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2001-July
File Copy Jefferson County Board of Health Agenda Minutes July 19 , 2001 a JEFFERSON COUNTY BOARD OF HEALTH Thursday, July 19, 2001 2:30—4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of Meetings of June 21, 2001 III. Public Comments IV. Old Business and Informational Items 1. Consumer Reports and WSMA Reports Articles on Vaccine Safety 2. Mandatory Vaccination Exemption Survey Timeline • V. New Business 1. Adult Diphtheria-Tetanus Vaccine Shortage-- Jefferson County Response Plan Tom ( 5 min) 2. Community Indicators Workgroup Presentation-- Dr. Chris Hale (60 min) 3. Policy Discussion —Required Connection to Community Sewer Systems Larry (20 min) 4. Policy Discussion —Building Permit Applications With Existing On-site Sewage Systems Larry (20 min) VI. Agenda Planning 1. Future Agenda Topics VII. Adjourn Next Meeting: August 16, 2001 —2:30—4:30 PM Main Conference Room Jefferson Health and Human Services • I JEFFERSON COUNTY BOARD OF HEALTH DR AftMINUTES Thursday, June 21, 2001 DRAFT Stag Members: Member:: Dan Ti::eriless.Member- Count Commissioner District#1 jean Baldwin. \l!rsinn Services Director Glen Huntinnord, _Member- Count; Commissioner District == Earn.Fa), Environmental Health Director Richard'IF"oi:.Member- County Commissioner District=3 Thomas Locke, MD. Health Officer Geoffrey Masci.Member- Port Townsend Cit; Cound! Jitl Busier, Chairman - Hospital Commissioner District=2 Sheila tFssterman, Lice Chairman - Cititien at Large (City) Roberta Frissell- Citi:zen at LarTe (Count)) Chairman Buhler called the meeting to order at 2:30 p.m. All Board and Staff members were present. Commissioner Titterness asked that an item titled Clearinghouse for Medicaid Billing be added under New Business. Member Masci moved to approve the agenda as revised. Commissioner Wojt seconded the motion, which carried by a unanimous vote. • APPROVAL OF MINUTES A correction was made to the last sentence on Page 3. The word "made" should be added so that the sentence reads "Member Frissell said while this may satisfy the situation when the property is sold, what is the mechanism when payments have not been made establishing a fund for system repairs?" Commissioner Huntingford moved to approve the minutes of May 17, 2001 as corrected. Member Masci seconded the motion, which carried by a unanimous vote. OLD BUSINESS Jefferson Health Access Summit 2001: Dr. Tom Locke noted that the meeting summary for this well- attended event was provided in the agenda packet. He believes the next step will include the original workgroup polling participants to plan a follow-up summit, which would focus on specific proposals, associated costs, legal authorities, and other issues. In other words, moving from issues to solutions. Member Masci noted that a common thread among the Summit workgroup was the idea of a community clinic. He proposed that since this subject keeps surfacing, the Board of Health may want to make a statement of support or a directive to look into it. 0 Vice-Chairman Westerman said while the subject of common elements from the summit workgroups could be a Board agenda topic, it may be premature to make a statement of support. HEALTH BOARD MINUTES - June 21. 2001 Page: 2 Dr. Locke said in planning the next summit, the work group will be looking, at common issues 11/among the Summit workgroups and the possibilities for bringing in more money or spending less money on administrative overhead. Commissioner Huntingford asked whether there may be a tie-in between the Hospital's search for additional revenues and the goals of the Access Committee? Chairman Buhler said that aside from looking at increasing revenue, the Hospital believes it will be important to reevaluate the many programs offered by both Jefferson General and the Department of Health to determine who can do the work most efficiently. Some trends in reimbursement may favor one entity over the other. Dr. Locke said the workgroup would be reporting back to the Board of Health in July. Legislative Update: The legislature produced a status quo budget of$22.8 billion in the two key public health areas of concern which were the I-695 backfill money (which replaced 90% of$27 million in local health funding and added a modest fiscal growth factor for the next two years) and local capacity development funding (which was to be a down payment on the public health improvement plan). The Child Death Review received a modest appropriation of$1 million, which will help defray some local expenses in reviewing unexpected deaths. It appears there is also some funding for investigating and cleaning up clandestine methamphetamine labs. • During discussion about what was not funded, County Administrator Charles Saddler commented that this budget included $600 million which came out of a one-time pension trust fund. It is projected that some agencies will run out of money before the end of the biennium. Community Indicators Workshop: Jean Baldwin reviewed the list of attendees of workgroup meetings . whose task it is to review data and how it is used, as well as identifying problems and priority areas. Topics of concern are senior issues, violence among kids, school enrollment, substance abuse. and affordable housing. The group decided that a review of health issues must include quality of life issues. She reported the County applied for a Motor Vehicle Accident grant to investigate the high incidence of motor vehicle injuries in Jefferson County. The County website incorporates data as it becomes available and includes regional data. As the BRFSS data is available, the committee will release this information to the community. Dr. Chris Hale expects to have her analysis of BRFSS complete by spring 2002. She will attend next month's Board of Health meeting. Member Masci mentioned that while the City and County agreed to co-fund BRFSS for two years, he believes a commitment to sustain this funding over a longer term will be needed as a way to support the strategic planning processes of each government. I • HEALTH BOARD MINUTES - June 21. 2001 Page: 3 Take Charge Program Implementation: Jean Baldwin described this program as a family planning waiver that allows DSHS Medical Assistance Administration to make available family planning services for clients not currently enrolled in DSHS. but who qualify based on their income. The intent of the program is to decrease unintended pregnancies and lower the number of births. She noted that JCHHS is increasing its family planning services to both Port Hadlock and Quilcene. A June 18 memo explains that 550 out of 936 JCHHS clients could qualify for Take Charge. Although there are billing issues to work through. this program provides an unexpected source of funding. Jean Baldwin reported that she recently received a contract from DSHS for an outreach program in Port Hadlock and South County. Because these contracts are only available to nurses. there is an opening for a three-days a-week, 4-hours-a-day nurse to perform this outreach and education. Additional handouts were a Provider Newsletter and a June 15 letter from Ms. Baldwin in support of Jefferson General's hospice work. Maternal Child Health — Hear & Say: Reading with Toddlers Program: Jean Baldwin explained that this universal prevention program encourages parents to work on reading to promote toddler language development. The philosophy is based on the knowledge that kids who cannot read well end up performing poorly in school and that a lack of success in school can lead to other issues. The study has proven that if a parent works with the toddler, the child's reading skill will improve. This research project is funded by private donations and will be available to all two year olds, using several different methods. The client base will be chosen from volunteers using birth certificate records and the WIC program. A part of this project will be training three or four local individuals to run the program so that it will be sustainable. Aside from providing office space, there is no cost to the JCHHS for this study. In response to questions about how success will be measured. Jean Baldwin said some of the data will be available in six months. Regarding funding an ongoing program, she said the amount of funding needed will depend on the best method. This program may be able to be integrated into another program. She noted that the schools and the libraries are both involved in the planning group to get the program going. Chairman Buhler suggested this item be placed on the agenda in seven months for an update. Topics for Local Board of Health Workshop — Survey Results: Based on a survey of interests for a potential leadership development workshop. Dr. Locke reviewed the prioritized list of topics included in the agenda packet. This list will be used to plan for the workshop, which has been scheduled for all day October 25 and a half-day on October 26 at Sea Tac. He reviewed the workshop format of presentations followed by small group discussions and urged Board members to put the workshop on their calendars. Member Frissell suggested a format allowing several different presentations to occur simultaneously so Board members may choose which to attend. L HEALTH BOARD MINUTES - June 21, 2001 Page: 4 Jefferson Health and Human Services Director Recruitment: County Administrator Charles Saddler briefed the Board on the internal assessment of JCHHS needs and issues. Based on this feedback, the • BOCC approved the appropriation of funding for the position of Health and Human Services Director. Staff has begun creating a recruitment brochure and gathering information on important traits or management skills. They expect to fill this new position by the fall 2001. In response to a question about this position's impact on the Board, Dr. Locke responded that when the expanded Board was created. the Director of HHS became the Administrative Officer of the Board. In Washington State, the role of Administrative Officer and Executive Secretary default to the Health Officer. The new director would become the Administrative Officer to the Board. This new position will not only allow the department managers to focus on the issues at hand, but assist the Board and managers' efforts on medium and long-range planning. Clearinghouse for Medicaid Billing: Commissioner Titterness asked to discuss the potential efficiency of a centralized Medicaid billing network. County Administrator said this issue arose from a problem identified by Jefferson Mental Health and the Department of Mental Health, where significant staff resources were necessary to do Medicaid billing. The question is whether there can be economies of scale. Jean Baldwin said that Washington is one of the hardest states in the country in which to accomplish DSHS billings, with a major problem being reimbursement rejections. Member Masci talked about medical software, which he and other practitioners use. He believes a good way to choose a product is to get a consultant to come in and evaluate the range of software, vendors, and support. Maybe several agencies having difficulties with billing could participate in such an evaluation. Jean Baldwin said what makes the billing complicated is that public agencies are asked not only how much the service costs, but to specify the deliverables and the types of services. There was consensus that a centralized Medicaid billing network is not a topic on which the Board wants to proceed. AGENDA CALENDAR / ADJOURN Charles Saddler said the Board would receive email asking them to identify the five most pressing issues concerning public health so as to assist the BOCC and elected officials in Jefferson County in a strategic planning process. HEALTH BOARD MINUTES - June 21. 2001 Page: 40 2001 AGENDA ITEMS 1. CONTINUED STABLE FUNDING TO REPLACE MVET 2. ACCESS HEALTH CARE 3. PROGRAM MEASURES (Genetic Research and Public Health Implications) 4. METHAMPHETAMINE SUMMIT 5. PERFORMANCE STANDARDS & COMMUNITY ASSESSMENT 6. TOBACCO PREVENTION AND COALITION 7. FLUORIDE 8. TRANSIT AND PUBLIC HOUSING 9. BIOTERRORISM READINESS & PLAN 10. AGING POPULATION 11. WATER 12. MATERNAL CHILD PREVENTION GOALS (0-3) Meeting adjourned at 4:33 p.m. The next meeting will be held on Thursday. July 19. 2001 at 2:30 p.m. JEFFERSON COUNTY BOARD OF HEALTH Jill Buhler. Chairman Geoffrey Masci, Member Sheila Westerman, Vice-Chairman Richard Wojt, Member Glen Huntingford, Member Roberta Frissell, Member Dan Titterness. Member I Board of Health Old Business Agenda Item # IV. , 1 • Consumer Reports and WSMA Reports Articles on Vaccine Safety July 19, 2001 • ' 1'PARrO ' `ofatwo-part series .,,,,, :: tH , t. x , , . 0,.. t �= x ' Y 4'tr1' issue o trus Misinformation and government foot-dragging are fanning fears. pneumonia also to local outbreaks of Ninety percent of pediatricians and 60 -'., � his is the season of the shots, p a andpercent of family doctors recently surveyed when parents scramble for appoint- vaccine-preventablemmuni- friend's dobts about vaccine safety by University of Michigan researchers said :T menu to bring their kids'or school �"` zations up to date in time for school worried Suzanne Walther to search the Internet ent refused ommun immunization.A childr at least one whose in Col- ` ' openings. The annual ritual ise fbe-r Tenn., rmho de r hin that popped up were 22 times more likely to contract coming anything but routine for for information."I just typed in the word orado found that unimmunized children growing numbers of parents who feel `vaccines'and everything they're confronting a terrible dilem- was antivaccine material,'says Walther,who measles (whooping times more oughikehan vaccinat- munity contract ely to ma: Do I expose my child and corn- decided as a result to postpone immuniza- pertussis ed children. munity to the risk of a serious disease?Or tion of her infant,Mary Catherine. Bruce Gellin, do I expose my child to the risk of one of She waited too long.On the eve of her "In the middle are parents who are p the to do the right thing;'says vaccinetho crare its l f—reaopon reactions keepto Haemophilus influenzae B(Hib)meningitis M.D., a preventive-medicine thi ' specialistineGeat • gabout itself—reactions the Interns that ing on Internet? and landed in intensive care.It was the first Vanderbilt University and executive director b Even for those who don't have small case the hospital had seen in es�nce the 1987 ht years;Hib Information,an independent source oof the National Network for Immunization cienn children or grandchildren,distrust of the meningitis has become rare vaccine program—one of America's most introduction of a fi ant chanagainst it. kihe lling s- ally verified vaccine information. successful public-health initiatives—is cause ease had g ,f or for concern.the adult vaccines for flu and natelyIt's contributing to a severe ,she ng lrecovered.e rtu116 ‘Ir underuse of ���„ 4 -tom s s '. ff R qty s l - , :.,, J.,7,I :1:-...." 1„..-'147-::----''' �' 4 '*'�s�.�.: *.�, tis t •,p„ :,....: JUST A TINY PINCH Dr.Peter > :,_ ' Richel(above)of Mt.Kisco,N.Y., 3 ` , .M+� gives Cariie Grave her polio and DTaP(diphtheria,tetanus, pertussis)boosters.Vaccines have spared Carlie and her friends at ., ,.. ._ t ` Quality Time Nursery School, ii- ..:,- , .. ,,,.. , „., , , , ,..0.- b.,- _,. . 7,--„, Katonah,N.Y. (left),the risk of 11 :. "`Y . ,, serious childhood diseases. .} I eza ' ':a .a - 'AUGUST 2001 ) CONSUMER REPORTS 17 Lt....! ��: r IriPr immunization decisions today -� � ,,. I t t-T A CLOSE CALL Anti- are in their 20s and 30s. "` l r r "We're prisoners of our "-` ► ':-;,. i , ��., vaccine arguments ��2 s' Y'L3 i 111111� t'r.'_ persuaded Suzanne _ own success, observes William ill --rte rw Walther of Murfreesboro, Schaffner, \I.D., chairman of -^- '�'0- • � ( air, � M" Tenn.,to postpone 1 the Department of Preventive -''e`�' `-÷--17."41#‘ ' :"'j:' r� vaccination for baby ::- Medicine at Vanderbilt Univer- \ OP' .-....,..7. ; Mary Catherine(in 11/2 sity. "When formerly dreaded striped romper).Just =-" �, diseases have been pushed into ....... A Q -.- before her first birthday, ^ ©•, the shadows—or eliminated- - i , ,f , of vaccine-the baby contracted a - questions about the vaccines } ,,` 'I� u , serious case 3- 1 :? themselves spring up." vaccines preventable HibsheII k The next decade is likely to _v ' meningitis.Luckily,y, t bring new vaccines against HIS', { - ' !ti +441, recovered fully. genital herpes,type 1 diabetes, A`; �`:, .."-+/' 4: Epstein-Barr virus,cervical can- t`. __ ",�� �°. cer, and streptococcus A and ' �» i .;' .4' '—,....,,,i,:.:.7 . t^� B, to name just a few under _.:•")` 'l 4:;:",214 ,, �, development. That will make ,. „..., '�1` , oversight of the benefits and } ,� risks of vaccines more crucial. ,fir"__,, ,r ., Improving the safety-record of vaccines is no small task for 'r - - ' THE ANSWER MAN several reasons: „���:::I,,�g�, Walther credits Dr.Bruce 1. Since vaccines are given to ,f- �= Gellof Vanderbilt healthy people,serious risks are University,where Mary Catherine was treated,for unacceptable.But what's"seri The small but influential7 taking her concerns seriously ous"?If a vaccine prevents 1,000 antivaccine groups circulating '� andfindinganswers to her deaths, are 10 vaccine-related the information that Walther • io fa injuries an acceptable trade-oft? .; ` ,, questions. I never felt like I • found are doing the nation both !/ a` ,` was being blamed,"Walther If you or your child is one of the a disservice and a service.Their ' � 10,the answer is probably no.If says.She is now an ardent best-known accusations—that = supporter of childhood you are a public-health official, too many vaccines"overwhelm" ,- _ „ Immunizations. the answer isn t so obvious. the immune system and that the a ►Most childhood vaccines en- MMR vaccine against measles, joy almost total protection from mumps,and rubella causes autism—appear the evidence behind the main arguments of product-liability lawsuits. While this has groundless,according to the latest research. the antivaccination activists. And we will kept manufacturers in the vaccine business, But the noise-making has shaken up the suggest ways in which consumers can bene- it has also removed one important incentive Food and Drug Administration(FDA)and fit from immunization while minimizing to improve safety beyond current levels. the Centers for Disease Control and Pre- risks.In an upcoming report this fall,we'll vention(CDC),the two agencies most con- take a closer look at adult vaccines. HOW VACCINES ARE TESTED cerned with vaccine safety. Most vaccines come to market with an Our examination of the vaccine-safety THE PRICE OF SUCCESS incomplete safety record.A new vaccine is record has found that in some areas this Under the current schedule,children receive typically tested on 10,000 to 20,000 people shake-up is long overdue: 23 shots against 11 diseases before starting before the FDA approves it.That's enough ►There are significant gaps in the system for kindergarten. Before the vaccines were to study disease protection but not enough monitoring the safety of newly introduced introduced,the toll of 10 of these vaccine- to reliably detect rare complications. In and older vaccines. preventable diseases—diphtheria,measles, 1998,the FDA licensed RotaShield,a vaccine ►The guardians of vaccine safety have been mumps,pertussis,polio,rubella(German to prevent an intestinal infection that was slow to address correctable problems.such measles),tetanus,hepatitis B,pneumococ- striking an average of 3.5 million babies in as the use of mercury as a preservative in cus,and Hib—was nearly 2 million report- the U.S.a year and killing 20.Of the 10,054 some infant vaccines. ed cases of disease per year,based on their babies vaccinated during the tests,5 devel- The adversarial treatment of the 150 or so peak year of incidence.Even the"mildest" oped a condition called intussusception,a Americans who apply each year for corn- vaccine-preventable disease,chicken pox, life-threatening collapse of the bowel.Since , pensation for adverse effects from vaccines claimed 100 lives each year. intussusception can also occur spontaneously, 40 has angered many and provided recruits to But the youngest Americans who can it wasn't mathematically clear whether or the antivaccine forces. remember diphtheria and whooping cough not the vaccine caused those cases. i In this report, we'll discuss where the are on Medicare. The youngest who can But within six months of the vaccine's vaccine-safety system has fallen short and remember polio and measles are in their 50s introduction,after some 1.5 million babies o how it can be improved.We will examine and 40s,respectively.Most parents making had received it,monitoring studies found 18 CONSUMER REPORTS .,;GUST 2001 s • ,. , % D e. ta lis on vattinations 111 The 11 diseases prevented by childhood vaccines were bad ones,as this table demonstrates.The damage they caused far outweighed even the most trou- blesome known vaccine-related complications.This chart shows the most common complications unique to each vaccine.In addition,any vaccine can cause minor reactions such as a mild fever or pain at the injection site.And very occasionally,any vaccine(or one of its inactive ingredients)can cause an imme- diate,serious allergic reaction known as anaphylaxis. VACCINE YEAR O . PEAK ANNUAL 1999' CONSE RIENCU OF- %OF CHILDREN;. KNOWN VACCINE INTRODUCTION DISEASE TOTAL TOTAL NATURAL DISEASE VACCINATED` SIDE EFFECTS Chicken pox 1995 4 million' N/A Encephalitis(2/10.000 cases),bacterial skin 594 Mild rash(1/20 doses) (varicella) infections,shingles(300,000/year) 93.3 Prolonged crying.fever of DTaP 105°F or higher Diphtheria 1923 206,939 1 Death(5 to 10/100 cases),muscle paralysis. heart failure Tetanus 1927 1,560' 40 Death(30/100 cases),fractured bones, Peripheral neuritis, pneumonia Guillain-Barré syndrome (temporary paralysis-rare) Pertussis 1926(whole cell) 265.269 7,288 Death(2/1.000 cases),pneumonia(10/100 cases), Brain disease(0 to 10/1 million 1991(acellular) seizures(1 to 2/100 cases) doses-whole-cell vaccine only) H influenzae B 1985 20,000' 71 Death(2 to 3/100 cases),meningitis,pneumonia, 93.5 (childhood) blood poisoning,inflammation of epiglottis, skin or bone infections Hepatitis B 981 300,000" 7,694 Death from cirrhosis or liver cancer(4,000 to 88.1 5.500/year) 91.5 Fever of 103°F or higher MMR (5 to 15/100 doses) Measles '963 894.134 100 Encephalitis(1/1,000 cases),pneumonia(6/100 cases),death(1 to 2/1,000 cases),seizure(6 to 7/1.000 cases) • Mumps 1967 152209 387 Deafness(1/20,000 cases),inflamed testicles(20 to 50/100 postpubertal males) Rubella '969 56.686 267 Blindness,deafness,heart defects and/or Temporary joint pain retardation in 85 percent of children born to (25/100 adult doses in women) mothers infected in early pregnancy Pneumococcal** 2000 93,000' New Meningitis(800 cases/year),pneumonia(77,000 New vaccine doses) Feverover100.3°F(22/100 (childhood) vaccine cases),blood poisoning(15,000 cases) Polio 955 21269 0 Death(2 to 5/100 case in children), 89.6 Vaccine-induced polio(oral (paralytic) respiratory failure.paralysis, vaccine only-1/2.4 million postpolio syndrome doses) Source:Centers for Disease Control and Prevention *Estimated "Journal of the American Medical Association.March 15,2000 that vaccinated babies had a 21-times higher main way of tracking unexpected complica- Mercury in vaccines. Even minuscule chance of intussusception than normal tions is through a federal program called the doses of mercury can impair the cognitive within the first few weeks after their shots. Vaccine Adverse Event Reporting System development of babies and young children. The vaccine is no longer in use. (VAERS).But this system has major draw- Just this year,the FDA warned pregnant and The obvious way to catch such problems backs: It's voluntary(except for manufac- nursing women and very young children to before marketing is to vaccinate more test turers),and reports don't necessarily mean avoid certain mercury-containing fish.Yet subjects.But the price of new vaccines is al- that the adverse reaction is truly associated until last year,the same agency permitted ready high—a single dose of the newest,a with the vaccination. the use of childhood vaccines containing vaccine against childhood pneumococcal To compensate for these failings, the mercury in quantities that many,including disease,costs 558—and testing more sub- government also finances a smaller but Consumers Union,consider unsafe. jects would drive costs still higher.Moreover, more complete program,the Vaccine Safety Mercury is a major constituent of thi- it's hard to recruit enough volunteers even Datalink, that uses the comprehensive merosal, a preservative that for the past for the modest-sized trials."Everybody wants records of several large managed care orga- 70 years has been added to multidose vials more babies studied,but whose babies are nizations to track vaccine outcomes.Addi- of vaccines to inhibit bacterial growth. 1111 these going to be?Your baby or somebody tional safety research programs are under There has never been a scientific study of else's baby?"asks Kathryn Edwards,M.D.,a development as well. the safety of using this product in chil- Vanderbilt University pediatrics professor dren's vaccines.Nevertheless, its use con- who has worked on many vaccine research TWO SAFETY LAPSES tinued until 1999,when the FDA added up projects. In two recent cases,vaccine-safety agencies vaccine-related thimerosal exposure for Once a vaccine goes on the market,the were slow to act on emerging problems: the first time, as part of an agencywide AUGUST 2001 : CONSUMER REPORTS 19 study of mercury-containing products. the injectable,inactivated vaccine that can- Vaccine Information Center, the most At the time, three vaccines routinely not cause polio.During that 20-year period, prominent of the antivaccine groups. given to newborns and infants,hepatitis B, there were eight to nine cases of vaccine- While Fisher's argument—that the per- Hib, and DTP, contained thimerosal. An associated paralytic polio each year. tussis vaccine caused an increase in epileptic 110 average-sized baby given vaccines con- "Why did it take 20 years to make the and learning-disabled children—appears taining the maximum concentration of change?" says John Salamone, a Virginia baseless,her activism led to the creation of a thimerosal was being exposed to 187 parent whose 11-year-old son developed compensation system for vaccine victims and micrograms of mercury,more than twice paralytic polio from his second dose of oral prompted the CDC to plan a major expan- what the Environmental Protection Agency vaccine."It was an egregious act by the gov- sion of programs to study vaccine safety: deems safe for very young children.(Expo- ernment." Other arguments and suppositions of sure didn't exceed the much looser FDA Some vaccine experts agree that the vac- antivaccine activists, Fisher included, are guideline, which Consumers Union be- cine's safety should have been considered either incorrect or misleading.Here are the lieves is too high.) sooner."The decision could have been made main ones: Nevertheless,the FDA and CDC allowed 10 years earlier," says Neal Halsey, M.D., Vaccines"overwhelm"the immune sys- immunizations with thimerosal-containing director of the Institute for Vaccine Safety at tern and cause it to turn against itself.Vac- vaccines to continue—while coop- cines work by stimulating the produc- crating with manufacturers to cre tion of protective antibodies.So the idea ate thimerosal-free versions asthat multiple vaccines can"overstress" quickly as possible.Not until early `1 • the immune systems of infants seems 'It Ifr4F. reasonable.It's behind the belief that the POLIO FROA1 VACCINE y� . d measles component of the measles- David Salamone,now • = / mumps-rubella (MMR) vaccine has Xigtr age 11,got polio from r , : caused an epidemic of autism. the oral vaccine he _ 4 In fact,vaccines tax the immune sys- received as a baby more .� tem much less than natural diseases,says r ,, than a decade after the • ! Halsey.A natural infection can lead to last case of"wild"polio the stimulation of as many as 25 to 50 '""i in the U.S.His father, ,, Ir;'t€ - - separate immune responses."When ewe tt John,spearheaded the ,€ give something like the Hib vaccine, successful effort to force f "i '---..-.1.0.` „,;z- we're giving only two antigens,” says It La .�'` a switch back to the safer - ♦ Halsey."The immune system's potential killed-virus injectable ^-tp 1 z'' is enormous.It can respond to 10 mil- `° polio vaccine. lion to 100 million antigens:' • 2` g `;' Vaccines are as dangerous as the dis ` eases.The statistics can be misleading.In 1999, nearly 12,000 vaccine "adverse _ events"—established or presumed,and mostly mild—were reported to govern- in 2001,more than a year and a half after Johns Hopkins University. ment health officials. That same year, the the issue first surfaced,were all childhood Salamone believes the turning point diseases themselves caused only 6,777 cases vaccines made without significant amounts came when affected families appeared of illness or injury.But that does not mean of thimerosal. before the CDC committee that sets im- that vaccines are a poor risk. Vaccine-associated polio.The oral polio munization policy. "Until these doctors Except for polio, vaccine-preventable vaccine in use from 1960 on had an advan- saw these kids in wheelchairs,they never diseases are still around. The Colorado tage over the original killed-virus Salk v-ac- put faces on what they were doing,"he says. studs'that documented an increased risk of cine.The live,weakened virus it contained measles and pertussis among unvaccinated replicated and spread from person to per- THE ANTI VACCINE ARGUMENT children also found that vaccine refusal puts son,immunizing many who were exposed This is not the only example of how vocal the community at risk, because vaccines to it even though they weren't vaccinated parents and antivaccine activists have don't"take"in everybody who gets them. themselves.This so-called herd immunity is pushed government agencies to improve The researchers found more measles and why experts expect that polio will soon be vaccine safety.In 1985 Barbara Loe Fisher,a whooping cough among vaccinated chil- the second disease in history,after smallpox, \Washington,D.C.,mother whose son devel- dren in schools with many unvaccinated to be eradicated from the globe. oped neurological and cognitive disorders children than in schools where nearly all But the oral vaccine has a little-known after his pertussis vaccination, wrote "A children had been vaccinated. downside: In about 1 in every 2.4 million Shot in the Dark."The book was a well- If someone gets sick soon after getting 1111 doses,the ingested virus mutates back into researched history and indictment of a a vaccine,the shot is to blame.This idea is a virulent form capable of causing disease. vaccine that even its supporters concede at the root of the most contentious vaccine- Since 1979, the only cases of polio in the caused an unusual incidence of reactions, safety issues: the alleged links between U.S.have been caused by the oral vaccine. from fever to seizures,because it was made vaccines and autism, brain damage, and Yet not until 1999 did the CDC's vaccine from whole,killed whooping-cough bacte- multiple sclerosis. Some antivaccine web policy-making group vote to switch back to ria. Fisher went on to found the National sites feature accounts of lively toddlers who, 20 CONSUMER REPORTS AUGUST 2001 C nsumer after receiving their MMR shot,turned into cine."They said one pair should be enough. Reports neurologically impaired preschoolers. They asked why he needed physical thera New Car Buying Guide But are vaccines really to blame?To date, py once a week." 41 two expert panels, one convened by the Vaccine-victim advocates say the pro- 2001 American Academy of Pediatrics and the grams accumulated$1.6 billion balance is other by the National Academy of Sciences, evidence of its lack of generosity.The gov 1i ow can you find the best model in this have studied the MMR vaccine and autism. ernment says the surplus is the result of the year's auto market?Consumer They found that autism cases did not development of ever-safer vaccines. Reports New Car Buying Guide 2001 will increase along the same trend lines as lead you through the choices with reviews and recommendations based on the latest increases in the percentages of children who RECOMMENDATIONS tests. received the MMR vaccine. Both expert ►Consumers should ask for the safest vac- groups have concluded that although more cines. The whole-cell pertussis vaccine, c nsumer •„r-; needs to be learned about autism—and childhood vaccines containing thimerosal as Reports. �"' ,. above all about the apparent increase in the a preservative, and the oral polio vaccine numbers of autistic children—the MMR may still be in the distribution system.Tell N "',w 1: A a vaccine is almost certainly not to blame. your doctor not to use these vaccines. ' i')/JAI; GIVIIIIIE For now,the most likely explanation for ►Be sure to let the doctor know if the child 2001 i the seeming link is pure coincidence.Many has a fever, diarrhea, or other significant = .'t childhood neurological and developmental medical symptom at the time of an immu- w problems first emerge at an age when chil- nization appointment.The doctor may rec- dren are getting vaccines frequently. ommend postponing the immunization.If this occurs,it's critical to promptly make up COMPENSATING THE INJURED the missed vaccine doses. For additional Inside this 256-page guide,you'll find: When the pertussis vaccine controversy sur- information, consult the CDC's Contra- +Top picks for 2001 faced in the U.S.in the mid-1980s,vaccine indications for Childhood Immunization •,Guide to the latest safety features manufacturers threatened to get out of the document, available on the Internet at A Step-by-step guide to buying and business rather than risk ruinous lawsuits. www.cdc.gov/nip/recs/contraindications.pdf leasing (Today,there are only four major childhood- P. Ask the doctor which post-vaccination P 20-year trends in auto reliability vaccine manufacturers in the U.S.: Glaxo symptoms are normal—and which warrant .Price-saving strategies for buying car III SmithKline,Aventis Pasteur,Wyeth Lederle, medical attention.Mild fever and fussiness insurance and Merck&Company.) are common consequences of vaccine- 'Auto sites on the Internet,plus how to do your online research quickly As a result, the federal Vaccine Injury induced immune reaction.But a high fever and efficiently Compensation Program was created in or seizure is out of the ordinary. , , 1988.Funded by a small tax on every lot of P. Seek information from reliable sources • Four-wheel drive vs.all-wheel drive, vaccine,it is in essence a no-fault insurance such as the CDC (www.cdc.gov/nip), the how to make your test-drive count, plan against childhood-vaccine injuries. National Network for Immunization In- and more! The program set up a list of conditions formation (www.immunizationinfo.org), The new CR SAFETY ASSESSMENT- such as vaccine-associated polio that,based the Immunization Action Coalition(www Consumer Reports sums up track- on scientific evidence,seem to be vaccine- .immunize.org),and the Vaccine Education test results and crash-test data to related.Anyone with a condition on the list Center (www.vaccine.chop.edu). Be aware make it easy to spot which modelsare safer. is entitled to compensation for"pain and that some groups with official-sounding __ __r__._r.____w _— suffering" suffering"and for ongoing medical expens- names,such as the National Vaccine Infor- On sale now wherever books and es.The trade-off giving up the right to sue mation Center and Parents Requesting magazines are sold, or manufacturers and doctors. Open Vaccine Education,are actually anti- mail the coupon below: "With respect to manufacturers and vaccine networks. I 1 physicians,the system has been an unqual- ►Policy-makers should continue—and ade- 1 To order Consumer Reports New Car Buying 1 ified success,"says Peter Meyers,a lawpro- quately finance—improvements in tracking I Guide 2001,please send a check or money 1 y y P 1order for$9.95 plus$3.50 shipping and 1 lessor who heads the vaccine-injury law and analyzing vaccine injuries.This includes I 1 clinic at George Washington University. expanding state immunization re g istries I handling,payable to Consumer Reports. 1 I Prod#P741 402107 I "But it's been a much more mixed record (with proper privacy safeguards),which are I I with respect to consumers" are invaluable for researching safety con- 1 "It's very difficult to bring a claim under terns.Vaccine-safety guardians need to keep 1 NAME PLEASE PRINK 1 this program,"Meyers says."The govern- faith with parents by taking prompt action 1 i ment is very aggressive.If there are any tech- when possible problems or concerns surface. 1 I nical loopholes,they raise them.They fight ►The Vaccine Injury Compensation Program I ADDRESS I APT. i IP everything to the bitter end." should use some of its burgeoning surplus to Even claimants who win compensation become more user-friendly.And physicians I i can run into trouble."I have had to fight to and health educators must deal fully and CITY STATE ZIP 1 get my son two pairs of braces a year, to respectfully with the vaccine-safety concerns I CONSUMER REPORTS i P.O.I Box 10637, Des Moines,IA 50336-06371 keep up with his growth,"says Salamone, of patients and parents.It's no longer enough I (Please allow 4 weeksfordelivery7 I whose son contracted polio from the vac- to say,"Trust us,we're the experts:' (� 1 I A000s7- :oci CONSUMER REPORTS 21 6 • I 1 t1 •• VvSi4lA . • . S A PUBLICATION FOR THE MEMBERS OF THE WASHINGTON STATE MEDICAL ASSOCIATION TABLE 0 F CONTENTS MAY/JUNE 2001 www.wsma.org Newsclips Safe vaccines: doubt a n d worry can • availablefforr patients report card trump facts to affect public's acceptance • yourgrA up managersence your group managers or administrators The debate over the safety and effectiveness of vaccines would seem to ■ Local clinic for low-income have been settled years ago.Vaccines are required for school entry in all 50 patients gets boost from feds states.A number of vaccine-preventable diseases are now almost non- ■ Local immunization information existent in the United States,thanks to widespread immunization. available on the Web • Free HIV/AIDS hotline ET POWERFUL STORIES FROM THE MEDIA AND concluded that they had identified a chronic material available for your the Internet can flood the public enterocolitis that might be linked to autism waiting rooms consciousness and fuel fear over even through an immune deficit, but they did not ■ Free email service for job the most well tested vaccines. When the go quite so far as to say they'd proven an seeking physicians medical community—both mainstream association between the MMR immunizations and alternative practitioners— raises and autism.The article received tremendous • Help make patients aware of questions about the safety or need for publicity in Great Britain and the United Tobacco Quit Line;free certain immunizations, those inquiries States and quickly resulted in a drop in MMR materials available 2 intertwine with the public debate and can continued on page 3 change public policy.` CMEs In 1998 in an article in Lancet, Dr.Andrew On immunizations and Upcoming courses 4 Wakefield,a pediatric gastroenterologist in the"burden"on the London, England,described 12 children with Update from rom Physicians both"pervasive developmental disorders" (9 immune system Insurance of the children had autism) and intestinal Report of claim trends by ; N THE UNITED STATES,WE IMMUNIZE ROUTINELY abnormalities.The parents of 8 of the 12 specialty 4 children reported that the behavioral symp- 1 against only ten infectious agents(measles, toms appeared around the time the youngsters I mumps,rubella,polio,diphtheria,pertussis, Health Care Economics received their measles-mumps-rubella(MMR) tetanus,hepatitis B,and varicella)out of the Law on physician referrals vaccine. Dr.Wakefield and his coauthors multitude of common childhood infections.The and ownership interests 6 *After physicians in Sweden questioned the need for primary function of the multifaceted immune pertussis vaccination in the 19705,coverage rates system is to identify foreign substances(anti- Risk Management dropped from 90%in 1974 to 12%five years later.Duringgens).When the immune system is presented Our culture binds us together''n 1980 to 1983,the annual incidence of pertussis for seeing what's right. Swedish children aged 0 to 4 years increased to 3,370 per with a foreign antigen,it mounts a response 100,000 with rates of serious complications fromwhat's not 8 p involving production ofantibodies(humoral pertussis approaching rates seen in developing immunity) activation of specific cells whose countries.In Japan in 1974,two children died within 24 Y p Drug errors hours of receiving their diphtheria/tetanus/pertussis purpose is to facilitate the elimination of foreign Tracking the patient with •ccines,and the minister of health and welfareik substances(cell-mediated immunity).The most an unexpected reaction 10 sponded by eliminating the vaccine.Over the next two years pertussis coverage for infants fell from 80%to 10%. powerful immune responses are generally Classifieds 14 In 1979 a pertussis epidemic resulted in more than produced in response to live antigens. 13,000 cases and 41 deaths.ln 1981 the acellularNewsmakers 16 continued on page 3 pertussis vaccine was introduced and widely adopted. .1 r 6 • i • Safe vaccines. . . continued from page 1 and MMR appears to be a coincidence On immunizations...continued from page 3 based on timing. Autism, which is a 4 immunization rates in England,Wales whole spectrum of disorders, is often Infants undergo constant exposure to and Ireland. Rep. Dan Burton of Indiana diagnosed between the ages of two and foreign antigens from the moment they held Congressional hearings on the link Five years, with symptoms first becom enter the world.The normal process of between MMR vaccines and autism. ing apparent in the second year. Most colonizing the oral mucosa and gas- The public's worry that the MMR all children receive an MMR vaccine at trointestinal tract exposes the infant to vaccine somehow causes autism escalated age two. Said Dr. Marcuse, "Anybody to the point that the Centers for Disease faced with a devastating illness looks for thousands of different antigens during the Control and the National Institutes of associations. Our way of relating to the first few months of Iife.An upper respira- Health commissioned the Institute of world is to employ temporal associa- tory viral infection exposes a child to 4-10 Medicine (IOM) last year to study the tions—something happens, something antigens and streptococcal pharyngitis to hypothesized connection.The IOM else happens. In fact, that is a basis for 25-50 antigens.In contrast,a hepatitis B report, released in April, concluded that taking a medical history." vaccination exposes an infant to one there is no evidence that MMR vaccine causes autism, and it could find no antigen.It is therefore unlikely that "proven biological mechanisms" that THE WAKEFIELD HYPOTHESIS SPUN AROUND immunization with multiple vaccinations would explain a relationship between the world with breathtaking velocity, would add an appreciable burden on the MMR vaccine and autism. It acknowl- showing up in newspapers and on developing immune system,which is edged that existing epidemiological tools television, radio (and the Internet) seemingly everywhere. "In the old days, learning to recognize thousands of may be unable to detect whether the g y different anti ens. MMR vaccine somehow contributes to physicians and scientists would raise a 9 autism in a very small number of hypothesis, then subsequent studies From:"vaccine Safety,"Current Problems in children, but it stressed that the health would refute or accept it," commented Pediatrics,Vol.31,Number 4,April 2001,by benefits of the vaccine far outweigh any Dr. Marcuse. "The debate would take Heather McPhillips,MD,MPH,and Edgar K. hypothetical risk. place within the scientific societies and Marcuse,MD,MPH,University of Washing- The report made the news nation- more recently, in the medical journals. ton.Reprinted with permission. •wide, prompting many parents to call Today the debate takes place on talk pediatricians, family practitioners, radio and the Internet. I get my school nurses and the state Department breaking [medical] news from National my facts. I don't judge them. My job is Public Radio." to find out what they are willing to do. of Health Immunization program. and my job changes depending on what Pediatrician David Springer, MD, their attitude is." who practices some homeopathy DR.ED MARCUSE,ASSOCIATE MEDICALalongside conventional medicine at his With their questions answered, the director at Children's Hospital and office in the Wallingford District of vast majority of parents do have their Regional Medical Seattle, often is on the receiving end of children immunized, Dr. Springer said. Center in Seattle, has media reports of the day. "If somebody But about 6-10% have less than all closely followed the talks about whooping cough and seizures, immunizations on the recommended controversy over theI'll get questions," he said. He's been schedule or have none at all. "Sometimes safety of the MMR4,,, quizzed by parents about the detrimen- I go only for tetanus immunization. vaccine as well as tal effects of mercury in vaccines, escala- They may be open to one, but want controversies over other ting reactions to shots, the advisability nothing to do with MMR or whooping vaccines. He also is on of trying to get separate vaccines for cough," he said. "At some visits, if you the steering committee each component of MMR,whether follow academy [American Academy of of the National Net Dr.EdMarcuse natural disease confers better immunity Pediatrics] standards, you can give five work for Immunization Information, a than a vaccine, and the connection shots covering seven diseases in one visit. group that disseminates scientifically between polio vaccine and AIDS. That is a bit overwhelming for parents. accurate materials to parents and "When you're a parent, anything is Dr. Springer witnessed an epidemic others. He's not surprised that the fact if it potentially will harm your of measles in New York City in 1970 MMR-autism hypothesis would attract child," he said. "Your ears perk up and saw first-hand some "pretty awful so much attention because parents and when you hear about a friend of a complications. "Parents need to hear health professionals were already friend who's had a shot and then six that these childhood illnesses are not looking hard for an explanation to an weeks later gets diagnosed with autism. benign. They want to think it is a safe �pparent rise in autism, attention "Whatever we know scientifically world out there." deficit hyperactivity disorder and other may not be the facts parents consider Family Practitioner Jim Merrill, MD, learning disabilities among children. for themselves," he added. "I try to of Enumclaw said that only a few But the connection between autism listen to their facts, and then I tell them parents have asked recently about continued on page 11 WSn1M14 Rznor. Mdv'/une _'001 - , ti ,Sate vaccines. . . continuedfrost page,3 the immunization record, it's possible there's not a shred of evidence that the that school officials suggest that the immune system can be overwhelmed by `1d1R and autism. Far more vexing, he parent sign an exemption report. If the childhood immunizations," said Dr. 4 aid, are claims by two of the school has neither an immunization Marcuse. comnntnin'S chiropractors that spinal record nor an exemption from a parent, manipulation, started on babies "from • the school is considered out of compli day one," can prevent disease as ante and does not receive certain state THE ANTI-VACCINATION FORCES ARE GETTING effectively as vaccines and more safely. funding. more sophisticated in purveying their Several l Years ago, Dr. Merrill chided Although it's hard to get at a true views.The president of the official- one chiropractor for scaring a parent exemption rate, the latest 3% is much sounding National Vaccine Information about the safety of immunizations for the same as it has been the last five years. Center has two children who, she says. her children. He told the chiropractor However, the rates do vary by have been injured by vaccines; she in a letter that he had removed the county. In Ferry County, 10% of managed to get featured in the New practitioner from his list of recom- school-age children are not immunized. York Times Magazine on May 6. In the mended chiropractic providers. In a Jefferson (8.9%), Skamania (8.3%), article, she commented on the "ever letter back, the chiropractor wrote, " . . San Juan (8.2%) and Stevens (7.1%) increasing number of vaccines. . . . If . the scientific community is increas- counties are well above the average, too, you give [biologically susceptible ingly alarmed at the increase in the as are Island (6.5%) and Whatcom children] 37 doses of 11 different strength of pathogens and the corre- (5.2%). In some of these counties, said vaccines, including MMR, you could be spondingdecrease in the ability of Norma Holliday, public health nurse creating a larger and larger group of vaccines and antibiotics to control consultant with the state immunization genetically susceptible children, tipping them. . . ." (However, there is nothem into neuroimmune dysfunction. program, "people have a different reliable scientific evidence that patho philosophy.They don't believe in (However, scientists have not found gens are developing resistance againstimmunization. They're free thinkers." medical or biological evidence to vaccines. There is evidence that certain Exemption rates above 5% are cause support this theory, nor have they even pathogens are becoming resistant tofor concern, said Dr. Marcuse. "Measles found a disorder labeled"neuroimmune antibiotics.)hi can go into a school where 5% are dysfunction.") • The chiropractor also implied he Dozens more vaccines are under susceptible and can pick them off. might sue Dr. Merrill for libel if Dr. They'll get sick; it's highly communi- development, and controversies over Merrill communicated to `anyone that cable." their efficacy and safety are certain to me, my approach or . . . my practice is A substantial minority of parents erupt as they become available. "Con- harmful." sumerism is on the rise," said Dr. does not have a good grasp of how Commented Dr. Merrill, "All the immunizations work, Dr. Marcuse Marcuse. "People have questions about people who don't get vaccinated end up added. He helped design a survey of their food, their air, their water, their looking pretty healthy down the road. parents conducted in April and May TV, their dental fillings. Why should But it's not the chiropractic protecting vaccines be any different?" 1999 for the National Network for them.They assume it is, but it's the Immunization Information Steering With fewer and fewer parents having herd immunity effect." Committee and published in Pediatrics direct experience with diseases like polio Although he believes that he has (Do Parents Understand Immuniza or measles, it is imperative that physi- "stemmed the tide" of misinformation tions?A National Telephone Survey, by cians talk to parents and patients about coming from that chiropractor, he still Bruce G. Gellin, MD et al., Vol. 106, immunization and its role in protecting worries about parents who either wait No. 5, November 2000. Pages 1097- both individuals' health and the public to oet their children immunized orMarcuse argues.health, Dr. �rtes. "For vaccines b 1102). b forgo immunizations altogether. Among the respondents, 25% the days of'if you build it, they will • believed that their child's immune comeare pretty much over," he said. THE STATE DEPARTMENT OF HEALTH REPORTS system could become weakened as a "Physicians and nurses must work result of too many immunizations; actively to sustain the public's confidence that about 97% of children newly ° in vaccines.These issues are too im or enteringschool in the 1999-2000 23% believed that children get more P immunizations than are good for them. rant to leave to the infectious disease school year had all their required urus and ublic health officials." immunizations. Of those not immunized Dr. Wakefield, in the Lancet article that g P (about 30,000 children), 91% were created such a stir, proposed that Dr. Marcuse recommends that physicians exempted for"philosophical or personal" components of the MMR vaccine be use the Web site http://www.idsociety.org/ 0 reasons, 4.5% for medical reasons and given separately lest the child's immune NNii/links.htm as a source of accurate 4.5% for religious reasons. Even though system be overwhelmed. A bill intro- immunization information. Please feel the exemption rate is low, Pat DeHart, duced in the Louisiana legislature last free to copy and distribute this WSMA a state epidemiologist, thinks that it year to give MMR components sepa- Reports article to patients. w might be inflated. If the parent can't find rarely failed by only two votes. "Yet, a • 6 Board of Health New Business Agenda Item # V. , 1 Adult DT Vaccine Shortage • Response Plan July 19, 2001 • - Jefferson County Health &Human Services • • 'r l l ', r 4444 CASTLE HILL CENTER • 615 SHERIDAN • PORT TOWNSEND,WA 98368 1 • July 5, 2001 To: Jefferson County Health Care Providers From: Tom Locke, MD, MPH, Jefferson County Health Officer 'Of Re: Response Plan for Tetanus-Diphtheria Vaccine Shortage As most health care practitioners are now aware, there is a nationwide shortage of adult- type Tetanus-Diphtheria vaccine caused by the abrupt discontinuation of manufacturing by the Wyeth-Lederle Corporation. Aventis Pasteur is now the sole manufacturer of this vaccine for the U.S. market and is committed to expanding capacity to fully meet national need. This process will not be completed until 2002. In the meantime, Aventis Pasteur is restricting sales of Td to hospitals and health departments only. During this period of relative shortage, the ACIP (Advisory Committee for Immunization • Practices) has revised its recommendation for Td use. Priority uses are: 1) Travel to countries with a high risk of diphtheria exposure, 2) Management of tetanus-prone wounds and injuries, 3) Lack of a primary (3 dose) tetanus-diphtheria vaccine series, and 4) Pregnant women whose last Td dose was >ten years ago (to prevent neonatal tetanus via transplacental passive immunization). A detailed listing of ACIP tetanus prevention guidelines is available at: http://www.cdc.gov/mmwr/preview/mmwrhtm1/00041645.htm Routine immunization of individuals whose last Td was > 10 years ago should be deferred until 2002 when vaccine supplies are expected to be adequate. Jefferson Health and Human Services (JCHHS) offers a wide range of immunizations during regular hours of operation and will continue to provide Td immunization to clients meeting the ACIP priority criteria. JCHHS will also make Td available to Jefferson County health care providers who agree to restrict its use to the priority groups listed above. Clinics or individual practitioners who are unable to purchase Td through normal supply channels may contact JCHHS at 385-9400 to arrange for at-cost purchase of Td vaccine. Due to our very limited supply, we will only be able to supply one 10-dose vial at a time. We ask that providers fully use each vial before placing additional orders to assure maximum distribution of limited vaccine supplies. i HEALTH ENVIRONMENTAL DEVELOPMENTAL ALCOHOL/DRUG DEPARTMENT HEALTH DISABILITIES ABUSE CENTER FAX 360/385-9400 360/385-9444 360/385-9400 360/385-9435 360/385-9401 6 Board of Health New Business Agenda Item # V. , 2 • Community Indicators Workgroup Presentation July 19, 2001 I t , Population Growth, Clallam, Jefferson & Kitsap Counties, 1981-83 through 1998-2000. Period Clallam County Jefferson County Kitsap County 1981-83 0.3% 1.1% 3.4% 4 1982-84 2.1% 2.7% 4.3% 1983-85 0.8% 5.6% 4.8% 1984-86 0.6% 4.8% 2.4% 1985-87 0.6% 3.7% 2.0% 1986-88 3.0% 4.4% 7.1% 1987-89 4.7% 6.2% 6.5% 1988-90 3.8% 5.3% 5.8% 1989-91 5.9% 9.8% 7.3% 1990-92 6.3% 11.7% 8.4% 1991-93 5.0% 8.8% 6.9% 1992-94 4.2% 8.0% 3.7% 1993-95 3.6% 6.8% 5.0% 1994-96 4.0% 5.8% 5.4% 1995-97 4.4% 3.8% 4.0% 1996-98 2.6% 4.7% 1.9% 1997-99 0.8% 6.5% 0.1% 1998-2000 -3.3% 7.0% 1.3% Population growth, Clallam, Jefferson, and Kitsap Counties, 1981-83 through 1998-2000. S Source: Intercensal projections and estimates generated by the Washington State Office Of Financial Management,September 2000. 14.0% - 12.0% - 10.0% -- 8.0% 8.0% - p . 6.0% - 4.0% - NIV ' 114101111111" A 2.0% ' 0.0% M et U7 co 1-- oo O> CO e- N M 'Cr 147 co I-- co O) O Oo co co °o co °o 0o W o O O Cr? T 131 a1 O W C e- '0443 M of U7 to N- oo O O . N r � M) Ca f ' -2.0%ar w °o 00 00 °o 00 00 °o C) a) C) C> rn w w C) N W C) a) a) a) a) w a) a) a) a) rn a) rn a) a) rn •• -4.0% - • -6.0% - j --•-Clallam County T Jefferson County --&-Kitsap County I 5/30/01 DRAFT . Median Age of Clallam, Jefferson, and Kitsap Counties , 1980-99. Year Clallam County Jefferson County Kitsap County 1980 31.7 35.0 29.3 1981 32.2 35.5 29.5 1982 32.9 36.3 29.7 1983 33.7 37.3 30.1 1984 34.5 37.9 30.4 1985 35.2 38.5 30.6 1986 35.9 39.0 30.9 1987 36.6 39.6 31.2 1988 37.3 40.2 31.4 1989 37.8 40.6 31.5 1990 38.4 41.0 31.7 1991 38.8 40.9 31.8 1992 39.1 40.8 31.8 1993 39.6 40.8 31.9 1994 40.2 40.9 32.1 1995 40.8 41.1 32.2 1996 41.2 41.4 32.5 1997 41.5 41.7 32.7 1998 41.9 42.1 33.0 1999 42.3 42.4 33.2 Median Age of Clallam, Jefferson, and Kitsap Counties, 1980-1999. • Source: Intercensal projections and estimates generated by the Washington State Office of Financial Management,September 2000. 45.0 - 40.0 - 1 35.0 30.0 -= 25.0 - 20.0 15.0 I 10.0 - 1 5.0 - 0.0 O T N M �' V) fD N- CO a) O r N M LO CD N- CO a) CO CO CO CO CO CO CO 00 CO CO a) C) a) a) a) a) a) a) a) Q) a) a) a) a) a) a) a) a) a) a) a) a) a) a) a) Q) W a) a) T T T T T T T T T T T T T T T T T T T T Clallam County -e--Jefferson County ---Kitsap County 5/30/01 DRAFT Percent Population Age 65+, Clallam, Jefferson, and Kitsap Counties , 1980, 1990-2000. Year Clallam County Jefferson County Kitsap County 4 1980 14.2% 15.8% 9.9% 1990 20.3% 20.3% 10.6% 1991 20.3% 20.1% 10.6% 1992 20.4% 20.1% 10.4% 1993 20.5% 19.8% 10.5% 1994 20.6% 19.6% 10.6% 1995 20.6% 19.6% 10.5% 1996 20.4% 19.7% 10.5% 1997 20.2% 19.6% 10.5% 1998 20.5% 19.7% 10.7% 1999 20.9% 20.0% 10.9% 2000 22.2% 21.0% 11.1% Population Age 65+, Clallam, Jefferson, and Kitsap Counties, 1980 and 1990-2000. Source: 1980, 1990,and 2000-U.S.Census. 1991-1999-Intercensal projections generated by the Washington State Office of Financial Management,September 2000. 25.0% T • 20.0% A----• 15.0% -- 10.0%10.0% 5.0% II 0.0% ' O o e- N M u7 CO t� 00 T co O) Q) T O W C) O) C) Q) T C) C) C) C) C) C) C) O 0) O) a) 0 -U-Clallam County -A--Jefferson County _a-Kitsap County 5/30/01 DRAFT Racial and ethnic composition of Clallam, Jefferson, and Kitsap Counties, US Census, 2000 Clallam County Jefferson County Kitsap County • White 87.4% 91.0% 82.2% African-American 0.8% 0.4% 2.8% Native American 4.8% 2.2% 1.5% Asian 1.1% 1.2% 4.3% Native Hawaiian/Other Pacific Islander 0.2% 0.1% 0.7% Other racial designation 0.1% 0.3% 0.3% Two or more races 2.1% 2.7% 4.0% 0 Hispanic* 3.4% 2.1% 4.1% *Hispanic persons may be of any race and are not included in any specific racial group. Racial and Ethnic Composition, Clallam, Jefferson, and Kitsap Counties, 2000 Source: U.S. Census, 2000 NOTE: Data are final. 100% — 90% — 80% 70% 60% -41- 50% r 50% 1 ■Clallam County J Jefferson County Kitsap County 40% 30% 20% 10% — 0% �t•`� ��`� P2. �� \a�a dab c No taG� Qac` ev • z. `� a° Qa �`a o0 P �' et ca �� a ��S` o��c map •a �; *Hispanic persons may be of any race and are not included in specific racial group. 5/30/01 DRAFT • Civilian unemployment rate, Clallam, Jefferson, and Kitsap Counties, 1980-2000. Year Clallam County Jefferson County Kitsap County 1980 13.6% 9.3% 6.1% 1981 17.9% 11.6% 7.7% 1982 19.1% 10.0% 8.7% 1983 14.4% 10.0% 7.7% 1984 12.3% 9.5% 6.9% 1985 10.1% 8.9% 5.9% 1986 9.7% 8.3% 6.3% 1987 9.6% 7.9% 6.0% 1988 8.2% 5.9% 5.4% 1989 8.5% 5.8% 5.3% 1990 6.9% 4.9% 4.0% 1991 7.7% 6.5% 4.9% 1992 8.8% 8.9% 6.0% 1993 10.0% 8.3% 6.8% 1994 10.1% 8.5% 6.0% 1995 8.5% 7.3% 6.7% 1996 9.7% 8.3% 6.8% 1997 7.9% 6.8% 5.5% 1998 7.9% 6.7% 5 2% 1999 7.2% 5.8% 5.0% 2000 7.9% 5.7% 5.6% Civilian unemployment rates, Clallam, Jefferson, and Kitsap Counties, 1980-2000. Source: Washington State Department of Labor and industry,April 2001. 25.0% - 20.0% - - --Clallam County --a-Jefferson County -A--Kitsap County 15.0% - \ 10.0% 5.0% 0.0% O r N M Tr u7 CC N- 00 C) O - CN M U) (C N 00 C) 00 00 CO 00 CO CO CO CO CO 00 C) C) C) C) C) C) C) C) C) C) O CO C) C) C) co co C) C) C) C) C) C) C) C) 0) C) C) C) C) C) O N 5/30/01 DRAFT Median household income, Clallam, Jefferson, and Kitsap Counties, 1989-2000. 1111 Year Clallam County Jefferson County Kitsap County 1989 $25,434 $25,197 $32,043 1990 $27,149 $27,350 $36,636 1991 $27,212 $28,207 $37,670 1992 $27,282 $28,569 $38,185 1993 $27,433 $28,821 $38,223 1994 $27,486 $29,122 $38,908 1995 $28,128 $29,002 $38,813 1996 $28,887 $30,028 $39,808 1997 $30,700 $31,749 $41,524 1998 $31,443 $32,664 $42,484 1999 $31,162 $33,446 $44,036 2000 $32,268 $34,662 $45,401 Median household income, Clallam, Jefferson, and Kitsap Counties, 1989-2000. Source Washington State Department of Labor and Industry,April 2001. $60,000 - • $50,000 ■Clallam County ❑Jefferson County a Kitsap County I r pri $40,000 1 0, 0 1 $30,000 / 0 $20,000 fg 0 0gr Vd r $10,000 - / r 00 ! d.''l'i 01 O I- N M .' It) t0 1s• 00 a> O 00 O 01 01 01 01 01 01 CO 0) 01 O W 01 O 01 w 0) W 01 W O 01 O r @- P !- 1- r l-- r r r CV • 5/30/01 DRAFT r • i . . • Median house price, Clallam, Jefferson, and Kitsap Counties, 1995-2000. Year Clallam County Jefferson County Kitsap County 1995 $102,000 $127,300 $124,600 1996 $110,100 $142,100 $127,700 1997 $112,300 $135,000 $131,200 1998 $118,000 $136.300 $145,600 1999 $120,000 $155,900 $143,100 2000 $117,800 $174,700 $148,500 Median house prices, Clallam, Jefferson, and Kitsap 1 Counties, 1995-2000. Source:Washington State Center for Real Estate Research,Washington State University,December 2000. $200,000 IN Clallam County ❑Jefferson County Z Kitsap County $175,000 - — • $150,000 - I $125,000rif7– I � 1 0 $100,000 �I / I r j $75,000 , f / �j 0 $50,000 ' / / j $25,000 - ✓ % ;/ I ! $0 tit / Z ✓ 4] up r- 00 Q0 O 0 e- r r ,- ,- N 11, 5/30/01 DRAFT Population Growth in Jefferson County and Washington State, 1981-83 through 1998-2000. Population S Year Jefferson County WA State %Growth 1980 15,965 4,132,156 Period Jefferson County Washington State 1981 16,736 4,229,278 1981-83 1.1% 1.8% 1982 17,017 4,276,549 1982-84 2.7% 1.8% 1983 16,925 4,307,247 1983-85 5.6% 2.5% 1984 17,480 4,354,067 1984-86 4.8% 2.5% 1985 17,873 4,415,785 1985-87 3.7% 2.5% 1986 18,317 4,462,212 1986-88 4.4% 3.5% 1987 18,533 4,527,098 1987-89 6.2% 4.4% 1988 19,131 4,616,886 1988-90 6.7% 5.4% 1989 19,673 4,728,077 1989-91 9.8% 5.8% 1990 20,406 4,866,692 1990-92 10.3% 5.1% 1991 21,600 5,000,400 1991-93 8.8% 4.8% 1992 22.500 5,116,700 1992-94 8.0% 4.3% 1993 23,500 5,240,900 1993-95 6.8% 3.6% 1994 24,300 5,334,400 1994-96 5.8% 3.4% 1995 25,099 5,429,900 1995-97 4.8% 3.3% 1996 25,700 5,516,800 1996-98 3.1% 3.1% 1997 26,300 5,608,100 1997-99 1.1% 2.7% 1998 26,500 5,685,300 1998-2000 -2.1% 3.7% 1999 26,600 5,757,400 2000 25,953 5,894,121 • Population growth in Jefferson County and Washington State, 1981-83 through 1998-2000. Source: Washington State Office of Financial Management Intercensal estimates, 1980-90.Washington State data are final intercensal counts adjusted to the 2000 census.Jefferson County data-projections 1991- ; 1999,census 2000. NOTE: Jefferson County data are provisional-OFM projections exceeded actual 2000 count. Adjusted 1991-99 numbers will be lower than those shown here. 12.0% - 10.0% 8.0% - 6.0% - Jefferson County 4.0% Washington State 2.0% 0.0% et to to N co a) o , N M d' to CO N °O a) 0 CO CO CO CO CO CO w e) a) a) a) CD CD a) a) a) o -2.0%;04 M°0 g to0 m 0No °oo ow o a) N) Co' 4 tco) (ao) r�rn o, a) 0) a) o) a) a) o) a) o) c) a) a) a) a) a) ao • '. T r r r T l"' r r P" r r r !- r r CD -4.0% I 5/30/01 DRAFT sources of population growth Components of Population Growth, Jefferson County, 1981-2000 6 Number of % growth from Year Observed Births Deaths Expected migrants Year Migration Natural Increase 1980 15,965 225 154 1980 1981 16,736 236 142 16,036 700 1981 90.8% 9.2% 1982 17,017 237 168 16,830 187 1982 66.5% 33.5% 1983 16,925 204 168 . 17,086 -161 1983 175.0% -75.0% 1984 17,480 224 164 16,961 519 1984 93.5% 6.5% 1985 17,873 223 148 17,540 333 1985 84.7% 15.3% 1986 18,317 197 186 17,948 369 1986 83.1% 16.9% 1987 18,533 218 174 18,328 205 1987 94.9% 5.1% 1988 19,131 230 197 18,577 554 1988 92.6% 7.4% 1989 19,673 199 221 19,164 509 1989 93.9% 6.1% 1990 20,406 216 209 19,651 755 1990 103.0% -3.0% 1991 21,600 247 195 20,413 1,187 1991 99.4% 0.6% 1992 22,500 233 203 21,652 848 1992 94.2% 5.8% 1993 23,500 236 232 22,530 970 1993 97.0% 3.0% 1994 24,300 212 254 23,504 796 1994 99.5% 0.5% 1995 25,099 216 241 24,258 841 1995 105.3% -5.3% 1996 25,700 199 267 25,074 626 1996 104.2% -4.2% 1997 26,300 214 255 25,632 668 1997 111.3% -11.3% 1998 26,500 207 282 26,259 241 1998 120.5% -20.5% 1999 26,600 220 283 26,425 175 1999 175.0% -75.0% 2000 25,953 26,537 -584 2000 90.3% 9.7% 0 Migration and Natural Increase as Sources of Population Growth, Jefferson County, 1981-2000 Source: Washington State Office of Financial Management Intercensal estimates, 1980-90, projections 1991-1999, census 2000. NOTE: Data are provisional-OFM projections exceeded actual 2000 count. Adjusted 1991-99 numbers will be lower than those shown here. 200.0% 180.0% 160.0% 140.0% 120.0% Natural Increase 100.0% 80.0% 60.0% i -c iMgration 0 h 40. % x 20.0% 0.0% , N M I) CO h CO C) 0 - N M In CO F CO 0) 0 CO CO c0 CO CO CO CO 00 CO C) 0) C) 0) C) C) C) C) C) 0) 0 C) 0) 0) C) C) 0) C) 0) 0) C) C) C) 0) C) C) C) 0) C) C) O IP 5/30/01 DRAFT Age Composition, Jefferson County, 1980 Age Group Males Females Age Group Males Females 41111 0-4 538 533 0-4 -3.4% 3.3% 5-9 534 505 5 9 -3.3% 3.2% 10-14 525 593 10-14 -3.3% 3.7% 15-19 579 542 15-19 -3.6% 3.4% 20-24 480 501 20-24 -3.0% 3.1% 25-29 632 662 25-29 -4.0% 4.1% 30-34 704 659 30-34 -4.4% 4.1% 35-39 517 475 35-39 -3.2% 3.0% 40-44 413 331 40-44 -2.6% 2.1% 45-49 354 380 45-49 -2.2% 2.4% 50-54 397 433 50-54 -2.5% 2.7% 55-59 512 564 55-59 -3.2% 3.5% 60-64 540 544 60-64 -3.4% 3.4% 65-69 522 482 65-69 -3.3% 3.0% 70-74 357 371 70-74 -2.2% 2.3% 75-79 184 196 75-79 -1.2% 1.2% 80-84 87 129 80-84 -0.5% 0.8% 85 + 73 117 85 + -0.5% 0.7% Age Composition, Jefferson County, 1980. Source: 1980 census. NOTE: data are final. 0 85+ 80-84 75-79 70-74 65-69 Males Females 60-64 55-59 0 50-54 I 0 i 45-49 I W 40-44 C, Q 35-39 ' 30-34 25-29 20-24 15-19 10-14 1 5-9 1 0-4 . -6% -4% -213/0 0% 2% 4% 6% Percent of Total Population (15,965) 5/30/01 DRAFT Age Composition, Jefferson County, 1990 Age Group Males Females Age Group Males Females II 0-4 570 596 0-4 -2.8% 2.9% 5-9 719 682 5-9 -3.5% 3.3% 10-14 682 611 10-14 -3.3% 3.0% 15-19 557 501 15-19 -2.7% 2.5% 20-24 412 353 20-24 -2.0% 1.7% 25-29 518 476 25-29 -2.5% 2.3% 30-34 757 734 30-34 -3.7% 3.6% 35-39 866 924 35-39 -4.2% 4.5% 40-44 899 840 40-44 -4.4% 4.1% 45-49 647 585 45-49 -3.2% 2.9% 50-54 485 492 50-54 -2.4% 2.4% 55-59 493 547 55-59 -2.4% 2.7% 60-64 637 686 60-64 -3.1% 3.4% 65-69 741 772 65-69 -3.6% 3.8% 70-74 605 599 70-74 -3.0% 2.9% 75-79 358 394 75-79 -1.8% 1.9% 80-84 171 223 80-84 -0.8% 1.1% 85 + 92 182 85 + -0.5% 0.9% Age Composition, Jefferson County, 1990. Source: 1990 census. NOTE: Data are final • 85+ 80-84 75-79 ! 70-74 1 65-69 UST$s i Females 55-59 C2- 50-54 (6- 45-49 a 40-44 Q 35-39 30-34 1 25-29 20-24 15-19 10-14 5-9 , 04 4111 -6% -4% -2% 0% 2% 4% 6% Percent of Total Population (20,406) 5/30/01 DRAFT Age Composition, Jefferson County, 1999 Projected Population Age Group Males Females Age Group Males Females II 0-4 739 703 0-4 -2.6% 2.4% 5-9 842 853 5-9 -2.9% 3.0% 10-14 925 875 10-14 -3.2% 3.0% 15-19 869 747 15-19 -3.0% 2.6% 20-24 574 555 20-24 -2.0% 1.9% 25-29 695 636 25-29 -2.4% 2.2% 30-34 720 648 30-34 -2.5% 2.2% 35-39 939 922 35-39 -3.3% 3.2% 40-44 1,083 1,108 40-44 -3.8% 3.8% 45-49 1,108 1,041 45-49 -3.8% 3.6% 50-54 934 868 50-54 -3.2% 3.0% 55-59 837 805 55-59 -2.9% 2.8% 60-64 679 724 60-64 -2.4% 2.5% 65-69 694 756 65-69 -2.4% 2.6% 70-74 669 753 70-74 -2.3% 2.6% 75-79 550 626 75-79 -1.9% 2.2% 80-84 290 367 80-84 -1.0% 1.3% 85 + 163 302 85 + -0.6% 1.0% Age Composition, Jefferson County, 1999 (projected) iSource: Washington State Office of Financial Management,September 2000,2000 precensus projections NOTE: Data are provisional-OFM projections exceeded actual 2000 count. Adjusted 1991-99 numbers will be lower than those shown here. 85+ 1 80-84 j 75-79 70-74 1 Females 65-69 Males 60-64 55-59 1 i M 50-54 C 45-49 1 C 4) 40-44 1 cn < 35-39 1 30-34 25-29 1 20-24 15-19 1 10-14 5-9 0-4 i Ai -6% -4% -2% 0% 2% 4% 6% Percent of Total Population (28,801) I 5/30/01 DRAFT Median Age of Jefferson County and Washington State, 1980-99. Year Jefferson County Washington State Index 1980 35.0 29.8 1.17 1981 35.5 30.0 1.18 1982 36.3 30.4 1.20 1983 37.3 30.9 1.21 1984 37.9 31.2 1.22 1985 38.5 31.6 1.22 1986 39.0 32.0 1.22 1987 39.6 32.3 1.23 1988 40.2 32.6 1.23 1989 40.6 32.8 1.24 1990 41.0 33.0 1.24 1991 40.9 33.2 1.23 1992 40.8 33.4 1.22 1993 40.8 33.6 1.22 1994 40.9 33.9 1.21 1995 41.1 34.2 1.20 1996 41.4 34.5 1.20 1997 41.7 34.8 1.20 1998 42.1 35.2 1.20 1999 42.4 35.4 1.20 Median Age, Jefferson County and Washington State, 1980-1999. Source: Washington State Office of Financial Management, Intercensal projections and estimates,September 2000. NOTE: Washington State 1980-2000 data are final; Jefferson County 1980-90 data are final but 1991-1999 data are provisional 45.0 - Jefferson County 40.0 35.0 Washington State 30.0 25.0 20.0 15.0 •- 10.0 5.0 0.0 ----- O e- N Co) rr 1.17 tD N 00 C) O r N M 'c7 U7 CD N 00 C) 00 CO CO 00 CO CO CO CO 00 CO 0) C) 0) 0) 0) C) 0) C) a) C) C) C) C) C) C) 0) Q) C) C) 0) 0) C) 07 C) 0) C) 0) CO 0) C) r r r r r r r r r r r r r r r r 5/30/01 DRAFT r Population age 65+, Jefferson County & Washington State, 1980 and 1990-2000 Year Jefferson County Washington State 0 1980 15.8% 10.4% 1990 20.3% 11.7% 1991 20.1% 11.6% 1992 20.1% 11.6% 1993 19.8% 11.4% 1994 19.6% 11.4% 1995 19.6% 11.4% 1996 19.7% 11.3% 1997 19.6% 11.2% 1998 19.7% 11.1% 1999 20.0% 11.1% 2000 21.0% 11.1% Population Age 65+, Jefferson County and Washington State, 1980 and 1990-2000. Source: Washington State Office of Financial Management,May 2001. NOTE: Washington State data are final; Jefferson County 1980 and 1990 data are final but 1991-1999 are provisional and subject to change. 25.0% - a Jefferson County 20.0% 15.0% -- Washington State ■ ! -a ■ ! f ■ i i 10.0% 5.0% - 0.0% ' O O ,- N Cl to CO N CO C) °C C) C) C) C) a) C) C) C) C) co C) C) C) C) C) C) C) C) C) C) C) IP 1 5/30/01 DRAFT Racial and ethnic composition of Jefferson County and Washington State, US Census, 2000 Jefferson County Washington State • White 91.0% 78.9% African-American 0.4% 3.1% Native American 2.2% 1.4% Asian 1.2% 5.3% Native Hawaiian/Other Pacific Islander 0.1% 0.4% Other racial designation 0.3% 0.2% Two or more races 2.7% 3.0% Hispanic* 2.1% 7.5% *Hispanic persons may be of any race and are not included in any specific racial group. Racial and Ethnic Composition, Jefferson County and Washington State, 2000 Source: US Census,2000. NOTE: All data are final. I 100% -7- 91.0%91.0% 90% - 80% - 78.9% 70% — 60% - 50% 40% — ! I 30% — '■Jefferson County E Washington State 20% — 10% — 5.3% 3.1% 2.2% 1.4% 1.2% I 0.4%I �r 0.1% 0.4% 0% White African-American Native American Asian Native Hawaiian/Other Pacific Islander *Hispanic persons may be of any race and are not included in any specific racial 5/30/01 DRAFT f Civilian unemployment rate in Jefferson County and Washington State, 1980-2000. 411 Year Jefferson County Washington State 1980 9.3% 7.9% 1981 11.6% 9.5% 1982 10.0% 12.1% 1983 10.0% 11.2% 1984 9.5% 9.5% 1985 8.9% 8.1% 1986 8.3% 8.2% 1987 7.9% 7.6% 1988 5.9% 6.2% 1989 5.8% 6.2% 1990 4.9% 4.9% 1991 6.5% 6.4% 1992 8.9% 7.6% 1993 8.3% 7.6% 1994 8.5% 6.4% 1995 7.3% 6.4% 1996 8.3% 6.5% 1997 6.8% 4.8% 1998 6.7% 4.8% 1999 5.8% 4.7% 2000 5.7% 5.2% • Civilian unemployment rates, Jefferson County and Washington State, 1980-2000. 14.0% - Source: Washington State Department of Labor and Industry,April 2001. 12.0% 10.0% - 8.0% effer •n Co 6.0% 4.0% - Washington State 2.0% -- 0.0%0.0% co °c0 03 CO MCOC003 CO 03 CO COCr) CC)) CC)) CC)) Com) C)) Ca) 0)) CC)) CC)) O C) C) C) C) C) C) C) C) C) C) C) C) C) Cr) C) C) C) C) C) C) N e 5/30/01 DRAFT Poverty Status by age in Washington State and Jefferson County, 1989, 1993,1995, and 1997. Jefferson County Washington State All persons. 1989 12.6% 11.0% 0 <18 years old. 1989 23.7% 16.7% 5-17 years old, 1989 20.5% 14.9% All persons, 1993 12.3% 12.0% <18 years old, 1993 19.8% 17.3% 5-17 years old, 1993 17.9% 15.0% All persons, 1995 11.4% 10.8% <18 years old, 1995 18.1% 15.1% 5-17 years old, 1995 16.3% 12.8% All persons, 1997 11.4% 10.2% <18 years old, 1997 18.2% 15.2% 5-17 years old, 1997 17.8% 13.7% Poverty by age, Jefferson County and Washington State, 1989, 1993, 1995, and 1997. Source: US Bureau of the Census,Small Area Income and Poverty Estimates Program, November 20000 . 2 % - 18.00.0% 16.0% - 14.0% - 12.0% 10.0% 8.0% - I I ,6.0% ± 4.0% 2.0% - I ! I1 0) W 0) M M M 00 CO 00 0) 0) 0) CO 0) D7 CO CO T 01 0) D7 0) CO Q) CO CO 0) 0) 0) 00 O O o O O O O O O L L L L a) ca t1:1 Q) cc to ) as ara d to to 9 >t 3., Vin 7 7 ■Jefferson County ❑Washington State 5/30/01 DRAFT Median household income, Jefferson County and Washington State, 1989-2000. Year Jefferson County Washington State Index 1989 $25.197 $31,183 0.81 1990 $27,350 $33,461 0.82 1991 $28.207 $34,374 0.82 1992 $28.569 $35,880 0.80 1993 $28.821 $36,519 0.79 1994 $29,122 $37,674 0.77 1995 $29.002 $38,707 0.75 1996 $30,028 $40,808 0.74 1997 $31.749 $43,460 0.73 1998 $32,664 $46,080 0.71 1999 $33,446 $48,289 0.69 2000 $34.662 $50,152 0.69 Median Household Income, Jefferson County and Washington State, 1989-2000. Source: Estimates and forecasts prepared by Washington State Office of Financial Management,September 2000 $60,000 -' • $50,000 $40,000 $30,000 1 I $20,000 I ii. .t Ii$10000Ii 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 ■Jefferson County C Washington State 5/30/01 DRAFT • t Median house sales prices, Jefferson County and Washington State, 1989-99. Year Jefferson County Washington State Index 1995 $127,300 3136.600 0.93 1996 $142,100 $142,200 1.00 1997 $135,000 $150,000 0.90 1998 $136,300 $160.700 0.85 1999 $155,900 $166,600 0.94 2000 $174,700 $176,900 0.99 • Median House Sales Prices, Jefferson County and Washington State, 1995-2000. Source:Wasington State Center for Real Estate Research, Washington State University, December 2000 $200,000 - $180,000 - I $160,000 - $140,000 - j $120,000 - i $100,000 - i $80,000 - $60,000 - $40,000 - $20,000 - $0 1995 1996 1997 1998 1999 2000 ■Jefferson County E Washington State 5/30/01 DRAFT Housing Affordability Index, Jefferson County and Washington State, 1989-2000. 41 Year Jefferson County Washington State 1995 118.2 109.2 1996 87.9 121.5 1997 84.3 109.3 1998 97.4 120.8 1999 103.2 126.1 2000 78.1 108.4 Housing Affordability Index, Jefferson County and Washington State, 1995-2000. Source:Washington Center for Real Estate Research, Washington State University,Octoberr 2000 140.0 - • 120.0 .shington State I 100.0 More Affordable 80.0 Jefferson County Less Affordable 60.0 - 40.0 - • 20.0 - 0.0 1995 1996 1997 1998 1999 2000 I 5/30/01 DRAFT • t Board of Health New Business Agenda Item # V. , 3 Required Connection to • Community Sewer Systems July 19, 2001 1 Jefferson County Board of Health Agenda Item Information / Description Regular Business 1, For Month of: July, 2001 Description - a brief description of the agenda item: please include project, road, contract, grant, etc. number if one is available for the Commissioner Index Discussion concerning policy options for sewer extensions within sewer service areas Issue - a short outline of the issue: including policy issue falls within; strategy or objective issue supports; key reference areas (law/policy/regulations) : This is a policy issue intended to clarify when the health department may require connection to public sewers . The attached document is offered to initiate the discussion. Opportunity Analysis - what is the type of action Board is being asked to take: discussion/decision - if decision - what is the range of possible solutions considered by the department in preparing its recommendation The board is being asked to review the attached document and offer policy direction from which staff will initiate, if appropriate, specific policy language for further board review. • Specific Departmental Recommendation - why was the action recommended and what would be the impact of not taking the action: what specific action is necessary by the BOCC approval - adoption - deny - remand back to department None at this time. Review Process - if this issue was sent back for further review by the board, please indicate additional reviews undertaken. If the review is simply good business policy - indicate what reviews have taken place Risk Management Legal/Prosecuting Attorney Fiscal/Budget Department Head Public Service Director Board Management Team Other Impacted Departments - please list Work Plan including What, Who, When and How has been completed YES (please provide copy) NO (why not?) (check one) • II Subject: Required connection to public sewers Issue: The recently adopted Jefferson County Onsite Sewage Ordinance requires connection to public sewers when sewer service is available. An onsite sewage system may be permitted only when sewer service is not available. The ordinance does not provide specify how to determine if sewer service is available. Current Guidance: Indirectly guidance is provided in several areas; • WAC 246-272 requires connection to sewer when sewer service is available within 200 feet of the residence, the existing onsite sewage system is failing, the sewer utility will provide the service and the health officer requires it. The state regulation does not address new systems and new construction. • Various utilities have policies concerning required connection. Port Townsend policy has undergone changes in recent years with connection required when service is available with in 200 to 500 feet of the property line. (I am not sure about the current standard) Additionally, the city requires connection of existing septic systems when sewer service becomes available. • • Port Ludlow policy is to allow sewer connection within the boundaries of the master planned resort at the expense of the property owner. In other words sewer service is available, but at a cost. Additionally, covenants establish requirements to connect to sewer when sewer is available for both new construction and existing buildings. The covenants do not specify how to determine availability. • Health and Human Services Policy Statement97-02, "Minimum Land Area Requirements", prohibits waivers from minimum land area requirements as established in WAC 246-272 when sewer service is available in a timely and reasonable matter. Discussion: Environmental Health frequently receives applications for onsite sewage system permits for properties located within areas generally served by sewers (Port Townsend and Port Ludlow) but where specific lots may not be conveniently located for connection. Typically the septic permit application has been submitted because the cost of extending sewer service greatly exceeds the cost of the individual septic system when only the lot in question is bearing the cost of the extension. When all the lots that may benefit from the extension are factored in, community sewers are often less expensive or cost competitive with onsite sewage. Practice has been to defer to the utility and proceed with the septic application only if the utility indicates an unwillingness to extend service as determined by the utility policies and the site will otherwise support a septic system irrespective of whether the lot density will support septics over the long run. • The problem with this approach is that the expediency and immediacy of the individual application takes precedent over the long-term interests of the community at large. When costs for sewering are considered only with respect to a specific property the cost of • installing a septic system will almost always be much less than extending a sewer line. When each development proposal is reviewed in isolation there will almost always be a short term interest is using onsite systems. However, each time a septic system is installed a barrier is created to the eventual extension of sewers. The owner of a lot with a septic system, especially one who has incurred the expense of an alternative system, is much more likely to be resistant to paying for future sewer service than the owner of an undeveloped lot. (assuming there are expectations of building in the future). And as the number of lots that will be sewered goes down, the cost per connection goes up creating an additional barrier. The basic problem then would appear to be how to motivate a community to work together or at least assure that when septic permits are issued they are issued at sustainable densities. To some extent this has occurred through the adoption of the county land area policy. Additionally, Port Townsend has adopted an ordinance limited septic installation to land areas of at least one acre. ( I believe this is mainly intended to keep septic density low enough that potential infill will drive eventual sewer extension.) Although the county land area policy has functioned reasonably well there has been increasing pressure by individuals to allow septics in Port Ludlow in particular even though lots sizes do not meet the policy requirements. Policy Options: • The staff preferred option would be a kind of carrot and stick approach initiated • by a clear policy statement from the BOH that sewer service is the first priority within sewer service areas and septics are the exception. (RCW70.118.050 provides that local boards of health may adopt more restrictive standards than those contained in 70.118 or rules adopted by the state.) This then would be followed up by the provision of technical assistance and guidance, possibly through public works or the PUD in the county, to assist the communities with the processes necessary to establish local utility or improvement districts leading towards financing the improvements. • A second option would be to continue as we have but reaffirm the limitations with respect to land area as specified in the adopted policy. • Irrespective of the above, Staff would recommend a clear statement with respect to subdivision within sewer service areas requiring extension of sewers into the new plats as a condition of approval • Board of Health New Business Agenda Item # V. , 4 • Building Permit Applications Existing On-site Sewage Systems July 19, 2001 • Jefferson County Board of Health Agenda Item Information / Description Regular Business dilFor Month of : July, 2001 Description - a brief description of the agenda item: please include project, road, contract, grant, etc. number if one is available for the Commissioner Index Draft policy regarding new construction using existing onsite sewage systmes . Issue - a short outline of the issue: including policy issue falls within; strategy or objective issue supports; key reference areas (law/policy/regulations) : RCW 70 . 118 authorizes local boards of health to adopt regulations more restrictive that those adopted by the state board of health or as established in 70 . 118 . The law specifically authorizes local boards ability to establish restrictions on expansions on residences when the board finds it necessary to do so in order to protect the public health and water quality standards . Section 8 . 15 . 060 of the Jefferson County Onsite Sewage Code states that any new or replacement structure may be connected to an existing onsite sewage system only when the system has the hydraulic capacity, sufficient horizontal and vertical separation and adequate reserve area. The draft policy statement addresses how existing onsite sewage systems will be evaluated in order to determine whether the intent outlined in 8 . 15 . 060 is met . Opportunity Analysis - what is the type of action Board is being asked to take : discussion/decision - if decision - what is the range of possible solutions considered by the department in preparing its recommendation The Board is being asked to review and comment on the draft policy. It is anticipated that board recommended revisions will be incorporated into a next draft for further review Specific Departmental Recommendation - why was the action recommended and what would be the impact of not taking the action: what specific action is necessary by the BOH approval - adoption - deny - remand back to department Staff does not have a specific recommendation with respect to the draft policy at this time . Review Process - if this issue was sent back for further review by the board, please indicate additional reviews undertaken. If the review is simply good business policy - indicate what reviews have taken place 411Risk Management Legal/Prosecuting Attorney Fiscal/Budget Department Head Public Service Director Board Management Team Other Impacted Departments - please list Work Plan including What, Who, When and How has been completed YES (please provide copy) NO (why not?) (check one) • . REVISED CODE OF WASHINGTON Page 1 of 1 RCW 70 . 118 . 050 411 Adoption of more restrictive standards . If the legislative authority of a county or city finds that more restrictive standards than those contained in *section 2 of this act or those adopted by the state board of health for systems allowed under *section 2 of this act or limitations on expansion of a residence are necessary to ensure protection of the public health, attainment of state water quality standards, and the protection of shellfish and other public resources, the legislative authority may adopt ordinances or resolutions setting standards as they may find necessary for implementing their findings. The legislative authority may identify the geographic areas where it is necessary to implement the more restrictive standards . In addition, the legislative authority may adopt standards for the design, construction, maintenance, and monitoring of sewage disposal systems . '1989 c 349 § 3. ] NOTES : *Reviser' s note : "Section 2 of this act" did not become law. See effective date note following. 111 Effective date -- 1989 c 349 : " (1) Except as provided in subsection (2) of this section, this act shall take effect November 1, 1989. (2) *Section 2 of this act shall not take effect if the state board of health adopts standards for the replacement and repair of existing on-site sewage disposal systems located on property adjacent to marine waters by October 31, 1989. " [1989 c 349 § 4 . ] *Reviser' s note: Section 2 of this act did not take effect . See chapter 248-96 WAC. • http://search.leg.wa.gov/wslrcw/RCW%20%2070%2.../RCW%20%2070%20118%20.050.ht 7/11/01 (j) An owner fails to complete required 0 & M inspections, comply with the 0 & M schedule in TABLE 1 and/or submit the reports to the PUD. (k) An owner fails to comply with conditions of the on-site sewage permit. • 8.15.060 ADEQUATE SEWAGE DISPOSAL REQUIRED (1) Every residence, place of business, or other building or place where people congregate. reside or are employed shall be connected to an approved public sewer. If no public sewer is available, the building sewer shall be connected to an on-site sewage system approved by the Health Officer. Said sewage disposal system shall be built or rebuilt, constructed and maintained in such manner as to meet the requirements as prescribed by the Health Officer in accordance with minimum requirements and standards of WAC 246-272 and this code. Such system may include the use of waterless toilet devices in conjunction with an approved graywater system or other proprietary devices approved by Washington State Department of Health. (2) Any unit/facility with the potential to generate waste water by virtue of being equipped with a toilet, sink, shower or other plumbing fixture that is in a water service area or has a well on site, shall be connected to an approved public sewer or shall be connected to an on-site sewage system approved by the Health Officer. (3) Any new or replacement residence or any expansion, as that term is defined in Section 8.15.050(7) of this Code, may be connected to a pre-existing on-site sewage system only when the pre-existing system has hydraulic capacity, sufficient vertical and horizontal separation, an adequate reserve area and satisfies all other requirements to be in compliance with current code. 8.15.070 NO DISCHARGE TO WATER OR GROUND SURFACE Effluent from any on-site sewage disposal system shall not be discharged directly or • indirectly to surface water or upon the surface of the ground, except where expressly permitted by the Health Division or by the Washington State Department of Ecology. 8.15.080 ON-SITE SEWAGE SYSTEM PERMIT (1) No person shall install or cause to be installed a new on-site sewage system, nor perform any alteration, extensions, relocation or connection to an existing on-site sewage system without a valid permit issued by the Health Officer. (2) When applying for a permit to install an on-site sewage system, a detailed to scale construction plan of the proposed system and site is required and shall include all items identified in WAC 246-272-11001 (2)(a). Each application shall contain the information required in WAC 246-272-09001 as a minimum. (3) The minimum land area required for approval of an OSS permit shall be determined by either Method 1 or Method 2 as established in WAC 246-272. (4) Permits are transferable with property ownership. (5) Any sewage disposal permit issued under this section shall be valid for a period of three (3) years from the date of issuance. (a) The permit may remain valid if the property for which the permit has been issued also has an active building permit for a structure that will be connected to the on-site sewage system. • JEFFERSON COUNTY HEALTH AND HUMAN SERVICES ENVIRONMENTAL HEALTH DIVISION POLICY STATEMENT PROGRAM — On-site Sewage Disposal SUBJECT — Review of Building Permit Applications Effective this date the following procedure shall be adopted concerning review of building permit applications on properties where there is an existing onsite sewage system. PURPOSE Applications for building permits for properties served by on-site sewage systems shall be approved only when the on-site sewage system has adequate hydraulic and treatment capacity to accommodate the proposed construction and an adequate repair area is available. APPLICABILITY This policy applies to building permit applications for new structures that contain plumbing; alterations or remodels to existing structures that contain plumbing; and structures not containing plumbing when the placement of that structure may interfere with the performance of an existing onsite system or the ability to replace the existing system. GENERAL POLICY STATEMENT It is the policy of the Jefferson County Board of Health that all existing onsite sewage systems will be evaluated to determine whether the system has been installed with adequate vertical and horizontal separation, sufficient hydraulic capacity and reserve area to support the proposed development without compromising the public health or water quality standards before approval of building permits for new or replacement structures. Whenever feasible, the evaluation will be based on information obtained from permit records. However, when permit records provide insufficient information, field evaluation may be required. Determinations will balance the expectations and commitments implicit in the permit record with the degree to which use of a permitted system may compromise the public health. in all cases public health protection is the highest priority. It is further policy of the Board that properties that have an installed onsite sewage system that was properly permitted by Jefferson County will not be Draft Policy Review of Building Permit Applications page 1 of 2 denied a building permit based solely on the adequacy of the system. However, the Board reserves the right to require that the system be upgraded in order to meet the public health and water quality protection standards. The exception to this policy is the case where use of an onsite sewage system would violate state laws. SPECIFIC STANDARDS • Existing systems with more than 1 foot of vertical separation, adequate hydraulic capacity, horizontal separation and sufficient reserve area will be considered to be in compliance but will be placed on an annual inspection frequency. • Existing systems with more than one foot but less than two feet of vertical separation that do not meet horizontal separation to wells or surface water will be required to install pretreatment unit capable of meeting treatment standard 2. • Existing systems on marine shorelines will be required to meet standards specified in Table VI of the State Onsite Sewage System Regulations. • Existing systems on lots where there is not sufficient reserve area, but otherwise meet the vertical and horizontal separation requirements and have sufficient hydraulic capacity will be required to install pretreatment units capable of meeting treatment standard 2. • EFFECTIVE DATE This policy shall become effective on the date of adoption and remain in effect until amended or repealed by action of the Jefferson County Board of Health. Health Officer Date Chairman of the Board of Health Date I Draft Policy Review of Building Permit Applications page 2 of 2 a Board of Health Media Report • July 19, 2001 • • Jefferson County Health and Human Services JUNE — JULY 2001 NEWS ARTICLES These issues and more are brought to you every month as a collection of news stories regarding Jefferson County Health and Human Services and its program for the public: 1. "People First of Jefferson County plans a workshop..." P.T. LEADER. June 14. 2001 2. "Adopt a cat this month" —P.T. LEADER, June 20, 2001 3. "Mental health groups seek referee" —Peninsula Daily News. June 21, 2001 4. "Tri-Area wells protected?" (2 pages)—P.T. LEADER. June 27. 2001 5. "Following the S206 billion trail from court to county—Peninsula Daily News, July 1. 2001 • 6. "Stemming tobacco use on Peninsula"- Peninsula Daily News. July 2, 2001 7. "Whooping cough treated"—P.T. LEADER. July 3. 2001 8. "County's teen pregnancy rate drops a third" — P.T. LEADER. July 3, 2001 I THURSDAY, JUNE 14 People First of Jefferson County plans a workshop on self-determination. 9- 3:30 p.m. at the WSU Jefferson County Extension Office,201 W.Patison,Port Hadlock.For information,call Tami Lydic,385-6878 or 385-9400. • S • • I Adopt a cat this month National-Adopt-A-Cat month the facility by the shelter's edu- is here.June is the designated month cational specialist Brian Muck. in which people are encouraged to 4-H'ers participating included • adopt a cat from the local shelter. Tara Styan, Robin VanDyke, Members of the Jefferson Nadine Chouinard,Rachel Ander- County's Paws-N-Claws 4-H Cat son,Sarah Rudolph,Callum Styan, Club visited the Jefferson County Morgan Osmer and Mikayla Osmer. Animal Services pet shelter last They took turns holding different month and were given a tour of cats that were up for adoption. 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V� ° �0 r JJ ° x? 411 June 27, 2001 Leader.com Visitor Info Website: Olympic-Peninsula.com Voi. 112 No. 26 • - •T rl- rea we s ro ec e •9 City, county, PUD wrestle over aquifer protection q By Barney Burke and the PUD selling its Glen Cove sys- that the current protections are adequate 1- Leader Staff Writer tern to the city. and that the appeal should be dropped. • But on Monday night, the Port But after public testimony and discussion, A continuing debate over the level of Townsend City Council voted to sustain, the council instead voted to continue the _round water protection offered by until further study is done, its appeal of appeal for at least another 60 days. efferson County's Uniform Develop- the county's UDC in order to ensure that Monday night, the council heard • ent Code (UDC) has put a damper on protections against saltwater intrusion and from the public and a representative of glans to complete the Tri-Area water possible groundwatercontaminationfrom Shine Community Action Council and ystem swap. asphalt batch plants were sufficient. the Olympic Environmental Council The swap would have the City of Port That 6-0 vote caught county officials (OEC), groups with their own appeals ownsend selling its Tri-Area water sys- by surprise.They had expected the coun- pending on the same groundwater •m to the Public Utility District(PUD), cil to follow a city staff recommendation See WATER, Page A 13 • Timmons and city attorney John I Watts told the council that, fol- Larry Fay,county director c der lowing meetings with county environmental health,thinks thi staff,they were satisfied that the introduces a whole new player r • protections are adequate. the mix. "The PUD never ap Quite a few city residents pealed the UDC when it had th 4Water: didn't have the same comfort level opportunity,"he said. . on the issue,nor did the council. If the county can't reach al 1 Continued from Page A 1 Kostelec suggested that the agreement with the city or wits protection1 issues raised by a sec- << council might as well take more Kostelec's two groups,the West tion of the UDC. We're getting time,since the two groups she rep- ern Washington Growth Manage When the Board of County lied to about who resents have asked for more time. ment Hearings Board will decid: Among the other speakers at the matter. With Kostelec's ap Commissioners learned Tuesday the council meeting was PUD peal extension already in place morning of the delay, the board was negotiating • canceled an informational work- Commissioner Wayne King of that won't happen until at leas shop scheduled for Wednesday in good faith." Gardiner, who said the three- the end of September. that could have facilitated a pos- PUD board unanimously Leader staff xcriter Shell. sible settlement between the David Alvarez supported the city's appeal. Testernutn conn•ibuted to this star county and Shine/OEC. civil deputy prosecuting A key factor in the PUD's per So in stepped the Public Util- attorney spective is the proposed water ity District (PUD).The PUD an- Jefferson County system swap, in which the PUD nounced later Tuesday that it is slated to buy the city's Tri-Area i would sponsor the informational water system, fed by two wells workshop instead,and it will occur i So my first reaction was, in the Port Hadlock area.Asphalt today,June 27,at 1:30 p.m.at the 1.,.. •'' batch plants, if allowed there, �iere's no'sense in having a meet- could contaminate those wells, Pon Townsend Community Cen- Then We ieari ed more of some officials fear. t ter at Tyler and Lawrence streets. what has gone on since,we said, Kingpointed out that protect- County officials also said they P f would suspend negotiations with 'Time to halt this thing.— ing those two wells is a point that the city and with Shine/OEC,cit- According to Titterness, his Timmons specifically made in a ing concerns that the two appeals colleague Glen Huntingford atso Feb.21 letter to the county."I'm have become "intermingled" in indicated that he was not interested really troubled with this deal," 0 I a way that is detrimental to the in proceeding with the meeting. King said.He also suggested that Colette Kostelec, the engi- studies on the saltwater intrusion county's ability to negotiate. g neerin "We're getting lied to about g consultant who is help- problem were not being taken i ingShine and the OEC negotiate into account bythe county. who was negotiating in good g with the county, helped resusci- But in a staff report,Timmons faith," said David Alvarez, tate the meeting under the spon- pointed out that asphalt batch Jefferson County civil deputy prosecuting attorney. Until the sorship of the PUD.She said the plants are only allowed in the intentions of all parties involved commitment from the Island heavy industrial zone (the Port are clarified,there will be no fur- ' County hydrogeologist had al- Townsend Paper Corp.'s proper- ther negotiations,he explained. ' ways been tentative. ties) and in commercial forest A June 26 e-mail from Dave Of the county's reaction, lands. The report also says that Kostelec said,"I'm looking to the the county's view is that batch Christensen,the county's natural county for the basis of their accu- plants were not prohibited in sus- resource division manager, said s cation,because they haven't given - S , the county was canceling the ceptible aquifer recharge'areas; meeting"because it appears that us any evidence to substantiate previously;and the new rules-of the cityand the OEC/Shine have Jit]."All she did,she said,was at- fer added protection by requiring been workingin concert on their tend Monday's City Council meet- ing and encourage the council not conditional use permits. UDC appeals without our knowl- to withdraw its appeal but to get The city staff report also states edge. Jefferson County is sus- that the county is willing to act educated on the subject by attend pending negotiations with OEC/ as a"repository"of data on salt- Shine and the Cityof Port ing the Wednesday workshop. water intrusion,and says that the Townsend until we have assured City appeal county's proposal "appears suf- ourselves that we know who we The cityhad filed an appeal ficient." are negotiating with and what we pp The next morning, Timmons I are negotiating about." of the county's UDC in Decem left a voice mail message for County Commissioner Dan91 ber 2000, citing concerns about County Administrator Charles Titterness expressed a different whether the county's revamped P development regulations would Saddler informing him that the reason to cancel the workshop. City Council acted in response to Apparently he had helped to set compromise the protection of PP Y P threatened litigation from the ' up the session and was hoping a well water from asphalt batch plants and saltwater intrusion. PUD. King had made a passing hydrogeologist from Island But June 25,City Manager David comment to the council about the County could attend to share his possibility of legal action if the city expertise. Early Tuesday morn- `-ws entered into an agreement with the ing,Titterness learned this scien- A county,which he felt could affect � aU 4� 3 o O oo ° U '' vi O s. h-0 y� 0." Q �'� ., O � mOo , mC � ,7 °', a30c ti cri C) d . O ;ac yc '° ce �amcr. 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Leader Staff Writer "It's , tween close friends or family Antibiotics are most useful in It s rare to have members,"said Locke. protecting close family members Whooping cough starts with so many cases Treatment requires quick ac- from the infection and decreas- an annoying tickle in the back of tion. Antibiotics are only effec- ing the amount of time an active your throat, but it progresses to under the age of tive in the first two to three days, pertussis case is contagious. uncontrollable coughing attacks 7 It's a a period when many people "If people know they have that make it extremely difficult haven't figured out they might been exposed, they should be to catch your breath. People can significant have the disease.After that three- tested, and I strongly urge par- turn blue because they can't take day period, a toxin secreted by encs to make sure their children in oxygen fast enough. outbreak" the Bordetella pertussis bacteria are immunized,"said Locke. "The worst part was the damages the lining of the airways He believes the county will sounds. the sounds of trying to Dr.Tom Locke and lungs, causing coughing. see additional cases before the catch your breath,"said one vic- Jefferson County Public Antibiotics can eradicate the number of cases of pertussis tim who is now on the road to Health 'causative bacteria, explained drops to a lower,more acceptable • recovery. "It was frightening." Locke, but can't repair the level. Jefferson County Health and Human Services now has six 8 and 9 percent of the students confirmed cases of pertussis, or are not fully vaccinated.That rate whooping cough, reported since is one of the highest for all Wash- June 12. Pertussis can be life- ington state counties. threatening in infants under the Locke said that of all the vac- age of 1 because they have such cinations, parents particularly small airways.The symptoms are have avoided pertussis.The older much less severe in teens and version, which used whole cells adults Luckily, none of the six of pertussis,had relatively severe illvictims were under 1,but five of side effects of high fevers and them were under 7. local reactions. But Locke "It's rare to have so many stressed that the new version, cases under the age of 7," said without whole cells, has much Dr. Tom Locke of Jefferson fewer side effects. County Public Health."It's a sig- According to Lisa McKenzie, nificant outbreak." a public health nurse and coor- Immunity from the pertussis dinator for the health accination can wear off in chil- department's contagious dis- dren over 7 eases,the pharmaceutical indus- "Pertussis is probably more try is developing a booster for common than we realize,but the children over 7. Unfortunately, people who might have con- there is no published indication tracied it aren't tested very of- of when the booster will be ready ten," said Locke. for sale. Locke said his agency's mis- Pertussis is only moderately sion is to protect children under contagious. Unlike measles, age 2.To do that,he strongly rec- which can be spread by just ommends that parents who have breathing the same air as a con- not immunized their children for tagious person,pertussis requires pertussis do so now. contact with respiratory secre- lt's a challenging recommen- tions from a person's mouth or dation in Jefferson County, be- nose. cause it has one of the higher rates of parents exempting their cnidren from vaccination," said • Locke When Jefferson County chil- dren enter kindergarten,between r ' ` - ' I 0 I Port Townsend&Jefferson County Leader County 's teen li pre anc � y rate drops a third By Janet Huck Metzger started with five peer Leader Staff Writer educators teiOotyhe ha2suds inPTownsend Teen pregnancy,a social chal- High School. Two months ago lenge for Jefferson County in the she started a similar program at early 1990s,has dropped nearly Chimacum High School. a third. Quilcene High School has started About 10 years ago, the its own peer education program county's teen pregnancy rate per this ear. the programfocuses thousand hovered around 50, Although sometimes rising as high as 66 on abstinence,Metzger said the per thousand. Those numbers peer educators don't abandon were well above the national tar- sexually active teens. Instead get figure of 45 per thousand. they give them information about Now Jefferson County boasts hs� eduction sexually for lsuch concernstran a figure of only 33 pregnancies ted pregnancy,se AIDS. it- per thousand for teenage girls. Sexually diseases active DS.teencan get "Whatever was done,changed Y behavior,"declared University of information and treatment at Washington epidemiologist Dr. local family clinics.Washing- Christiane Hale in January as she ton state law allows county presented her analysis on health health department family plan- 411101 and economic risk factors for the ning clinics to offer confiden- Jefferson County Health and tial referrals ulting,to tee nagers.and Human Services Department. The What has been done was a Jefferson County health depart- successful combination of edu- ment offers clinics in different cation, information and ser- parts of the county at different vices. The health department times of the week, so the ser- offers everything from absti- vices are broadly available. nence programs to family plan- Teens can also receive emer- ning. "It's a woven quilt of gency contraception.If teens take offerings,"said Jean Baldwin,the the emergency contraception health department's community within 72 hours,they can prevent health director. pregnancy. "For a rural county,we have "They don't have to get I a good comprehensive[sex]edu- pregnant if they made a mis- cation program that starts with take," explained Metzger. "It the basics and moves on to pre- isn't abortion,though.It won't vention." said Hilary Metzger, stop a pregnancy that has be- i health department health educa- gun. But conception is a pro- 1 for and public health nurse. cess that takes days." Metzger began a peer educa- Metzger also credits the fami- lion program 11 years ago in lies, the communities and which she trained a core group present-day society, which is . of teenagers who then reached more open in talking about these out to their peers. Though the issues honestly,as contributing to program is focused on absti- the drop in pregnancy rates. zs nence, the peer educators offer "Families are a bigger piece s their fellow students real-life in-,,..JSP a4Y Rf PK:programs,"said formation about healthy relation-` Metzger.economy is too."In times u ships and self-esteem as well as The scondoms.It appears to be an ef- of economic prosperity,teenage s fective program. pregnancy traditionally goes 411 s "It would be wonderful if the down because young women see teens would stop their unhealthy more opportunities to become an activities immediately," said adult,"Metzger explained. i- Metzger."But it takes awhile for "I don't want us patting our- d it to become cool to abstain from selves on the back prematurely," iy drugs,alcohol and sexual actin- she cautiond. "If the ewe could see a my ik ity.But once you find you are not goes down rise alone,it's easier to abstain." in teen pregnancy again." ;o r •