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2004-November
File Copy • Jefferson County Board of Health Agenda • Minutes November 18, 2004 • JEFFERSON COUNTY BOARD OF HEALTH Thursday, November 18, 2004 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 October 21, 2004 III. Public Comments IV. Old Business and Informational Items 1. Follow-up to Dept. of Health and Human Services Funding Request 2. Public View of Public Health—Washington State Polling Data V. New Business • 1. Washington State Food Code(WAC 246-215)—Changes Effective May 2005 2. Influenza Vaccine Shortage: Regional Update and Vaccine Policy Ramifications 3. Washington State On-site Sewage Code Revisions—Key Issues VI. Activity Update VII. Agenda Planning VIII. 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Exemptions bed&breakfast facility. service of commercially include a home used to prepare Exemptions include private home pre-packaged foods;dry non-PHF for religious or charity gathering and farmers'produce beans/grains;etc. bake sale;a"food processing sales. plant";home day care;bed& Clarification that activities breakfast facility;produce stand. licensed by WSDA are exempt from this rule 1-201.10(B)(65)Potentially -010(40) PHF includes"certain" Food Code Hazardous Food(PHF)includes cooked plant foods;water activity Clarification that fresh cooked plant food;water activity above 0.90;no exclusion for hard- herbs in oil are PHF above 0.85;excludes air-cooled boiled eggs hard-boiled eggs with shell intact 1-201.10(B)(95)Temporary Food -010(49)Temporary Food Service Single event for 21 Establishment operates not more Establishment operates at a fixed consecutive days max; than 14 consecutive days location for not more than 21 Recurring event for 3 days consecutive days per week maximum Person in 2-101.11 Be present during hours No equivalent Food Code charge of operation 2-102.11 Demonstrate knowledge No equivalent Food Code 2-201.12 Exclude food workers -260(2)(c)&(e) Health officer Blended modification with diseases and symptoms restricts food workers No equivalent -080(6)(a)Ensure all food workers WAC comply with provisions of Chapter Clarification on reference to 69.06 RCW and Chapter 246-217 Chapter 69.06 RCW and WAC regarding food worker cards Chapter 246-217 WAC Hand washing 2-301.12 20-second wash, -080(1)Less specific Food Code vigorous,underneath fingernails, between fingers 2-301.16 Hand sanitizers must -080(3) No hand sanitizer Food Code conform to specifics,when used in specifications,when used in addition to washing addition to washing 5-203.11(C)If approved,may use No equivalent WAC(water required for towelettes for handwashing handwashing) Employee 2-302.11 Fingernails trimmed and No equivalent Food Code,modified to hygiene filed;no polish or artificial nails prohibit polish or artificial unless wear gloves fingernails during food preparation unless wearing gloves • 09/08/04 .. ._ Fav. s�. ffIt ,: tti ...._ if $ Employee 2-303.11 Jewelry and watches on No equivalent Food Code,modified to hygiene(cont'd) hands and arms not allowed while exempt wedding and preparing food,except smooth engagement rings if covered wedding bands by gloves 2-401.11 No eating,drinking -080(4) Similar,except drinking Food Code (except closed beverage not addressed containers), tobacco 2-402.11 Hair restraints specified -080(2)(c) Hair restraints"as Food Code necessary" Approved 3-201.11(B) No foods prepared in -270 Variance allowed for source Non-PH baked goods for source private homes,except see Food charitable fund raiser not Establishment definition regulated;(also variance 1-201.10(B)(36) allowed otherwise) 3-201.16 Wild mushrooms must No equivalent wild mushroom WAC be individually inspected by expert inspection requirement 3-201.17 Field-dressed wild game -020(6)(d)Health officer may Wild game allowed for must be inspected by veterinarian approve wild game meat for use in charitable donation without jails and soup kitchens veterinary inspection; labeling to cook to 165°F internal temperature 3-202.11 PHF must be 41°F or No equivalent receiving Food Code less at receiving(unless other rules temperature specify otherwise)and not have evidence of temperature abuse 3.202.14 Milk must be obtained -020(2)(a)Grade A raw milk may WAC pasteurized be sold only for off-premises 3-603.11 Unless a warning sign is consumption posted • 3-203.12 Molluscan shellfish tags -020(3)(b)(iii) Identifying Food Code;except received and kept on original information may be on invoice commingling allowed for container;held for 90 days;no rather than container;no shellstock from same commingling of shellstock with requirement to keep tags or other growing area different tags identifying information for 90 days 3-201.11(D)&3-402.11 Fish No equivalent Food Code served raw,except tuna, must be previously frozen to kill parasites; 3-402.12 Keep records of freezing Preventing 3-301.11 No bare hand contact -030(1)(g)"Minimize"hand Food Code contamination with ready-to-eat-foods,except as contact by using utensils or gloves otherwise approved when practical;guidance policy 3-302.11(A)(2) Prevent cross- No equivalent requirement Food Code contamination of different species between different species raw meats 3-302.13 Pasteurized eggs used -070(3)(i)Applies only for health Food Code for undercooked recipes unless care facilities and nursing homes warning posted 3-304.12(F)Store in-use utensils -050(3)(c)(iii)Store in-use utensils WAC in water 140°F or greater in water> 140°F or<41°F 3-304.15 Gloves used for only one No equivalent requirement to Food Code task,discarded if soiled or discard gloves after single task damaged No equivalent -030(1)(j)&(k) Limited use of WAC pooled eggs;no egg-breaking machines • 2 09/08/04 • Rr o >Hll�4 2oactodxisting WA� z R . s��W 4'a Cooking 3-401.11(A)(1) 145°F for 15 -070(3)(e)&(f) 140°F for eggs Food Code • temperatures seconds minimum for eggs and and other foods of animal origin many other foods of animal origin not otherwise specified 3-401.11(A)(2) 155°F for 15 -070(3)(b) 155°F for 15 seconds Food Code,modified to seconds for ground meats,ratites, for ground meats;no specific single-temp corresponding injected meats,pooled eggs;also requirements for ratites or injected to 15-second contact time; table allowing cooking as low as meats;—030(1)(j)(ii)pooled eggs Prohibit pooled eggs unless 145°F for 3 minutes cooked to 140°F within 30 cooked to 145 within 30 minutes of breaking minutes of breaking 3-401.11(B) 130-158°F for time -070(3)(c) 150°F for pork Food Code specified in table for whole beef -070(3)(d) 130°F minimum for and pork roasts rare roast beef;no table of alternative temperatures 3-401.11(C) 145°F outside of -070(3)(d)(ii) 130°F for rare beef Food Code meat only for intact beef steak steak 3-401.12 Microwave cooking of No differences between Food Code raw PHF to 165°F;procedures microwave and conventional specified cooking method temperatures Heating/ 3-401.13 Fruits/vegetables to be No equivalent cooking Food Code reheating hot held must be cooked to 140°F requirements for fruits and or greater vegetables 3-403.11(A) 165°F for 15 No equivalent time requirement, Food Code seconds just temperature 3-403.11(B) Microwave to 165° No equivalent time requirement, Food Code F,rotated,stirred,let stand for 2 just temperature minutes 3-403.11(D) 165°F within 2 -070(8)(b) 165°F within 1 hour; Food Code,except require • hours except within 30 minutes for reheating at temporary temporary food service events and on mobiles within 60 minutes 3-501.13 Allows cooking of large -070(2)(c) Prohibits cooking of Food Code pieces of frozen meat or poultry unthawed foods greater than 4 inches thick Cooling 3-501.14(A) Cooked PHF cooled -070(6) PHF cooled from 140°F Food Code;except WAC from 140°F to 70°F within 2 to 45°F within 4 hours or shallow shallow pan cooling hours and to 41°F or 45°F pan cooling alternative alternative allowed without within 6 hours;with time/temp time/temp monitoring monitoring 3-501.14(B) PHF cooled to 41°F -050(3)(f) Prepare PHF salads and Food Code or 45°F within 4 hours if prepared sandwich spreads with ingredients from ingredients at ambient pre-chilled to 45°F temperatures 3-501.15 Cooling methods -070(6) Cooling methods more Food Code general specified without specific depths, specific,including procedures;WAC shallow loosely covered allowed depths/thickness,uncovered pan procedure allowed alternative to time/temp monitoring Cold holding PHF at 41°F or 45°F if current -050(3)(a) PHF at 45°F or less Food Code equipment not capable of maintaining lower temperature; equipment must achieve 41°F within 5 years of rule adoption • 3 09/08/04 • Time as control 3-501.19 No cold or hot holding No equivalent provision alloiving Food Code temperature needed if PHF is room temperature display for a • discarded within 4 hours or specified period of time working supply is cooked within 4 hours;time must be marked on food Reduced 3-502.12(B) HACCP plan -060(3) HACCP plan and health Food Code oxygen required if Clostridium botulinum officer approval required other packaging is hazard than for non-potentially hazardous foods,raw meats,certain cheeses 3-502.12(B)(2)(a) Water activity -060(3)(a) Water activity of 0.93 Food Code 0.91 or less is one barrier or less is one barrier 3-502.12(B)(3) Store at 41°F or -060(4)(a) Store at 38°F or less Food Code less 3-502.12(B)(4) Label says to store -060(4)(a) Label says to store at Food Code at 41°F or less and discard within 38°F or less and discard or freeze 14 days within 7 days 3-502.12(B)(7) Training required No equivalent Food Code Date marking 3-501.17 Ready-to-eat foods,if No equivalent WAC held more that 24 hours,must be date marked to use within 7 days when stored at 41*F or less and within 4 days if stored at 41-45°F; including opened containers packaged at a food processing plant _ _ Discard time 3-501.18 Ready-to-eat foods must No equivalent WAC • be discarded within 7 days when stored at 41°F or less and within 4 days if stored at 41-45°F; including opened containers packaged at a food processing plant Consumer 3-603.11 Raw or undercooked -040(10) Raw or undercooked Food Code--with addition advisory ready-to-eat foods of animal origin ready-to-eat foods of animal origin of unpasteurized juice and (intended to be consumed without (intended to be consumed without raw milk products (except more processing)must be further processing)must be hard and semi-soft cheeses) identified by label,brochure,or on identified by label,menu,or sign; menu;the risk,especially to the risk does not need to be vulnerable consumers,must be explained,except for raw milk e plained. products Highly 3-8 Additional safeguards No equivalent except—070(3)(e)(i) Food Code susceptible eggs pasteurized or cooked to 140° population F for certain clients Equipment 4-101.16 Sponges may not be No equivalent Food Code used in contact with in-use food- contact surfaces 4-204.110 Molluscan shellfish live -030(4)Molluscan shellfish live Food Code tanks allowed under variance tanks allowed under specified DOH will develop conditions guidelines for issuing variance 4-501.11(C)Piercing parts of can No equivalent Food Code,modified to openers must be kept sharp require can opener blade to be replaced when needed, not sharpened 4 09/08/04 ve TO. e�nrl einem � ? ' $ Equipment 4-501.16(B)Ware washing sinks -090(8),(9)&(11)Food WAC • (con't) may be used to wash produce preparation sinks required and not used for other purposes except if facility was operating in 1992 Cleaning& 4-602.11 Food-contact surfaces No equivalent requirement Food Code sanitizing must be cleaned before each use between different types of raw with a different type of raw animal animal foods food;exception for sequence of products requiring higher cook temps;frequency of every 4 hours unless otherwise specified Curbed refuse 6.202.110 Outdoor refuse storage No equivalent WAC storage areas areas curbed and graded to drain Mobile food 5-3 Mobile water tanks&5-401 -160 Extensive criteria for WAC with additions;water unit Mobile holding tanks only physical facilities and operation supply tank minimum size 5 gallons for handwashing; kiosk-type operations allowed following mobile provisions Waivers 8-103.10 Regulatory authority -270 [Local]health officer may Food Code may grant variance for any portion grant a variance regarding physical of code facilities,equipment standards,and food source Exempt from No equivalent 200(2)(d) [Local]health officer WAC,modified to specify permit may exempt operators from foods obtaining permit for certain foods with concurrence of DOH HACCP 8-201.13 Health officer may No HACCP requirement,except Food Code require HACCP plan as condition for modified atmosphere to grant a variance packa in Inspection 8-401.10 Once every 6 months, -230(6)At least once a year Food Code,modified. frequency except the inspection authority Regulatory authority not may increase the interval based on required to telephone food conditions that lower risk establishment operator every 6 months. Temporary estab.must be inspected during permit period,unless exempted by regulatory authority's risk-based plan. Proper implementation of self-inspection program is one condition that lowers risk. Refusal of 8-402.20 If access to inspect is -200(3)(d)Permit suspension for WAC access refused,authority must make "interference with health officer in additional request for access the performance of his/her duties" Overnight No specific provision -070(4)Overnight cooking or hot WAC cooking holding prohibited unless temperature is monitored provision -120(6)Toilet facilities must be WAC Restrooms for No — -- patrons provided for patrons if seating for on-premises consumption is • provided and facility was constructed or extensively remodeled after 5/2/92. 5 09/08/04 tetel4A, ‘,S1 & ossa a @ Bed& 1-201.10(B)(36)(c)(vi) Exempt -180 Exempt from many physical Blended modification of breakfast from rules if B&B has no more facility provisions;food service both.Exempt from some 40 establishments than 6 guest rooms and 18 guests; limited to overnight guests provisions if B&B has no food service limited to breakfast more than 8 guest rooms. for overnight guests (Grandfathering of existing facilities in Food Code chapter 8.) Allow preparation and service of non-PH baked goods to overnight guests at any time. Temporary No equivalent -190 Extensive criteria for WAC,except modified to food service physical facilities and operation; require reheating for hot reheating for hot holding within 30 holding within 60 minutes; minutes insulated water tank for handwashing minimum size 5 gallons SPECIAL LEGISLATIVE MANDATE Donated foods No special provisions No special provisions in WAC. _Minimal requirements for Mandate from legislature in RCW donated food distributing 69.80.060 to develop special organisations;distributing minimal rule provisions for organizations exempt from distributing organizations, permit;charitable kitchens guidelines for donors,and to not located in private homes assure safety but also encourage and donors are exempt from le donations. rules;distributing organizations required to keep record of certain foods received for 30 days i 6 09/08/04 Washington State Department o f • .1Health Summary of Major Changes Revision of Chapter 246-215 WAC, Food Service As Adopted by the State Board of Health September 8, 2004 (effective May 2, 2005) Definitions • "Food establishment" changed to exempt more low-risk operations • "Temporary establishment" changed to add recurring event for maximum of 3 days per week Potlucks • Non-commercial potlucks are exempt from the rules Person in charge • Requires a designated person in charge to be present during hours of operation, who must be able to demonstrate food safety knowledge Employee hygiene • • More clearly defines employee hygiene, limits certain activities while working with food, includes detailed hand washing instructions (20 seconds) Approved source • Potentially hazardous food(PHF)must be 41°F or less at receiving • Shellfish tags must be kept for 90 days • Fish served raw, except tuna, must be previously frozen to kill parasites Preventing contamination • No bare hand contact with ready-to-eat food, except under an approved plan • Single-use gloves must be discarded when soiled, damaged, or use interrupted Cooking temperatures • 145°F on exterior for intact whole-muscle beef steak • 155°F for ostrich meat, injected meats, and ground meats • Range of 130°F-158°F (112-0 minutes) for whole beef&pork roasts • 145°F for eggs and intact pieces of fish and meat (except poultry) • Microwave cooking-- all PHF cooked to 165°F, stirred, let stand for 2 minutes • Cooking of large pieces of frozen meat without pre-thawing allowed, except temporary establishments Heating/reheating • Fruits/vegetables must be heated to 140°F degrees before hot holding i • Reheating to 165°F for 15 seconds within 2 hours before hot holding; except reheat within 60 minutes for mobile units and temporary events 09/08/04 Cooling • Maximum 6-hour cooling time to 41°F (2 hours to get to 70°F) • Alternative is 2" depth uncovered (no monitoring required) • Pre-chilling of ingredients for preparing PHF salads and sandwiches is not required • Cold holding • PHF must be held at 41°F • 5-year grace period for replacing existing equipment that cannot hold 41°F • Time as control (without temperature control) • Maximum 2 hours during active preparation • Maximum 4 hours during display for immediate consumption or for a working supply(requires written plan, time marking, discard at end of holding period) Reduced oxygen packaging • Requires variance, HACCP plan, training Consumer advisory • Health warning is required to be added to consumer advisory when serving raw or undercooked ready-to-eat food of animal origin or unpasteurized juice --- warning must be placed on menu, label, table tent, placard, or brochure Equipment • Food contact surfaces must be cleaned every 4 hours and between different raw animal foods Exempt from permit • • Must apply for exemption • Added statewide list of foods that may be served without permit(must still follow safe handling rules) Enforcement • Existing physical facilities not required to meet new requirements unless public health hazard determined (except refrigeration equipment) • Regulatory authority(local health jurisdiction) may grant waiver/variance for most provisions • Inspection frequency every 6 months --- or less frequently if a risk-based plan is developed by regulatory authority Donated foods • Minimal provisions for donated food distributing organizations • Donated food distributing organizations are exempt from permit • Donors and charitable kitchens are exempt from rules Effective date • May 2, 2005 is statewide effective date Additional information is available at http://www.doh.wa.gov/ehp/sf/FoodRuleMain.htm • 09/08/04 • Board of Health New Business Agenda Item # V., 2 • Influenza Vaccine Shortage: Regional Update & Vaccine Policy Ramifications November 18, 2004 • INSTITUTE OF MEDICINE Shaping the Future for Health CALLING THE SHOTS CALLING THE SHOTS IMMUNIZATION FINANCE POLICIES AND PRACTICE Federal, state, and private-sector investments in vaccine purchases and immunization programs are lagging behind emerging opportunities to reduce the risks of vaccine-preventable disease. Although federal as- sistance to the states for immunization programs and data collection efforts rapidly expanded in the early part of the 1990s, significant cutbacks have oc- curred in the last 5 years that have reduced the size of state grant awards by more than 50 percent from their highest point.During this same period,the vaccine delivery system for children and adults has become more complex and fragmented. If unmet immunization needs are not identified and ad- dressed, state and national coverage rates, which reached record levels for vaccines in widespread use(79 percent in 1998), can be expected to decline ` and preventable disease outbreaks may occur as a result. At the request of the Senate Committee on Appropriations,the Institute of Medicine (IOM), an arm of the National Academy of Sciences, established a committee to examine the roles and responsibilities of state and federal gov- ernments in supporting immunization services and to identify basic strategies that could strengthen the national immunization system in the current health care climate. Problems Within the National Immunization System During the 1990s, federal and state governments partnered to build a dy- namic and flexible immunization system that has adapted to extensive changes in the science of vaccines, in demographic patterns, and in service delivery, in places ranging from remote rural counties to densely populated metropolitan areas. This highly decentralized system is complex and cumber- some, shaped by local circumstances, resources, and needs, as well as by na- tional goals and policies. Yet it has demonstrated an extraordinary capacity to ensure the reliable delivery of an increasing number of vaccine antigens for an expanding range of age groups, including newborns, preschool and school-aged children, adolescents, and adults in a growing number of private and public health care settings. Despite its success, increasing instability within the public fi health infrastructure supporting pumert... 25 the national immunization system '; - 4:3,r ,‘ IS- could potentially create dispari- ties in vaccine coverage, resulting in infectious disease outbreaks. 1 15 17 Several factors contribute to this i instability, including the rapid acceleration in the science of tri Despite its success, vaccine research and production, increasing instabil- increasing complexity of the s- ° -A ire ity within theublic p health care services environment health infrastructure of the United States, and recent a' F supporting the na- ' } 0 IGO y °° tional immunization reductions in federal immunizaYlaw - system could poten- tion grants to the states. The recur- Changes in the Childhood Vaccination Schedule, 1975-2000. tially create dispari- gence of measles in 1989-1991 in SOURCE: CDC,2000. ties in vaccine coy- the United States, which included a erage, resulting in series of outbreaks that contributed infectious disease to 43,000 cases and more than 100 deaths, primarily among children younger than outbreaks. 5 years of age, is a constant reminder that the presence of vaccines alone is insuf- ficient to protect populations against vaccine-preventable disease. Although record levels of immunization were achieved across the United • States in the 1990s, many problems persist, including the following: • The need to sustain and document high levels of immunization coverage for a growing number of vaccines delivered within multiple health care settings. An enormous effort is required in both private and public health care settings to sustain high levels of completion of the rec4- ,,..„ , \ , ommended immuniza- art s tion series. Improving `' ►+m SIS Y Atm* coverage levels to reach ,_ at le VA the national goal of 90 a 'IP ;, ill KJ As percent coverage will be o i� t increasingly difficult as ` new vaccines are added . , "Arair � A.%.ar: to the recommended 7. " schedule and as uncer- • • tainties about the bene- 0044,14 fits of vaccines increase • in the absence of visible harm from infectious Immunization coverage levels with the 4:3:1:3 series(4 DTP,3 polio, 1 MMR, and 3 Hib), by state(national coverage=79%). National Immuni- disease. zation Survey,July 1998—June 1999. SOURCE:CDC, 1999. • 2 • • Persistent disparities in childhood levels of immunization coverage. The immunization system has successfully reduced racial and ethnic disparities in childhood immunization levels, but significant disparities persist in coverage rates in many metropolitan areas with large populations of low-income residents. In some cases, childhood vaccination coverage rates are as much as 19 percentage points lower for urban residents, compared to the remainder of the state. • Low coverage rates and racial and ethnic disparities for adult vaccines. Immunization coverage rates for adults are well below those achieved for childhood immunizations and significant racial and ethnic disparities persist in adult immunization levels. Only 42 percent of noninstitutionalized adults over age 65 had ever received a pneumococcal vaccination by 1997. Coverage rates for high-risk adults who suffer from chronic disease(e.g., heart or lung disease or diabetes)are especially poor. • Mortality and morbidity from preventable infectious disease. Between 50,000 and 70,000 adults and about 300 children in the United States die annually from vaccine-preventable diseases or their complications. • Serious gaps and inconsistencies in the coordination,support, and docu- Stress-related cracks mentation of immunization efforts stemming from the Stress-related cracks stemming from the complexity of the nation's immuni- complexity of the na- zation system show signs of deepening as shifts occur within public and private tion's immunization • health care delivery systems. Recent controversies over the use of federally fi- nanced vaccines for children who are enrolled in stand-alone(i.e., non-Medicaid) deepening as shifts State Children's Health Insurance Programs(SCHIPs), for example, reflect incon- occur within public and private health care sistencies and ambiguities in service delivery efforts. delivery systems. Financing Immunization Infrastructure A key element of the national immunization system is a federal grant pro- gram, Section 317, that allows states and other grantees to purchase vaccines for disadvantaged populations and to support immunization infrastructure, including professional education, outreach, surveillance of coverage levels and vaccine safety, and efforts to improve coverage rates in child and adult populations.The Section 317 grants, administered by the Centers for Disease Control and Preven- tion, are awarded annually in response to proposals submitted by each state,ter- ritory, and selected metropolitan regions(64 grantees in all). In 1990 and 1991, infrastructure grants to the states were about one-quarter of the federal grants used by the states to purchase vaccines.At mid-decade, immu- nization infrastructure grants increased substantially, rising to twice the level of the vaccine purchase grants. New money for infrastructure awards increased more than seven-fold from a total of$37 million awarded for 1990 to $261 million for 1995. By the end of the decade, newly awarded infrastructure grants had declined to $116 million for 1998 and$111 million for 1999. This rapid fluctuation in fed- i, 3 eral support for immunization infrastructure has created un- 1lOpootons New +mia certainty and instability at both • the state and local level. taso During this same period,the $150- vaccine delivery system for sioo, children and adults became more complex and fragmented ims, ice' law ma ma agoo -aatn aunt* as the number of sites adminis- '" tering childhood or adult vac- Section 317 Grant operations funding history, 1995-2001 ($in millions). In 1995, CDC transferred funds not needed for cines purchased with govern- vaccine purchase to state operations. SOURCE: CDC,2000. ment funds escalated dramatically—from about 3,000 public health clinics and several hundred Medi- caid health care providers in the 1980s to more than 50,000 public and private sites in 1999. This rapid increase,while increasing coverage, has complicated the tasks of educating providers, assessing safety, documenting coverage rates, and assuring fairness in providing access to vaccines in public and private settings. Public and Private Roles and Responsibilities Each state currently State governments are the public health stewards for disadvantaged popula- invests in immuni- tions, and have traditionally been responsible for meeting the health needs of resi- • zation programs dents who are not served by the private health care sector. Each state currently in- through direct or in- vests in immunization programs through direct or in-kind support, but all states kind support, but all rely on federal dollars for crucial support. Federal assistance for vaccine purchase states rely on fed- eral dollars for cru- and infrastructure helps each state maintain the essential elements of an immuni- cial support. zation program,respond to unexpected circumstances and changing conditions, and address national priorities in infectious disease prevention and control. Vaccine Purchase Federal assistance for state vaccine purchases and immunization programs is provided by several funding streams. In FY 1999, the federal government sup- plied more than $600 million in(primarily childhood)vaccines to the states through the Section 317 and Vaccines for Children (VFC)programs. In 1998 the Health Care Financing Administration(HCFA)paid Medicare providers,whose benefits include preventive adult vaccines, $114 million for influenza and pneu- mococcal immunizations, primarily for adults over age 65. The vast majority of states depend primarily on federal grants for the purchase of vaccines.Although the VFC program provides vaccines to uninsured children and others who meet certain eligibility criteria, a sizeable population of"underin- sured"children and adults remain who are not able to obtain vaccines without as- sistance. States use Section 317 funds or their own budgets to meet this need. Half the states use state funds to purchase less than 10 percent of the vaccines provided • to disadvantaged populations in their jurisdiction. Ten states use their own funds 4 • for more than 30 percent of such vaccines. Fifteen states have universal purchase policies, whereby they supply vaccines for all children served by public clinics and participating private providers, regardless of insurance status. Immunization Infrastructure Each state differs in the scope and type of public health infrastructure that they rely on to provide both immunization services for disadvantaged individuals as well as to maintain population wide programs that benefit all citizens within the state. Recent transitions in health care programs, reductions in Section 317 grants, and restrictions on the use of federal funds have significantly reduced the ability of many states to develop innovative approaches to program management, data collection, or interactions with private health care providers. Because the Section 317 grants program does not require matching state investments, fiscal incentives for states to share the costs of developing immunization programs that benefit state residents are absent. The range of population-adjusted contributions among the states is extremely Only four states have broad; 4 states reported spending more than$10 per child from state funds, while direct state funding the majority reported contributions of less than $5 per child. Only 4 states have for a substantial por- direct state funding for a substantial portion(more than 40 percent) of their im- tion (more than 40 munization program infrastructure, and almost half provide no direct state funding Percent) of their im- for infrastructure needs. When compared to vaccine purchase practices, these es- munization program • timates indicate a limited commitment within the states to support the public infrastructure, and almost half provide health infrastructure that is required to meet local needs as well as national goals. no direct state fund- ing for infrastructure needs. Private-Sector Role The role of the private sector in providing routine medical care for disadvan- taged populations requires ongoing attention and oversight to determine whether vulnerable groups are up to date in their immunization coverage. Traditionally, individual health care providers and health plans have not been expected to monitor patterns of vaccine coverage or disease within their communities, nor are they currently equipped to assess coverage levels in formats that can facilitate population studies or analysis of local or statewide health patterns. The Need for a National Strategic Vision In reviewing the information and data provided by the CDC and professional health organizations, the IOM committee noted the following findings and con- clusions: • The repetitive ebb and flow in the distribution of public resources for im- • munization programs have created instability and uncertainty that impedes project 5 planning at the state and local levels and delays the public benefit of advances in • the development of new vaccines for both children and adults. • Immunization policy needs to be national in scope, yet flexible enough to respond to special circumstances that exist at the state and local level. • Federal and state governments have important roles in achieving and sus- taining national immunization goals. State legislatures and governments should be expected to sustain an immunization infrastructure that reflects each state's need, capacity, and performance. • Comprehensive insurance and high-quality primary care services do not re- place the need for public health infrastructure. However,private health care plans and providers can improve their capacity and involvement in implementing im- munization surveillance and preventive programs within their health practices. A reform and The committee concluded that a reform and strengthening of the strengthening of the federal and state immuniza- federal and state im- tion partnership is necessary.A conceptual munization partner- framework was developed to guide the future ship is necessary, partnership which identified six fundamental roles of the national immunization system: to assure the purchase of vaccines and service de- livery;to prevent and control infectious disease; to monitor and survey levels of immunization coverage and vaccine safety concern, especially within high-risk settings; to sustain and improve vaccine coverage rates for child and adult popu- r lations; and to use primary care and public health resources efficiently in achieving national immunization goals. Six roles of the national immunization system. What Can Be Done To renew and strengthen the immunization partnership, federal and state gov- ernments require a coherent strategy, additional funds, and a multiyear finance plan that can help expedite the delivery of new vaccines; strengthen the immuni- zation assessment, assurance, and policy development functions in each state; and adapt immunization programs to serve the needs of new age groups in a variety of health care environments. As a beginning step in implementing a strategic plan,the IOM committee rec- ommends that federal and state governments allocate $1.5 billion in federal and state resources over the first 5 years to strengthen the infrastructure for child and adult immunization—an annual increase of$175 million over current spending levels. These resources would consist of$200 million per year in Section 317 in- frastructure grants awarded by CDC and an additional$100 million per year in increased state contributions. The committee also recommends that Congress re- place the current discretionary Section 317 grants with a formula approach for . state immunization grant awards to improve the targeting and stability of federal 6 • immunization grants. The formula should provide a base level of support to all states as well as additional amounts related to each state's need, capacity, and per- formance. The committee further recommends that Congress introduce a state math requirement for the receipt of increased federal funds to strengthen and sta- bilize the public health infrastructure. The IOM committee observed that the construction of a grant formula and the The committee also calculation of weights as recommended above is a complex analytical process that recommends that requires estimating the appropriate size of the federal base grant; determining the Congress replace conditions that would facilitate redistribution of federal resources to areas of need the current discre- but also maintain an adequate level of investment within each state; developing an tionary Section 317 grants with a for- appropriate set of proxy measures that reflect need, capacity, and performance in mula approach for the field of immunization; and choosing the appropriate multiyear finance mecha- state immunization nism for the allocation of federal funds. This work should begin immediately to grant awards to im- guide the reauthorization of Section 317 in 2002.Along with the development of prove the targeting a strategic investment plan to support immunization infrastructure, the committee and stability of fed- recommends that the federal government provide $50 million in additional funds eral immunization to help states purchase pneumococcal, influenza, or other vaccines for adults un- grants. der age 65 who are not eligible for other forms of public health insurance and who have chronic illnesses such as heart and lung disease or diabetes. The committee further recommends that states increase their own vaccine purchases by $11 mil- lion annually for adults who cannot afford vaccines but who are not eligible for federal assistance(i.e., the"underinsured"). Finally, the committee recommends that federal and state agencies develop a • set of consistent and comparable measures to monitor the status of children and adults enrolled in public and private health plans. Such measures can also facili- tate efforts by state and federal health officials to assess the quality of primary- care health services within private-sector health plans, so that public health agen- cies can direct appropriate resources to areas in which private-sector plans do not have sufficient capacity to meet health care needs. s'JZe3 Additional Materials . . . The following background materials that contributed to the development of the report Calling the Shots are also available: • American Journal of Preventive Medicine—A 120-page supplemental issue fo- cused on case studies and other background papers prepared for the IOM study;Vol. 19(3Suppl.),October 2000.Guest editors are David R. Smith, Wilhelmine Miller,Hanns Kuttner,and William Roper. • Case Study Reports available from the National Academy Press in electronic form[www.books.nap.edu/catalog/9836.htm1]. Case study summaries describing im- munization finance strategies in Alabama,Maine,Michigan,New Jersey,North Carolina, Texas,Washington,and Los Angeles/San Diego Counties in California. • 7 For More Information . . . • Copies of Calling the Shots:Immunization Finance Policies and Practice are available for sale from the National Academy Press; call(800)624-6242 or(202)334-3313 (in the Washington metropolitan area),or visit the NAP home page at www.nap.edu.The full text of the report is available on line at books.nap.edu/catalog/9836.htmL This study was funded by the Centers for Disease Control and Prevention. The Institute of Medicine is a private,nonprofit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences.For more information about the Institute of Medicine,visit the IOM home page at www.iom.edu. ©2000 by the National Academy of Sciences.All rights reserved. Permission is granted to reproduce this document in its entirety, with no additions or alterations. COMMITTEE ON IMMUNIZATION FINANCE POLICIES AND PRACTICES BERNARD GUYER,(Chair)Johns Hopkins School of Hygiene and Public Health DAVID R SMITH,(Vice-Chair)Texas Tech University Health Sciences Center, 411 Lubbock E.RUSSELL ALEXANDER,University of Washington GORDON BERLIN,Manpower Demonstration Research Corporation,New York City STEVE BLACK,Vaccine Study Center,Kaiser Permanente,Oakland,California SHEILA BURKE,John F.Kennedy School of Government,Harvard University BARBARA DeBUONO,Health Care Consultant,New York City GORDON DeFRIESE,University of North Carolina at Chapel Hill R. GORDON DOUGLAS,JR.,Former President,Merck Vaccines(retired),Princeton, N.J. WALTER FAGGETT,Medlink Hospital, Washington,D.C. SAMUEL L.KATZ,Duke University Medical Center SARA ROSENBAUM,George Washington University Medical Center CATHY SCHOEN,The Commonwealth Fund,New York City JANE E.SISK,Mount Sinai School of Medicine BARBARA WOLFE,Institute for Research on Poverty,University of Wisconsin- Madison Staff ROSEMARY CHALK,Study Director SUZANNE MILLER,Research Assistant WILHELMINE MILLER,Ph.D., Senior Program Officer TRACY McKAY,Senior Project Assistant 9/00 • WHEN YOU RECEIVE YOUR INFLUENZA VACCINE Important Information for Vaccine Providers from the Centers for Disease Control and Prevention (CDC) CDC urges each provider or organization receiving a shipment of influenza vaccine to contact your state and local public health departments to tell them that vaccine has been received. This voluntary communication is critical to help state and local officials determine: • which facilities in their jurisdictions have vaccine • where the gaps in vaccine distribution may exist Background Information About This Request With the assistance of Aventis Pasteur, CDC is actively working to ensure that all doses of vaccine distributed after October 5, 2004, are directed to providers serving priority high risk patients. Distribution plans being developed account for: • geographic information about the number of high risk individuals • doses already shipped Despite these efforts, many providers will receive limited doses of vaccine and some will not receive any vaccine. State and local public health officials will play a critical role in monitoring local vaccine supply • and distribution. These entities will work closely with CDC and you to address any problem of vaccine supply within your community. CDC, your state, and your local public health officials need your support and cooperation to ensure that limited supplies of influenza vaccine this year are directed to those individuals that the ACIP has prioritized for vaccination this year. The groups prioritized for vaccination this year include: • children ages 6 months to 23 months; • people 65 years of age and older; • adults and children 2-64 years of age and older with chronic lung or heart disorders including heart disease and asthma; chronic metabolic diseases (including diabetes); kidney diseases; blood disorders (such as sickle cell anemia); or weakened immune systems, including persons with HIV/AIDS; • women who will be pregnant during the influenza season; • residents of nursing homes and other chronic-care facilities; • children and teenagers, 6 months to 18 years of age, who take aspirin daily; • healthcare workers who provide direct, hands-on care to patients; and • household members and out-of-home caregivers of infants under the age of 6 months. In addition, people not included in one of the priority groups described above should be informed about the urgent vaccine supply situation and asked to forego or defer vaccination. For more information,visit www.cdc.gov/flu, or call the National Immunization Hotline at(800) 232-2522 (English), (800) 232-0233 (espanol), or(800) 243-7889 (TTY). October 25, 2004 • DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS vow DiSEAS CONTROL ANDR VItINTIO@ SA ES4 HEALTHIER.PEOPLE' Board of Health New Business Agenda Item # V., 3 � WA State On-site Sewage Code Revisions Key Issues November 18, 2004 • Onsite Sewage—Revision of State Code WAC 246-272 • Update to Board of Health November 18, 2004 Possible effective date Spring 2005 Background: An advisory group, the Rule Development Committee (RDC), was formed Feb. 2002 with representatives from industry, state and local health and consumers. Two rounds of public comment and a preliminary economic analysis have been completed. The third draft was released November 5. Key Issues: Our status or the impact we will feel is noted in Italics • Management Plan required for all marine counties. Plan must be completed within 2 years. Some of the plan elements have already been addressed in our local ordinance. • Exemption to allow reduction to 75' to marine waters was removed but has been reinstated in the most recent draft. We have an adopted policy 2-91 that does not allow any reduction without a formal waiver request and upgrade of the system to meet the mitigations as described by State DOH. • Soil types made more consistent with EPA manual. Changes will result in larger drainfields for a given soil type. • Increase the number of treatment levels to allow better matching of soil type with site conditions. Went from 2 treatment standards to 6 treatment levels. • In design requirements the designer is required to address nitrogen through lot size and/or . treatment where it has been identified as a contaminant of concern by the local management plan. It also requires the design to include elements to facilitate operation, monitoring and maintenance through the use of risers to grade and monitoring ports. Both of these items are currently in local rule. • Removes the allowance for homeowners on marine shorelines to install their own system. • Requires the Health Department to inspect installation prior to cover of an installation unless the designer completes an inspection prior to cover. Our current rule will need to be revised to address this change. • Requires annual inspection for systems except conventional gravity fed. This could impact us - based on our current local code: annual inspection is only required for small lots or on sites where systems are located less than 200'to the shoreline. • Allows but does not require the use of operation permits. • For developments and subdivisions—Minimum land area requirements when using the basic prescriptive Method 1 have increased to .5 acres for all soil types where public water is provided. Method 2, the analytic approach, retains the same minimum land area of 12,500 square feet (with exceptions) and will require an analysis of nitrogen loading to existing ground and surface water along with the other 15 items. We will need to address this change in our local policy on minimum land area. For new subdivisions our planning densities exceed the.5 acre in all cases already. It may impact commercial and non-single family residence flows for a given lot size. 411 Onsite State Code Revision page 1 of 2 November 10,2004 Next Steps: • • The RDC will be reviewing the November 5th draft on November 17. • A series of 5 workshops for the public are planned after the Nov. 17th meeting. • The DOH plans to filing this draft as the CR102 with the Washington State Code Reviser by January 2005. • The next opportunity for public comment will be after the CR102 is filed. • The State Board of Health hearing will be either at the February or March meeting. • On the local level we have begun identifying and considering areas in our local code that will need to be amended. A local advisory group similar to that used in our 2000 update will be brought together. • • Onsite State Code Revision page 2 of 2 November 10,2004 • Board of Health Media Report • November 18, 2004 • • Jefferson County Health and Human Services OCTOBER — NOVEMBER 2004 NEWS ARTICLES 1. "PT residents line up for shots", Peninsula Daily News, October 10, 2004 2. "Calm urged in flu shot shortage",Peninsula Daily News, October 10, 2004 3. "Flu shots only for high-risk people", PT Leader, October 13, 2004 4. "Jefferson to reaffirm animal control motion",Peninsula Daily News, October 17, 2004 5. "Substance abuse report asks county for more help",PT Leader, October 20, 2004 6. "Donation" (to Jefferson County Breast& Cervical Health Program), Peninsula Daily News, October 21, 2004 • 7. "'High-risk' will get flu vaccine", Peninsula Daily News, October 22, 2004 8. "Plenty of flu vaccine for babies",PT Leader,November 3, 2004 9. "Nasal spray is a flu shot option",PT Leader,November 10, 2004 • ,. 4 SUNDAY, OCTOBER 10, 2004 Peninsulallorthwest '• ' a a 'z • �a„ • � ! a r .. ,. . �� .. sa :, e 4e�:. `3 ' 1 s�°'-sb „z �� ,x" s .s,",`,;..:-.i.,.."1.,-.,':::::,-,4"..,'-.•;, * �. '?#4,:,,,,,-.. , �+„�, n �; £ ".sa> mm3 �:s '•;,‘ .ifli„, Okt ' "''41tT!`:.0fr':',14,-,-‘ i". ':-' :,'"' V.„*.i?"4:1( ,,, :!-, 1 -v.,\ 't', \ ', -;=, 'Alte ' r AS ,.o,. S ,rte—,_....�. ;:i ",.=`,',14'l'''...,<''..":-4' . ,� q-s� 7 �`�� F � 1,4 `r i�, " g l[ . R �,; F.. i Viet 5 F; �gga ,..:s lis. .. 'gY fit ,,L.;;;,.„—.„, aL �i° "" `a € '�4"�@? Iiti.--1.4.',1;4 ''''' . s''.4.,,:,,,--,:, ';"'*'I'-:4 . r `- q 7a' ', ,�: ,€ \ , ". t,yam �a \ maz *,. r , ;, fat' ' ; � fiaa � . —.-.4.-.-7,, a�"x :.� � s e x ��-. ..i ;`,!•:•-...'-','''' w { z ^;' P,' --.1kk" est 'y a , a x,az` ., as 'r ae �*. � i. a a " NICK KOVESHNIKOV;PE\I\9C1_a D,,11-7 Port Townsend residenot - t Mimi Li Call, 84, fills out a questionnaire while several hundred patients wait in line outside Port Townsend Family Physicians clinic to receive flu vaccinations on Saturday. PT ,:• ' .,-,.lfor shotsk,,,,.„,...„,,.„.. ,:k7:7„...,_...„.,..,tv,_,$,,,, , p PENINSULA DAILY NEWS vaccine shots. shutdown of the major flu-shot Clinic personnel on Satur- PORT TOWN In Vaccinated on Saturday were vaccine supplier day reported several visitors just three hours Saturday, 520 babies ages 6 months to 23 in Britain. . from Seattle, who came to Port months, adults 65 and older, Family Physicians is plan- Townsend because their doe residents, mostly senior Citi- and others with "high risk" Hing two more clinics on Oct.23 tors are out of vaccinations in zens, received flu shots in health conditions. and Nov 6, but manager Joeen the Puget Sound area. health care authorities' The action was scheduled as Nutsford said she is unsure the Clinics are also scheduled response to an unexpected part of the nation's sudden vac facility has enough stock for Oct. 16 and 30 at Olympic Pri national shortage of flu cine shortage caused by the two more rounds. maty Care, 1010 Sheridan St. t Calm u in flu shot s -. shortage Health chief ealth Officer Dr. says its early Tomlacke am ndsaid both in season . Jefferson counties will get more shipments of vaccine as the season progresses. BY EMELJ E COKELET PENINSULA DAILY NEWS - use this flu season. People shouldn't panic as One other company, Aven- they face current shortages of tis Pasteur, is supplying 55.4 the influenza vaccine, the million doses of flu vaccine for head of Clallam County's Americans this year. health department says. In Clallam County, the vac- "This is certainly a problem cine supply is hit-or-miss that needs to be addressed, among the pharmacies, stores but it's not something that and organizations that had people should feel they need to planned public flu shot clinics. urgently deal with in this next Some locations have can- week, because we're not see- celed their clinics because they ing any influenza outbreak," did not receive their planned Health Officer Dr. Tom Locke supply,while others are draw- • said. ing long lines of people want- Locke is health officer for ing to make sure they were both Clallam and Jefferson immunized. counties. Though the shortage 600 shots at Elks Lodge announced last week means nearly half of the United The Sequim Elks Lodge States'estimated flu shot sup- gave out 600 flu shots on ply might not be available this Tuesday and Wednesday, and year, Locke said it's still "very the company offering the early" in the immunization shots there planned to offer season. more this week if they It's possible to be vacci- obtained the amount of vac- nated too early and have the cine they expected, past vaccine's benefits wear off Exalted Ruler Richard Doty before flu outbreaks actually said. . occur,Locke said. Locke said both Clallam The best time for a flu shot and Jefferson counties will get is probably in November. more shipments of vaccine as Locke's comments came the season progresses. three days after U.S. health "What people have now is officials were told the British not a good predictor of how government had suspended much they will have over the the licensed of Chiron Corp. course of the season,"he said. after bacterial contamination There is no anticipated was found in some of the corn- shortage of the lower-dose vac= pany's flu vaccine. cine used for young children Chiron was poised to supply ages 6 months to 35 months, about half of the United Locke said. . States' flu vaccine this year. Health officials throughout Food and Drug Administra- the nation are urging pharma- tion officials and Chiron offi- cies and locations with the cials were conducting an in- vaccine to prioritize their sup- depth inspectiont.of4th9 boor pMy.,.for.,people,most at risk,of . pany's Liverpool,'England; getting•the flu; ' 3• vaccine production facility Locke, meanwhile, recom- Saturday and today. mends people stay informed On Friday,the FDA's acting about the country's flu vaccine commissioner, Dr. Lester M. situation as the story unfolds. t_i o - O K Crawford, said the agency is unlikely to find Chiron's flu The Associated Press con- vaccine safe for Americans to tributed to this report. A 2•Wednesdky,October 1 3,2004 Port Townsend lir Jefferson County Leader high -risk �lu shois onl for people Nnal shortage of vaccine means some local flu shot clinics are cancelednet Huck people were concerned about the County's public health officer. Leader Staff Writer surprise news last week that the Last year,87 million Americans nation's vaccine supply for this were eventually vaccinated, rrin the worst- • • • When the Port Townsend year's flu season was cut rough- "The larger question is why Flu shot curie schedule Family Physicians staff arrived ly in half,from around 100 mil- problems with the vaccine keep case Scenario, Aaoo g to Jefferson County Depart ant of Health and Shy morning an hour early lion doses to 54 million. A happening year after year," Hummt-Resoru ores,here's an. to prepat,e for the flu shot clinic, British the remaining 54 chntcs:e updated list of�hodntea flu shot:: regulatory agency sus- Locke said"Why is it as unsta- "' - a line of mostly senior citizens pended the license of a ble and unreliable as it is/I'm Je fferson`Me16 -Group,834 Sheridan St;Pat 1 had:'already formed. At its Liverpool flu vaccine company hopeful this year will shed more million doses are pleaseays your 16,and 30, 9 am.,toot. height,.the line snaked out the for three months. The action attention on theproblem.and P1 Medtcut Medicare etra. door and down 10th Street,curl- effectivelybarely enough to dazds Al]Au others S15 No insurance, prevented any release provoke political action to fix g '. tog' around the rear of the clinic. from the major supplier that what from a public health view- cover the high- c tie•1010.$lteridan-Si.,Pitt 7a;three'hours, three nurses planned to ship 46 to 48 million point is a broken system. 3�Yx pa Patients 9 a:in,-Hoot, •� �� ax� f gave'519 shots,one right after shots to the United States. Medicare pi t an«ra risk population grourM tarean>ia.Av()al- gae "I'm very concerned about Random distributionrWe expected as SIS.Na insurance btTled ; , a count the situation because,,in the Fortunately, .. Jefferson in the United Port'. J - flims.:- . ous years, but•we .w'arstcase.sxturio the'r main- •Healthcare Yoh _Port. wr .t expecartg over 500 poo- ing 54 million doses are barely' merit of 5.000 flu iva encsStates." Townsertd' Saturdays, Oct 23 and Nov,:6 9 M1.-noon ,aid Joeen Nuisf en ,please a oro,prat- enough to cover the high-risk large supply. However, Phillip $15 Io'i once bled M cards Aili.prleers Lice 1n population in the United States'.. Matt, pharmacist for QFC in Or.Tom Lodce Q Pharmacy •189(1 irixndale r lttough not apprehensive, said Dr. Ttxn'Locke;Jefferson port liadlocic where l ••oiid lock ,200 adults public health officer Tentatively scheduled deperi fmg on yaoc e were•taamunized last •year, Health and Human Resources and Friday, 2122 8 am-12:30 p m and 130 6 Y announcedhis'start would get Jefferson County Medicare,Medicaid and Tricaie ase btlkd'Pleatt ` onlyyour 700 doses this year cameo orprd.All otliers$20 for flushots, Port Townsend Safeway can- slyds: S30 forprterunoria sled its October vaccine clinics, clinic last Saturday, Oct. 9. Quilcene..South County Medical Clinic, 294843 1•Tighway 101, According to Lisa McKenzie, Its practice manager reported 'Mondays patients ple Thursdays,s,8:30 die a.m.and Allli public health nurse in charge of that many spouses who were othepinrs medicate tc� Y5-3111 for rappointment p cards. the communicable disease pro- younger or healthier than ods wed Hospice s ice o Clall Call d Jefferson a son Counties, o nti s,port gram at Jefferson County Health their high-risk partners volun- Totense 1lC Center, Cla620 and Jefferson Port Townsend,n,Por, and Human Services, the gro- tarily opted not to take the wedneernd Senior0 Center• 620 Tyler St., r eery store chain isn't planning shot when they realized they those esdabl�'�•9 am.4 p.m.Assured bills Medicare for any flu clinics here or elsewhere didn't qualify. eligible;all others$20. because all its vaccine Caine A receptionist encountered a from the suspended British corn- high-risk couple over age 65 party(See the sidebar on sched- fro,„ Seattle. For some reason, Are you high rl s k r, uled flu clinics.) "Ilia distribution is r they couldn't get shots from The Centers for Disease Control and Prevention recommends dePerndi+ng whom YOU orderedom, then,doctors so they traveled to rationing the vaccine this season.MI Jefferson County flu shot d in- • , it from,"explained Locke."Our Port Ludlow, stayed overnight sox agree and plan to reserve the limited vaccine for the following challenge is to improve the dis- with friends and came in with high-risk categories: le their friends for shots. •All children ages 6-23 months. • tribution to get it to the .They were high risk so we .Adults age 65 years and older. who need it" PSP � •All Jefferson Coun clinic gave them the shots," said • Persons age 2-64 years with underlying chronic medical condi- ty Nutsford.:They were the minor- dons. officials agreed to follow the ity. Only two out of 519 were •All women who will be pregnant during the influenza season. new Centers for Disease from Seattle. We are sig •Residents of nursing homes and long-term cart facilities. • Control and Prevention recom- out the ones who weren't hi mendations for rationing the •• h •Children ages 6 months to 18 years on chronic aspirin therapy vaccine this season to high-risk McKenzie said she doesn't •Healthcare workers involved in direct patient care. clients such as pregnant moth- believe Jefferson Countyotti •ssOut-of-homeann6 caregivers and household contacts of children who are crs,young children and senior less than 6 months old. cials have an ability to say no to citizens over 65. out-of-county residents who "We are encouraging all resi- qualify as high-risk patients. tive for health dents of Jefferson County to healthy people from 5 to vaccine,said McKenzie. adhere to the guidelines;" 'There may be a call for 49 years of age.About one mil- Locke added there arc med- add McKenzie.theCDC gust le redistribution of vaccine lion to two million doses of the ications that interfere with the will honor them." PSP because some counties across inhaled flu vaccine, FluMist, replication of the viruses.They the country have an adequate will be available in the United can be used in group settings supply and some don't," said States. According to the CDC, such as nursing homes where a Good coverage McKenzie. "The Washington the nasal spray flu vaccine has lot of high-risk people reside. In fact, people did honor Department of Health is asking proven to reduce respiratory There are also old-fashioned them at the PT Physicians'flu how much vaccine each county tract illnesses, days of illness, ways to prevent the spread of flu. has so the officials have idea of lost work days, healthcare said Locke. 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