The election is on March 3, 2020 at the Vienna Community Center from 8am to 8pm.  

Absentee ballots are now available for the March 3, 2020 Presidential Primary Election.

The last day for absentee voting requests is February 27 without Special Circumstances.

There are primary ballots for the Democratic Party and the Republican Party. 

There is also a Special Referendum ballot. The ballot reads:

Question 1 - Do you want to reject the new law that removes religious and philosophical exemptions to requiring immunization against certain communicable diseases for students to attend schools and colleges and for employees of nursery schools and health care facilities?

 A "Yes" vote rejects the new law and maintains religious and philosophical exemptions to     immunization requirements

A "No" vote approves the new law, which removes religious and philosophical exemptions to immunization requirements.

The Maine Green Independents Caucus is 2pm Saturday, March 7 at the Vienna Community Center.  New and unenrolled voters may register as a Green Independent starting at 1pm before the meeting begins. The caucus is being called by Bob Weingarten, 293-2630

The Maine Democratic Caucus is March 8. Registration is 1pm and the caucus starts at 2pm at the Vienna Community Center.

The Maine Republican Caucus is February 22. Registration is 9am and the caucus starts at 10am at the Gardiner Boys and Girls Club at 14 Pray Street, Gardiner ME.

Immunizations for School Children

Dan Onion, MD, MPH

Mt. Vernon/Vienna Health Officer

293-2076; dkonion@gmail.com

January 2020

I was puzzled last week by this political poster at the corner of Castle Island Rd and Rte 27: “Reject Big Pharma”? And what’s “1”?  I suspected a referendum question and was aware that the new school vaccination law had been put on hold until a veto referendum could be held, and I wasn’t sure when or if “1” was it. I hadn’t heard of any other referendums, so I went hunting on the internet and by gory it is about that school vaccine referendum indeed! The vote on the recall is to be held state-wide on March 3^rd. This is an important public health issue, so I think it appropriate for me, who, as town health officer, is charged with Vienna’s and Mt Vernon’s populations’ health, to write about it. 

The medical background.

Infectious disease epidemics occur when disease germs are passed from person to person easily (hence “communicable”) and threaten people’s health and lives. The following immunizations are currently required for children to attend public school in Maine. All but tetanus are communicable, which means they are caught from those around us, who are already infected and spreading the disease: 

•Measles (rubeola), a potentially fatal disease in young and/or sickly children, especially in developing countries where it has a 2-10% mortality; in rare cases it can cause an encephalopathy (brain inflammation) 20 years later in adults who had cases as children. Maine had its first measles case in 20 years in 2018, and a 2nd last year. Right now, there are measles epidemics spreading across the country with nearly 1250 cases reported nationally last year, the most since 1994. The closest cases are in Massachusetts; last year New York state had the most in the US. That recrudescence of measles nearby probably played an important role in pushing the Maine legislation (LD 798) allowing vaccination exemptions only for medical reasons through this past year. Vaccines were developed and have been widely available since the 1960s.

•German measles (rubella) doesn’t bother the children infected much, causing only mild rash and fever, but it does cause serious birth defects in the unborn fetus if pregnant mothers are not immune already. The last case in Maine was in 2008. Vaccines were developed and available in the 1960s. 

•Chicken pox (varicella) makes infected people, usually children, very sick with bad fever and rash which can get secondarily infected with staph and strep germs; in teens and adults it can cause bad lung scarring. In 2018 there were 252 Maine cases, and 72 in 2019. Vaccines were developed and available in the 1990s.

•Mumps, still relatively rare since widespread vaccination has been achieved, at least for now. It causes fever and salivary gland swelling, occasionally a viral meningitis, but in teens and adults can cause testicular inflammation and damage, pneumonia, joint damage and even pancreatitis. There were 5 Maine cases of mumps in 2019. Vaccines developed and available in the 1960s.

•Polio has been nearly completely eradicated in the world with the exception of some pockets in India and the far East. However, a traveler from those regions could cause an outbreak. Unlike the others, it is spread not by respiratory droplets but by the “fecal-oral” route. Public swimming pools or dirty hands used to be the most common source before the vaccines became available in the 1950s

•Whooping cough (pertussis) is tolerated fairly well by anybody over age 2 or 3, although it may cause persistent cough (“cough of a 100 days”), which continues spreading it. The big danger is mortality in young children, especially newborns up to 6-9-months, who are too young to vaccinate but run out of their mother’s immunity (given them via the placenta before birth or through breast milk), or whose mothers have no immunity to give because they weren’t vaccinated themselves. Half of children under 3 months with whooping cough require hospitalization and some die every year in the US, none in Maine yet that I know of. In 2018 there were 446 Maine cases, and 327 in 2019. Vaccines were developed and available in the 1940s.

•Diphtheria is pretty rare now after 80 years of effective vaccinations, beginning in the 1940s, but a few pockets of persistent disease exist in homeless populations which pose a continuous epidemic threat

•Meningococcal meningitis, a bad, disabling, often fatal disease, occurs in epidemics, often when young adults are crowded together, as with army recruits or college students. Maine had 4 cases last year. Vaccines available since 1950s, but the combination of all 4 common meningococcal types in one vaccine became available only in 2005.

•Tetanus (lock jaw), caused by germs in dirt, does not cause epidemics. Usually a fatal disease in the un-immunized. Just last year tetanus nearly killed an unimmunized farm boy in Oregon. But it has been quite rare since vaccinations began during WWII and shortly thereafter in schools. 

Currently Maine law requires all public and private schools to assure that all students have had the following immunizations, with some students exempted for medical reasons, like other diseases which could worsen because of the shots (see below)

•Required for kindergarten entry:

-5 DTaP (diphtheria, tetanus, acellular pertussis [whooping cough])

-4 Polio 

-4 MMR (measles, mumps, rubella [German measles])

-1 Varicella (chickenpox) or reliable history of having had the disease

•Required for 7^th grade entry: 

• 1 Tdap
• 1 Meningococcal conjugate (MCV4)

•Required for 12 grade entry:

-2 Meningococcal conjugate vaccinations; only 1 dose, if 1^st given after 16^th birthday

The politics of it all

“Community immunity” is an important aspect of successful vaccination strategies, as is clear in population studies of epidemics in highly vs less highly immunized communities. These studies have demonstrated fewer and less extensive epidemics once vaccination rates achieve 94-96% levels, presumably because there are no longer enough unimmunized people to sustain ongoing cycles of infections. Preventing disease in 95% of individuals has the spin off benefit of decreasing disease likelihoods in the remaining unimmunized 5% once the 95% rate is achieved. That has allowed a few, <5%, not to be vaccinated for religious or medical reasons ever since these laws were established beginning in the 1940s. Back then the shots were only for diphtheria, tetanus, and whooping cough. Gradually 6 more have been added to the list, all of which have reduced greatly the incidence of these diseases. In addition, several other vaccines are now available and recommended for children for diseases that don’t cause epidemics. Examples are the pneumococcal and Hemophilus vaccines against germs that live in our respiratory tract and cause significant injury and death in children and adults from overwhelming respiratory tract infections. The same is true for hepatitis, and perhaps Rotovirus now. About 20 years ago in Maine, a third exemption option was legally added for parental “philosophical” reasons. That exempted number has grown to about 5% alone, which now, on top of the medical and religious exemptions, has put Maine over the critical 5-6% number (see bar graph below). This increase in exemptions, combined with the growing whooping cough epidemic in Maine, large national measles epidemics in the past few years, and the difficulty with defining justifiable religious exemptions have led to the new Maine law in April 2019 to eliminate all exemptions except medical ones.   

Different states have different approaches to these exemptions (see map below). Many have or are contemplating greater exemption restrictions.

National data for 2018 not yet available

Things have changed a lot since “the good old days.” Twenty years ago, I began seeing whooping cough cases for the first time in my professional life, right here in Kennebec County. Children now get many more vaccinations, and because of that, many fewer serious illnesses. A good thing, since we have many fewer children around. When I started practice in Maine in 1972, the state had 25,000 births per year. Smaller family size has cut that number to around 12,500 now. Many other medical risks have been reduced over these decades. Child car seats and safer cars have dramatically reduced traumatic injury and death for adults and children. Medical advances save many more children and adults. All these improved survivals have allowed more and more people to reach their old age, a “squaring off of the survival curve”, as epidemiologists call it when the survival curves look more and more like a rectangle than a right triangle (compare 1900 with 1997 in the graph). A big part of this “squaring off” is due to improved immunizations against childhood diseases, eliminating that awful 20% mortality in the first 5 years of life one sees on the 1900 graph line. 

So, the existential question is: do individual parental rights to reject immunization of their own children trump effective immunization for the whole community, when the consequence is that these individual choices are bringing back old days-type epidemics. There is understandable parental reluctance about more and more childhood immunizations, and their not wanting those vaccinations to be a requirement for a public education. The referendum #1 sign gives no explanation of these complicated issues; its only plea, to “reject big pharma”, is particularly puzzling. Pro and con donations certainly don't look like “big pharma” is in the game, about $65,000 for the con and $350,000 for the yes vote on #1 on December 31. Plus, virtually all these childhood vaccines are provided free to children through State and Federal mass purchases. The Federal Center for Disease Control works closely with the vaccine manufacturers to assure high quality and improve and supply vaccines quickly when changes are needed. As Dianne Clay of Litchfield recently said in the Kennebec Journal, ”….we pay outrageous prices for many important medications. However, the drugs that are putting a strain on the family budget are not vaccinations for our children. No one should be advocating for us to stop using these medications that have kept us safe all these years. These signs are misleading.”

 I think we need more, not less or misleading, information, to understand the issues. I am impressed that the combined medical and religious exemptions policy did keep the exempt number under 5% for a long time. It is the “philosophical” exemptions that have risen intolerably high. I have learned that the legislators heard no objections from organized religion representatives in their public hearings. So, lacking a third option to eliminate only the “philosophical” one, I will vote for trying out the new law and vote No on Referendum question #1 on March 3 to protect all our children.

It has been a long road from the days of many serious common diseases, to the present where immunizations offer significant protections, but only imperfectly, unless all participate. If we are to live, work, and play together, we cannot allow immunization opt-outs, any more than we can allow driving on the wrong side of the road. Parents falsely hoping to protect their own children by avoiding vaccinating them appropriately, jeopardize their health and that of all our children. 

Helpful references:

https://wgme.com/news/local/new-maine-law-tightening-vaccination-rules-has-an-exception-for-special-ed-students

https://ballotpedia.org/Maine_Question_1,_Religious_and_Philosophical_Vaccination_Exemptions_Referendum_(March_2020)

MINUTES OF THE REGULAR MEETING OF THE VIENNA

PLANNING BOARD HELD OCTOBER 23, 2019

The meeting convened at the Town House at 7:00 PM. Regular members present were Waine Whittier, Alan Williams, Creston Gaither, Ed Lawless, and Tim Bickford. Mark Rains was also present. Creston had invited the Ordinance Review Committee to this meeting but they did not attend.

Mark inquired as to steps necessary to construct solar electric panels in his meadow. He was advised of Shoreland Zoning Ordinance setback and permitting requirements. He said the prospective site might also lie within the floodplain. The Board said it would have to review the Floodplain Management Ordinance in order to say what the administrative requirements would be.  No formal action was taken.

It was suggested that the Board combine its November and December meetings into one meeting on December 11 and make this a public hearing on a proposed setback ordinance. Creston will advertise this as such.

Waine will draft a first draft of said ordinance.

Creston will bring Paul Fontaine’s SZO permit to the next meeting.

The meeting adjourned at 7:40 PM.

                                                                                Creston Gaither, secretary

MINUTES OF THE REGULAR MEETING OF THE VIENNA

PLANNING BOARD HELD DECEMBER 11, 2019

Regular members Creston Gaither and Ed Lawless met briefly and informally with Sue Burns, at the Town House at 7:00 PM. Tonight’s meeting having been advertised as a public hearing on the proposed Setback Ordinance. Lacking a quorum for a Planning Board meeting, the public hearing began at 7:10 PM. Sue said the draft Ordinance may not have sufficient “boilerplate language,” i.e. indicating legislative authority,etc., to hold up legally, and suggested that the Ordinance should clarify that if a right-of-way line can be determined, the required setback should be 15 feet from that line. She agreed to provide suggested revisions for the Board’s consideration.

Alan Williams arrived at 7:15 PM and was elected Acting Chair in Waine Whittier’s absence.The Board’s meeting began at that point, a quorum now being in place. Minutes of the October 23 meeting were read and accepted. The public hearing, and discussion of the proposed Setback Ordinance resumed at 7:20 PM.

It was suggested that the word “on” in paragraph 3 in the draft should probably be “or.”

Creston suggested that the Ordinance needs  language regarding enforcement, and suggested that it replicate the Notification of Construction Ordinance language in that regard.

It was agreed that final edits on the Ordinance could wait until the Board’s next meeting.

The meeting adjourned at 7:50 PM.

                                                                                Creston Gaither, secretary

Nomination papers from the Town Clerk are available for the following:

• 1st Selectman - 3 year term
• RSU #9 School Board Representative -  3 year term

Deadline for filing is Jan 28, 2020

MINUTES OF THE REGULAR MEETING OF THE VIENNA

PLANNING BOARD HELD APRIL 24, 2019

At 6:00 PM regular members Waine Whittier, Alan Williams, Creston Gaither, Ed Lawless, and Tim Bickford met with builder Eric Kinney at Becky Davis’s Kimball Pond property, depicted on 2019 tax map 3 as lot 8-K, to discuss a proposed addition on the south side of  the cabin on the parcel; he was advised that the addition would not be permissible as the cabin’s existing footprint lies in part less than 25 feet from high water mark. Rules for expansion of non-conforming structures were briefly outlined but no formal action was taken.

At 7:00 PM the regular members listed above convened the Board’s regular meeting at the Town House. Jim Meader and Dave Gifford were also present.  Minutes of the March 27 meeting were read, corrected, and accepted. Dave’s Flying Pond application (see March minutes) was reviewed. His written soil erosion control plan was reviewed. The Board had visited the site in March and has received Dave’s site plan and SSWD permit.

Based on its site visit and on Dave’s verbal representations and his sketch, and a subsequent examination of the pertinent flood hazard map, the Board determined that the project as outlined in March:

1. Will maintain safe and healthful conditions;
2. Will not result in water pollution, erosion, or sedimentation to surface waters;
3. Will adequately provide for the disposal of all wastewater;
4. Will not have an adverse impact on spawning grounds, fish, aquatic life, bird or other wildlife habitat;
5. Will conserve shore cover and visual, as well as actual, points of access to inland waters;
6. Will protect archaeological and historic resources as designated in the comprehensive plan;
7. Will avoid problems associated with floodplain development and use; and
8. Is in conformance with the provisions of Section 15, Land Use Standards.

It was voted 5 – 0 to authorize Creston to issue the usual permit by letter for this proposal; he had prepared a draft of the permit and it was issued at this time.

The meeting adjourned at 7:30 PM.

                                                                                Creston Gaither, secretary

MINUTES OF THE REGULAR MEETING OF THE VIENNA

PLANNING BOARD HELD AUGUST 28, 2019

The meeting convened at the Town House at 7:00 PM. Regular members present were Waine Whittier, Alan Williams, Creston Gaither,  and Ed Lawless. Minutes of the July 24 meeting were read and accepted. Also present were Paul Fontaine and, briefly, Lew Emery.

Paul Fontaine appeared regarding his Flying Pond property depicted on tax map 11 as lot V-19-21. He would like to build a 4’ x 25’ staircase there between the road and the pond. The Board visited the site on June 26 and thus felt that no new site visit was necessary. Paul presented a sketch of the proposal and the Board briefly reviewed Section 15.B.(6) of the Shoreland Zoning Ordinance (SZO) and found that the staircase would be permissible if limited to 4 feet in width.

Based on its on-site observations and Paul’s sketch and  verbal representations, and a subsequent examination of the pertinent flood hazard map, the Board determined that the project as outlined above:

1. Will maintain safe and healthful conditions;
2. Will not result in water pollution, erosion, or sedimentation to surface waters;
3. Will adequately provide for the disposal of all wastewater;
4. Will not have an adverse impact on spawning grounds, fish, aquatic life, bird or other wildlife habitat;
5. Will conserve shore cover and visual, as well as actual, points of access to inland waters;
6. Will protect archaeological and historic resources as designated in the comprehensive plan;
7. Will avoid problems associated with floodplain development and use; and
8. Is in conformance with the provisions of Section 15, Land Use Standards.

The Board then voted 4 – 0  to authorize Creston to issue the usual SZO permit by letter for this work.

The Zweigbaum situation was discussed (see July minutes). It has been reported that a recreational vehicle (RV) is in place on the gravel pad. Should it become clear at some point  that the RV has been in place for more than 120 days it was agreed that the Code Enforcement Officer should be notified as per SZO requirements.

Alan suggested that the Board present an ordinance to the Town to create uniform setback requirements throughout the Town so that  we don’t have different requirements in the shoreland zone and in subdivisions and elsewhere. Creston will email the Ordinance Review Committee and invite them to the Board’s September meeting to discuss this informally.

Waine will miss the next meeting.

The meeting adjourned at 7:35 PM.

                                                                                Creston Gaither, secretary

MINUTES OF THE REGULAR MEETING OF THE VIENNA

PLANNING BOARD HELD SEPTEMBER 25, 2019

The meeting convened at the Town House at 7:00 PM. Regular members present were Alan Williams, Creston Gaither, Ed Lawless, and Tim Bickford.

Alan was elected Acting Chairman in Waine Whittier’s absence. Minutes of the August  28 meeting were read and accepted. 

Larry Bacon’s email of Sept. 22 was read aloud and discussed. The Board then voted 4 – 0 that the propane tank enclosures he describes should be considered a “structure” as defined by the Shoreland Zoning Ordinance and would thus require both a SZO and a Notification of Construction permit. Creston will advise Mr. Bacon of this.

Ed reported on the Broadband Committee. Consolidated and Spectrum have offered to present options but as yet have not done so. 6 Towns are on the Committee but some of them seem to have diverse concerns. A consultant is to give a report in a few months providing specifics on services and cost. Advantages of satellite service over fiber to the home were discussed. Ed suggested that Vienna and Mt. Vernon consider forming a small co-op to do broadband on their own.

The meeting adjourned at 7:30 PM.

                                                                                Creston Gaither, secretary

How’s your Hearing—What??

Dan Onion, MD, MPH

Mt. Vernon/Vienna Health Officer

293-2076; dkonion@gmail.com

December, 2019

This column is largely about public health issues, i.e. issues that have a general population health impact. Most often those involve the prevention of diseases with direct or indirect effects beyond the individual to at least portions of the rest of the population, as immunizations do.  Last month I wrote about sleep, which has only indirect public health implications resulting from sleepy people driving home from work or elsewhere, or generally not being their best. Mt. Vernon’s John Olson thanked me for the insights it gave him and suggested I might write about hearing loss as a sequel. The only public health issues there are in the possibilities in preventing or diminishing the afflictions; nevertheless, I suspect hearing loss is of interest to many, so here goes!

Deafness is a relatively rare condition until people reach retirement age. Sure, a few youngsters suffer it, but by the time people reach age 70, nearly half of them are significantly deaf by formal testing. Deafness rapidly develops in most of the other half over the next 2 decades; well over 90% over 90 suffer have hearing loss, according to epidemiologic statistics. That number seems a little high to me, but many with the disease hide it well; for instance, they start agreeing with me after the first repeat, even though they have no clue what I just said. So, my impression of how many have significant hearing loss, is undoubtedly an undercount.  

Almost all deafness is due to injury or blockage of both ears. Thank the Lord we are given two ears by evolution, so knocking out one ear is only a minor inconvenience.  Here is how hearing works. Each ear is made up of 3 parts: 

•External ear, the ear lobe and canal

•Middle ear (the ear drum, ear bones, and the air-filled space drained by the Eustachian tubes to the back of the throat

•Inner ear, very complicated, containing:

-Semi-circular canals, like 3 small gyroscopes lined with hair-cell, which, via the 8th cranial nerve, alert the brain where little sand grains inside each canal land, in 3 dimensions, to tell you where you are in relation to gravity

-Cochlea, another long, coiled tube like a snail shell, also lined with hair cells that are twitched by each different frequency in the normal hearing range, low to high, roughly 0.5-2.5 cps [cycles per second, or “Hertz”) 

Deafness is caused predominantly by presbycusis, Greek for “old hearing”, which means the cumulative effects of aging on hearing, almost always from recurrent exposure to loud (at or over 85 decibels) noise, be it music, chain saws, or many other things you can imagine. That level  is a consensus of professionals, although there are no national standards or clinical trials (not surprising, since who would volunteer to be a subject in a study where they might be subjected to high decibel noise daily for many years, to see what happens!) Loud noise repeatedly hitting the middle C hair cell in the cochlea, causes that cell eventually to be damaged. The high-pitched hair cells above high C are the most sensitive to such injury. So, high pitch hearing is usually lost first. And because consonants provide a major part of word meaning, the loss of their whispery, high pitched sounds severely impacts a person’s ability to interpret other’s speech. Vowel sounds are in the 0.5-1.5 cps range and hence are lost much later. Manifesting very similarly is much rarer interference or damage to the auditory nerve from medicines, like the reversible ear-ringing caused by aspirin in moderately high doses (over 1 gm daily), permanently from some medicines, classically antibiotics, like streptomycins, or other diseases like Menniér’s Disease. These types of losses are all categorized as a Sensory-Neural (S-N) hearing loss.

The second most common contributor to presbycusis is ear wax in the external ear. Usually this normal mixture of dead skin, sweat and oil stays soft and leaks out of the canal on its own or with the help of warm water in dry climates like winter. But if it does not, it can build up into very firm, dark -brown plugs. Ineffective efforts to dislodge it with fingers, Q-tips or other tools can pack it even more firmly against the ear drum causing a “conductive” hearing loss. Ironically hearing aids do this very well too. Older people have less oily skin secretions and hence get this condition more easily. Usually it can be prevented by simply running warm water into the ear canals while bathing or showering. And for people with recurrent wax impaction and resultant conductive hearing loss, a family member can gain the skill of looking in there weekly or monthly to prompt more room temperature water irrigation with a bulb syringe and frequent ear drops to soften the impacted wax.

Clinicians can distinguish between S-N and conductive hearing loss by looking in the ear and with simple tuning fork tests called Rinné and Weber. 

So, what can we do to help/cope?

First, prevention: 

•Avoid loud noise damage. Ear protectors work fine, though they can be uncomfortable on a hot summer day. Wear them or ear plugs, which I think are a little less good because they are harder to get a good fit. Make your nearly adult kids to protect their hearing at concerts or using machines; they may thank you decades later.

•Be sure you are not given medicines that can cause permanent damage unless you must have it to survive.

•Run bath water into your ear canals while bathing 

Second, accommodate:

• If wax impaction occurs, regularly check for impacted wax and irrigate the ears clear.

•Speak in low frequencies to presbycusis sufferers. Men’s voices work better than women’s; women can speak in their lowest voices. Don’t shout; that diminishes the clarity of consonants, which are crucial to understanding speech. Look at the person, so they can see your lips move; use confirming gestures. They can begin to learn lip reading that way.

•Hearing loss accompanies dementia often, and each makes the other worse. Isolation can be due to either, and accommodating hearing loss can slow progression of dementia.

•Hearing loss also causes depression; sufferers withdraw from contacts because of frustration with not being able to participate in conversations. Find ways to engage anyway.

•Many users experience “recruitment,” which is a condition where the useful loudness of sound lies in a very narrow decibel range. You may have spoken louder and louder to a deaf person who suddenly says “quieter, you don’t have to shout”; you know then that you overstepped their narrow range. The same can happen with a hearing aids.

•Use assistive devices, just as you would a cane with a bad set of knees. A cheap stethoscope in the sufferers’ ears and held toward you can markedly improve their understanding. Electronic devices are often available at churches, as they are for TV sets and telephones. 

•Explore hearing aids, though beware, there are a lot of shysters out there. Get an evaluation at a hospital audiology center (MaineGeneral centers in Augusta and Waterville, and elsewhere). The problems with hearing aids are that they are moderately hard to keep working, especially with concomitant cognitive problems. They magnify all sounds, not just the ones you want to focus on. Aids can be very expensive, in the many $1000s. 

So, practice prevention starting now, wherever you are on the hearing spectrum. Prevent ear wax build up if you or family members have a problem. Use assistive devices sooner rather than later.

Did I help, John?