) that is given with a needle. The flu shot is approved for use in people 6 months of age and older, including healthy people and people with chronic medical conditions.

The nasal-spray flu vaccine – a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for “Live Attenuated Influenza Vaccine”). LAIV is approved for use in healthy people 2 years to 49 years of age who are not pregnant.

About two weeks after getting the vaccine, antibodies develop that protect against the flu. Flu vaccines will not protect against other viral illnesses What are other steps that can be taken to prevent the flu? Maine CDC recommends following the “No Flu 4 You” Approach:

1. Wash your hands 2. Cover your cough 3. Stay home when you are sick 4. Get vaccinated

How soon will I get sick if I am exposed to the flu? The time from when a person is exposed to flu virus to when symptoms begin is one to four days, with an average of two days.

How do I find out if I have the flu? It is hard to tell the flu from other causes of respiratory illnesses on the basis of symptoms alone. A lab test can confirm that an illness is the flu if the patient is tested within the first two to three days after symptoms begin. In addition, a doctor's exam may be needed to determine whether a person has another infection that is a complication of the flu.

Updated 3/11/2016

If I got the flu last year, will I have immunity against the flu this year?________________ It is possible, but varies widely. Young and healthy people with strong immune systems will likely have good immunity against the same or closely related strains of virus from one year to the next. However, people with weakened immune systems are less likely to have immunity that carries over in other years.

Flu viruses are constantly changing, so antibody made against one strain will become less effective against new strains as they change over time. In addition, there are different types of flu viruses circulating and different strains within virus types. The same type of flu virus does not necessarily circulate each year.

How long is a person with flu virus contagious? Most healthy adults may be able to infect others from 1 day prior to becoming sick to 5 days after they first develop symptoms. Some young children and people with weakened immune systems may be contagious for longer than a week.

How many people get sick or die from the flu every year?_____________________________ Each flu season is unique, but it is estimated that, on average, approximately 5% to 20% of U.S. residents get the flu, and more than 200,000 persons are hospitalized for flu-related complications each year. About 36,000 Americans die on average per year from the complications of flu.

How long can flu viruses live on hard surfaces (such as books and doorknobs)? Flu viruses generally can survive on hard surfaces for between 2 and 8 hours.

What kills the flu virus? _________ Routine soaps, disinfectants and alcohols are effective against flu viruses if used properly. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed until they are dry.

What is novel or variant flu? Novel or variant flu is any type of flu strain that is not commonly seen. This can include flu viruses that are normally found in pigs, birds, dogs, bats or other animals. How bad the novel strain is

depends on many things, and may be different for each novel type. Symptoms of novel flu are usually the same as regular flu. Lab testing is required to find out if a strain is a common one, or a novel one. The “No Flu 4 You” approach should also be used to prevent novel flu. Where can I get more information? For more information contact your healthcare provider or local health center. You can also contact Maine Center for Disease Control and Prevention by calling 1-800-821-5821 or visiting the website www.maineflu.gov. The federal Centers for Disease Control and Prevention website - http://www.cdc.gov/flu – is another excellent source of health information.

Department of Health and Human Services Commissioner’s Office

221 State Street 11 State House Station

Augusta, Maine 04333-0011 Tel.: (207) 287-3707; Fax: (207) 287-3005

TTY Users: Dial 711 (Maine Relay)

Guidance for School Administrators during Prolonged Elevated Student Absenteeism

School that experience greater than or equal to 15% absenteeism among students may also experience prolonged and higher rates of absenteeism among students and staff. School administrators may benefit from consistent guidance to plan steps that can be taken if the school continues to experience elevated absenteeism. Closing school is at the school administrator’s authority. Maine CDC is available to consult with schools at any time by calling 1-800-821-5821. The following questions are intended to provide guidance to schools as they consider disease control activities and potential closure.

1. Are the majority of absent students ill with a common infectious disease? 2. Is the number of absent students less than the number being served by programming? 3. Is there sufficient staff to continue programming in a safe and structured environment? 4. Are there other prevention and control strategies that can be implemented in advance of closure

or significantly changing programming?

a. Consider environmental or programming changes in cafeteria, gym or classroom activities that may curb transmission, such as suspending combined classes, reading buddies, close contact activities, and afterschool events.

5. Will transmission of the illness be interrupted by school closure? 6. If school closes, how will parents and families accommodate a closure?

Last reviewed 09/18/2017

Department of Health and Human Services Commissioner’s Office

221 State Street 11 State House Station

Augusta, Maine 04333-0011 Tel.: (207) 287-3707; Fax: (207) 287-3005

TTY Users: Dial 711 (Maine Relay)

Flu Symptom Checklist for Families Confirmed cases of influenza have been identified in Maine. We expect that we will continue to detect cases into the fall and winter, and that the number of cases may increase. As we strive to keep everyone healthy this school year, it is most important that students and adults who are sick not go to school, work, or social activities. The following checklist can help determine if someone has influenza-like illness (ILI). Does my child have the flu? Yes No Does your child have a fever of 100 degrees of more? Yes No Does your child have a cough? Yes No Does your child have a sore throat?

Should I keep my child home? If you checked yes to: Fever of 100 degrees or more And A cough or a sore throat Your child has an influenza-like illness. Keep your child home for 24 hours after the fever resolves without the use of medication. If you checked yes to only one of the questions above, or if your child is ill with other symptoms, keep your child at home at least one day to observe for additional symptoms. If additional symptoms develop, use the checklist questions again to decide whether to continue to keep the child home.

When should my child go to the doctor? Call your doctor or seek medical care if your child has trouble breathing or has behavior changes including changes in eating or drinking habits. Call your health care provider if your child is ill enough that you would normally seek health care advice. For more information please see www.maineflu.gov

Norovirus Infections Fact Sheet

What are noroviruses? Noroviruses are a group of viruses that cause diarrhea and vomiting in people. What are the symptoms of illness? The symptoms include nausea, throwing up (vomiting), diarrhea, and some stomach cramping. Sometimes people also have a low-grade fever, chills, headache, muscle aches, and tiredness. The illness often begins suddenly. The illness is usually short, with symptoms lasting 1 or 2 days. Children have more vomiting than adults. When do symptoms appear? Symptoms usually start about 24 to 48 hours after swallowing the virus, but can appear as early as 10 hours after exposure to the virus. How do people become ill? The virus is found in the stool (poop) or vomit of sick people. People can become sick with the virus in several ways, including:

eating food or drinking liquids that are contaminated with norovirus

touching surfaces or objects contaminated with norovirus, and then placing their hand in their mouth

having close contact with another person who is sick, for example:

o being present while someone is throwing up

o sharing food or utensils

o drinking waters or liquids from the same cup/bottle

o caring for a sick person

o shaking hands

Persons working in daycare centers or nursing homes should pay special attention to children or residents who are sick with diarrhea and vomiting. This virus is very contagious and can spread quickly in these settings.

Is the virus contagious? Norovirus is very contagious and can spread easily from person to person. Both stool and vomit can spread the virus. Special care should be taken with young children in diapers who may have diarrhea. How long can people pass the virus to others? Sick persons can spread the virus from the moment they begin feeling sick and for at least 3 days after illness ends. Some people may be able to spread it for as long as 2 weeks after feeling better. It is important for people to use good hand washing even after they feel better. Who gets sick? Anyone can become sick. There are many different strains of norovirus, which makes it difficult for a person to become immune and they can become sick more than once. Some persons develop more severe illness than others because of differences in the virus and a person’s existing medical conditions. How serious is the illness? Illness is usually not serious, although people may feel very sick and throw up many times a day. Most people get better within 1 or 2 days, and they have no long-term health effects related to their illness. Sometimes people are unable to drink enough liquids to replace the liquids they lost because of vomiting and diarrhea. These persons can become dehydrated and may need special medical attention. Symptoms of dangerous fluid loss include a decrease in urine, dry mouth and throat and feeling dizzy when standing up. Children who are dehydrated may cry with few or no tears and be unusually sleepy or fussy. This problem is usually only seen among the very young, the elderly, and persons with weak immune systems. Is treatment available? There is no medicine to treat norovirus. The virus cannot be treated with antibiotics, because antibiotics work to fight bacteria and not viruses.

Updated on 9/9/2015 Source of Information: Centers for Disease Control and Prevention http://www.cdc.gov/norovirus (accessed 8/30/2015)

Illness is usually brief in healthy persons. When people are sick with vomiting and diarrhea, they should drink lots of fluids to prevent dehydration. By drinking juice or water, people can reduce their chance of becoming dehydrated. Can illness be prevented? Yes. You can decrease your chance of illness by following these steps:

Wash your hands often with soap and water and dry hands with a disposable towel

o after toilet visits

o after changing diapers

o before eating or preparing food

o after touching animals

Carefully wash fruits and vegetables

Cook oysters thoroughly before eating them

Thoroughly clean and disinfect contaminated surfaces after an episode of illness by using a bleach-based household cleaner or EPA-registered disinfectant (http://www.epa.gov/oppad001/chemregindex.htm)

Immediately remove and wash clothing or linens that may be contaminated with virus after an episode of illness (use hot water and soap and dry at highest temperature possible)

Flush or discard any vomit and/or stool in the toilet and make sure that the surrounding area is kept clean

Ill persons should not prepare food while they have symptoms and for 2-3 days after symptoms end

Should I work or go to school if I am sick?

Persons employed in food service or who prepare food for others should not prepare food while they have symptoms and for 2-3 days after they recover from their illness

Daycare and school-aged children should stay home while they have symptoms

Healthcare workers should stay home while they have symptoms

Is a vaccine available? No. There is no vaccine available for norovirus. Is norovirus common? Norovirus is common in Maine and in the rest of the country. The federal CDC estimates that 21 million cases of acute gastroenteritis per year are due to norovirus. Because the virus is so common, especially in the winter months, the Maine CDC only investigates outbreaks. Outbreaks in nursing homes, schools and other community settings are not uncommon and occur every year. Where can I get more information? For more information contact your healthcare provider or local health center. You can also contact the Maine Center for Disease Control and Prevention by calling 1-800-821-5821 or visiting www.maine.gov/idepi. The federal Centers for Disease Control and Prevention website - http://www.cdc.gov/norovirus – is another excellent source of health information.

Updated 9/2017

Department of Health and Human Services

Maine Center for Disease Control and Prevention

286 Water Street

11 State House Station

Augusta, Maine 04333-0011

Tel: (207) 287-8016; Fax (207) 287-9058

TTY Users: Dial 711 (Maine Relay)

Checklist for Schools Experiencing a GI Outbreak

Recognition, Reporting & Testing

□ Upon suspicion of a norovirus outbreak, notify Maine CDC by calling 1-800-821-5821 or emailing

disease.reporting@maine.gov (please no patient information)

□ Obtain an outbreak number from Field Epidemiologists for identification purposes: #_________

□ Maintain a line listing of symptomatic students and staff

□ Recommend and/or submit 3-5 specimens from affected students and staff as soon as an outbreak is

suspected

□ Follow Maine Health and Environmental Testing Laboratory (HETL) guidelines for specimen

collection, handling, and transport; label specimens with Outbreak #

□ Outbreak is consider resolved when 96 hours (2 incubation periods) has elapsed from last onset of

symptoms

Control Measures:

Infection Control:

□ Exclude any ill staff or student from school setting and school related activities

□ Minimize the number of group activities, such as parties and field trips, until the outbreak is over

□ Enforce strict hand hygiene for all staff and students, including washing hands with soap and water

after contamination with vomit or feces

□ Supplement hand washing with soap and water with ethanol or alcohol-based hand sanitizers

□ Implement cleaning procedures in buses and other vehicles used for official school transportation

□ Food service staff should not handle food if they have been recently ill with any gastrointestinal

symptoms until they can be interviewed/further evaluated by public health professionals.

Environmental Controls:

□ Clean all high traffic areas and high touch items (faucets, door handles, and toilet or bath rails)

□ Use EPA-registered disinfectants or detergents/disinfectants approved for use against norovirus for

routine cleaning and disinfection (include link)

□ Clean soiled carpets and soft furnishings with hot water and detergent or steam clean as appropriate

□ Handle soiled linens carefully using appropriate infection control precautions

□ Conduct thorough cleaning of affected personal and communal areas 48 hours after resolution of the

last case

Administrative Controls:

□ Exclude ill staff from work for at least 48 hours after symptoms have resolved

□ Minimize group activities as much as possible until after the outbreak is contained. Consider

risks/benefits of limiting salad bars and areas of food service that enhance hand touching

□ Post signage about the outbreak and proper hand hygiene

Internal and External Communications

□ Identify a single point of contact for internal communications

□ Identify a single point of contact for external communications

□ Notify staff of outbreak and control measures and conduct enhanced surveillance for ill staff

□ Notify parents and guardians of the outbreak, control measures taken, to watch for symptoms, and

request the school nurse be notified of gastrointestinal illness

□ Consider a final communication to staff, students, parents, and guardians when the outbreak has

resolved