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Home My WebLink About2004-December File Copy • Jefferson County Board of Health Agenda • Minutes December 16 , 2004 • • JEFFERSON COUNTY BOARD OF HEALTH Thursday, December 16, 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 November 18, 2004 III. Public Comments IV. Old Business and Informational Items 1. Nurse Family Partnership Follow-Up 2. Hepatitis C Surveillance System V. New Business • 1. Influenza Update: Vaccine Redistribution,Influenza Activity, Policy Implications 2. Public Health Emergency Preparedness and Response (aka Bioterrorism) Workplan,2005 VI. Activity Update VII. Agenda Planning VIII. Proposed Next Meeting: January 20, 2004 Main Conference Room Jefferson Health and Human Services • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, November 18, 2004 Board Members: StaffMembers: Dan Tittemess, Chairman- County Commissioner District#1 Jean Baldwin, Health &Human Services Director Glen Huntingford-County Commissioner District#2 Dan Bruce,Environmental Health Director Patrick M Rodgers- County Commissioner District#3 Julia Danskin,Nursing Services Director Geoffrey Masci-Port Townsend City Council Thomas Locke,MD, Health Officer Jill Buhler-Hospital Commissioner District#2 Sheila Westerman-Citi?en at Large(City) Ex-officio Roberta Frissell, Vice Chairman-Citizen at Large(County) David Sullivan, PUD#1 Chairman Titterness called the meeting to order at 2:40 p.m. in the Health Department Conference Room. All Board and Staff members were present. There was a quorum. OLD BUSINESS AND INFORMATIONAL ITEMS 1111 Follow-up to Department of Health and Human Services (DSHS)Funding Request: Jean Baldwin indicated that the packet contained a response from Dennis Braddock,the Secretary of the DSHS to the request for funding of the Nurse Family Partnership. The$25,000 in assistance would enable the County to supplement and extend expiring City and County services through June 2005. The packet also contained a memorandum summarizing budget modifications resulting from meetings with the County Administrator and Central Services Director. Toward the goal of keeping the Department's base budget similar to 2004,the 2005 contribution from the General Fund will be $469,304.However,the Department will be responsible for covering$52,145 in general liability insurance coverage,which would hopefully be offset by projected decreases in health benefit costs of about$63,832. It is not known how union negotiations on the wage benefit package might impact these savings. Public View of Public Health—Washington State Polling Data: Dr. Tom Locke reviewed highlights from a poll by the Washington State Public Health Association conducted last summer. Roughly 40% said they feel public health has enough or too much money,whereas 49%thought there was inadequate funding, a number that is down from previous polls. Support for raising taxes has shrunk to 25%and of those who feel more money should be put into the public health system, the majority felt it should come from other government programs. APPROVAL OF AGENDA Member Masci moved to approve the Agenda as written.Member Buhler seconded the • motion,which carried by a unanimous vote. HEALTH BOARD MINUTES -November 18,2004 Page: 2 • APPROVAL OF MINUTES Member Masci moved to approve the minutes of October 21,2004 as written.Member Buhler seconded the motion,which carried by a unanimous vote. PUBLIC COMMENT-None NEW BUSINESS Washington State Food Code(WAC)246-215–Changes Effective May 2005: Dr. Locke provided a brief history of the contentious food code, disliked mostly by the restaurant association, which is trying to limit the authority of local boards of health. To prevent further legislative action, the State Board of Health adopted proposed revisions to the Food Service Code, which will become effective on May 2,2005. The revisions adopt the 2001 Food and Drug Administration's (FDA) Food Code,with some modifications to retain the local boards of health authority to adopt more stringent standards. This move provides the State with rules more consistent with not only the national food safety standards but with 42 other states whose food service rules are also based on the federal Food Code. Food Safety Program Specialist Dana Fickeisen summarized the major differences and changes to the code as provided in the agenda packet. • Member Masci expressed interest in hand-washing requirements for vendors such as at the Farmers Market and about inspections of donated food through the food bank. Ms. Fickeisen responded that currently,there is a requirement for temporary hand-washing setups with hot water. It was mentioned that there are roughly 230 food establishments in the County, a high number for a community of our size. In addition, there are also approximately 80 temporary food service permits. The Department does not issue permits for food banks,but she does work with them on food handling practices. Ms. Fickeisen then reviewed improvements to the Code. There is a colder temperature requirement, an emphasis on ill food workers—personal hygiene,prevention of transmission of illness through hand washing,no bare hand contact, and staying home when sick. There is a requirement that there be a person in charge who knows about food safety and there are also clearer rules for mobile and temporary events. Among the local concerns were that the increased level of detail in the Code might pose a challenge for food workers and managers to absorb. Further discussion might be necessary regarding the impact to staffmg of the new requirement to inspect twice rather than once a year. In May, Staff would start the annual inspections and begin to assess whether fees need to be adjusted. Food workers are challenged by the prohibition of bare hand contact. There might also be concerns about the changes to bed and breakfast rules,which restrict the use of their kitchen to breakfast preparation. A Food Safety Advisory Committee has begun to meet and a workgroup would consider updates to the Jefferson County Food Safety Code. There would also be community and • food industry presentations,a new food worker curriculum and a new inspection form. The Food Safety Advisory Committee provides guidance on public education of this new code. HEALTH BOARD MINUTES -November 18,2004 Page: 3 Influenza Vaccine Shortage—Regional Update and Vaccine Policy: Dr. Locke reported that this month's media packet was full of influenza articles, coverage that will continue should there be a lot of flu activity this year. This awareness provides an opportunity to expand public education about prevention of respiratory infections. Effective ways of preventing transmission of communicable disease include respiratory etiquette,hand washing, and staying home when sick(voluntary isolation).Noting that the packet included an article from the Institute of Medicine on vaccine production,he said production difficulties, economic disincentives, and the number of manufacturers pulling out of the market might also shape future policy. The shortages most severely impacted childhood vaccines. About 9,000 people meet the at-risk criteria for the 12-13,000 doses received in Jefferson County, so the surplus vaccines were shared with Clallam and Kitsap Counties. Jefferson Healthcare was also able to supply Olympic Medical Center with doses to vaccinate front-line healthcare workers and others at locations such as the dialysis center. Some pediatric vaccine was also shared with Clallam County. The County's eligible candidates are likely to have already been vaccinated, which is not the case in most of the other areas of the state. The remaining 120,000 doses promised to the State would go to the critical shortage areas. In order to immunize a population, about 80% of the people need to be vaccinated to prevent the spread. Influenza activity in Washington has been sporadic and at a low level. If it tracks like a normal flu outbreak,it will spread after the holidays,peaking in January or February. Most of the cases have been Influenza A,which is a strain included in the vaccine. Once vaccinations and infection control activities are underway, surveillance would continue and emphasis would shift to using medication to control outbreaks, shortening the duration and decreasing the amount of virus shed. Dr. Locke • said Staff is using this current situation as an opportunity to improve its response capacity in the event of something much worse such as an avian flu pandemic. Jean Baldwin then reported on two upcoming bio-terrorism events in which the Board of Health might get involved—a February isolation and quarantine workshop and in March, a Jefferson- Clallam-Kitsap three-day infectious disease practice event. Washington State On-Site Sewage Code Revisions—Key Issues: Environmental Health Specialist Linda Atkins provided an update on the status of the on-site sewage code revision,the effective date of which is spring 2005. She reviewed the list of key issues that have risen to the legislative level and identified those whose impact would be felt in Jefferson County. An operations and maintenance management plan would need to be completed within two years for all marine counties;many items have already been addressed in the County. An exemption for those 75 feet from marine waters remains in the code. In 1991,the County adopted a policy that did not allow a reduction without a formal waiver and mitigation, so the County has never utilized this exemption. Changes to the soil types to be more consistent with the EPA manual would result in larger drain fields. The number of treatment levels would also be increased from two to six to allow more flexibility for matching a given soil type with site condition.Where it has been identified as an area of concern in the management plan,design requirements must address nitrogen through lot size and/or treatment. It also requires the design to include elements to facilitate operation,monitoring and maintenance,which are already part of the local code. The draft would remove the allowance for homeowners on marine shorelines to install their own systems and the Health Department would • be required to conduct annual inspections of systems except those that are conventional gravity-fed. The County would need to figure out how it might address this, such as by asking homeowners to do a portion of the inspections and then requiring a third-party inspection every third year. The rule HEALTH BOARD MINUTES -November 18,2004 Page: 4 allows for,but does not require, the use of operational permits. Some discussion ensued about the potential impact to the County of changes in the minimum land area requirements. Linda Atkins noted that because the County's policy on minimum land area is not currently required by State code, the County would have to consider how the State code revision would meld with the corresponding local policy. She agreed to put together a paper outlining minimum land area requirements and some possible options. The Rule Development Committee met yesterday to summarize their comments and there would next be a series of public workshops. She invited any Board member to join her for the one in Olympia. Following the State Board of Health's hearing on the code in March, she would return to the Board for another briefing. Dan Bruce thanked Linda Atkins and Dana Fickeisen for their presentations. Member Buhler also spoke highly of Linda Atkins' helpfulness to people throughout the community. Hospital and Health Department Partnership: Member Buhler reviewed discussions exploring opportunities for hospital/health department collaboration on programs.Given the Health Department budget shortfall it was suggested that a partnership might allow the Department to take advantage of the hospital's cost-based reimbursement for Medicare. Although there have just been preliminary conversations,programs that look promising are the breast and cervical cancer prevention,MASH line clinic, and possibly a Case Coordinator to help someone get into available programs. Reminding that critical access and rural health designations can change, she said it would not be wise to cut any funding, adding that a partnership should be viewed as an opportunity to fill service gaps and consider how best to fulfill community needs by improving access. Commissioner Rogers expressed his appreciation for this innovative idea. Member Buhler noted that with new legislation, Jefferson Healthcare might be able to increase its number of beds. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS-None AGENDA PLANNING/ADJOURN The meeting was adjourned at 4:00 p.m. The next meeting will be on December 16,2004 at 2:30 p.m. in the Conference Room of the Jefferson County Health Department. JEFFERSON COUNTY BOARD OF HEALTH Dan Titterness,Chairman Jill Buhler,Member Roberta Frissell,Vice Chairman Sheila Westerman, Member Geoffrey Masci,Member Glen Huntingford,Member Patrick M. Rodgers,Member • Board of Health Old Business Agenda Item # IV. , 1 Nurse Family Partnership Follow-Up • December 16, 2004 • Iviore cniiaren win ale until state mends holes in satety net Page 1 of 3 3 L , • m Jump to s - Weather ; Traffic I Webtowns I Mariners I Seahawks I Sc ' a , �`• „ --, ,,,,_ ,‘,,t,w2, ` Cod m near I NEWS OPINION Local TOOLS Neighborhoods Friday,November 26,2004 Sports Nation/World More children will die until state mends holes in Print this Business safety net Most prig A&E Lifestyle H EADLIN 1 NW Outdoors STATE LOU DICKERSON STATE REPRESENTATIVE Photos The budget Special Reports Multiple part How many more children must die before we are willing to build a safety COMMENTARY net that effectively protects the children of Washington?The tragic A parental ti Opinion deaths, by starvation, of 16-month-old Justice Robinson and 6-week-old Columnists Raiden Robinson are unacceptable. It's not that we haven't been warned Homes for tt Letters year afteryear that our safetynet has gaping holes. On an annual basis, That's a mg David Horsey g P g Saturday Spin we hear grisly stories of children dying at the hands of parents caught in rightbetweer Forums a cycle of substance abuse. It's sure to c COFFEE BREAKThe patterns are all too familiar. The death involves a mother or father secular liber. Comics&Games TV Listings known to Child Protective Services. In fact, usually there have been More childre several referrals for child neglect. The referrals are marked "low-risk,” State mends • FIND IT! have little or no follow-up investigation or are referred to the community Foreigners k Nwciassifieds for follow-up. The parent elects not to take advantage of the voluntary propped up ® � �s services offered and then suddenly we hear that a child has died. T-Day, read • Real Estate We are what ® Rentals Of course these deaths represent a very small fraction of the children of N /source Washington who are being seriously harmed by substance-abusing Count'em a. ® shopp,i,g P arents. The emotional co nitive and h • Personals g physical growth of these children Voting revie, • Yellow pages is derailed by the failure to nurture, feed,teach and positively interact • Maps/directions with them. As we know, it is not only the children who suffer from this TCanadahe gran, is Newspaper ads neglect, our communities pay the real costs later on--with increased P-I Archives crime and demand for continued social and legal services.Neglected No immedial Photo Reprints children usuallydo poorlyschool, have difficulty interacting with ahead Obituaries m other children, get into trouble with the law and are much more likely to Road to todz P-I ANYWHERE need some form of financial assistance when they become adults. E-mail Newsletters Helping thus News Alerts harvest PDA Ne What are the important components of an effective safety net? Cell Phones New techniq RSS Feeds We need to change state law so that judges can order neglectful parents heart diseas to fully participate in effective community-based programs or risk having OUR AFFILIATES their children removed from the household. Most states already have laws that call for this level of protection. Judges also need to do a better job of emphasizing the safety and health of children, as the highest oily ply priority, when they make decisions that involve child neglect. Judges, 'ke I III amtoo, could benefit from intensive child-neglect training. i http://seattlepi.nwsource.com/opinion/201008_dickerson26.html 11/26/2004 1.1V1V V11111A1 V11 WW 111 kali, 61111.11 36a1G 111Glius uuies m sarety net Page 2 of 3 The Children's Administration within the Department of Social and Health Services is already working on reform.New caseworkers are being trained in how to work with child neglect. Plans are also under way to add child development experts in many CPS offices. More,however, • needs to be done. All Children's Administration caseworkers should be trained in effective interventions for child neglect. A flagging system should also be developed, so that supervisors automatically review any case that has three or more referrals for neglect. Consideration should be given to a higher-level risk assessment for such cases,triggering more immediate and extensive investigation. We already know a great deal about what can work in protecting children living in families where the mother is a substance abuser. Two programs, "Safe Babies, Safe Moms" and Parent-Child Assistance Program(P- CAP),have succeeded in bringing substance-abusing parents into effective treatment and case management services. In both programs, motivational interviewing is used to help the mothers make the decision to leave substance abuse, in favor of the health and safety of their children. Public health nurses also have a long history of success supporting families with young children to become more effective in their parenting. Research has shown time and again that longer-term,intensive services allow for the development of a relationship between the nurse and the • mothers of young children in need of support.Nurses are well accepted by families, and the therapeutic relationship they develop is vital in supporting mothers to make positive yet difficult changes in their lifestyles. These changes often involve substance use,mental health or family violence. Children's Administration has begun to recognize the value of these relationships between public health nurses and clients and,recently, has extended the length of contracted public health nursing services to families referred by CPS. However,overall decreases in funding for health and human services have challenged public health's ability to provide these effective services to all struggling families in Washington state. An effective safety net is possible but it will require considerable public investment,and money is tight in Olympia right now.However,if you asked the citizens of Washington if they are willing to use their tax dollars to save defenseless children such as Justice and Raiden,I bet the answer would be a resounding yes. State Rep. Mary Lou Dickerson, Democrat, represents the 36th District in Seattle. • http://seattlepi.nwsource.com/opinion/201008_dickerson26.html 11/26/2004 NPR Page 1 of 3 l p 1This article is print ready and will remain available for 24 hours I Instructions for saving » Search for another transcript » Most Requested Transcripts NPR home page Profile: Nurse visits for first-time poor mothers proves to be worthwhile December 8, 2004 STEVE INSKEEP, host: Researchers think they've found a way to make it a little easier to raise healthy children. New mothers know their role is always hard, and it's even harder when the mother is a poor, unmarried teen-ager. Those vulnerable mothers were the subject of a study published in the journal Pediatrics. The research says there are powerful benefits when a nurse begins visiting a pregnant young woman at home. NPR's Michelle Trudeau reports. MICHELLE TRUDEAU reporting: The nurse home visit program has been more than 25 years in the making, with the University of Colorado psychologist David Olds shepherding it along since 1977, testing it in different settings. First, with poor white families in rural New York and, now, most recently with over a thousand low-income African-American mothers in urban Memphis, Tennessee. Mr. DAVID OLDS (University of Colorado Psychologist): The sample of women who are participating in this study are very low income. Eighty-five percent of the women were at or below the federal poverty guidelines. • TRUDEAU: Most of the mothers were teen-agers. Ninety-eight percent of them were unmarried. And all were having their first babies. Mr. OLDS: That's crucial because we think that if we can get women off to a good start with their first pregnancies and care of their first child that those skills will carry over to subsequent children. TRUDEAU: Now the nurses, specially trained in prenatal care and early child development, regularly visit these moms at home, starting early in pregnancy and throughout the next two years after the baby is born. And it's the same nurse every visit. Mr. OLDS: For many of the young mothers, they haven't had someone who is consistently there for them. And this relationship, many of the young mothers tell us, is a lifeline. It's a lifesaver for them, for them and their chid. TRUDEAU: Melissa is a young mother who had an unplanned first pregnancy in her early 20s. She signed up for the nurse home visit program. That's when the home health nurse entered Melissa's life. MELISSA: Helping me out with the steps to take through pregnancy, how to stay healthy, you know, eating correctly. If I had any problems or there was things I was worried about, I didn't know how to handle things, she was really like my--God, she was almost like my counselor, like my support system. Like she was really awesome. TRUDEAU: At the end of September 2002, Melissa gave birth to a healthy baby girl, Faye, and the nurse continued to visit. • MELISSA: She came in once a week for like the first couple of months, and she'd weigh the baby and just talk to me about how she was doing, you know, how she was sleeping, how she .../Archives?p_action=doc&p_docid=106DDCB866897B9E&p_docnum=3&s accountid=AC(12/9/2004 NPR Page 2 of 3 was eating and just--I mean, when she was around Faye, like, she was just so good with her. And I kind of looked to like want to model myself after her. TRUDEAU: Melissa has a good job now, works hard, about 50 hours a week. Nurses in the • program do more than just health counseling. They typically make referrals to job training programs, help moms write resumes and follow up on job interviews. Melissa says she couldn't have done it all without the nurse's visits. MELISSA: She really helped me, you know, feel that I was going in the right direction, doing the right thing, and if I ever questioned myself I could call her anytime, she'd come visit me and, you know, she was awesome. I love her. I kind of miss her because the program ends when the babies turn two. TRUDEAU: The nurses stop their home visits when the babies reach their second birthday. To see if the program has any lasting effects, researcher David Olds waits until the children turn six to see how they're doing. Mr. OLDS: The major finding is that nurse-visited children are better prepared to enter school. They have better language development. They have better cognitive development. TRUDEAU: At first grade, IQ scores were three points higher, language and math scores up two to three points. These are modest effects, yet they persisted even four years after the program had ended. The children in the program also showed fewer behavioral problems and less aggressiveness at home and at school. The mothers did significantly better, too. Mr. OLDS: Nurse-visited women were less likely to have subsequent pregnancies. Nurse-visited women were less likely to use welfare and food stamps. TRUDEAU: Child psychiatrist William Beardslee from Children's Hospital in Boston calls this • study 'ground-breaking.' He says the innovative part of this program is the long-term consistent relationship between the nurse and the mother. And the nurses say they like the relationships, too. The job turnover rate is low, about 13 percent per year, less than half the rate of nurses in acute care centers. Dr. WILLIAM BEARDSLEE (Children's Hospital, Boston): We should invest more resources in these kinds of preventive interventions. They're effective, they work and they can make quite a significant difference. TRUDEAU: Effective and cost-effective, too, according to the Washington State Institute for Public Policy. This non-partisan group looked at the costs and benefits of all early intervention programs that had some evidence of effectiveness. Their report came out in September. David Olds' nurse home visits program costs about $9,000 per family for the three-year period. The report says that the program generates the largest cost-savings of any home visit, child welfare or early intervention program evaluated, including Early Head Start. The savings added up to over $17,000 per family in welfare, criminal justice system and medical costs saved. So now that there are 25 years of research studies, finding that this program is effective in different settings and cost-effective, the program is being implemented by governments around the country. Officially called the Nurse-Family Partnership, it now serves 50,000 women throughout 260 counties in 22 states. Michelle Trudeau, NPR News. (Soundbite of music) INSKEEP: The time is 29 minutes past the hour. Copyright©1990-2004 National Public Radio®. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to National Public Radio. This transcript • may not be reproduced in whole or in part without prior written permission. For further information, please contact NPR's Permissions Coordinator at (202) 513-2000. .../Archives?p_action=doc&p_docid=106DDCB866897B9E&p_docnum=3&s_accountid=AC 12/9/2004 Board of Health Old Business Agenda Item # IV., 2 Hepatitis C Surveillance System • December 16, 2004 }V c Region 2 Public Health & i Hospital Emergency 1•l �«rv., Region Preparedness & Response 3 December 2004 Subject: Proposed Region 2 Isolation and Quarantine Workshop 1. Isolation and Quarantine (I&Q) is an effective disease control strategy for dealing with Severe Acute Respiratory Syndrome (SARS) and many other infectious diseases,including those of potential use as a bioterrorist agent. 2. Implementation of an effective broad-scale I&Q effort requires the rapid response by a number of community partners, including elected officials, emergency management, EMS, fire hospitals, the judiciary, law enforcement, Navy and Coast Guard,prosecuting attorneys,public health,and tribes. 3. A broad-scale I&Q effort has not been implemented in the United States since the eradication of many infectious diseases in the 1950s. As a result, the skills, policies, and procedures needed to mount an effective I&Q strategy have atrophied. 4. The prospect of a bioterrorist attack, and the worldwide SARS outbreak in 2003 highlighted the need for a community to be prepared to implement a broad-scale • I&Q campaign. On 15 December 2003, Region 6 Homeland Security and Public Health Seattle and King County hosted an Isolation and Quarantine Conference that brought together many of their community partners to address the issues involved in I&Q. 5. The Region 2 Public Health and Hospital Emergency Preparedness. & Response Project proposes hosting an Isolation and Quarantine Workshop similar to the conference hosted by our colleagues in Seattle. This workshop would serve both to prepare the region for the upcoming full-scale exercise in March of 2005, and to establish the processes and procedures needed to implement I&Q in the event of a real-world infectious disease outbreak,whether naturally-occurring or the result of a bioterrorist attack. 6. Proposed date: Thursday,3 February 2005. 7. Proposed location: The Commons at Fort Worden,Port Townsend,WA 8. Proposed agenda: 0830 Check-in 0900 Welcome and Introductions - Kitsap County Health District (KCHD) • 0915 Disease Containment and Community Response - The Medical Basis for Isolation and Quarantine-Dr.Tom Locke 2 1015 Break 1030 Processes & Procedures - Implementing an Effective Isolation & • Quarantine Campaign - KCHD and Kitsap County Prosecuting Attorney's Office 1130 Isolation and Quarantine - A Hospital Perspective - Jeffrey M. Sconyers (Children's Hospital&Regional Medical Center) 1200 Lunch 1300 Isolation and Quarantine - A Law Enforcement Perspective - Seattle Police Department 1330 _ Isolation and Quarantine-Support Issues-To Be Determined 1400 Wrap-Up and Next Steps 9. Proposed attendees: a. Elected Officials: (1) County Commissioners and Boards of Health for Clallam,Jefferson,and Kitsap counties (2) Mayors for Forks,Port Angeles,Sequim,Port Townsend,Port Orchard, Bainbridge Island,Bremerton,Poulsbo,etc. b. Emergency Management (1) Emergency Management representatives from Clallam,Jefferson, and Kitsap , counties,Navy Region Northwest,and the tribes. (2) Region 2 Homeland Security. (3) Representatives from Washington State Emergency Management Division c. Emergency Medical Service(EMS)] (1) Representatives from Clallam,Jefferson,Kitsap,and West End EMS Councils • (2) Representatives from the Northwest Region EMS Council. d. Fire-representatives from local fire chiefs e. Hospitals (1) Forks Community Hospital (2) Harrison Hospital (3) Jefferson General Hospital (4) Naval Hospital Bremerton (5) Olympic Medical Center f. Judiciary-Superior Court judges for Clallam,Jefferson,and Kitsap counties. g. Law Enforcement (1) Sheriffs from Clallam,Jefferson,and Kitsap counties. 3 (2) Representatives from city police departments (3) Representatives from tribal police departments h. Navy&Coast Guard (1) Representatives from Navy Region Northwest. (2) Representatives from Coast Guard District 13 and Coast Guard Group Port Angeles. i. Prosecuting Attorneys (1) Prosecuting Attorneys from Clallam,Jefferson,and Kitsap counties. (2) Representatives from the Washington State Attorneys General's office. j. Public Health (1) Health Officers and Directors from Clallam,Jefferson,and Kitsap counties. (2) Representatives from the Washington State Department of Health (3) Representatives from tribal clinics k. Tribes-representatives from the tribal councils for the seven tribes in Region 2. S Rick A.Gunderson Public Health Regional Emergency Response Coordinator Region 2(Clallam,Jefferson,and Kitsap Counties) Kitsap County Health District 109 Austin Drive Bremerton,WA 98312-1805 Phone: (360)337-5265 Fax: (360)337-5298 E-Mail: gunder@health.co.kitsap.wa.us • S -5p :CPUBLIC HEALTH oA „e',,{ ` Always Working for a Safer and „ HEALTHIER JEFFERSON 0 ,,fo, - — 615 Sheridan Street,Port Townsend,Washington 98368 Date: June 7, 2004 To: Primary Care Providers From: Tom Locke, M.D.,M.P.H., Jefferson County Health Officer Re: Reporting System for Chronic Hepatitis C Acute and chronic hepatitis C became notifiable conditions in Washington in 2001. Prior to introduction of a specific diagnostic test in 1992 hepatitis C was classified as nonA, nonB hepatitis. About 1.8% of the U.S. population has chronic hepatitis C, which is the most common indication for liver transplantation among adults in this country. Washington State data on chronic hepatitis C will become available for the first time in the 2003 Annual Communicable Disease Report. We have very incomplete prevalence information for chronic hepatitis C in Jefferson County. Jefferson County Health and Human Services (JCHHS)would like to ensure that we have a good understanding of the prevalence and epidemiology of hepatitis C in Jefferson County. The Washington State Chronic Hepatitis B/Chronic Hepatitis C Confidential Case Report form IIIincludes details that will help characterize the pattern of hepatitis C infection in Washington and in Jefferson County. This will provide a better understanding of the proportion of disease that is due to blood products received before 1992, injection drug use, occupational exposure, etc. This information will help us to better target education and prevention activities. The enclosed Request for Reporting letter will be sent to your clinic when JCHHS receives a copy of a positive lab result for hepatitis C for a patient who has not been reported previously Please complete as much information on the report form as possible. Please ask the patient the risk information questions at the visit while discussing lab results with them. The report may be sent back to JCHHS through the JGH mail courier. If you suspect that a patient has acute hepatitis please call JCHHS at 385-9400 and ask for the Communicable Disease Nurse. We would like to assess possible sources of exposure and recent contacts. There is a different reporting form for acute hepatitis. Also enclosed is the full list of Notifiable conditions for Washington State. Reports may be made to JCHHS at 385-9400 during office hours. For urgent reports or questions after hours call my pager number, (360) 582-8353. If you are unable to reach me please call Jean Baldwin at(360) 531-1736. The CDC's Hepatitis C Fact Sheet is enclosed in case you would like to use it for a patient education handout. If you would like additional patient education materials, or if you have • questions about reporting, please call Lisa McKenzie at 385-9422. Thank you for helping with this effort. COMMUNITY ENVIRONMENTAL DEVELOPMENTAL SUBSTANCE ABUSE HEALTH HEALTH DISABILITIES & PREVENTION (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9400 • �gflty C PUBLIC HEALTH A Always Working for a Safer and + HEALTHIER_JEFFERSON 615 Sheridan Street,Port Townsend,Washington 98368 Request for Reportable Conditions Information for Chronic Hepatitis B or C Date: To: From: Re: Chronic hepatitis C and B are conditions for which we have incomplete prevalence information in Jefferson County. Jefferson County Health and Human Services (JCHHS)would like to ensure that we have a good understanding of the prevalence and epidemiology of these conditions in Jefferson County. This is needed in order to target prevention activities. Please see the attached lab result for your patient and the report form. Please complete as much information on the report form as possible. Please ask the patient the risk information questions • at the visit while discussing lab results with them. I realize that you may not have all requested information in your records for this patient. If you suspect that this patient has acute hepatitis please call JCHHS at 385-9400. We would like to assess possible sources of exposure and recent contacts. There is a different reporting form for acute hepatitis. Thank you in advance for your timely attention to this report. Please send the report back to JCHHS as soon as possible, through the JGH mail courier. • COMMUNITY ENVIRONMENTAL DEVELOPMENTAL SUBSTANCE ABUSE HEALTH HEALTH DISABILITIES & PREVENTION (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9400 • I • CONFIDENTIAL CHRONIC HEPATITIS B/CHRONIC HEPATITIS C CASE REPORT Patient Data: Last Name First Name mit Address City State Zip Code County Date of Diagnosis Ethnicity Race'-Check all that apply Sex Date of Birth Mo Day Yr Hisp❑Non-Hisp❑Unk 0 W❑ B❑ Al/AN❑ A❑NH/OPI❑ 00 U❑ M ❑ F❑ Mo Day Yr `White; B-Black; AI/AN-American Indian/Alaskan Native; A-Asian; NH/OPI-Native Hawaiian/Other Pacific Islander; 0-Other; U-Unknown Date of acute illness(if known): _/ Test Date Not (mo/yr) Positive Negative Unk Done Yes No Unk Risk information(check all that apply): IgM hepatitis A antibody(IgM anti-HAV) _/_ 0 0 0 0 0 ❑ 0 Injection drug use ever IgM hepatitis B antibody(IgM anti-HBc) _/ 0 0 0 0 0 0 0 Blood products or solid organ transplant Initial hepatitis B surface antigen(HBsAg) _/ 0 0 0 0 before July 1992 Most recent hepatitis B surface antigen(HBsAg) _/_ 0 0 0 0 0 0 0 Factor concentrates before 1987 HBV DNA: Qualitative 0 ❑ 0 0 0 0 0 Chronic hemodialysis (circle one) Quantitative _/_ copies or Eq/mi ❑ ❑ ❑ History of occupational needle Hepatitis C screening antibody(anti-HCV) _/_ 0 0 0 0 stick or blood splash Anti-HCV supplementary antibody test(e.g., RIBA) _/_ 0 0 0 0 0 0 0 Sex partner HBV+/HCV+(circle one) Viral RNA: Qualitative 0 0 0 0 0 0 0 Infant of HBV+/HCV+mother(circle one) (circle one) Quantitative _/ copies or Eq/mi ❑ 0 0 Other risk(specify) Liver Function Tests: (consider investigating for acute intection it>3 times normal) 0 ❑ 0 If female,is currently pregnant: ALT(SGPT) / Value: Due Date AST(SGOT) _/ Value: 0 0 0 Interviewed by the provider Bilirubin _/_ Value: 0 0 0 Interviewed by the LHJ .'-.:'.�..a ..„a:.: -ch s�KBrt u++x"°..'zi t'``s. iPrxs'r• fix,'-`, t'�,''r - ..`+.. -" ;' .�..3..:*+ .. 5 a «.«'3^r rt :. —.;-?r =-1V-7„=�+:J;;s' ents: Submitted by(provider) Provider telephone City State Person completing report Person Completing report telephone �. • Board of Health New Business Agenda Item # V. , 1 Influenza Update: Vaccine Redistribution, Influenza Activity, Policy Implications December 16, 2004 • • Joint Statement from Jefferson Healthcare and Jefferson County Health and Human Services on Influenza Vaccination and Prevention For the 2004-05 Influenza Season Jefferson Healthcare and Jefferson County Health and Human Services share the public's concern about the shortage of influenza vaccine available in the United States this year.We are working together to assure that persons who are at risk for serious complications from influenza will be able to be vaccinated.In order to do this,the guidelines developed by the CDC are being used at all immunization clinics to determine who is eligible for the vaccine during the 2004-05 season. The following priority groups for vaccination with inactivated influenza vaccine are considered to be of equal importance: • All children aged 6-23 months; • Adults aged 65 years and older; • Persons aged 2-64 years with chronic lung or heart disorders including heart disease and • asthma; • Persons aged 2-64 years with chronic metabolic diseases(including diabetes),kidney diseases,blood disorders(such as sickle cell anemia); • Persons with a weakened immune system due to HIV/AIDS or another disease that _ affects the immune system,long-term steroid treatment,and cancer treatment with radiation or drugs; • All women who will be pregnant during the influenza season; • Residents of nursing homes and long-term care facilities; • Children aged 6 months-18 years on chronic aspirin therapy; • Health-care workers involved in direct patient contact;and • Out-of-home caregivers and household contacts of infants under the age of 6 months. Two large groups no longer on the priority list include persons age 50-64 without chronic high- risk medical conditions,and healthy people who live with persons who have high-risk medical conditions. • Persons who ARE NOT included in one of the priority groups described above should forego or defer vaccination with the inactivated vaccine this season.Intranasally administered,live attenuated influenza vaccine(FluMist),may be used for healthy persons who are aged 5-49 years and are not pregnant,including health-care workers(except those who care for severely immunocompromised patients in special care units)and persons caring for children under the age of 6 months. Over the next six to eight weeks Jefferson Healthcare and Jefferson County Health and Human Services will be working with the Washington State Department of Health(DOH)and the CDC in the effort to obtain more vaccine.Any additional supplies of vaccine will be used by clinics to immunize high priority patients who were not able to obtain vaccine from existing supplies. In addition to vaccination there are other important steps that people can take to avoid spreading or catching influenza.These practices will also help prevent other respiratory infections,including colds,whooping cough(pertussis)and severe acute respiratory syndrome (SARS).The germs(viruses and bacteria)that cause these infections are spread from person-to- person in droplets from the nose,throat and lungs of someone who is sick. The following practices will help prevent the spread of germs from persons who are ill,and prevent persons who are well from catching someone else's germs. Keep your germs to yourself: • Cover your nose and mouth with a tissue when sneezing,coughing,or blowing your nose. _ • Throw out used tissues in the trash as soon as you can. • • Always wash your hands after sneezing,blowing your nose,or coughing,or after touching used tissues or handkerchiefs.Wash hands often if you are sick. • Use warm water and soap or alcohol-based hand sanitizers to wash your hands. • Try to stay home if you have a cough and fever. • - • Call your doctor if you have a cough and fever that lasts longer than 3 days. • • Get plenty of rest. • If asked to,use facemasks provided in your doctor's or clinic waiting room and follow their instructions to help stop the spread of germs. Keep the germs away: . • Wash your hands before eating,or touching your eyes,nose,or mouth. • Avoid close contact with people who have a respiratory illness. • Wash your hands after touching anyone else who is sneezing,coughing,blowing their nose,or whose nose is running. • Don't share things like cigarettes,towels,lipstick,toys,or anything else that might be contaminated with respiratory germs. • Don't share food,utensils or beverage containers with others. • • • nICI u:u uy a comprenensive discussion of the flu vaccine(before the shortage)in Mothering magazine,July/August 2004,we offer you theseimportant fact as concerned practitioners. (This information is reprinted with permission of the author and health practitioner, Richard Pitt.) WHAT YOU DON'T KNOW ABOUT • THE FLU SHOTS MIGHT HURT YOU . • WHAT'S IN THE VACCINE? Flu deaths are more often the result of true too for picking up tissues that others have dropped or left behind •Injetted flu vaccine may still contain ethyl mercury In the form of the secondary bacterial infections and a Use a tissue to pick up their tissue and then wash your hands when yot preservative thimerosal.Mercury Is a neurotoxin-poison to human nerve can' cells.Despite the fact that many agencies and organizations have called general weakness in a person's immune •If someone around you has a cold,you might also want to wipe of for its removal,the flu vaccine and several others still contain thimerosal. System and overall health. ** countertops,door knobs,and phone handles periodically.You can us, Citizens have not been given routine disclosure about thimerasal and the a mild solution of bleach and water. option to choose thimerosal-free flu vaccines.* SEE PREVENTION AND HEALTHY TIPS for •Don't use sponges in the kitchen-they are often called bacteria hotels. • The vaccine is prepared using the body fluids of chick embryos safe, natural ways to effectively protect Use a washcloth and launder it often. Or you can do what many inoculated with a specific type or types of influenza virus(generally only restaurants do and soak the cloth in the mild bleach solution while you're 3 of the many potential strains that exist).The strains of flu virus in the you and your family from flu and colds. wiping down surfaces. vaccine are inactivated with formaldehyde and preserved with thimerosal, •Use the nursery school method for covering a sneeze-coveryour mouth the mercury derivative.Because the vaccine is grown on hen/chicken IS THE FLUMIST A GOOD ALTERNATIVE? and nose with your arm rather than your hands.And,of course,turn away eggs, the American Academy of Pediatrics (AAP) recommends that from others. children with actual or suspected allergic reactions to chicken or egg '' protein.not be given the flu vaccine unless they undergo desensitization.** Not only is the FluMlst(a"live virus"nasal spray from Medlmmune/ HEALTHY TIPS FOR ANY SEASON WHO ARE THE MOST VULNERABLE? Wyeth)expensive,it carries even More side effects and risk.One.rarely Why wait for the"flu season"to practice good health?Here are the mentioned is that a live virus can be spread from the vaccine recipient to basics: *The two groups most vulnerable to thimerosal or ethyl mercury are:the other,non-vaccinated people for up to 21 days.Even the package carries a warning: "avoid close contact with anyone with a compromised growing fetus and children ages 14 or younger.This is according to the 'Get plenty of rest and quality sleep.Some easy ways to encourage a Centers for Disease Control and Prevention(CDC).`* immune system."How would you ever know if someone you accidentally good night's sleep are:Take a hot bath prior to bedtime,keep your sneezed on while shopping is HIV positive,pregnant,undergoing cancer bedroom relatively cool,and transition into sleep with a good book or •Most children,especially those being breastfed,are at small risk of treatment,a senior with a chronic disease,or a child with asthma?Could soothing music rather than the TV. getting the flu(as opposed to a much greater risk of the common cold), you responsibly leave the house and unknowingly expose someone else •Get at least 30-45 minutes of exercise most days of the week.Simple and that if they do,they usually recover quickly,without complications. to the flu? walking works well.The woods and beaches of our area not only provide * unlimited beauty but a safe and nurturing way to get fit and reduce stress. • Even the AAP (who is advocating the vaccine forwildren) say THE U.S. FLU You'll raise your,body's natural"killer"cells and reduce "Protective efficacy against influenza illness confirmed by 'ttiveculture PHENOMENON your susceptibility to infections with consistent exercise. varies between 30%to 95%.This means that actual immune protection varies to a large degree.'**' The media's love of"a good , •Eat a well-balanced diet-emphasizing fresh fruits and •The CDC recommends that all pregnant women receive the flu vaccine story" and the continuing t,) � ' vegetables that you have washed before serving. In their second or third trimester.This Is despite the fact that the vaccine influence of drug companies t t F 'si '. ,,`.,i •Drink plenty of water-8 to 10 glasses per day is the remain. tegory C drug(one for which the risk to pregnant women on health protection and r d standard recommendation. and t es in unknown).No adequate studies have been made to policymaking organizations are •You may want to include Immune system support moni accine'a safety due to the mercury content If pregnant two of the big reasons why this lrt+ , `)I . ' `•/ from supplements as well.Here's some practical advice women are being told to limit their intake of certain fish(tuna,etc.)due Is considered a U.S. (,i from a local pharmacist:"People are going to have to be to mercury content,why wouldn't they want to avoid mercury that may phenomenon. European z,k f . reallycareful...bywashingtheirhandsand taking Vitamin be/likely is present in the vaccine?" countries do not advocate s> ,'r, , ,i C." (Peninsula Daily News,October 7,2004) blanket flu vaccine program; Psf ,' 'ra r, •Practice ways to relieve stress,Stress lowers the immune ARE THERE SIDE EFFECTS?YES The winter of 2003.04 txIit tl system function.Laugh,be grateful,and perform acts of produced an explosion of fear kindness. The CDC lists: fever, fatigue, muscle aches, and headache. These and has Influenced not only 1 symptoms,which •sound Just like the flu,are exactly what many people health policy and medical 'And...pass the chicken soup.Many people still don't experience from the vaccine. More serious side effects have been providers but contributed to .f realize that antibiotics do not help viral infections. studied,linking the flu vaccine to Guillain-Barre syndrome(GBS), an what many experts see as an Chicken soup often tops the list of home remedies and autoimmune nervous-system reaction characterized by unstable gait, outright American phobia snow being studied for why it seems to help so much. loss of sensation,and loss of muscle control or paralysis. about the flu. it In the meantime,listen to your body.And,if you should According to Hugh Fudenberg, MC, one of the world's leading F get the flu or a cold,use good judgment about whether immunogeneticists,if an individual had 5 flu shots between 1970 and PREVENTION, :1„:1;,'„,,,, '' to go to work or to school.Sharing,when it comes to •1980(the years studied), his or her chances of getting Alzheimer's PREVENTION colds and flu,isn't really the kind of generosity your disease are ten times higher than a person who had one,two,or no shots, coworkers and classmates want from you. He explained that mercury and aluminum were found In every flu shot. Many practitioners, including the sponsors of this public service The gradual buildup of mercury and aluminum In the brain causes announcement,think there are many safe and healthy ways for you to NOTES: cognitive dysfunction.*•`* protect you and your family against the flu,colds and other infections this *American lournai of Diseases of Children,severai articles. HOW EFFECTIVE IS THE VACCINE? season naturally- ''''www,cdc.gov/flu/keyfacrs.htm Center for Disease Control and Prevention. The routine application of the flu vaccine raises questions that are rarely The majority of viruses are picked up on website for htfp://v nv.hhs.gov/nvpo/ National vaccine Program Office a government rinformation, asked in the medical community or by the public. people's hands and then transmitted to •••Journal of the American Medical Association,290(2003):1608-1616. Only a few years ago, the flu vaccine was recommended mainly for •'*•H.Hugh Fudenberg,M.D.is one of the world's leadingimmu the mouth, eyes and nose, gy.H etclsts elderly people,who were considered to be at risk for flu complications y and the Chief Editor of Clinical Immunology and Immunopathology.He is the such as pneumonia.In 2002.2003,the flu vaccine was recommended for •Keep your fingers out of your mouth,nose,and eyes-this is one of the hauthoror co-author of 800+scientific articles,many published in the world's most children who already had a disease such as asthma,and who were also aost t work,on ways toIntroduce germs,especially if you are in public and hl y-res est edol theals(suco Acodemy o1 en e,Ne.England Journal of Medicine, considered more likely to suffer flu complications. According to a places, panes,or haven't washed your hands in the last September 24, 2003 report In USA Today, the CDC was already couple of hours. "•* http://www.cdc.gov/nodod/eld/vol7no3_supp/levy.htrn "Antibacterial recommending that everyone get the vaccine in the fall of 2003. •Wash your hands often and always before eating.Usingwarm water Household Products:Cause for Concern.” Media coverage of 5 Colorado children In November 2003 launched a ordinary soap for 20 seconds should do the trick.This Is about the INational Vaccine like etofread the Center wvI that sho el and 'passive panic among parents and others,Rumors spread by a variety of amount of time it takes to sing the"A,B,C song"all the waythrough. service, you yold ane in read thein mag zine served u the baso(pates 1 47. sources predicted,that like an earthquake,a"big epidemic"was overdue Keep the soap on until you're at Z•then rinse t orou hl . g Theyouyou can sofad it it the specific magazine,footnoted,otin 2004,above. at 47. Ind a van of transmission theories were put forth without much •Think"natural"when you are looking for anti-bacterial products.You There will also find specific citations in brief,above. esearc uary of 2004,the media had dropped the frightening don't need to use harsh products.Lavender,tea tree and eucalyptus oils This Information Is brought to you as a public service by the ront pa Ines and gone on to other topics,The medical community are natural antiseptic aids that have strong germicidal effects.We have following local practitioners and healthcare providers:)anelCarlson, Ind the pu is were left to assume that they needed the flu shot and a found these essential oil products at garden,flower,gift,tea,natural DC Melissa Carlson,DC,Dale Fountain,DC•Carlson Chiropractic shortage would be a disaster. food,and grocery stores In the county. and Wellness Center;Cory Reddish,ND,William Wolf,ND•Uptown A/as the 2003 flu vaccine effectivelThere Is no evidence that more people •When you leave spublic bathroom,use the paper you used todryyour Center for Natural Medicine; Robert K. Rushing, DC, LMP, Port lied in 2003-4 than in any other flu season. hands to open the door and then properly dispose of the paper.This is Townsend;Marjorie L.Pederson,DC,Port Ludlow;and Tim Cymanskl, DC,Port Hadlock. CLIP THIS OUT FOR EASY REFERENCE - - - - " " - - - - - CLIP THIS OUT FOR EASY REFERENCE PREVENTION, I HEALTHY REVENTION! • Keep fingers out of your mouth,eyes&nose I TIPS! 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