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HomeMy WebLinkAbout2005-October File Copy • Jefferson County Board of Health .agenda Minutes October 20, 2005 • JEFFERSON COUNTY BOARD OF HEALTH Thursday, October 20, 2005 2:30—4:30 PM Jefferson County Courthouse First Floor Conference Room AGENDA I. Approval of Agenda II. Approval of Minutes of September 15, 2005 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. West Nile Virus Newsletter 2. Provider Alert—Pertussis 3. Influenza and Pneumococcal Vaccination Information for Health Care Providers V. New Business 1. Public Hearing—Jefferson County Solid/Hazardous Waste Regulations Ordinance 2. Environmental Health Fee Schedule Development—Regional Comparisons 3. Pandemic Influenza Planning—Risk Communication 4. Preventive Services Funding and the Port Townsend Liquor Excise Tax 5. Hood Canal Coordinating Council Survey and November 16, 2005 Multi- County Meeting Briefing VI. Activity Update VII. Agenda Planning VIII. Next Scheduled Meeting: November 17, 2005 2:30 PM-4:30 PM Main Conference Room Jefferson Health and Human Services • el JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, September 15, 2005 0 P &11Board Members: Staff Members: Geoffrey Masci, Chairman—Port Townsend City Council Jean Baldwin,Health&Human Services Director David Sullivan, Vice Chairman—County Commissioner District#2 Julia Danskin,Nursing Services Director Phil Johnson—County Commissioner District#1 Thomas Locke,MD,Health Officer Patrick M. Rodgers-County Commissioner District#3 Mike McNickle, Environmental Health Director Jill Buhler—Hospital Commissioner District#2 Sheila Westerman—Citizen at Large(City) Roberta Frissell—Citizen at Large(County) Vice Chairman Sullivan called the meeting to order at 2:37 p.m. in the Health Department Conference Room. All Board and Staff members were present with the exception of Chairman Masci and Member Buhler. Visitors in attendance included Dana Fickeisen, Mark Sperrazza and Laurie Strong. There was a quorum. APPROVAL OF AGENDA Jean Baldwin requested one addition to the agenda under New Business to give an informational report on school services. Member Westerman moved to approve the Agenda as amended. Member Johnson seconded the motion,which carried by a unanimous vote. APPROVAL OF MINUTES Vice Chairman Sullivan moved to approve the Minutes from July 21,2005, as written.Member Westerman seconded the motion,which carried by a unanimous vote. PUBLIC COMMENT Laurie Strong, Jefferson Mental Health Executive Director, drew attention to the upcoming Jefferson County Board of Commissioners public hearing, October 3, 2005 regarding the creation of a tax for mental health and chemical dependency services. She explained that the expanded services that this funding would provide could offer a unique opportunity for the County to bring those services to people with the kind of disorders that are very expensive to the system. She asked the Board of Health to support the implementation of the proposed one-tenth of 1 percent sales and excise tax. Ms. Strong answered questions and Member Westerman suggested that this item be added to the agenda so that the Board might discuss it more in-depth in advance of the public hearing. It was noted that the hearing is only about instituting the tax, decisions on how monies would be spent from year to year would be an ongoing budget decision and the BOH would have input on those decisions. Jean Baldwin noted that staff recommendations had previously been requested by the BOH and she had them available upon request. She also noted that the Law and Justice group and the Substance Abuse Committee were asked to give opinions and to weigh-in, and will most likely be at the formal hearing. The Board agreed to return to this topic and added this as item#6 under New Business. HEALTH BOARD MINUTES— September 15, 2005 Page: 2 OLD BUSINESS AND INFORMATIONAL ITEMS West Nile Virus Detection in E. Washington: Dr. Tom Locke gave an update on the status of • WNV in the state. He noted that the virus now has been officially detected in Washington in mosquito samples. Given the fact that we're not seeing birds or animal cases yet at this time of year, it is very unlikely that Washington is going to have any significant human activity this year. The virus has made it to the State and if the right combinations of weather and bird migration occur, we may start to see human cases next year. Health Department Director, Jean Baldwin noted that JCPH plans to issue press releases about the mosquito sampling that has been going on within the county. The purpose of this sampling is to determine species. Certain types of mosquitos are much more likely to carry West Nile than others. Correspondence — Jefferson Health Care: Jean Baldwin reviewed a letter sent (over the signatures of Dr. Locke and herself) to Vic Dirksen of Jefferson Healthcare. The letter formally requested that Jefferson Healthcare contribute $25,000 for calendar year 2006 to maintain and expand community health assessment capacity in Jefferson County. Dr. Locke noted that, after receipt of the letter, the hospital has set up a meeting in October for follow-up. Jean would also like to send a similar letter to the City of Port Townsend and asked for direction as to whether it should be sent from herself, Dr. Locke or the BOH. She explained that the City doesn't provide dedicated funding for public health services provided to City residents nor does the hospital have a funding mechanism to support public health services that benefit Jefferson Healthcare clients.. There was discussion about what the County contributes by way of providing infrastructure. Member Westerman suggested that a more positive response might come from the City if the letter of request gives details demonstrating that the County is offering an equal commitment of resources. It should also note the hospital's commitment. Jean will draft a letter reflecting those suggestions. Correspondence — Department of Health & Human Services: Jean Baldwin reviewed a letter that was sent (over the signature of David Sullivan) to DSHS and their response in regard to an appeal for prevention funding for the Nurse Family Partnership. This turned out to be unsuccessful in securing ongoing funding. Region 2 PHEPR Newsletter: Dr. Locke noted that the newsletter is coming out quarterly and goes to all health care providers in the 3 county region. He pointed out that they are now publishing selected notifiable condition reports covering a 3 month period. Member Westerman suggested that it would be helpful to show the differing county populations on the chart. Dr. Locke said that they will add something that reflects the relative size of the counties. The newsletter will be included in BOH packets every 3 months. He noted that there is also a quarterly regional meeting where they come up with themes for the next newsletter. The next issue will reinforce respiratory etiquette issues because we will be heading into flu season and also push for flu vaccination, especially among health care workers. It appears that there will be an adequate supply of influenza vaccine available. American Public Health Association — In Defense of Science: Dr. Locke explained the American Public Health Association's Resolution 2004-11, adopted November, 2004 "In Defense of Science". He commented on the organization's concerns that science as a basis of policy-making is increasingly being challenged. This is an issue for those that believe that public health policy should be evidence based. HEALTH BOARD MINUTES — September 15, 2005 Page: 3 • "Bracing for the Inevitable" — Global Pandemic Flu Planning: Jean Baldwin and Dr. Locke reviewed and commented on an article from the Washington Post discussing the grave possibility of pandemic flu. In terms of likely communicable disease outbreaks of global significance, this is now #1. As it spreads from country to country, this strain of"bird flu" in Asia is becoming more and more dangerous. Dr. Locke noted that if it becomes less lethal and more contagious it will pose a serious global threat. In contrast, a virus that has a high fatality rate is not very successful at spreading broadly. Regional, state, national and international public health agencies are very serious about preparing for this. He noted that the challenge would be to have sufficient personnel capacity to deal with something of this scale. It is also possible that this particular virus may never mutate and trigger a global pandemic. NEW BUSINESS Draft Jefferson County Solid Waste Ordinance and Enforcement Procedures: Mike McNickle, Environmental Health Director, gave a detailed presentation on JCPH Solid/Hazardous Waste Regulations. His presentation covered the history of county solid waste regulations; main goals of the proposed regulations; specific changes from existing regulations; enforcement procedures; and the specifics of"notice of civil infraction" (ticketing). His Power Point presentation also included photos showing examples of solid waste problems in Jefferson County. Mike requested that the Board move forward in the adoption process of the solid waste regulations and give permission to move forward with adopting the enforcement procedures as policy. The Board asked questions and discussed specific issues. Recommendations were made for needed 411 changes to the printed regulations. They discussed the process to move ahead, which is: 1) to call for a public hearing, 2) publish the regulations for public distribution (generally a minimum of 2 weeks, and sometimes longer), 3) make it available on our web site and make copies available upon request, 4) receive feedback from the public by conducting one or more public informational meetings, and 5)present feedback to the BOH at the hearing which will occur at their next regularly scheduled meeting on October 20th. The public will have the opportunity to testify at the meeting. Mike recommended that Environment Health host two open houses (North County and South County) as an education piece, in advance of the public hearing. This would provide opportunities for one-on-one interaction to address any public concerns. The Board agreed to hold the hearing at the BoCC chambers. Member Frissell moved to have a public hearing at the October 20, 2005 Board of Health meeting in the Commissioners Chambers. Member Johnson seconded the motion, which carried by a unanimous vote. Public Health Service Fee Setting Authority: Dr. Locke explained this issue of BOH authority as relates to adopting fees. He noted that County Commissioners have a general fee setting authority, depending on how broadly you construe their licensing authority under RCW 36.32 . For public health services, Boards of Health have a very specific statutory authority to set fees. This authority is very broad and is delegated by the legislature in order to provide the local board of health with the funding necessary to carry out their responsibilities. As a practical matter, the majority of fees are for environmental health services. There are some non-environmental health services (like adult immunizations) that are also within Board of Health fee setting authority. Staff is not % proposing a specific set of fees today. This issue before the Board today is whether to take on the task of setting fees. Dr. Locke strongly recommended that the Board take on this responsibility. HEALTH BOARD MINUTES — September 15, 2005 Page: 4 The Board would need to adopt a new fee schedule before we would want to approach the BOCC and seek a repeal of the existing one. • Jean Baldwin explained that in the past there was a whole different cycle of how our fees were set as a department, and that it was done differently than other departments. She further explained that fees are reviewed every 2 years based on a comparison to other counties and a cost analysis of each service. She noted that updates are needed in the EH fees and some Community Health fees. The process is scheduled to begin in the Fall and, in the past, the BOH has been invited to participate in the workgroup. She expressed her hope that some of the Board would want to participate as we start the process. Member Westerman stated that she welcomed this responsibility and felt it appropriate. Her preference would be that staff brought the Board specific information and recommendations in preparation to voting. Member Frissell volunteered to help in any way that staff would see fit. Jean agreed to bring back recommendations to the Board at the October 20th meeting for discussion. A public hearing could be scheduled in November. Ideally, food service fees need to be adopted to go into effect January 1, 2006 because payments are due at the first of the month. The billing goes out at the end of December.) Draft Food Service Inspection Frequency Policy: Dana Fickeisen presented a revised draft policy statement for the Food Safety program. She introduced Mark Sperrazza from Port Townsend School District who sits on her advisory committee. She informed the Board that the food code that was adopted and implemented in May allows for local health jurisdictions to decide on the frequency of inspections with a risk based plan. She explained routine inspection frequency, re- inspections and pre-opening inspections. She noted that the main goal is to make sure we're doing inspections frequently enough and that we comply with the WA State code. The goal of the policy is to standardize inspection frequency throughout the county. Joint Meeting — Jefferson, Kisap, Mason County BOH — November 8, 2005 - Re: On-site Sewage Systems and Hood Canal Water Quality : Jean Baldwin noted that Mason County could not come to the other tentative date that had been set so it has been rescheduled to 11/8/05. This joint meeting will focus on the on-site sewage systems and Hood Canal water quality. There will be some discussion about current projects, and an update on the work the University of Washington and others are doing in monitoring water quality. The agenda is still being worked on for this discussion. All 3 counties are involved with Hood Canal water quality and the Boards of Health are specifically charged with developing plans for marine water quality protection.. The meeting will be held from 11:00 am —1:00 pm at Kitsap Health District in the Norm Dicks building in downtown Bremerton. It will be facilitated by Hood Canal Coordinating Council's Dave Christiansen. A van pool will be arranged. Clallam County BOH members have also been invited to attend. Call Mike or Jean with any specific items you would like to have on the agenda. Jefferson County Board of Commissioners Public Hearing October 3, 2005: Discussion resumed from earlier in the meeting about the full BOH officially supporting the BoCC in regard to implementation of the proposed tax increase for mental health funding. The question was raised to the three County Commissioners present by Member Westerman as to whether it would be helpful to have a letter of support or gesture from the BOH. Some individual views were expressed about the need for the tax. Member Westerman stated that support from the full Board would be a stronger statement than individual support. Member Frissell expressed disappointment that this source of funding would not be coming through the BOH. Member Rodgers noted that since the Substance Abuse Board is now under the purview of the HEALTH BOARD MINUTES —September 15, 2005 Page: 5 BOH, in that sense there are funds coming for that piece, and it addresses public health problems • because the Commissioners recognize mental health as a public health problem, not as a separate problem. Vice-Chair Sullivan believes that it would lessen competition for money at the local and state level. Dr. Locke noted that although it is certainly appropriate for the Board to take positions on issues of this type, the critical health issue concerning this new legislation is how the money would be spent. He encouraged the Board to look at its role in deciding what would be done with the funding. Jean Baldwin expressed concerns and made comments about assessment issues. Commissioners Sullivan and Rodgers both expressed some awkwardness at a full Board vote of support since they serve in dual roles as BOH members and BOCC members. Dr. Locke suggested the most effective approach would be to testify individually as a BOH member before the BOCC in support of this. The date of the hearing is Monday, October 3, 2005 at 9:00 am. Katie Carlson School Services Report: Jean Baldwin pointed out the project Take Time evaluation summary and invited anyone who would like the in-depth report to contact her. She noted that the summary looks at services being provided in the schools under this outside contract. She has concerns about this project (as well as Big Brothers / Big Sisters) because the money is being held "very dear". If this topic is something of interest to the Board she will arrange a short overview from Katie Carlson. It's a program that is doing a fair amount of prevention in the community. Interest was expressed in having a further presentation at a later time. AGENDA PLANNING/ADJOURN Member Frissell recently returned from a cruise where there was a staff environmental officer on the ship that was responsible for monitoring their systems, and also, the cruise line showed a DVD about their systems and how they protect the environment. She offered to obtain the 20 minute DVD for the Board to view if they were interested. She also has information on new regulations on dumping. Some interest was expressed. The meeting was adjourned at 4:20 p.m. The next meeting will be on October 20, 2005 to be held at the Jefferson County Courthouse Commissioner chambers. JEFFERSON COUNTY BOARD OF HEALTH Commissioner Sullivan, Vice Chairman Sheila Westerman, Member Patrick M. Rodgers, Member Phil Johnson, Member Roberta Frissell, Member Excused toGeoff Masci, Chairman Jill Buhler, Member • Board of 3-fealth Old Business .agenda Item # 1V., 1 • "West iCe irus Netivsletter October 20, 2005 • f y',:,;;,"---,-,:",-,,,,,-1,-41.,,,,,,,,,,y • West Nile Virus Nev,sfrtt . ;r -'-';', . . , ,Zoonotic Disease Program, Washington State Department of Health r; Terri October 5, 2005 Volume 3, Issue 14 Purpose West Nile virus activityin the Northwest To keep our partners F and other interested ' entities informed about ;' ----- 1 , L West Nile virus(WNV) T, ---- _ -] - fl No Activity Detected In This Issue C � WNV Activity Detected WNV found in Yakima County horse Source: Antibody's success ` Idaho Department of Health against WNV surprise r &Welfare Web site,October 5,2005. scientists �re8' Idaho Oregon Department of Journal articles from September 22,2 05. site, CDC's Emerging 4 Washington State Infectious Diseases illi- ,j� Department of Health Web f� site,October 5,2005. National,northwest,and state surveillance Washington: One horse, one bird and two mosquito pools from Yakima County t = have tested positive for WNV. Idaho: Thirteen humans, one-hundred and six • horses (press release on eastern Idaho WNV positive horse), seventeen mosquito Previous Issue pools, fourteen birds, and one doghave been infected. Oregon: Seven humans, Dead bird and another p g mosquito pool testis; fifteen horses, fourteen birds, eight mosquito pools, and four sentinel chickens positive for WNV have tested positive for WNV. South Dakota getting hit ), hard this year t Mosquito spraying in West Nile virus found in Yakima County horse New Orleans OLYMPIA—West Nile virus has been confirmed in a 27-year-old horse in National, northwest,and Yakima County, the state Department of Agriculture announced today(Sept. 23). state surveillance ,', The Prosser-area mare was tested after she became unsteady and developed signs View the September 22°d of central nervous system infection. The horse was not vaccinated for West Nile WNV Newsletter virus. This is the first reported case of West Nile infection in a horse where the infection Subscribe, was acquired in Washington state this year. The other announced equine cases Submit Articles, involved infections that were contracted out of state. • Suggestions Contact Benilton(o�Hamilton The positive test results were reported today by the Washington Animal.Disease benjamin.hamdoh.wa °v," Diagnostic Laboratory at Washington State University in Pullman. li Earlier this week, health officials in Oregon's Umatilla County announced a Milton-Freewater horse tested positive for the virus. In mid-September, the Benton • County Mosquito Control District detected positive test results in mosquitoes ii collected in Yakima County, and the WSU lab last week confirmed a magpie If infected with the disease, also in Yakima County. 14 "This is a clear indication that West Nile virus is in our state and it's already WNV Web amplified enough in mosquitoes and birds to spread the infection to horses," said Resources Dr. Leonard Eldridge. "We have been anticipating this since it's been seen in Washington State Department of Health neighboring states. The public and horse owners should take protective measures www.doh.wa.gov/wnv 1 and avoid mosquito bites." Centers for Disease news release at Control and Prevention View the Department of Agriculture's www.cdc.qov/ncidod/dvb ` http://www.agr.wa.gov/News/2005/05-44.htm. id/westnile US Geological Survey& CDCArboNET maps West Nile virus activity in the United States http://westnilemaps.usgs e ored to CDC as of October 4, 2005) Rt P ) Cornell University, CDC Environmental Risk -Indiicates human disease case(s). Com`'*-_ Analysis Program .,,,_. Avian,animal or mosquito infections. http://environmentalrisk.c r ornell.edu/WNV/ WA E I MT ND • �.. E,, NH SD Washington State °ID 34 wx ii MA University Cooperative A; w zsi 7 M` ` . Extension 6 IA - PA NE www.wnv,wsu.edu NV UT 23 IL IN OM 21 <, CT 111 CA ai CO Ks MO if SKY N7 Washington State 744 '' IN z 14 a VA Department of OK TN N` , DE Agriculture , AZ NM a AR v 3C MD® www.agr.wa.gov/FoodAn, r" 26 i MS AL GA ' _ imal/AnimalHealth/Disea< ��� Tx Ln 9 7 11 Dci 40 ses/WestNileVirus/defaul AK =- 76 431 , r- ; t.htm --,(-6,, FL 1 WV HI Puerto Rico Northwest Links Idaho Department of As of October 4, 2005 a total of 41 states have published 2,016 human cases, Health 8,Welfare www.westnile.idaho.gov compared with 1,865 cases from 39 states at this time in 2004. = Oregon Department of National maps and data available at Human Services http;//egov.oregon.gov/D. http://www.cdc.gov/ncidod/dvbid/westnile/surv&control.htm. HS/ph/acd/diseases/wnil e/survey.shtml British Columbia Center Antibody's success against WNV surprise scientists for Disease Control www.bccdc.orq A monoclonal antibody that can effectively treat mice infected with West Nile virus has an intriguing secret: Contrary to scientists' expectations, it does not block the virus's ability to attach to host cells. Instead, the antibody somehow stops the infectious process at a later point. "This was a complete surprise to us,but it gives us some very useful insights," says senior author Daved Fremont, Ph.D., associate professor of pathology & immunology and of biochemistry &molecular biophysics at Washington University School of Medicine in St. Louis. "Based on what we've learned,we are now developing therapeutic antibodies for related viruses that also are effective at stopping the process of infection after the virus attaches to host cells." • Page 2 Continue reading this entire article at http://www.innovations- report.com/html/reports/life sciences/report-49860.html. a DOH WNV Journal articles Aft Contacts Centers for Disease Control and Prevention, Emerging Infectious Diseases, Volume 11, Number 10—October Issue l ` ¢' IIIV Toll Free Info Line 1-866-78VIRUS Rapid West Nile Virus Antigen Detection, N.A. Panella et al. x http://www. s Publication Requests r'yndi Frees West Nile Virus Infection and Con unctival Exposure, K. Fonseca 360-236-3384 j cvndi.free(a�doh.wa.gov et al. http://www.cdc.gov/ncidod/eid/vo111no10/04-0212.htm Mosquito Surveillance r Jo Marie Brauner 360-236-3064 Washington non-human surveillance summary iomarie.brauner(cadoh wa qov '" (Reported to DOH as of October 5, 2005) Bird and Horse Surveillance Tom Gibbs Horses't Birds`" Sentinel Flocked*' Mosquito Pools'"' 360-236-3060 County Tested Positive Tested Positive Tested Positive Tested Positive ,:,, tom.giboh.wa oov '-ci Q a rc.,°,1,..":".40:11'..,,,::1: ,,,,eett � � 0 0 Aquatic Mosquito Benton 0 23 0 .. Control NPDES Permit °' 001 i_" 3''''''l''''''::::,ir,,z,w.-80 Ben Hamilton cIalism .44, try,, 0 0 0 0 0 D b360ia-236-3364 a: 0 Columbia o B " °» 9 t . Conutetn.hamitton(c�doh wa qov�l :itt 0 0 0 0 .0 ,6.,l_... Wit,' i F , +g>- D las :, - 9 1 WNV in Humans 0 0 0 a o e 0° ,:::1;3,177::.:4 Local Health Jurisdiction, Fr nkGn 0 , �° :=;6141,,,,4:4:,), i w., 9 ...t DOH Cominunicabie grant 0 0 disease Epidemiology , 0 0 1 . 41) 206-418-5500 or �` island ��. 1 '0 411 " ° .or 4 " ''09 0 t 877-539-4344 '` 0 News Releases aid,.2.1t.4'.,::..71 !' � ' gx 0 Yr i) 0 : -.A.. 3 a a " Media Response`'� imtas Assistance f ' _ _ °1-, if ti. ;0i." 0 0 0 Donn toMer Lewis 0 ca 18 0 O +t t' IV 0 ti 360-236-4076 Lincoln ' ��'". .. ,,,,,J.,;„....,,x 0: � s' 0 .; �' Q Macon 0 0 0 ,. 0 f} 9 donn.moverC�doh.wa.gov , '"� 20 0 Okanogan—447 a"' 0 0 Pacif c 0' 0 t Tim Church . 1 0 0 a 0 Fend Qreil� E � � 0 „,,,q7:11.14:::::',-P.,'. 0 , � 0 r 360-236-4077 Pierce 0 0 97 OF 0' tim.churchdoh.wa.gov «� �. a a 0 81, O San x�an ' 0 © „,i7,.:411,7 � >�” 0,' p 0� a i i 12 0 or WNV Program Skan,anaa 0 D 0 0 a o" Management s Snohomish 6, 0 c 0 Di 0 a,: €3 Maryanne Guichard <� SPorcefle ^f 0 1 � 0 a �l a 360-236-3391 Stevens f 0 a 0` 0 0 51 LI D3 0 0I 0 marvanne.quichard(o�doh.wa.qov Thurvfon 0 a 7$ 001 0 OJ 0 WNV Coordinator Wags wails 1 °` a 0; a a� Dorothy Tibbetts W1`natcom 0 $i 0 D 0 c O 4±Vhrtmart 4 a0 0'= a a 0 360-236-3361 t 0 s c 0 dorothv.tibbetts(c�doh.wa.gov fakima O 6' a } Ib? Totals ' 26 1 578= t 8' 0 222: .lg 9" 4 852 'A:otai of 34 horses have been tested for 1'9'est'lrie vinas.Eqpt were not included a the tab•e because eoun:yistaie information eras rot avaslab'e.. WADDL Report Dated:August 31,2005. ."vf6V pasiuve acquired in stare. "A total of 5g3 buds have been submitted for West virus test;ng of vmicm 15 birds were cnsuitab'e anal not tes:ed for r't'es Nile varus J333 Report Date;Septer-der 20,2005 and tJADDL Repert Date:�ctoaer 3,2005 "'Berton County MCD Report Dated:September 27.2005 •'.•tlosq Co poc;s tested cy USAC4PP�.t-'uVest Report Date;September-30,2305�;vveek:ate: • Page 3 Cowlt-County MCD Rep rt O te:Augast25.2008,Benton MCD Report Date September 2005. Frarklm MCD Report.=at august-2430- 05,CI rk MCD Repcat Dat=-September;z,203&..and 1:.4-3DL Repor.Date.September 7.2305. • Board of Health OCcI Business .agenda Item # IV., 2 • Provider ,alert Pertussis October 20, 2005 • o .JEFFERSON COUNTY PUBLIC HEALTH TOM LOCKE, MD, MPH, HEALTH OFFICER x,,7 C0G ^ Always Working for a Sa fer and Healthier Jefferson (360) 385-94000 l5�1 NCsK�Alt � Pertussis Alert October 2005 We are seeing an increase in pertussis like illness in Jefferson County children. We have had one lab confirmed case and one epi-linked case in the last month. There are a growing number of children with pertussis-like illness who meet the clinical case definition. Kitsap County has had a record number of cases since June, with 47 confirmed cases. CLINICAL CASE DEFINITION A cough illness lasting>2 weeks with one of the following: paroxysms of coughing, inspiratory"whoop", or post-tussive vomiting,without other apparent cause. LABORATORY TESTING Diagnosis of B.pertussis is based on the recovery of the organism from nasopharyngeal swabs obtained during the catarrhal or early paroxysmal stages of the illness. The standard laboratory tests include: culture and direct immunoflourescence(DFA). Polymerase chain reaction(PCR)testing is also available. If you suspect pertussis, a culture should be taken and then antibiotic therapy should be started immediately, regardless of age or immunization history. In addition to guiding individual therapy, culture based diagnosis enables Providers and Public Health to identify and appropriately treat contacts of confirmed cases. CASE CLASSIFICATION • Probable: a case that meets the clinical case definition, is not laboratory confirmed, and is not epidemiologically linked to a laboratory-confirmed case. Confirmed: a case that is laboratory confirmed or one that meets the clinical case definition and is epidemiologically linked to a laboratory-confirmed case TREATMENT RECOMMENDATIONS (applies to case and close contacts) The drug of choice is: • Erythromycin estolate(40-50mg/kg per day, orally, in 4 divided doses; maximum 2g/day)for 14 days. The newer macrolides may be as effective as erythromycin and have fewer adverse effects and better compliance- • Azithromycin dihydrate(10-12 mg/kg per day, orally, in 1 dose for 5 days; maximum 600 mg/day), more data are also accumulating that may support the use of the"Z-Pak"dose and duration; OR • Clarithromycin (15-20 mg/kg per day, orally, in 2 divided doses; maximum 1 g/day for 7 days). Patients with pertussis should be considered contagious and should avoid public contact until they have completed 5 days of an appropriate antibiotic treatment. CONTACT MANAGEMENT Close contacts of a case of pertussis should receive antimicrobial therapy as listed above. Contacts at highest priority for prophylaxis include: infants <1 year of age,pregnant women, and those who have contact with infants or pregnant women. All close contacts<7 years of age who are unimmunized or who have fewer than 4 doses of pertussis vaccine • (DTaP), should initiate or complete the series. Children who received their third dose 6 months or more before exposure should be given a fourth dose at this time. Children who have had 4 doses of pertussis vaccine should receive a booster dose unless a dose has been given within the last 3 years or they are 7 years of age or older. 615 Sheridan Street,Port Townsend, Washington 98368 fax: (360)385-9401 web: www.jeffersoncountypublichealth.org • Board of Health OCdBusiness .agenda Item # 1V., 3 • influenza & Pneumococcal `Vaccination Information October 20, 2005 • w, oN s coG� JEFFERSON COUNTY PUBLIC HEALTH i4; otAlways Working for a Safer and Healthier Jefferson 16H I N 6CO • September 26, 2005 To: Area Health Care Providers From:Jane Kurata, PHN Re: 2005 Influenza Vaccine Information Jefferson County Public Health (JCPH) will publicize information about influenza vaccine availability in local newspapers again this year, and will assist your immunization efforts in any way we can.JCPH will not have influenza vaccine available for the general public, but will have state-supplied flu vaccines in our clinics for children with certain risk factors. Enclosed is information for influenza and pneumonia vaccines that may be helpful for the approaching flu clinic season. Included are vaccine information statements, recommendations on vaccine use, excerpts from CDC's Advisory Committee on Immunization Practices (ACIP), and information regarding use of influenza vaccines in children. The entire CDC recommendations on influenza and pneumonia can be viewed at the MMWR Recommendations and Reports website at www.cdc.gov/mmwr/mmwr_rr.html. The MMWR discussing influenza also has a section on the use of antiviral medications for influenza. For information on influenza surveillance throughout the season check the following Washington State and CDC sites: http://vvww.doh.wa.gov/FluNews/default.htm , http://www.cdc.gov/flu/weekly/ . • Influenza Vaccine. The CDC is projectinthat there should be plenty of flu vaccine available this year. Four manufacturers, Sanofi Pasteur, GlaxoSmithkline, Chiron and Medimmune Vaccines are expected to supply influenza vaccine to the U.S. market this year. Last year, the lack of specific guidance regarding when influenza vaccine could be made more widely available caused much confusion and contributed to millions of doses of vaccine being unused. The CDC has developed a specific time frame for the 2005-2006 influenza season. To ensure that those at highest risk of complications from influenza have access to vaccine, CDC recommends that certain priority groups receive inactivated influenza vaccine until October 24, 2005. Beginning October 24, 2005, all persons will be eligible for vaccination. The following priority groups should be targeted to receive inactivated influenza vaccine prior to October 24, 2005: • persons aged 65 years and older, with and without chronic health conditions • residents of long term care facilities • persons aged 2-64 years with chronic health conditions • children aged 6-23 months • pregnant women • health care personnel who provide direct patient care strongly recommended to protect vulnerable patients • household contacts and out-of-home caregivers of children aged <6 months • COMMUNITY ENVIRONMENTAL DEVELOPMENTAL NATURAL HEALTH HEALTH DISABILITIES RESOURCES (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9444 615 Sheridan Street, Port Townsend, Washington 98368 fax: (360)385-9401 web: www.ieffersoncountypublichealth.org X45°N coG JEFFERSON COUNTY PUBLIC HEALTH . Always Working for a Safer and Healthier Jefferson Flu vaccine is available from the State Immunization Program this year for children from 6 months of age up to the 19th birthday who meet the following high-risk criteria: • All children from 6 to 23 months old. Children under age 9 receiving flu vaccine for the first time need 2 doses given I month apart. • Children with chronic illness, i.e. chronic pulmonary or cardiovascular conditions, metabolic diseases, renal dysfunction, hemoglobinopathies • Children receiving chronic aspirin therapy • Children receiving immunosuppression therapy • Pregnant teens under age 19 • Children less than 19 years of age who are household contacts or caregivers of infants 0 - 23 months of age, or of children with high-risk conditions. Children 6 months up to the 3rd birthday receiving an influenza vaccination for the first time should receive two 0.25 ml doses a minimum of one month apart. Children from 3 years of age up to the 9th birthday receiving an influenza vaccination for the first time should receive two 0.5 ml doses a minimum of one month apart. A recall system to remind parents about the second dose is recommended. Any child who has previously received flu vaccine needs only I dose. Children age 9 and older should receive one 0.5 ml dose. Please refer to Table 4 in the ACIP excerpts and the Washington State Department of Health materials. State-supplied influenza vaccine has been ordered for clinics that routinely receive pediatric vaccines through the State Immunization Program. Preservative-free vaccine will be supplied for children 6-35 • months old. For clinics with pediatric client, a screening form to determine eligibility for State-supplied vaccine, and a flow sheet to guide correct dosing of children are included in this packet. Children not eligible for publicly funded vaccine can still be vaccinated with privately purchased vaccine. Live Intranasal Influenza Vaccine. FluMist, the live, attenuated influenza vaccine that is administered intranasally is again available. Anyone considered high-risk for complications of influenza is NOT an appropriate candidate for FluMist. It is licensed for healthy people between the ages of 5 and 49 who have no risk factors for complications of influenza. FluMist is contraindicated for anyone in close contact with a severely immuno-compromised person. Pneumonia Vaccines. Recommendations for use of pneumococcal polysaccharide vaccine are unchanged this year. Excerpts from the ACIP guidelines regarding administration and revaccination are enclosed. Pneumonia vaccine is recommended for all adults age 65 years and over and children and adults age 2-64 years with certain chronic conditions. I will submit a listing of area flu clinic locations and times for publication in the Port Townsend &Jefferson County Leader each week. If there are any changes in your clinic plans, please let me know and I will publicize those changes. If I can answer any questions or be of assistance, please call me, or Lisa McKenzie, at 385-9400. 41/1 COMMUNITY ENVIRONMENTAL DEVELOPMENTAL NATURAL HEALTH HEALTH DISABILITIES RESOURCES (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9444 615 Sheridan Street, Port Townsend, Washington 98368 fax: (360)385-9401 web: www.ieffersoncountypublichealth.orq JEFFERSON COUNTY • FLU VACCINE CLINICS September 29,2005 Dr. Richard Lynn, 1136 Water St, Port Townsend. • Fridays, October 21, 28, November 4, 11, and 18, from 8 pm - 12 noon. Medicare patients please bring your Medicare cards. All others $20. No insurance will be billed. Established clients only. Jefferson Medical Group, 834 Sheridan St, Port Townsend. • Saturdays, October 15 and October 29, from 9 am-12 noon. Medicare patients please bring your Medicare cards. All others $20. No insurance will be billed. Monroe Street Medical Clinic, 242 Monroe St, Port Townsend. • Limited supply for High-Risk only. $25 per shot. Please call 385-5658 for an appointment. No insurance will be billed. Olympic Primary Care, 1010 Sheridan St, Port Townsend. • Saturdays, October 22 and November 5, from 9 am -12 noon. Medicare patients please bring your Medicare cards. All others $20. • No insurance will be billed. Port Hadlock Medical Care, 121 Oak Bay Road, Kivley Center, Port Hadlock. • Established clients only. Please call 379-6737 for an appointment. Medicare patients please bring your Medicare cards. All others $20. No insurance will be billed. Port Townsend Family Physicians, 934 Sheridan, Port Townsend. • Saturdays, October 15 and October 29, from 9 am-12 noon. Medicare patients please bring your Medicare cards. All others $20. No insurance will be billed. QFC Pharmacy, 1890 Irondale Rd, Port Hadlock. • Thursday and Friday, October 13 and 14, and Thursday October 27, from 12:00 noon — 6 pm. Medicare and Medicaid patients please bring your coupon or card. All others $28 for flu shots, $35 for pneumonia shots. Safeway Pharmacy, 442 Sims Way, Port Townsend. • Clinic schedules to be announced at a later date. South County Medical Clinic, 294843 Highway 101, Quilcene. • Mondays through Thursdays, 5 -6 pm. Medicare patients please bring your Medicare cards. All others $20. • No insurance will be billed. Please call 765-3111 for an appointment. • • INACTIVATED INFLUENZAVACCINE (WHAT YOU NEED TO W) (i I Why get vaccinated? ) 3 I )Who should get inactivated Influenza ("flu") is a very contagious disease. Influenza vaccine? It is caused by the influenza virus,which spreads from Influenza vaccine can be given to people 6 months of age and older. It is recommended for people who are at risk infected persons to the nose or throat of others. of serious influenza or its complications,and for Other illnesses can have the same symptoms and are often people who can spread influenza to those at high risk mistaken for influenza. But only an illness caused by the (including all household members): influenza virus is really influenza. Anyone can get influenza. For most people,it lasts only a People at high risk for complications from influenza: few days. It can cause: • All children 6-23 months of age. • fever. • sore throat • chills • fatigue • People 65 years of age and older. • cough • headache • muscle aches • Residents of long-term care facilities housing persons Some people get much sicker. Influenza can lead to with chronic medical conditions. pneumonia and can be dangerous for people with heart or breathing conditions. It can cause high fever and seizures ' People who have long-term health problems with: in children. Influenza kills about 36,000 people each year -heart disease -kidney disease -lung disease -metabolic disease,such as diabetes in the United States,mostly among the elderly. - asthma -anemia,and other blood disorders • Influenza vaccine can prevent influenza. • People with certain conditions (such as neuromuscular disorders) that can cause breathing problems. L2 I Inactivated Influenza vaccine ) • People with a weakened immune system due to: - HIV/AIDS or other diseases affecting the immune system There are two types of influenza vaccine: - long-term treatment with drugs such as steroids An inactivated (killed) vaccine,given as a shot,has been - cancer treatment with x-rays or drugs used in the United States for many years. • People 6 months to 18 years of age on long-term A live,weakened vaccine was licensed in 2003.It is sprayed aspirin treatment (these people could develop Reye into the nostrils. This vaccine is described in a separateVaccine Syndrome if they got influenza). Information Statement. • Women who will bere p grant during influenza season. Influenza viruses are constantly changing. Therefore, People who can spread influenza to those at high risk: influenza vaccines are updated every year,and an annual vaccination is recommended. • Household contacts and out-of-home caretakers of For most people influenza vaccine prevents serious illness infants from 0-23 months of age. caused by the influenza virus. It will not prevent"influenza- • Physicians,nurses,family members,or anyone else in like"illnesses caused by other viruses. close contact with people at risk of serious influenza. It takes about 2 weeks for protection to develop after the Influenza vaccine is also recommended for adults 50-64 shot,and protection can last up to a year. years of age and anyone else who wants to reduce their Inactivated influenza vaccine maybe chance of catching influenza. given at the same time as other vaccines,including pneumococcal vaccine. An annual flu shot should be considered for: Some inactivated influenza vaccine contains thimerosal,a • People who provide essential community services. preservative that contains mercury. Some people believe thimerosal may be related to developmental problems in • People living in dormitories or under other crowded children. In 2004 the Institute of Medicine published a report conditions,to prevent outbreaks. concluding that,based on scientific studies,there is no evidence• • People at high risk of influenza complications who travel of such a relationship. If you are concerned about thimerosal, to the Southern hemisphere between April and September, ask your doctor about thimerosal-free influenza vaccine. or to the tropics or in organized tourist groups at any time. If these problems occur,they usually begin soon after the shot (4 When should I get influenza and last 1-2 days. vaccine? • Severe problems: The best time to get influenza vaccine is in October or November. • Life-threatening allergic reactions from vaccines are very rare.If they do occur,it is within a few minutes to a few Influenza season usually peaks in February,but it can peak any hours after the shot. time from November through May. So getting the vaccine in December,or even later,can be beneficial in most years. • In 1976,a certain type of influenza (swine flu)vaccine was associated with Guillain-Barré Syndrome (GBS).Since Some people should get their flu shot in October or earlier: then,flu vaccines have not been clearly linked to GBS. -people 50 years of age and older, However,if there is a risk of GBS from current flu vaccines, -younger people at high risk from influenza and its complications it would be no more than 1 or 2 cases per million people (including children 6 through 23 months of age), vaccinated. This is much lower than the risk of severe -household contacts of people at high risk, influenza,which can be prevented by vaccination. -healthcare workers,and -children younger than 9 years of age getting influenza7 What if there is a severe ) vaccine for the first time. reaction? Most people need one flu shot each year. Children younger What should I look for? than 9 years of age getting influenza vaccine for the first • Any unusual condition,such as a high fever or behavior time should get 2 doses,given at least one month apart. changes.Signs of a serious allergic reaction can include difficulty breathing,hoarseness or wheezing,hives, Some people should talk with a paleness,weakness,a fast heart beat or dizziness. 5 doctor before getting influenza What should I do? Vaccine • Call a doctor,or get the person to a doctor right away. Some people should not get inactivated influenza vaccine or • Tell your doctor what happened,the date and time it should wait before getting it. happened,and when the vaccination was given. • Tell your doctor if you have any severe (life-threatening) • Ask your doctor,nurse,or health department to report the reaction by filing a Vaccine Adverse Event Reporting allergies. Allergic reactions to influenza vaccine are rare. System(VAERS) form. III - Influenza vaccine virus is grown in eggs. People with a severe egg allergy should not get the vaccine. Or you can file this report through the VAERS web site at - A severe allergy to any vaccine component is also a www.vaers.hhs.gov,or by calling 1-800-822-7967. reason to not get the vaccine. VAERS does not provide medical advice. - If you have had a severe reaction after a previous dose of influenza vaccine,tell your doctor. p The National Vaccine Injury ) • Tell your doctor if you ever had Guillain-Barre Syndrome (a v Compensation Program severe paralytic illness,also called GBS). You may be able to In the event that you or your child has a serious reaction to a get the vaccine,but your doctor should help you make the vaccine,a federal program has been created to help pay for the decision. care of those who have been harmed. • People who are moderately or severely ill should usually For details about the National Vaccine Injury Compensation wait until they recover before getting flu vaccine. If you Program,call 1-800-338-2382 or visit their website at are ill,talk to your doctor or nurse about whether to www.hrsa.govlosp/vicp reschedule the vaccination. People with a mild illness can usually get the vaccine. (9 How can I learn more? ) 6 What are the risks from • Ask your immunization provider.They can give you the vaccine inactivated influenza vaccine? package insert or suggest other sources of information. A vaccine,like any medicine,could possibly cause serious • Call your local or state health department. problems,such as severe allergic reactions. The risk of a • Contact the Centers for Disease Control and Prevention(CDC): vaccine causing serious harm,or death,is extremely small. - Call 1-800-232-4636 (1-800-CDC-INFO) Serious problems from influenza vaccine are very rare.The - Visit CDC's website at www.cdc.govlflu viruses in inactivated influenza vaccine have been killed,so you cannot get influenza from the vaccine. , Mild problems: gg ` •soreness,redness,or swelling where the shot was given e 4 • • fever • aches DEPARTMENT OP HEALTH AND HUMAN SERVICES Vaccine Information Statement-Interim CENTERS FOR DISEASE CONTROL AND PREVENTION Inactivated Influenza Vaccine(7/18/05) 42 U.S.C.§300aa-26 NATIONAL.IMMUNIZATION PROGRAM LIVEINTRANASAL , INTRINFLUENZAVACCINE ( WHAT YOU NEED TO W) 1 Why get vaccinated? ) CJ3Who can get LAIV? ) Influenza ("flu") is a very contagious disease. Live,intranasal influenza vaccine is approved for It is caused by the influenza virus,which spreads from healthy children and adults from 5 through 49 years of age,including most health-care workers and house- infected persons to the nose or throat of others. hold contacts of most people at high risk for influenza Other illnesses can have the same symptoms and are complications. However,LAIV should not be given often mistaken for influenza. But only an illness to pregnant women or people with certain medical caused by the influenza virus is really influenza. conditions. Anyone can get influenza,but rates of infection are highest among children. For most people,it lasts only a few days. It can cause: Who should not get LAIV? ) • fever • sore throat • chills • fatigue • cough • headache • muscle aches The following people should not get live intranasal influenza vaccine. They should check with their Some people get much sicker. Influenza can lead to health-care provider about getting the inactivated pneumonia and can be dangerous for people with vaccine. heart or breathing conditions. It can cause high fever and seizures in children. Influenza kills about 36,000 ' Adults 50 years of age or older or children • people each year in the United States. younger than 5. • People who have long-term health problems with: Influenza vaccine can prevent influenza. -heart disease -kidney disease - lung disease -metabolic disease, such as diabetes (2 I Live, attenuated influenza - asthma -anemia, and other blood disorders vaccine (nasal spray) • People with a weakened immune system due to: -HIV/AIDS or other diseases affecting the immune There are two types of influenza vaccine: Live, attenuated influenza vaccine system (LAIV) was -long-term treatment with drugs that weaken the licensed in 2003. LAIV contains live but attenuated (weakened) influenza virus. It is sprayed into the immune system, such as steroids nostrils rather than injected into the muscle. It is -cancer treatment with x-rays or drugs recommended for healthy children and adults from 5 • Children or adolescents on long-term aspirin through 49 years of age,who are not pregnant. treatment (these people could develop Reye Inactivated influenza vaccine, sometimes called the syndrome if they get influenza). "flu shot,"has been used for many years and is given • Pregnant women. by injection. This vaccine is described in a separate • Anyone with a history of Guillain-Barre syndrome Vaccine Information Statement. (a severe paralytic illness,also called GBS). Influenza viruses are constantly changing.Therefore, influenza vaccines are updated everyInactivated influenza vaccine (the flu shot) is the P year, and annual preferred vaccine for people (including health-care vaccination is recommended. workers, and family members) coming in close For most people influenza vaccine prevents serious contact with anyone who has a severely illness caused by the influenza virus. It will not prevent weakened immune system (that is, anyone who • "influenza-like"illnesses caused by other viruses. requires care in a protected environment). It takes about 2 weeks for protection to develop after Some people should talk with a doctor before getting vaccination, and protection can last up to a year. either influenza vaccine: • Anyone who has ever had a serious allergic reaction to • If rare reactions occur with any new product,they may eggs or to a previous dose of influenza vaccine. not be identified until thousands,or millions,of people have used it. Over two million doses of LAW have been • People who are moderately or severely ill should usually . wait until they recover before getting flu vaccine. If you distributed since it was licensed,and no serious problems have been identified.Like all vaccines,LAW will are ill,talk to your doctor or nurse about whether to continue to be monitored for unusual or severe problems. reschedule the vaccination.People with a mild illness can usually get the vaccine. ) 7 What if there is a severe When should I get influenzaC reaction? 5 vaccine? What should I look for? The best time to get influenza vaccine is in October or • Any unusual condition,such as a high fever or behavior November. Influenza season usually peaks in February, changes. Signs of a serious allergic reaction can include but it can peak any time from November through May. So difficulty breathing,hoarseness or wheezing,hives, getting the vaccine in December,or even later,can be paleness,weakness,a fast heart beat or dizziness. beneficial in most years. What should I do? Most people need one dose of influenza vaccine each year. • Call a doctor,or get the person to a doctor right away. Children younger than 9 years of age getting • Tell your doctor what happened,the date and time it influenza vaccine for the first time should get 2 doses happened,and when the vaccination was given. For LAIV,these doses should be given 6-10 weeks apart. • Ask your doctor,nurse,or health department to report LAIV may be given at the same time as other vaccines. the reaction by filing a Vaccine Adverse Event Reporting This includes other live vaccines,such as MMR or System (VAERS) form. chickenpox. But if two live vaccines are not given on the same day,they should be given at least 4 weeks apart. Or you can file this report through the VAERS website at www.vaers.hhs.gov,or by calling 1-800-822-7967. (6 What are the risks from LAIV? ) VAERS does not provide medical advice. • A vaccine,like any medicine,could possibly cause serious 8 The National Vaccine Injury ) • problems,such as severe allergic reactions. However,the Compensation Program risk of a vaccine causing serious harm,or death,is extremely small. In the event that you or your child has a serious reaction to a vaccine,a federal program has been created to help pay Live influenza vaccine viruses rarely spread from person to for the care of those who have been harmed. person.Even if they do,they are not likely to cause illness. For details about the National Vaccine Injury LAIV is made from weakened virus and does not cause Compensation Program,call 1-800-338-2382 or visit their influenza. The vaccine can cause mild symptoms in people website at www.hrsa.gov/osp/vice who get it (see below). Mild problems: (9 How can I learn more? ) Some children and adolescents 5-17 years of age have \ reported mild reactions,including: • Ask your immunization provider. They can give you the •runny nose,nasal congestion or cough vaccine package insert or suggest other sources of •headache and muscle aches •fever information. • abdominal pain or occasional vomiting or diarrhea • Call your local or state health department. Some adults 18-49 years of age have reported: • runny nose or nasal congestion •sore throat • Contact the Centers for Disease Control and Prevention • cough,chills,tiredness/weakness •headache (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) These symptoms did not last long and went away on their - Visit CDC's website at www.cdc.gov/flu own. Although they can occur after vaccination,they may not have been caused by the vaccine. Severe problems: • Life-threatening allergic reactions from vaccines are very ;'' ` rare.If they do occur,it is within a few minutes to a few i CDC' hours after the vaccination. ° DEPARTMENT OF HEALTH AND HUMAN SERVICES III Vaccine Information Statement-Interim CENTERS FOR DISEASE CONTROL AND PREVENTION Live,Attenuated Influenza Vaccine(7/18/05) U.S.C.42§300aa-26 NATIONAL IMMUNIZATION PROGRAM Prevention of Pneumococcal Disease • Recommendations of the Advisory Committee on Immunization Practices (ACIP) April 4, 1997/46(RR08) Recommendations for Vaccine Use Immunocompetent Persons The vaccine is both cost effective and protective against invasive pneumococcal infection when administered to immunocompetent persons aged greater than or equal to 2 years. Therefore, all persons in the following categories should receive the 23-valent pneumococcal polysaccharide vaccine (Table_2). If earlier vaccination status is unknown, persons in these categories should be administered pneumococcal vaccine. Persons Aged greater than or equal to 65 Years All persons in this category should receive the pneumococcal vaccine, including previously unvaccinated persons and persons who have not received vaccine within 5 years (and were less than 65 years of age at the time of vaccination). All persons who have unknown vaccination status should receive one dose of vaccine (Figure_I). • Persons Aged 2-64 Years Who Have Chronic Illness Persons aged 2-64 years who are at increased risk for pneumococcal disease or its complications if they become infected should be vaccinated. Persons at increased risk for severe disease include those with chronic illness such as chronic cardiovascular disease (e.g., congestive heart failure {CHF} or cardiomyopathies), chronic pulmonary disease (e.g., COPD or emphysema, but not asthma), diabetes mellitus, alcoholism, chronic liver disease (cirrhosis), or CSF leaks. Persons aged 50-64 years commonly have chronic illness, and 12% have pulmonary risk factors for invasive pneumococcal disease. Therefore, persons in this age group who have these risk factors should receive the vaccine (86). Persons aged 50 years should have their overall vaccination status reviewed to determine whether they have risk factors that indicate a need for pneumococcal vaccination (87). Vaccination status also should be assessed during the adolescent immunization visit at I I-12 years of age (88). Persons Aged 2-64 Years Who Have Functional or Anatomic Asplenia Persons aged 2-64 years who have functional or anatomic asplenia (e.g., sickle cell disease or splenectomy) also should be vaccinated. Persons with such a condition should be informed that vaccination does not guarantee protection against fulminant pneumococcal disease, for which the case-fatality rate is 50%-80%. Asplenic patients with unexplained fever or manifestations of sepsis should receive prompt medical attention, including evaluation and treatment for suspected • bacteremia. Chemoprophylaxis also should be considered in these patients (see Other Methods of Prevention). When elective splenectomy is being planned, pneumococcal vaccine should be administered at least 2 weeks before surgery. • Persons Aged 2-64 Years Who Are Livingin Special Environments p or Social Settings Persons aged 2-64 years who are living in environments or social settings in which the risk for invasive pneumococcal disease or its complications is increased (e.g., Alaskan Natives and certain American Indian populations) should be vaccinated. In addition, because of recently reported outbreaks of pneumococcal disease (89), vaccination status should be assessed for residents of nursing homes and other long-term-care facilities. Available data do not support routine pneumococcal vaccination of healthy children attending day care facilities. Recurrent upper respiratory tract diseases, including otitis media and sinusitis, are not specific indications for pneumococcal vaccine. Immunocompromised Persons Persons who have conditions associated with decreased immunologic function that increase the risk for severe pneumococcal disease or its complications should be vaccinated. Although the vaccine is not as effective for immunocompromised patients as it is for immunocompetent persons, the potential benefits and safety of the vaccine justify its use. The vaccine is recommended for persons in the following groups: immunocompromised persons aged greater than or equal to 2 years, including persons with HIV infection, leukemia, lymphoma, Hodgkins disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic • syndrome, or other conditions associated with immunosuppression (e.g., organ or bone marrow transplantation); and persons receiving immunosuppressive chemotherapy, including long-term systemic corticosteroids. If earlier vaccination status is unknown, immunocompromised persons should be administered pneumococcal vaccine. Persons with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis is confirmed. Plasma HIV levels have been found to be transiently elevated after pneumococcal vaccination in some studies (68); other studies have not demonstrated such an elevation (90). However, no adverse effects of pneumococcal vaccination on patient survival have been detected (68,90). When cancer chemotherapy or other immunosuppressive therapy is being considered (e.g., for patients with Hodgkins disease or those who undergo organ or bone marrow transplantation), the interval between vaccination and initiation of immunosuppressive therapy should be at least 2 weeks. Vaccination during chemotherapy or radiation therapy should be avoided. Revaccination Duration of Immunity Following pneumococcal vaccination, serotype-specific antibody levels decline after 5-10 years and decrease more rapidly in some groups than others (56,57,61-63), which suggests that revaccination • may be indicated to provide continued protection. However, data concerning serologic correlates of protection are not conclusive, which limits the ability to precisely define indications for revaccination based on serologic data alone. Polysaccharide vaccines, including the currently available pneumococcal vaccine, do not induce T-cell-dependent responses associated with • immunologic memory. Antibody levels increase after revaccination, but an anamnestic response does not occur (91). The overall increase in antibody levels among elderly persons has been determined to be lower after revaccination than following primary vaccination (92). Long-term follow-up data concerning antibody levels in persons who have been revaccinated are not yet available. Data from one epidemiologic study have suggested that vaccination may provide protection for at least 9 years after receipt of the initial dose (44). Decreasing estimates of effectiveness with increasing interval since vaccination, particularly among the very elderly (i.e., persons aged greater than or equal to 85 years), have been reported (79). Adverse Reactions Following Revaccination Early studies have indicated that local reactions (i.e., arthus-type reactions) among adults receivin the second dose of 14-valent vaccine within 2 years after the first dose are more severe than g those occurring after initial vaccination (20,93). However, subsequent studies have suggested that revaccination after intervals of greater than or equal to 4 years is not associated with an increased incidence of adverse side effects (20,94,95). Although severe local reactions may occur following a second dose of pneumococcal vaccine, the rate of adverse reactions is no greater than the rate after the first dose. An evaluation of 1,000 elderly Medicare enrollees who received a second dose of pneumococcal vaccine indicated that they were not significantly more likely to be hospitalized in • the 30 days after vaccination than were the approximately 66,000 persons who received their first dose of vaccine (96). No data are available to allow estimates of adverse reaction rates among persons who received more than two doses of pneumococcal vaccine. Indications for Revaccination Routine revaccination of immunocompetent persons previously vaccinated with 23-valent polysaccharide vaccine is not recommended. However, revaccination once is recommended for persons aged greater than or equal to 2 years who are at highest risk for serious pneumococcal infection and those who are likely to have a rapid decline in pneumococcal antibody levels, provided that 5 years have elapsed since receipt of the first dose of pneumococcal vaccine. Revaccination 3 years after the previous dose may be considered for children at highest risk for severe pneumococcal infection who would be aged less than or equal to 10 years at the time of revaccination. These children include those with functional or anatomic asplenia (e.g., sickle cell disease or splenectomy) and those with conditions associated with rapid antibody decline after initial vaccination (e.g., nephrotic syndrome, renal failure, or renal transplantation). Revaccination is contraindicated for persons who had a severe reaction (e.g., anaphylactic reaction or localized arthus-type reaction) to the initial dose they received. Persons at highest risk and those most likely to have rapid declines in antibody levels include persons with functional or anatomic asplenia (e.g., sickle cell disease or splenectomy), HIV cinfectionhronic ,renal leukemiafail ,ure,lymphomnepha Hsyndodgkinsrome,diseaseoroth,er multiple myconditionseloma, generalizeassociatedwithdimmunosumalignanc 411 ppressiony, nephrotic (e.g., organ or bone marrow transplantation), and those receiving immunosuppressive ` A chemotherapy (including long-term systemic corticosteroids). If vaccination status is unknown, patients in these categories should be administered pneumococcal vaccine. • Persons aged greater than or equal to 65 years should be administered a second dose of vaccine if they received the vaccine greater than or equal to 5 years previously and were aged less than 65 years at the time of primary vaccination. Elderly persons with unknown vaccination status should be administered one dose of vaccine (Figure_I). The need for subsequent doses of pneumococcal vaccine is unclear and will be assessed when additional data become available. Because data are insufficient concerning the safety of pneumococcal vaccine when administered three or more times, revaccination following a second dose is not routinely recommended. Persons with Uncertain Vaccination Status To help avoid the administration of unnecessary doses, every patient should be given a record of the vaccination. However, providers should not withhold vaccination in the absence of an immunization record or complete medical record. The patient's verbal history should be used to determine prior vaccination status.When indicated, vaccine should be administered to patients who are uncertain about their vaccination history. FIGURE 1. Algorithm for vaccinating persons aged >_65 years No or • unsure Has the person been —11P- Vaccination indicated vaccinated previously? 7)1 Yes 11 Yes Was the person aged No Have >5 years elapsed X65 years at the time since the first dose? of last vaccination? T)ir Yes* No Vaccination not indicated *Note: For any person who has received a dose of pneumococcal vaccine at age }65 years, revaccination is not indicated. • • 12 MMWR April 4, 1997 TABLE 2. Recommendations for the use of pneumococcal vaccine Groups for which vaccination Strength of is recommended recommendation" Revaccinations Immunocompetent persons; Persons aged >65 years A Second dose of vaccine if patient received vaccine>_5 years previously and were aged <65 years at the time of vaccination. Persons aged 2-64 years with A Not recommended. chronic cardiovascular disease.1 chronic pulmonary disease,** or diabetes mellitus Persons aged 2-64 years with alco- holism, chronic liver disease,tt or B Not recommended. cerebrospinal fluid leaks Persons aged 2-84 years with func- A If patient is aged >10 years: single tional or anatomic asplenia revaccination years after previous dose. If patient is aged 5_10 years: consider revaccination 3 years after previous dose. Persons aged 2-64 years living in C special environments or social set- Not recommended. tingsli Immunocompromised personsf • Immunocompromised persons aged C >_2 years, including those with HIV Single revaccination if_>5 years have infection, leukemia, lymphoma, elapsed since receipt of first dose. Hodgkins disease, multiple If patient is aged <_10 years: myeloma, generalized malignancy, consider revaccination 3 years after previous dose. chronic renal failure, or nephrotic syndrome;those receiving immu- nosuppressive chemotherapy (including corticosteroids);and those who have received an organ or bone marrow transplant. *The following categories reflect the strength of evidence supporting the recommendations for vaccination: A=Strong epidemiologic evidence and substantial clinical benefit support the recommendation for vaccine use. B=Moderate evidence supports the recommendation for vaccine use. C=Effectiveness of vaccination is not proven, but the high risk for disease and the potential benefits and safety of the vaccine justify vaccination. tStrength of evidence for all revaccination recommendations is "C." 5I earlier vaccination status is unknown, patients in this group should be administered pneumococcal vaccine. ilncluding congestive heart failure and cardiomyopathies. **Including chronic obstructive pulmonary disease and emphysema, ttlncluding cirrhosis. "Including sickle cell disease and splenectomy. 11lncluding Alaskan Natives and certain American Indian populations. • PNEUMOCOCCJ&JJ VA •POLYSACHjmDE WHAT YOU NEED TO KNOW €1 Why get vaccinated? al Who should get PPV? Pneumococcal disease is a serious disease that • causes much sickness and death. In fact, pneumococcal All adults 65 years of age or older. disease kills more people in the United States each year • Anyone over 2 years of age who has a long-term health than all other vaccine-preventable diseases combined. problem such as: Anyone can get pneumococcal disease. However, some — heart disease people are at greater risk from the disease. These include — sickle cell disease lung disease people 65 and older, the very young, and people — diabetes le with — alcoholism — cirrhosis special health problems such as alcoholism, heart or lung — leaks of cerebrospinal fluid disease, kidney failure, diabetes, HIV infection,or certain types of cancer. • Anyone over 2 years of age who has a disease or condition that lowers the body's resistance to infection, Pneumococcal disease can lead to serious infections such as: of the lungs (pneumonia), the blood (bacteremia), and the covering of the brain (meningitis).About I out of —— Hodgkin's disease — lymphoma, leukemia kidney failure — multiple myeloma every 20 people who get pneumococcal pneumonia dies (prom it, as do about 2 people out of 10 who get — nephrotic syndrome — HIV infection or AIDS — damaged spleen, or no spleen acteremia and 3 people out of 10 who get meningitis. People with the special health problems mentioned — organ transplant • Anyone over 2 years of age who is taking any drug or above are even more likely to die from the disease. treatment that lowers the body's resistance to infection, Drugs such as penicillin were once effective in treating these infections; but the disease has become such as: more resistant to these drugs, making treatment of — long long-term steroids = certain cancer drugs pneumococcal infections more difficult. This makes — radiation therapy prevention of the disease through vaccination even more • Alaskan Natives and certain Native American populations. important. 2 Pneumococcal polysaccharide ; «t vaccine (PPV) J :1010)......,i, 1 _, ,..„ The pneumococcal polysaccharide vaccine(PPV) o--- , / r) ,..., ) ,,,0 protects against 23 types of pneumococcal bacteria. 4 � " A Most healthy adults who get the vaccine develop protec- \\__1tion to most or all of these types within 2 to 3 weeks of 'i getting the shot. Very old people, children under 2 years (c_f, of age, and people with some long-term illnesses might "� s� ��')+ -j",;\ �1 not respond as well or at all. _ e • ,. n slate ,of Ye mit DOH 348 011 (REV. 7/29/97) How many doses of PPV 6 What are the risks from 4 are needed? PPV?• Usually one dose of PPV is all that is needed. PPV is a very safe vaccine. However, under some circumstances a second dose may About half of those who get the vaccine have very mild side be given. effects, such as redness or pain where the shot is given. • A second dose is recommended for those people Less than 1% develop a fever, muscle aches, or more severe aged 65 and older who got their first dose when local reactions. they were under 65, if 5 or more years have passed Severe allergic reactions have been reported very rarely. since that dose. As with any medicine,there is a very small risk that serious • A second dose is also recommended for problems,even death, could occur after getting a vaccine. people who: — have a damaged spleen or no spleen Getting the disease is much more likely to cause serious — have sickle-cell disease problems than getting the vaccine. — have HIV infection or AIDS — have cancer, leukemia, lymphoma, multiple myeloma 7 What if there is a serious — have kidney failure reaction? — have nephrotic syndrome — have had an organ or bone marrow transplant — are taking medication that lowers immunity What should I look for? (such as chemotherapy or long-term steroids) • Severe allergic reaction (hives, difficulty breathing, Children 10 years old and younger may get this second shock) • dose 3 years after the first dose.Those older than 10 What should I do? should get it 5 years after the first dose. • Call a doctor, or get to a doctor right away. • Tell your doctor what happened,the date and time it a Other facts about getting happened, and when the vaccination was given. • Ask your doctor,nurse,or health department to file a the vaccine Vaccine Adverse Event Reporting System(VAERS) form, or call VAERS yourself at 1-800-822-7967. • Otherwise healthy children who often get ear infections, sinus infections, or other upper • respiratory diseases do not need to get PPV 8 How can I learn more? because of these conditions. • PPV may be less effective in some people, especially • Ask your doctor or nurse.They can give you the those with lower resistance to infection. But these vaccine package insert or suggest other sources of people should still be vaccinated,because they are information. more likely to get seriously ill from pneumococcal • Call your local or state health department. disease. • Contact the Centers for Disease Control and Prevention • Pregnancy:The safety of PPV for pregnant women (CDC): has not yet been studied. There is no evidence that Call 1-800-232-7468 (English) the vaccine is harmful to either the mother or the OR fetus, but pregnant women should consult with their Call1-800-232-0233 (Spanish) • doctor before being vaccinated. Women who are at OR high risk of pneumococcal disease should be Visit the National Immunization Program website vaccinated before becoming pregnant, if possible. at http://www.cdc.gov/nip / U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES CDC Paccine nfor — ion /97 ;+ (` Centers for Disease Control and Prevention bow Vaccine Information Statement „. 'National Immunization Program • BOaYGCOf HQaCth Netiv Business gencCa Item # `V., 1 • Public 3-fearing Jefferson Co. Solid/ .3fazardous Waste R.eguCations Ordinance October 20, 2005 Oh CO ti L JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • APPOINTMENT OF ENFORCEMENT OFFICERS FOR 7.80 RCW and JEFFERSON COUNTY SOLID WASTE ORDINANCE No. 09-0175-04 Under authority conferred by RCW 70.05.070 Local Health Officer—Powers and Duties, the following persons are given the title and duties of"enforcement officers" for purposes of Ch. 7.80 RCW. These individuals are empowered to enforce all aspects of state and local public health codes pertaining to solid and hazardous waste control. Appointed Employees: Jefferson County Public Health,Environmental Health Division Mike McNickle, Director Mark Nelson Alan Gardner Jefferson County Department of Community Development • Molly Pearson Jefferson County Sheriff's Department All commissioned officers, including the elected Sheriff Signed, Thomas Locke, MD, MPH Date Jefferson County Health Officer • COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES NATURAL RESOURCES FAX:360--385 940100 HEALTHIER COMMUNITY MAIN:360-385-9444 FAX:360-385-9401 Board-of 3-CeaCth Wow Business .agenda Item # 1�, 3 • Pandemic InfCuenza Planning Risk Communication October 20, 2005 • g j 2. ,,',,: ,,!i,,,. ...,,,,,,, :4,-':—r":-,, '::- :''''' --- '-:°-- ''-.,.', '''''' '''''''''''''''. —. ' ' ' '''''' - '--' -on L o* - ;.;.-;,i,:::}iiiiii,,,iiiiitif 33r � T' Hi Volume 1 0 II 5 .g...T4 Me Magazine of clue an erican Health Organization Regi,U, ,Qffice officeof e World h ealth Organization �fa Lfig ,PyFy ? x rq fEvl `� i/ s ,r. ��f� � ' ' , . :,:pw:;,.,1-.,-r.<4,-.-..-.....,.. ,,..',..,,,-.1.,::::-.::,.,0.4.,::,---tv.:i-'`''''*..-e- ...,,,.','.: .,,,,,,k. % ',- 1,...-. ti,......:-.:,*. -<-0.11 ;:-.0-11---- i';',-N,..f.'E x t rs�.; (, 1 Ato it' x kms'„ ,y { .. a d< swAiNgs! f E rk N,i } f . i': �. i. 11 ,,,, ;4',;',,,..', n • � iia�' �� x �e� �:.y � 1y + � y ao4 : r r. 6 ¢ Y 45 y t $z Y "'S ��� •a �°' .;.--,c,;,.,-'--....,:::'t - pl. : • . • e a F 'z ', i '6sxtle .y, x� 1_ � ,rfi .4 ` ,q t� <,--,.:-„,',,--,..,,,n1:#4, • r:4!::'''''''''''''' '. . . '''''',Alf::;.7c.'ii'f-,. • ,.'' . . , . ' ,—,,iii'''' •-. ,,,..-',. ,',,i,,,,,) ,,,,„', , :,,:,:i''''''''''"711.0,,,,:j.;141.tittglii!i,:::', 11;i...,.45,411:Vti { off.: y 'A } "d' . '!".,3.:i,;::..;-:;:;.:E.#2,..74'.;.%.,..141? , � o- - ,a. r 5't .i" y �,y.1 YDS. 3 ,r �'� ,' u 3 ,may ` ','��"> 4�a` � N { ° r'�ak t,.z. .: ,�,,; ' �e4 °� fid o- 4,p,W � ek I' '�"� �' vg a•; � � �i< t��' S sem ' "� ,?,-1 ' ° .. " :. .,. "( ' 0kms& x t] , (lir Communication: risky business AN�1at is it about risk L()111111t1111C1t1t)11 that leads people to create lists of do's and ^fin A�.. • don't's?In researching the topic earlier this year I came across scores of suggestions,recom- mendations,and advice from experts.In fact,a list of 26 recommendations I found comes from Peter M.Sandman and his mite Jody Lanard,who\\7ite a superb article about risk corn- • munication as it relates to bird flu in this edition of Petspectines in Health. f The recommendations vary,but those that sn-ike me as the most curious are the ones tha "4,44144344M0150,1V414401 109 • 7;r414-4*t call on public health experts to involve the public. Apparently,even public health proles �± ° aye} sionals need to be reminded of the essential role of the public in maintaining public health. .~ ' But then again,risk and crisis situations evoke a host of contradictions for many in medicine and public health.They imply rapid response in the face of uncertainty,raising the alarm but r also calming fears,and empathizing with public opinion even when it's misguided. All too often the medical profession's preferred response i•s "It be all right,"and"Here's what's �� s� ,.� going to happen."In the case of most hazards and crises,no one really knows. "44 , Risk communication is a growing area of expertise and a growing necessity in an in= creasingly unstable world.Post-September 11,2001,the management of risks and cases and the communications integrally built into these processes can mean the difference be = tween credible governance and chaos. Risk and crisis communication should be an rote' gral part of governments'planning and preparation for everything from bioterronsm to ,fit �, ; - p Marburg hemorrhagic fever-In the latter, crisis communication has included everything �.,n from raising awareness of how to handle dead bodies to fear-assuaging explanations about the use of bio-suits_A good plan is flexible and builds on success—or error. It was dur- • ing the Ebola outbreak in Africa during the 1990s when doctors learned that,to main hey 1 taua trust,thad to allow family members to see the treatment they were giving and � � ` to not hide patients behind screens. That's why the lists come in handy.Lists of sins:Don t meet the media or the public un- . prepared.Lists explaining how to address the public:Always stay on message and acknowl .,. edge that you don't have all the answers.Even personaLpresentauon guidelines Watch your gestures and maintain eye contact. As Sandmanand Lanard point out,one thing the experts do know is that reaction to and perception of risksvary vastly. For example, nataral disasters are scary but not as scary as :, e ` those termed"man-made."Hazards to children are often considered much less acceptable f,41,f4i,s;g0;01,,,,ftivIst,2,,,,,,,,,,,,,,„:„,„,41H, than those to adults.Frequency and adaptability are key factors that influence how situations = are perceived.Children living in war zones may not drop to the ground at the sound of bul lets.Residents in earthquake-prone areas may not react in panic to a tremor. "; A young man may have unprotected sex with several partners because he doesn't see the cN risk of contracting HIV/AIDS.And if he does,he may figure he can beat it with antiretro v' als.In such a case,the risk is high,the perception is low,and die response by public health officials should be to raise the alarm. On the other hand, in 2002 uvo snipers clear Washington,D.C.,randonily shot 16 people;killing 10 of them, over 47 days:They effec a ; • lively had the entire metropolitan area in a panic.Yet' robabilisncally,geople in the area were a' ;1 i p � about twice as likely to be killed in a drunk-driving incident during the same penod. But people(that is,die public)want to believe and to trust those conveying mformanon ..' P P d about risks and eiises.They will accept that some answers may have to come later,but they zxrr want the information as soon as it is available:This means authorities caimot w:ut until thev have"all die facts"before speaking with the public or the media.And exerts must use their >° skills to ensure they have communicated(not just released information)and that their mere sages have been understood.This is the bottom line of good risk communication.Authon •••• ties'credibility •rests on the line,acid,once lost,it is awfully hard to regain. rk a ft H° ;8 dig Bina B;conan Area Manager,PAHO Public Information' • 3 , • ' ','4,,7e,44,04,31,41ktds,444,141r00#402,P4.3U444,1*.P14-,„"•4 x° �i f ��-a'raslk kr`", � y �,�, �' �r � - a S • I � a rJ s`k,"'y' s s ,-' a -� r 7s�. �et�w r� �'a4 ;41,,,,,,,,,, � Y yK h ,o ,k 5 .4*4 Sty y 7 f" � N F+ "i 6p „� s',:' � S � 4tYn�rd3 aa.�. ,, iyrT ' s '.,y `' 4 . x z ;I ' 'y t 4 � ` "s,� o9" • �z noxa t t '''''': < AiiPli communicajing ; sv ..., a v'4�' ., .`�, �.vnri.. N • by Peter Mz . Sandman and Jody Lanard Health authorities want to spread the word that avian influenza has brought the world perilously • close to a new flu pandemic. But raising awareness re about uncertain threats can itself be perilous. Two a leading risk communication experts offer advice on how to sound the alarm. UP wwwpaho.org PAN AMERICANH E A LT H ORGANIZATIONORGAN , s Communication wouldn't be such a 7 0-k' problem if iti were possible to get ready for ' the next pandemic without talking to the r public.It isn't.Health authorities Leant the , publicto be aware of this grave threat for three fundamental reasons: so people will 4zF themselves and logis ,; s tically;prepare so people will helpemotionally their schools, i:'' businesses, hospitals, and other organiza- tions parand people will o ,Q rhe prepreparednesse; efforts of their govern supprt- menu.And there's a fourth reason:If and dt *Ja when a pandemic begins,people who have ` had time to get used to the idea are likelier to understand their risks,follow official'aid4,1' e r_� W " vice, and take an active role in protecting �� � themselves. ` ` Officials don't want to , f, � ¢ ' be accused of need- lessly frightening the �' also don't " public.They ''''''''''''''1,‘;,::,,;.',:‘,,,,.„!'"'.7.--;,,',:,`11.,',i,' accused want to be r2 �� :� :."" �, ' later of leaving the P •� public underprepared K 6 , disaster. - for a ,or'',::;3:•,1-r,:','":-4-:"7..,i;'..'•;• '.4,,,,,,,ii,:.:,i '44tAlli.;';':::'''' ^,s.-4tM,40,"4'',..';%,,,:. { h Health authorities know that too soft a , ss - warning just won't get heard;it's not easy • l "1� Y to pierce people s apathy and squeeze et another problem onto our already s �' = crowded lists of concerns- But they fear - rl that too loud a warning could overshoot, Holle--- .,,,,::,,,,1„,,,,,,,,,„„.,,,,,,,...,,,,,,,,,,, ,,,,„� provoking needless(or at least premature) a : fear and economic damage, perhaps even ; the nil,a. �_ a: panic and an every man for himself chaos. " X ,. Aa Authorities often miss the middle ground o 4`` that can help build mutual oust:involving N die public early, arousing an appropriate N ublic health officials have a pandemic size communication problem. level of public fear, and helping people cs Experts believe a deadly influenza pandemic is quite likely to be launched bear it. O usk communication is a set of skills and by the H5N1 avian virus that has killed millions of birds and dozens of •t P eople in Asia. They are more anxious than they have bleetn i dec des. ciadersta ands hold this Imiddleagrouond- But infectious diseases are unpredictable. HSN1 cool pP m swine flu did in 1976—and "The CreaeP.aEndei1if H5N1 doeosuelausiesa Oyr risk corn iunication approacheserlt from a strain that doesn't even exist y human pandemic,it might weaken and produce only mild`disease. arit to•So °a cuset's drd for officials uses of needlessly sncertn�nty,�t slperresldile�vtsnits�aboutly'�ats � - .41 to know how aggressively to sound the alarm.They don't110'u These and other risk communication frightening the public. They also don't want to be accused—later—of leaving the public to do, and it does not aim for zero ear• underprepared for a disaster. 140 Poultry lion awaitbisalehave at a mmy .Mthan milrds died orlivestock been destroyed arketIndonesia in the Asianore bird flu epidemic.Estimates off potential deaths from an eventual human pandemic range from 2 million to nearly 100 million. • r 414 recommendations help build mutual trust, When some other disease like SARS or%"4It isn't voluntary,but in developed coun- • one of the overarching goals of the World West Nile virus captures the headlines, au- tries getting vaccinated against it usually Health Organization's (WHO) newly thorities and columnists contemptuous of is. It is chronic rather than catastrophic, published outbreak communication guide- the"hype"often compare the new disease reappearing every year like clockwork.It's lines. The threat of bird flu presents a to influenza.Whatever we're"overly"wor- not especially dreaded.Except for striking timely—and urgent—case for looking at tied about kills fewer people every year too many old people, it is undiscriminat- how risk communication works. than the flu,they tell us.We're not worried ingly fair.And there aren't very many flu Before we introduce some of the funda- about the flu. So why worry about this controversies in a typical year—no battles mentals of risk communication, here is a other thing? over control or fairness, no issues of primer on avian influenza—and why There are good risk communication an- morality or trust or responsiveness. It is sounding the alarm isn't easy. swers to this question. Compared with flu, very, very difficult to get people really SARS and West Nile virus are unfamiliar; worried about influenza. Flu again? Who cares? there is more reason to wonder if the ex- perts really know what they're doing and if Not your ordinary flu! Influenza has long been the neglected they're telling all they know A fundamental child in the infectious disease family.Every risk communication truth is that the factors In 1997, a child in Hong Kong died winter, tens of millions of people get the that make a risk upsetting and the factors not of human flu but of bird flu,an avian flu.Most are home,sick and miserable,for that make it dangerous are completely dif- influenza strain known to virologists as about a week.Some—mostly the elderly— ferent. Mortality and morbidity statistics H5N1. Since then H5N1 has spread in- die.We know the worldwide death toll ex- determine the technical seriousness of the exorably throughout Southeast Asia's ceeds a few hundred thousand people a risk. But they often have little impact on bird population.It is a big problem for the year, but even in developed countries the how worried, frightened, or angry people poultry industry. So far it is only a small numbers are uncertain, because medical are.Think of that as"cultural seriousness," problem for human health. As of late authorities don't usually verify who actu- determined by factors like these: Is the risk June,around a hundred people were be- ally died of influenza and who died of a voluntary or coerced? Familiar or exotic? lieved to have caught H5N1 directly from "flu-like illness."People think of the flu as Controlled by the people at risk or by oth- birds. A couple of people are thought to a minor nuisance. Even a major contro- ers?(See sidebar p.6.) have caught it from other people. But versy like last year's contamination of half The annual flu is a perfect paradigm of more than half of the confirmed cases the U.S. vaccine supply provokes only a a risk that is serious technically but not so have died.And a high percentage of the • • temporary blip in flu anxiety. For a few serious culturally—the sort of risk that dead were young and otherwise healthy. weeks people stood in line to get vacci- kills people but doesn't much upset them. Because H5N1 has never infected hu- nated(and were inaccurately seen as pan- It is familiar rather than exotic, and any- mans before,people have no natural im- icking by many harassed officials). By thing but memorable (especially since it munity to it, and there is not yet an January there was vaccine left over, ra- has been so long since the last pandemic). H5N1 vaccine developed and approved tinning was abandoned, and the authori- ties were back to urging everyone to go get a shot,please! The factors that make • a risk upsetting and the factors that make 6Y ;b � Ni it dangerous areo � � � , completely different.• zw? ',„, Actual mortality andli ,f,„,:, ;! morbidity often have i� F1-tql.44i ii61/2Ci '),Wilf.4 i'iPi'fji i;'1''iii: 7 little impact on how , : 7 ke• worried, frightened, VI or angry people are. ,. „,,,,,4- P „,c a i a o ,' ;,, �” 4 to . aa ' E, n . fi" s «; ms1f,b 111. A A Vietnamese mother cradles a portrait of her 4-year-old son who died of avian influenza in 2004.The family,from a village near Hanoi,had killed and eaten chickens that had the disease. I PAN AMERICAN HEALTH ORGANIZATION I. for human use.The only thing protecting can make enough of it.Those are big ifs, how to communicate about risks, the us from H5N1 is that so far bird flu is a especially the last one;most of the world's field of risk communication dates back • hard disease for people to catch. But in- poorer countries get virtually no vaccine only to the 1980s, evolving from health fluenza viruses keep changing. They mu- against the annual flu now. education, public relations, psychology, tate. And they exchange genetic material Even in the experts'best-case scenario— risk perception, and risk assessment. with other flu viruses,a process called re- 2-7 million deaths—a flu pandemic could There are at least three kinds of risk corn- assortment.All that's needed to launch a slow travel to a trickle,lead cities to forbid munication: human health crisis is a mutation or reas- inessential gatherings, and precipitate a sortment that produces a new variant of worldwide depression. Preparing for it • Precaution advocacy ("Watch out!"): H5N1 that transmits easily between peo- could include, among other things: na- How to alert people to serious hazards pie the way "regular" flu does. If that tional governments streamlining vaccine when they are unduly apathetic. happens,we face a worldwide epidemic:a approval procedures;school boards decid- • Outrage management("Calm down!"): pandemic. ing whether and how to close the schools How to reassure people about minor Most virologists fear an H5N1 pan- for extended periods; businesses planning hazards when they are unduly upset. demic will happen sooner or later. Many for the twin problems of absenteeism and • Crisis communication ("We'll get fear it will happen soon. The unprece- presenteeism (sick people bringing the through it together!"): How to guide dented and almost inconceivable worst virus to work with them);hospitals stock- people through serious hazards when case is a human strain as deadly as the cur- piling antiviral medications and personal they are appropriately upset(or even in rent hard-to-transmit H5N1 strain,but as protective equipment for staff; communi- denial). easily transmitted as the annual flu. That ties figuring out how to recruit and use could literally end life as we know it. Not volunteers to keep essential services run- Bird flu risk communication is partly so dire but still worse than any pandemic ning—including the all-important sur- precaution advocacy and partly crisis corn- in living memory: a strain that transmits vivors of the first pandemic wave,who will munication. It's precaution advocacy if easily and kills,say,5-10 percent of its vie- be the only ones immune before a vaccine you're talking to Southeast Asian poultry rims. (The granddaddy of flu pandemics, becomes available. farmers who haven't heard much yet about the Spanish flu of 1918-19, killed about All of this information is publicly avail- bird flu.It's crisis communication if you're 2.5 percent.) Do the math. The world able. Most people have already heard a talking to poultry farmers who are trying population is 6.4 billion.A pandemic that little about bird flu. But people face a to figure out how to cope with this huge struck 30 percent of the population and host of other problems, and except for new threat to their flocks,their livelihoods, • killed 5 percent of those it struck would public health officials and poultry farm- and potentially their lives. It will be crisis cause 96 million deaths.An H5N1 vaccine ers, few are gearing up for action about communication everywhere if and when could cut this number sharply—if scientists H5N1.Yet. the pandemic materializes. . can develop one that works, if govern- Enter risk communication. Although Meanwhile, for most of us, it's precau- ments can license it,and if manufacturers people have always tried to figure out tion advocacy. Many infectious disease ex- perts are as worried about H5N1 as they ,�,, s have ever been about any microorganism. ft k �, They feel weirdly alienated when they try '' .. to explain their worry to spouses or r friends—or the general public. They have i convinced a few medical journalists, who –4-',` then feel weirdly alienated when they try { r ,; to explain their worry to their editors.Bird ' � � 4� flu is way over there in Asia. H5N1 is still f �. flu, and flu is still the sort of risk people u, �� � don't take all that seriously. N z•n e..; �t r r The recommendations listed below are ry �.S f 9 h r' e • rte _ „ "' 4 : .�� 9 , � ` grounded in two convictions: that nnOtl- Z � t ,�; �� � k �. �,°� � .� z eating people to start taking bird flu sell- � `a - U ously should be a top priority for • tott ,� m government health departments,and that o r r&�:sem l� t- # k'X r g e ;, ' ',n ,� i�, �� risk communication principles provide the a best guidance on how to do so. The rs "`" > 4' world's governments will inevitably vary in = �� � ��,, � . �� � k the extent to which they agree. How ag x; st ,, gressively will these recommendations be v ,'-','',Vs'.. ` E followed? How well will they work: f; s a ,tea' u �� -4,a ,i: a4 ` ,�: Nobody knows yet. lila A A lab technician at Indonesia's Disease Investigation Centre checks for the avian flu virus in samples taken from poultry. *off t C it it-if,::,,, £,, �1 i� kti"3\\A‘M,4 4,41 �r .41c(i‘,, Zioi r1 ^?"�.a� r � E, z .,. " �� z. a a '4244 h �{ t 4 ■ +ip''Ti� ,, � � *� a� �� e �' ani `�s � .,, , , ,icilii, f t gr" ix ,ra' v s �� €� s, ,, "�P`4 yt �"r R et';,N c .. ,,. A i$tv ,yd�t, If you make a list of risks in order of how many year,then list them in order of how upsetting they are to thnogeneral ple epublic y kill ethe-ach M o r a I i t y ' two lists will be very different There are risks that kill a lot of people without they're not especiallyme risks aren't uhastrhmful.Talking about r risk-benefitrmful;they're evil—and they eoraii evil even tradeoffs�' upsetting many—not just flu but food poisoning,smoking,overeating,not exer- sounds very callous when the risk is morally relevant.Imagine arpolice s chief insist cising,etc.And there are risks that upset a lot of people without killing very many. ing that an occasional child molester is an"acceptable risk." Both problems frustrate risk experts and make them irritated with the public for being afraid of the"wrong risks."Risk communication experts can't completely cure Familiarity this mismatch,but we can help the experts understand why the public so often Exotic,high-tech facilities provoke more outrage than familiar risks(your home, seems to get it"wrong." The core problem is definition.To the experts,risk means expected annual mor your car,your potbelly,the annual winter flu season). tality(or morbidity).To the public,risk means much more than that Let's redefine M e m o r a b i I i t y terms: Call the death rate (what the experts mean by risk) "hazard," Gather A memorable accident(Bhopal or Chernobyl,for example)can make some risks together all the other factors that make people frightened,angry,or otherwise easy to imagine for decades—and that in turn makes those particular risks a bigger upset about a risk and label them,collectively,"outrage."Risk=Hazard+Outrage. source of outrage and thus more risky as we have defined the term.A potent sym- The public pays too little attention to hazard;the experts pay absolutely no atten- bol can do the same thing:a drum of some chemical or,better yet a leaking drum tion to outrage.Not surprisingly,the two groups rank risks differently. of chemical wastes. Risk perception scholars have identified more than 20"outrage factors."Here • are some of the main ones: Dread Voluntariness Some illnesses are more dreaded than others;compare AIDS and cancer with, say, The long A voluntary risk is much more acceptable to people than a coerced risk,because ca ci oge ssema.add to the dreadlatency of most cancers and the undetectability of most it generates no outrage.Consider the difference between getting pushed down a mountain on slippery sticks and deciding to go skiing. Diffusion in time and space Control Hazard A kills 50 anonymous people a year across the country.Hazard B has one chance 10 of wiping out a neighborhood of 5, ople sometime in the nex Almost everybody feels safer driving than riding in the passenger seat.When decade.'n Risk assessment tells us the two have the000 samn expected annual mortality: prevention and mitigation are in the individual's hands,the risk(though not the 50."Outrage assessment"tells us A is probably acceptable and B is certainly not hazard)is much lower than when they are in the hands of a government agency. Catastrophic risks provoke a level of outrage that chronic risks just can't arouse. Fairness hse utrage factors are not disto People who must endure greater risks than their neighbors,without access to are i tri sic parts of what we mean by risk.Since the publicions in the public'sperception responds mof risk;they ore to out- greater utgreater benefits,are naturally outraged—especially if the differences are grounded rage than to hazard,risk managers must try to get people more outraged about in politics,poverty,or race.An unfair risk is a big risk.The same is true of countries serious hazards by appealing to outrage factors like the ones listed.Successful cam- N that are forced to endure risks that other countries don't have to bear. paigns against drunk driving and passive smoking are two of many examples of raising public concern about serious hazards by feeding the outrage.Similarly,to Ni Trust s,risk managers must work to dimin- z In a high-tech world,people often doubt their own ability to distinguish dan- shcthe soutrage.publicconcern When people are trea ed wabout moest ith honesty and respect for their right o gerous risks from insignificant ones.But we feel confident that we can tell trust- to make their own decisions,they are a lot less likely to overestimate small hazards. worthy sources from those who distort or withhold information.So we use trust There is a peculiar paradox here.Risk experts often resist the pressure to con- credibility,and candor as stand-ins for hazard.Why"buy"a risk assessment from sider outrage when making risk management decisions,or even risk communica- i someone you wouldn't buy a used car from? iir tion decisions.They disparage the"irrational"public and insist that"sound science" = Responsiveness should wholly determine what they do and what they say.But we have decades of Does the corporation or government agency that imposes the risk or tells you mportante oce mponents of people'sundefin t on of risk.When a risksound indicating that vriness, control, faiess, amanthe rest are ager c ntin- d it's trivial seem concerned,or arrogant?Does it tell the community what's going on ues to ignore these factors—and continues to be surprised by the public's before decisions are made?Does it listen and respond to community concerns? response—it is worth asking just whose behavior is irrational. c Mr www.paho.org • Board of Health New Business .agenda Item # 17., 4 • Preventive Services Funding & the Port 7"otivnsend Liquor Excise max October 20, 2005 • \„„,„ JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org October 12, 2005 David Timmons City Manager, Port Townsend 181 Quincy Street Port Townsend WA 98368 SUBJECT: Port Townsend Liquor Excise Tax Dear David, This letter is in response to your October 9, 2005 email to John Fischbach. I was surprised by your recommendation to the Port Townsend City Council that the moneys currently earmarked for prevention and education be allocated to the police budget so that they can measure the benefit to city priorities and can demonstrate results with use of these funds. The Port Townsend Liquor Excise Tax funds two specific programs that serve Port Townsend youth, Project Alert and Big Brothers Big Sisters. The loss of City Liquor Excise Tax would seriously jeopardize these services. Both of these programs are demonstrated to be effective at preventing or delaying youth substance abuse. 411 In addition to jeopardizing the above mentioned services, the loss of the Port Townsend Liquor Excise tax would, in all likelihood, compromise our ability to fulfill the terms of the Drug Free Communities grant. The $28,000 generated in liquor excise tax is used as match for that grant. This match includes the staff time associated with delivery of Project Alert to students at Blue Heron and a $7,000 annual contribution to Big Brothers Big Sisters. We use a braided funding approach. The Prevention Specialist position, (the staff person assigned to deliver Project Alert) is funded through several sources—DASA Prevention funds, Port Townsend Liquor Excise Tax and County Liquor Excise Tax. Brothers Big Sisters is funded similarly—Drug Free Communities, Tobacco Prevention, Port Townsend Liquor Excise Tax and County Liquor Excise Tax. With regards to accountability, both of the services funded with City Excise tax dollars have been rigorously researched and are nationally recognized best practices. We will gladly provide you with outcome data. What we can tell you, on relatively short notice is that in the 2004-2005 school year, 211 Blue Heron students, during 72 classroom sessions, participated in the 13 core and booster Project Alert lessons. Additionally, during the past 11 months over 40 Jefferson County youth have benefited from over 320 mentoring contacts and 1,382 mentoring hours through Big Brothers Big Sisters. • COMMUNITY HEALTH PUBLICHEAL H ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES NATURAL RESOURCES MAIN: 360-385-9400 A,;_I(,!AVS�"1'uRK:NG u H SAFER AND MAIN:360-385-9444 FAX: 360-385-9401 HEALTHIER COMMUNITY FAX:360-385-9401 Timmons Letter October 12, 2005 • Page 2 of 2 Jefferson County Public Health adheres to the standards set forth in the Guide to Prevention (The Guide). The Guide was endorsed by both the City of Port Townsend and Port Townsend Police Department. We have assessed our community's needs, reviewed data to set priorities, set goals that are SMART (specific, measurable, achievable, relevant, and time-bound) and the strategies being delivered have a solid research-base. The strategies that are funded through Port Townsend City Excise Tax dollars are facilitating movement towards healthier individuals, families and communities as outlined in the prevention Principles. A re-allocation of City Liquor Excise tax dollars threatens to unravel important services in our community. The $28,000 City Liquor Excise Tax serves as match for $100,000 in program services. In a small area braided funding insures program viability. We look forward to working with the City of Port Townsend to develop solutions that serve the community as a whole. Sincerely 11 J an Baldwin, Director Jefferson County Public Health • CC: Catharine Robinson, Mayor, Port Townsend City Council Michelle Sandoval, Deputy Mayor, Port Townsend City Council Kees Kolff, Port Townsend City Council Geoff Masci, Port Townsend City Council Freida Fenn, Port Townsend City Council Frank Benskin, Port Townsend City Council Laurie Medlicott, Port Townsend City Council Michael Legarsky, Finance Director, City of Port Townsend Mike Mingee, Fire Chief, City of Port Townsend Conner Daily, Chief, Port Townsend Police Phil Johnson, Chair, Jefferson Board of County Commissioners David Sullivan. Jefferson Board of County Commissioners Pat Rodgers, Jefferson Board of County Commissioners John Fischbach, Jefferson County Administrator • • Board of Health Mew Business .agenda Item # 3-ToodCanal Coordinating Council Survey & November 16, ZooS Multi-county Meeting Briefing October 20, 2005 • • Interim Report Survey of Homeowner Attitudes Regarding Hood Canal Water Quality and Sewage Treatment ill 4 , 1 :R Dave Christensen Water Quality Program Manager Hood Canal Coordinating Council 17791 Fjord Drive NE, Box HH Poulsbo, WA 98370-8481 September 30, 2005 Funded by: Department of Ecology #G0500064 Puget Sound Action Team#IAC200312 National Fish and Wildlife Foundation#2005-0012-001 Hood Canal Survey Results DRAFT Introduction • The Hood Canal Coordinating Council administered a survey to 1,482 randomly selected homeowners in the Hood Canal watershed between March and May of 2005. From that total, 881 surveys were returned. To help validate the survey, HCCC staff also obtained data collected from the US Census for the year 2000. Where direct comparisons could be made, there was in general excellent agreement between the demographic information between the surveyed population and the comparable population from the census. No statistical differences were detectable between the population demographics in the survey population versus the census population.' Therefore, we have assumed that the survey results represent a random sampling of the population of the Hood Canal watershed. This report does not report on every single question in the survey. HCCC staff have taken the most salient information and compiled it into this interim report. We feel that the information will prove useful to governmental regulatory staff and policy makers, educators and interested members of the general public. General Findings/Demographic Information • The average age of-the onsite systems in Hood Canal is 20 years old.2 • • About 22% of homeowners do not know the age of their onsite sewage system. As an alternative, we asked the age of their home. The average age of homes for those who do not know age of their onsite sewage system is 28 years old.3 • There are more very old onsite sewage systems (installed before 1972) for those that have frontage on marine waters (Hood Canal) versus the rest of the watershed (Figure 1).4 • 96% of homeowners know where their septic tank is located. • 92% of homeowners know where their drain field is located. • 94% of homeowners know what type of onsite sewage system they have. The complete breakout of system types is shown in Figure 2. On average, people have: • Owned their Hood Canal home for 13 years5 • 2.4 occupants in their home6 • 2.5 bedrooms in their home 1 See Appendix A for all statistical analyses involving census data. 2 95%confidence interval for age of onsite sewage system installation: 1985 to 1987,n=608 3 95%confidence interval for age of home: 1975 to 1979,n=299 4 x2.05,4= 16.76,p<.005 5 95%confidence interval for length of ownership: 12.5 to 14.2 years, n=695 . 6 95%confidence interval for number of occupants: 2.3 to 2.5,n=705 7 95%confidence interval for number of bedrooms: 2.4 to 2.5,n=724 Sept. 30,2005 2 Hood Canal Survey Results ', -)F., + '-'1I • Age of Onsite Sewage Systems 40% — 35% 30% £s` d k� c 25% 0a N 0 D No Marine Frontage CL 20% ;' v •Marine Frontage c w ; 0> 15% .'; ,, ,': ° �WI'rliff' �# 1 10/0 _ o ' . r , ,�' ■� ',, „,„,,, ■ IV IIt 0% Less than 5 5 to 10 11 to 20 21 to 33 Greater than 33 Age in Years Figure 1. Age of onsite sewage system in the Hood Canal watershed. IllType of Onsite Sewage System Not Sure No drainfield Other Alternative 6% 3% 5% 6,F , Pressure or pump 18% Conventional 68% • Figure 2. Proportion of each type of onsite sewage system in the Hood Canal watershed. Sept. 30,2005 3 Hood Canal Survey Results As would be expected based on the age of onsite sewage systems, most of the onsite sewage systems in the Hood Canal watershed are conventional, gravity onsite systems (Figure 2). About 3% of homeowners have either seepage pits or septic tanks without a drainfield. Where is your Hood Canal house 20% 18% 16% 14% 0 O. 12% � H cu C.' 10% ' O. ! 4% p o°c eek c�a ece °c Gya , ie0<;" J° °5a s 0 GO 5Q°*-� ''° e� • , or ,Ac Figure 3. Distribution of which community homeowners indicated they were closest to. The survey respondents identified themselves with living in one of about 25 communities. Most commonly, respondents' houses were in Belfair or Brinnon(Figure 3). Overall, the usage of homes in the Hood Canal watershed is as follows: • 68%permanent, basically year-round • 10%weekend use • 16% seasonal (summer) • 5% "other" However, these statistics do not accurately represent the watershed residency. The differences between those homes with marine frontage and those without are shown in Figure 4. There are significantly more homeowners that use their homes with marine frontage as weekend or for seasonal use than in the remainder of the watershed.8 8 X2.05s= 108.2,p<.001 • Sept. 30,2005 4 Hood Canal Survey Results I , , • Primary Use of Canal Residence 90% 80% 70% Sprl 60% i o tip„ y 50% ■Marine Frontage 0 No Marine Frontage 40% 4.1L. D. 30% 20% 10% •r° 0% .f aai Year Round Weekend Seasonal Other Figure 4. Response to question: what is your primary use of your Hood Canal residence? • Additionally, household income is significantly higher for those who own homes with marine frontage versus all others in the watershed. Overall, more than 37% of homeowners who have marine frontage have income of$100,000 per year or greater. About 20%of the homeowners who have marine frontage have incomes of$40,000 per year or less. • 9 P<.001,t=5.747, df=240 Sept. 30,2005 5 Hood Canal Survey Results DR-``°I:1 Low Dissolved Oxygen • The survey asked several questions about the understanding and concerns that homeowners had about the low dissolved oxygen conditions in Hood Canal. Overall 88% of the homeowners in Hood Canal have heard of the low dissolved oxygen condition. There was no statistical difference in the response from homeowners who lived full-time, year-round in the Hood Canal watershed versus those that did not. Significantly more homeowners that think scientific understanding is fair or poor versus those that think scientific understanding is good or excellent (Figure 5)10. Interestingly, more homeowners in Hood Canal believe low dissolved oxygen is "a big problem" versus "not a big problem" (Figure 6)11. How well do scientist understand Low DO 40% 35% s ' 'i rw- T 30% r`n;-_,, V,' A? N • C 25% a � ,,,,,,,...,,,, ... „.. ,,„ „ ..„,,7 --- tliN, jv. • 0 re 20% e. . o_ 15% Mi' i Ii s , V s 5% 1 -:`.i ;.+;c .` t 0% X6-6a. Poor Fair Moderate Good Excellent Figure 5. Response to question: how good is the scientific understanding of causes of low DO in Hood Canal. Homeowners were neutral when questioned about whether they believed human sewage contributed to low DO in Hood Canal. Significantly more homeowners believe that sewage treatment contributes to low dissolved oxygen than do not(Figure 7),12 although the difference is not as graphically obvious as in Figure 6. i°p=.001,t=-3.192,df=667 • p<.001,t=23.051,df=663 12 p=.001,t=3.484,df=657 Sept. 30,2005 6 Hood Canal Survey Results DRAFT • How Serious of a Problem 40% 35% 30% 4 4 CM o 'ftf 25/o 44 e to cc 20% ,n a, �4' a 15% IcIlf., r 10% E `' a s 5% 1-i,,',' Not a Big Problem Moderate A Big Problem • Figure 6. Response to question: How serious a problem is low DO in Hood Canal? How much sewage contributes 45% 40% 4if4 '` 35% ,. I r x 30%cn " C 0 y 25% CD y 20% d 15% 10% 5% 0°/a =�T Very Little Moderately Significantly IllFigure 7. Response to question: How much does human sewage contribute to low DO? Sept. 30,2005 7 Hood Canal Survey Results D/1 .`" 1 General Stewardship Issues 111 As a whole, the population surveyed was relatively neutral about whether they felt responsibility to take actions to address the oxygen problem. The question was answered as follows: • 36% said "yes" • 27% said they felt"some responsibility" • 37% said "no" However, again there are significant differences between homeowners who had marine frontage on Hood Canal versus those without. Those homeowners who have marine frontage were significantly more likely to indicate they feel more responsible to take action for low dissolved oxygen conditions (Figure 8)than the rest of the watershed13 Responsibility to Take Action 60% 50% m 40% . N ti O n f4 •Yes cu d' e 30% y j t 4._14 0 Some O / k . jVA wi4 Np t1.1 10/0 �,�*' 4,y. �,«:,� r;_ , 4-, ,w , 0% All Marine Frontage No Marine Frontage Figure 8. Response to question: do you feel responsibility to take action to address low dissolved oxygen conditions in Hood Canal. • 13 P<.001,t=4.240, df=425 Sept. 30,2005 8 Hood Canal Survey Results e i\I 1 • Specific Stewardship Actions Regarding Onsite Sewage One question asked homeowners if they would voluntarily join an onsite sewage management cooperative at a cost of$20 per month. The response was as follows: • 6% Definitely would • 37% Maybe, need more information • 21%Probably not • 24% Definitely not • 12%Not sure But, again there was a significant difference between those that have marine frontage versus those without(Figure 9). Those homeowners with marine frontage were significantly more likely to want to join a management cooperative than those homeowners in the rest of the watershed.14 Join Management Cooperative 60% 50% 40% W O 0 CC 30% 4' ■Marine Frontage 0 No Marine Frontage C, ,a 1 a q 20% Aki10% 4b�,y}�� W T pct T Y 0% Yes Maybe Prob.Not/No Not Sure Figure 9. Response to question: would you join an onsite sewage management cooperative at a cost of$20/month? • 14 p<.001,t=4.578,d752 Sept. 30,2005 9 Hood Canal Survey Results DRAFT Connect to Community Sewage III 60% - 50% ,it r ot 40% a, ?i", co c o. y ■Marine Frontage CL 30% D No Marine Frontage � - m'; a 20% riv v.,„ .40,44 10% 4ft. tri', Sr i., 0% Yes Maybe Prob.Not/No Not Sure Figure 10. Response to question: would you connect to a community sewage system if Ill the cost were $15,000? There was a similar significant difference in how people responded to the question if they would voluntarily connect to a community sewage system.15 Those homeowners with marine frontage were significantly more likely to say "yes" or"maybe" versus those without marine frontage (Figure 10). In contrast to the differences in responses to questions regarding connecting to community sewage systems, all homeowners in the watershed have similar opinions about voluntary onsite sewage upgrades. Overall, there is less support in voluntary onsite sewage upgrades. And, in contrast to sewage management cooperative and community system connections,there are no significant differences based on whether the property owner had marine frontage or not. This less enthusiastic support of voluntary onsite sewage system upgrades is present with both options for low interest loans or for interest- free, payment-deferred loans (Figure 11). • 15 p<.001,t=4.498,df=732 Sept. 30,2005 10 Hood Canal Survey Results DRAF • Voluntary Upgrade 70% - 60% 50% c �4 Q, 40% U, 1x. ■Low Interest Loan 4.1 0 No Interest Loan v 30% 20% 0% 0% loo Yes Maybe Prob Not/No No-Just Upgraded Not Sure Figure 11. Response to question: would you voluntarily upgrade your onsite sewage • system if the cost were $15,000? Additional analyses will be conducted, based on the request of the HCCC Board, and when specific policy questions are asked that can be informed by the survey data. These potential future analyses will be added to this "interim"report for inclusion with the final report to the Department of Ecology. County-Specific Analyses From a policy perspective, it is important to know how each county's homeowners attitudes are similar and how they differ. Policies are established at the county level for many aspects of sewage management, especially in the onsite sewage regulatory arena. Therefore, we conducted pairwise comparative analyses between counties. The factor that seemed to determine significance for all others was once again the difference in attitudes between residents with waterfront homes versus the rest of the watershed. All the county differences could be explained, with stronger statistical power, simply by the percentage of waterfront homeowners represented in the sample. Figure 12 shows that 40 percent of Mason County homeowners in the Hood Canal watershed have marine frontage and 60 percent of Mason County homeowners in the • watershed do not have marine frontage. That is a higher proportion of marine frontage Sept. 30,2005 11 Hood Canal Survey Results r)R A I than homeowners in Jefferson County have and much higher than in Kitsap County. That • difference (marine frontage vs. not marine frontage), and the attitude differences between the homeowners from those two groups, drive some differences between the counties. However,these differences are not necessarily county specific, they are simply a function of the different amount of marine frontage in each county. Marine Frontage by County 100% - — 90% 80% 70% CD H ��v o '14 a ■Mason Ce �• 50% 0 Jefferson Kitsap i 40% — O. 30% r 20% 10% � 0% Marine Frontage Not Marine Frontage Figure 12. Proportion of homeowners indicating marine frontage and not indicating marine frontage broken out by county. For example, there appears to be significant differences between Kitsap County and Mason County on a number of factors when pairwise comparisons are made. These include: • Mason County homeowners feel more responsibility than Kitsap County homeowners to take action to address low dissolved oxygen • Mason County homeowners have a higher income than Kitsap County homeowners • Mason County homeowners are more willing to join a management cooperative (at a hypothetical cost of$20 per month)than Kitsap County homeowners • Mason County homeowners are more willing to connect to community sewage system (at a hypothetical cost of$15,000) than Kitsap County homeowners • There were no differences between Mason County and Kitsap County in • homeowners' willingness for voluntary upgrades of onsite sewage systems. Sept. 30,2005 12 Hood Canal Survey Results DRAFT • However, none of these statistical differences are as strong as the differences measured between marine waterfront homeowners versus homeowners in the rest of the watershed. Therefore,we believe that these differences may be"autocorrelated", meaning that the significance is based on related factors and not cannot be directly attributed to county of origin. Further analysis will be made into determining the statistical implications. There were no pairwise statistical differences between Jefferson County and Kitsap County, or Jefferson County and Mason County. In many ways, data for Jefferson County homeowners appear to be midpoint between Kitsap and Mason. On a spectrum, Mason County has the highest proportion of marine waterfront homeowners, Jefferson County has the next highest, and Kitsap County is a distant third. The statistical differences noted in attitudes could be explained simply by that one population attribute. Demographic Comparison to U.S. Census of 2000 In order to make estimates for the entire Hood Canal population from the HCCC Attitude Survey, we had to determine if the demographic information was consistent between the sample and the population. To do this, we asked questions that could be directly compared to the U.S. Census related to: • Income • • Education • Age • Tenure (length of time living in the house) • Number of Bedrooms in the house • Number of Occupants in the house The results are tabulated in Appendix A. Overall,there was general agreement between the demographic parameters in the census population and the sample obtained from the HCCC survey. The detailed data obtained from the census, and the methodology used in calculating census population in the Hood Canal watershed is in Appendix B, which is NOT included with this report. Appendix B can be obtained by contacting HCCC staff. • Sept. 30,2005 13 Hood Canal Survey Results DRAI;'I: Appendix A. Demographic Comparisons between Hood Canal Survey . and 2000 US Census Data Income 35% 30% 25% �_ '..:"14:1'41';':'47:11::1"21;r'Illi: xi r 20% ■Census 0 Survey 10, 15% 10% k 414 .!;'1:1;;:1/4r,,,i':i.,,,,,'1:'',:::1:1.1';: 5% 0% <$19,999 $20,000 to $40,000 to $60,000 to >$100,000 Ill$39,999 $59,999 $99,999 Education 50% 45% - 40% t 35% 30% ' ■Census 25% - ,, ip Survey 20% 15% 10% Fl I I 7 5% '7,:.:11*i'1.::‘1:it ,,.iges, , V-�t 0% , Some High High School Some College College Graduate Graduate Degree School Graduate • Sept. 30,2005 14 Hood Canal Survey Results DRAFT 0 Table A-1. Demographic comparison"Permanent-year round" in survey vs. census "homeowners" Question Category Census Survey Age Under 25 1% 0 25-34 7% 5% 35-44 22% 15% 45-54 27% 27% 55-64 19% 24% 65-84 22% 26% 85 and over 1% 3% Yrs in House <2 11% 10% 2-5 28% 23% 5-10 25% 20% 10-20 22% 26% >20 14% 22% No. Bedrooms 1 6% 7% 2 25% 34% 3 50% 50% • 4 15% 8% >4 2% 1% Household Size 1 18% 17% 2 43% 54% 3 15% 12% 4 15% 11% >4 9% 6% • Sept.30,2005 15 DRAFT Agenda for Hood Canal Regional Environmental Health meeting— • November 16,2005 Concept of regional/coordinated BOH mtgs. • What is the need/benefit? • What would the scope of issues be? • Logistical issues to be resolved if future mtgs. are desired Specific Issues • What each county is doing differently; what works; what doesn't • Specific policy issues related to OSS o OSS Inspection at time of property sale o Small lots—existing lots of record o O&M issues o Regional approach to low interest loans? • Anticipated legislation in 2006 and beyond • • Board of.�Cealth Media Report • October 20, 2005 • Jefferson County Health and Human Services • SEPTEMBER — OCTOBER 2005 NEWS ARTICLES 1. "AIDS Walk is Sunday",PT Leader, 9/14/05 2. "Judge orders firing range to stop",PT Leader, 9/14/05 3. "Sales tax proposal would boost treatment programs", PT Leader, 9/14/05 4. "Commentary Viewpoints", PDN, 9/18/05 5. "Bird positive for West Nile", 9/18/05 6. "Peninsula water takes center stage", PDN, 9/18/05 7. "Coming water debate will pit varying interests", PDN, 9/19/05 • 8. "Community Roundtable set Oct. 5 on healthcare", PT Leader, 9/21/05 9. "Vaccination increase OK'd", PDN, 9/21/05 10. "Officer says flu shots will be plentiful", PDN, 9/21/05 11. "Girls Night Out is Oct. 6", PT Leader, 9/28/05 12. "Quilcene WIC", PT Leader, 9/28/05 13. "Water opinions flow as DOE considers rules", PT Leader, 9/28/05 14. "County considers writing infractions for solid waste", PT Leader, 9/28/05 15. "Judge's ruling Monday", PDN, 10/2/05 16. "Jefferson Oks mental health tax boost", PDN, 10/4/05 17. "More flu doses available", PT Leader, 10/5/05 18. "Girls Night out in PT has benefits",PDN, 10/2/05 • 19. "Breast Cancer Awareness Month", 10/2/05 20. "Girls' Night Out", 10/5/05 21. "Breast Cancer Awareness Month, by Margie Boyd, RN", PDN 22. "Community Roundtable on healthcare Oct. 5",PT Leader, 10/5/05 23. "Flu vaccine plentiful; shot clinics scheduled, PDN, 10/11/05 24. "Starting Oct. 24, everyone here can get a flu shot",PT Leader, 10/12/05 • • • WalkAID is In a time of diminishing donations to AIDS pearing. Two AIDS patients lost their Section 8 organizations for the now controllable disease, housing vouchers, forcing them to move in with Jefferson AIDS Services(JAS)has been struggling family and friends in other cities and states. One to keep its funding the same as last year. man lived in his car for two months,trying to stay Its biggest moneymaker is the annual AIDS close to his children,but finally gave up to move Walk•that is scheduled this Sunday, Sept. 18. in with a friend in Long Beach.now has an active Registration starts at 10 a.m., and the brief walk In Jefferson County, JAS starts at 11 a.m.,rain or shine,from Chetzemoka client list of 10 disabled with AIDS.Three clients Park in Port Townsend. have died in the last two years from the side effects Donations by community members and walkers of the drugs that kept them alive. The local, all- help make up for under-funded federal and state volunteer organization also supports spouses and programs that subsidize the life-saving prescrip- children,so it is helping about 15 people this year tions.The prescription subsidies have been dwin- with grants for food,housing and utilities. dling, causing some people living with AIDS to "The demand is going up," said JAS Chair Al pay a third more for their essential drugs this year. Hernandez, "and•our funding faces some chal- Federal subsidies in housing are also disap- lenges.Please help." (Q-442eA,--• 62 • • + r • • , . • Y- to4 U1T!JR1DJi R 5' a0w o °' ° ' aaa. o C7 . $ 5 dao . Cali A 12•Wednesday,September 14,2005 .t w y 0 y G HIBrII14Ui * ' ��11• 77 g CD Continued from Page Althe "hoops he jumpedthrough" °'cn R ^ c i3 6 0 P g C.) _ SSNW continued training to come in compliance with ° 4 11.1.1 after the orders were posted. county code, mentioning that Johnsen said county Director D'Amico had hired engineers o: a a o of Community Development Al and surveyors to help determine ti ° o g 'o e) 4 fad'Scalf's"ability to administer the what would be necessary to bring 8 2. unified development code will unpermitted buildings into corn- rn cr P 0 c,...,, "", (1) En 1.11 be impaired if he can't enforce pliance with county code.Verser `�, `� b the stop work order." also said he respected Amster's y 1 �i SSNW attorney Glenn arguments. a f° 5. ' ? P .t (0 Amster 'argued that there was However, he agreed with 1. E E co • m , cen no legal basis for the stop work Johnsen that the continued vio- a' o d- a �, n orders and that the county has lation of the orders could impair 8 'o°. R.� m TV, O, � not shown sufficient evidence to Scalf's ability to enforce the 'ig Li o+ • prove that D'Amico's business county code in other cases. 8 e- F !n �?Q O is causing anyone any harm. "Mr. D'Amico, you can't a p, g• o 'c11110 "Make[the county]show you keep doing what you're doing," how they have a legal right to he said. 4. ,1 '-h o b '8 o o g 4. stop this man's business today," Johnsen said the restraining 5: a v R- g• cn ,r-.0 `- z .5v. , Amster told the judge. "They order confirms that the stop work c a; Q" iy 5 o e� °O c, o ` _ (lc? haven't done it." order needs to be complied with -L g• . o: c4. N 'o "o Amster called the restraining and gives the county the grounds Rill y ter. a :; 5 6 g o - f•g. order "a severe penalty for a to file a motion for contempt lv S. S 20 ° w ° °° business" and later urged Judge if SSNW continues training. E 0 Boo ~' ti o•, 5et"0. ii.b 5 ° r Verser to allow the countyhear- Contempt of court, '" r* 'n P 1:oo p which in this -5 g E ,z d k ° ings examiner to determine what case would be a violation of the y o. �' P �' S 5' i2 btob' � �- - compliance with the stop work judge's order, is punishable by N C° E . �' R' `r g w c, o °2, o orders would be necessary. up to a$5,000 fine and one year . ao 5 n P, to 9V K cr 5 ;; s a :• : : Judge Verser agreed that the in jail for each count, according co y W 8' `, ° E`� a cm- hearings examiner, at least at to Washington state law. ,Do 5 g 1 00 w = p M o �'�' 8 this level, should handle much Johnsen did not anticipate VI "o , 2-. � oo . 4 5+ c, . 6 S a. C1) of the dispute. Verser said he any violations. couldn't "determine whether Amster said the company i 8 g R 8 N -g• 8 8- ,1 H Mr. D'Amico's operation is a would respect the restraining . .. B a ccn 0 o• a'� o violation of the zoning code or order. He said he was disap- g ° 5. 8 a. n c 'b ° R.,a . a the unified development code. pointed, but respected Judge 8 a. �' a 6 m o F That's not my determination to Verser's decision. 11 4 'o , q. o a C , ° " o make at this hearing." I think he made.a well-rea- o R. v o „d , g - In y He commended D'Amico for soned decision," Amster said. ~ 5' 8 5 0 0 0 a �5• `� a o C7 CD _.. "He's right that� the hearings (1)* 1 oq 5 0 ^ N . CA 6 examiner is where we're supposed z C �' • o 0• , . a. 5 y emtb- to be,'and that's why we wanted to t: 5 tX a • g c' co 8 8- Clip gq there in the first place." . i $. o g o- o. o M z 8 Amster said he is hoping for. 5 Er a hearing soon,since"there is an a 8 k 8 S E 1 8g: talCi E urgency to have this stop work ^' `� E p, o K • a. P.. C• T °5° . order issue resolved." • Port Townsend&Jefferson County Leader Sa es ax ro osa l would boost By Steven J. Barry tax and implementation of this els of alcohol consumption and setting up their own programs," Leader Staff Writer proposal," wrote Laurie Strong, drug use here make this an emer- Kessler said. chairwoman of the Jefferson gent need. County Commissioner Pat The Board of County County Substance Abuse According to the Jefferson Rodgers, though he has yet tc Commissioners is considering a Advisory Board, in a letter to County Department of Public take an official stance on the proposal to increase sales tax in the BOCC. , Health, alcohol consumption proposed sales tax increase, is Jefferson County by one-tenth "We also believe that tax- patterns are much higher in not so convinced. He said the of 1 percent to help expand the payer money will be saved," Jefferson County that the rest resolution is written so that the county's chemical dependency she wrote. "The cost to county of the state of Washington. One tax monies could not be used to and mental health treatment pro- citizens as well as tourists will out of five adults in the county bolster current substance abuse grams. be negligible ... but the reduc- are considered"heavy drinkers," treatment programs here, which The new tax would bring the tion in cost to the citizens who meaning they consume five or he said are "anemic" due to a overall sales tax in Jefferson are paying for health, law and more drinks in a sitting, while lack of funding. He said adding County to 8.4 percent and would justice and other systems strug- two out of every five adults more programs might not neces- Illiride about$300,000 a year for with [people afflicted by] ages 18-34 are"heavy drinkers," sarily be the answer to mental ewgig"Co-occurring Disorder these disorders,through property according to the health depart- health and substance abuse prob- Integrated Treatment" program taxes,could be significant." ment. lems in the area. (CODIT). The program would The sales and use tax would Those people who need sub- "We have this huge, huge help individuals who simulta- apply to Port Townsend and stance abuse treatment as well as need and it is an unmet need, neously suffer from both men- Jefferson County. The revenue mental health treatment usually and I am so sensitive to that," tal illness and substance abuse would be deposited in a new get a heavy dose of only one Rodgers said. "I want to make problems. The proposed resolu- fund that would be adminis- type of treatment after problems sure /hat what we do makes tion for the tax asserts that those tered by county Treasurer Judi arise,he said. sense. I want to use our money people are at the greatest risk for Morris. "If this is approved, I think wisely." violence,homelessness and HIV Ford Kessler, the owner of it will greatly enhance the treat- The BOCC set a hearing or hepatitis infections. Safe Harbor, an outpatient drug ment services that are provided to discuss the proposed tax at "We strongly believe that and alcohol treatment facility, in Jefferson County, and it may 11:45 a.m. Sept. 26 in the corn- lives literally will be saved by worked with Strong to draft the be the leading edge to some missioners' chambers at the the immediate passage of this proposal. He said that high ley- other counties in the state maybe courthouse. 1./ • • 7) i ' ,. S C?in/ mentaryViewpCbats r .. ' AlliMim. ,I .. .- '.41514:T' '. II i •'' ' _ :It .V:(1' lill,_' <3.‘,0'.'''w•. . 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WRIA2Q t' t Rk= �, Forks r„re um ^' ° calaT <t r b�, •w • � CI4., AF " 9ahie!Rive 'r, ti- cr JeffersoCo4ut - ,,w Hoh River- t£ ''N"ww „„ ,M; tig lk vY ''w^"'v ,----w " F , <k wE�C ° /Veer- r:h3' ,/.4*I , s 3- YHN\M+ M-.YN•� I'YW�w`V. 6x3 0,o ^*F',r N. r. 4 �; - vwvw� " i�w�,.�g � �£sq&�o Y� �'1,..4',..,'','� '#,' � V,`,�.�,VVWvw•Y•/.✓v,^, b�H '��` 5 E �ot �pE.JaL`9' Gdyb .7 .04 KEITH THORPE/PENINSULA DAILY NEWS j • Comingwaterdebatewill pit varying interests• (Part Two in a two-part series on watershed man ement lan. „ , North Olympic Peninsula water "The � p posed new rule: It calls for closure of issues.) geography of this area is dif- the Big Quilcene River from March 1 ferent than a typical (water) basin,” to Nov 15 and Chimacum Creek from BY JEFF CHEWsaid Dave Nazy, state Department of March 1 to Nov 30. to new water PENINSULA DAILY NEWS Ecology hydrogeologist. "You have many different basins, appropriations. PORT TOWNSEND—After years and seawater intrusion." . It also closesear- otherndwater bodies inr of discussion, study, planning and During an open house at 6:30 p.m. the area year-round to future water hundreds. of thousands of dollars Tuesday at Fort Worden State Prk's rights. spent doing so,most people agree that USO Hall, Nazy and other Ecology Nt e said that ere rule would not affect East Jefferson County's water - officials will address questions about applications existing water for water righrigghs, only new sources face challenges. the Watershed Resource Inventory ts. It's how to address those chal- Area 17 plan. Islands such as ,Marrowstone are lenges, and to what extent, that con- Specifically, Ecology will address closed to new groundwater with- tinues to bubble to the surface. its new water management rule approveddrawals under the new rule "unless The complexity of East Jefferson which has stirred misconceptions by the department in con County's geography and geology among county water users. sultation with Jefferson County." makes it difficult to build a workable One thing is certain about the pro- TURN TO WATER/A$ w , caoiE1fl .n oo13.m �:_ _R F4 , £ ma 5 m , 1iLI1JflhUtH y wOcapg70° H=< m`-< az'° m m N ,NNt- = v-`; °. r0 m, o �Fo5 €',x�. a�, 8a' N m pig �a o.= $. °o.'o° <.,4 ° „,3.aoo uo,N"agA tzl.- m `-`, 8c , om , try 3m'� n�7 ° o0�4 E ° �� Yco=c �mN " d o c 8 �n my8 o. hioS,-, o 7. oq'g NQ m 6ToA _3, ;.5--34 % wb s° �s;=-1, a _'G y > rs 3 8-Z8 °,o �ao o za Stl4 = a•'D K. 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R' ,ro R o xm g 5(�•° g'51 . 0 v b g.i G c.E m 3 c F—" M 5r"--'.2. 4 S .Y. v* O G O �, Oa . •c Sq L'`5 o 5 .r"o m w 3 a °,-,..9, r a<< `5 i* Y ,•e t5 x, '`,4- 7..�,a4 .a<<" f-°,7,-• 5.c8 Fo 'N s • Wednesday,September 21,2005•B 3 ommunl oun a e set O 5 on healtHcare "Health Care: National and generate a community discussion each other,"said Pat Teal,a corn- cific issues,and another who can Local" is the subject of the inau- on the issue, and if we find that mittee member."My take on things talk about local connections. It is gural Community Roundtable dis- we need more roundtables on this is that you have to be really poor intended to be informational, not cussion intended to bring together issue,we'll do it" or really rich to afford healthcare, point-counterpoint or political. healthcare professionals to answer Guest speakers Oct.5 are Jean and the poor are being squeezed." The group's criteria for select- questions and generate ideas for Baldwin,director of the Jefferson Organizers hope to attract a ing topics are: issues of impor- resolving problems. County Health Department, wide economic and age demo- tance to the community, issues The roundtable is 7-9 p.m. and Mary Looker of the state graphic for this discussion. with national and international Wednesday, Oct. 5 at Chimacum Department of Health, Office of Moderator is Joe Wagner,a retired aspects, issues that are complex Grange Hall, across State Route Community and Rural Health. minister. and involve differences of under- 19 from Chimacum School. A local physician is also being Community Roundtables are standing and opinion. This roundtable initiates a recruited for the panel. sponsored by a working group of Future topics include Social series to be hosted on a bi-month- The concept is to have a group Port Townsend-Jefferson County Security, tax justice and fairness, ly basis. It is a free, nonpartisan discussion, then split into five- Democracy for America. Each education, employment,housing, effort to learn more about pressing member "roundtable" groups, meeting is intended to feature a and emergency preparedness. concerns• with each addressing a specific speaker who can address state Call Taylor at 385-3666 or 'The idea is to bring diverse issue. Those groups will have a and/or national aspects of spe- Wagner at 344-3904. •voices together and then to take limited time to develop and pres- action," said Jenifer Taylor, a ent a response. committee member. "We want to "We have a lot to learn from TT' • . ..V • acc � na ion increase OK' d • • be State-supplied immunizations outksuffiin cient hurricane-devastated against hepatitis A visit receive l' and B. They also should will cost $ 15 for an office a all the immu- - receive shots for diphtheria nizations they ., -,, and typhoid, plus a tetanus need, espe- booster if they are due for one. BY JIM CASEY Fees for vaccinations with . cially those The county Department of PENINSULA DAILY NEWS privately purchased vaccines that require ' Health and Human Services PORT ANGELES — It will will include the cost of the vac multiple shots cine plus a $10 handling. and • kith da offices other programs with cost more to get needled at the Ys In fees include: administration fee.. between them. Clallam County Department An office visit also will cost Locke ■ Blood specimen collec- of Health. The lone tion: $15plus laboratorycosts. County health commission- $15, for which a sliding sched- person testifying at the public ule mayapply. hearing, Linda Nutter of Port Blood-borne pathogen ers approved a "cost-plus training: two-, four- and Angeles, supported the schedule for vaccinations after Traveler's packets increased fees. seven-hc'ir courses, $20, $40 a public hearing Monday, "The county can't give and $70 per person, respec' reflecting price fluctuations in Traveler's trip preparation tively. vaceuies,tl atcan change'daily,"'packets are included in the`"away ke said she said. Locke said he:has noticed a'' - Death certificate. cor according to Dr. Tom Locke. handling-and-administration spike in people requesting rections: $5 per occurrence. Locke is health officer for fees for people who makeimmunizations before visiting ■ Home or office visit: Clallam and Jefferson coun- advance appointments. the Gulf Coast or volunteering $50. ties. Walk-in traveler consulta- in hurricane-relief activities. ■ H;fVtesting and coup- Vaccinations withstate- tions, however, will cost$90. "We are seeing' a big seling. $30. supplied vaccine will cost $15 "We hope this will provide upsurge in requests for vacci-. ■Account set up for orga- (up from $12) for an office an incentive for people to nations in our clinics in:Port nizations requesting visit plus $5 for administra- come in earlier," Locke said. Angeles and Sequin'," he said: account for billable services. tion, he said. He said that some travelers He said that people going to $50. 4. P Dry • • PENINSULA DAILY NEWS q-a 1-o s 'Off■ '• The Victoria Clipper out of e e r says Seattle also offered high-speed "flu cruises" to Victoria for •flu shots, charging$105. They stopped afteronly five S - days, however, purportedly because the Clipper's Cana- dian supplier ran low on vac- cine. be e n ' - u Rush for vaccines • • This year, however, health Later in the flu season, the. Vaccines set authorities will urge that rush was on to the Jefferson school-age children be vacci- Healthcare clinic in Quilcene, for clinics nated, Locke said. He noted which received a windfall ship- that most influenza contagion ment of vaccine. spreads in classrooms. People lining up for shots on Peninsula Vaccinating children could included seniors from the cut in half the number of adult Bainbridge Island Senior Cen- BY JIM CASEY cases of influenza, he said. ter. PENINSULA DAILY NEWS When ,what most people PORT ANGELES — The More vaccine produced called flu finally hit the North More companiesOlympic Peninsula in Febru- coming winter won't see a are pro- ary and March, most cases reoccurrence of last year's flu ducing the vaccine this year weren't influenza at all. vaccine shortage. ' than did for the 2005 flu sea- Instead, people caught one Dr. Tom Locke, health offi- son. of a wide variety of other res- cer for.Clallam and Jefferson The -federal government piratory viruses, Locke said. counties,said 90 million to 100 announced last October that it Eight major types of non- million doses of the vaccine for would be short 45 million flu respiratory illness circu- flu strains expected in 2006 doses of flu vaccine = about lated during the season, plus will be available at physician's half of the country's demand "literally dozens of minor ones offices and public health clin- —after British drug manufac •ics across the United States. turer Chiron Corp. couldn't that can occur on a case-by- Clallam County Health deliver its 50 million doses: case basis," he said. and Human Services Depart- The shortage left sole sup- In addition, health authori- ment will have about 2,000 plier Aventis Pasteur with ties saw a new fever-causing shots of the vaccine,plus some about 54 million doses to illness-they couldn't identify. live-virus nasal spray doses. deliver nationwide. So why worry about getting' Both vaccines will be avail- Manufacturers want a gov- a flu shot if it won't keep you able at the department's clin- ernment guarantee to buy all from getting sick? ics in Forks, Port Angeles and their vaccine. The answer: Influenza can Sequim. In past years, manufactur- be deadly, while the ailments The virus in the nasal spray ers have had to destroy as that mimic flu only cause peo- dies before it reaches body many as 20 million surplus ple to feel miserable. temperature, Locke said. doses of vaccine, Locke said. Besides causing the blood to Influenza gets the atten- Lasttion because it's one of the produce antibodies, it immu- spurredyear's shortage deadliest of the pack," Locke nizes mucous membranes. many Washington res- said, "especially for the very The spray is recommended • idents to seek vaccinations in for people 5 to 50 years old Canada. young or very old. Bus owner Kevin Harris of although it probably is safe for "It has the potential to Port Townsend ran "Flu Shot mutate into a deadly pan- people 65 and older, Locke Tours" to Victoria from Jeffer demic. said. son and Clallam counties via' The flu itself produced no the MV Coho. ' more illnesses than in an aver- Vaccine arrives in October age year, however, in Clallam Along with seeing the Clallam County will receive sights of the British Columbia County. its vaccine in October, coincid- capital, tourists stopped at a And although late last win- ing with a campaign urging downtown Victoria pharmacy ter it seemed as if every class people to be vaccinated. where vaccine was plentiful room and workplace was deci- Vaccinations usually are for Americans. mated by absences, JoAnne advocated for adults 65 or Cost of the tours, including Dille then director of Clallam older, children 23 months or ferry fare and injection, was County Health and Human younger, and others with seri- $95 Services, said, The total per- ous or life-threatening ail tentage of illnesses still is rel- ments. • atively low." • • Port Townsend&Jefferson County Leader Girls ' Night u ZS C1.. 6 Port Townsend Main Street Program hosts ship assistance. US Bank and the Jefferson County Health the 2005 "Girls' Night Out" on Thursday, October is Breast Cancer Awareness Department have made contributions to the Oct. 6 from 11 a.m. to 8 p.m. The focus is Month, and the sale of Girls' Night Out goody bags,which cost$5 and will be avail- on fun: activities and in-store events, special "goody bags" generates donations for the able in special location. sales and snacks. local Breast and Cervical Health Program This year's preliminary schedule includes "Treat yourself and a girlfriend to a day of the Jefferson County Health Department mini-massages and facials, decadent choco- and night on the town at dozens of par- Last year's event raised $1,500 from goody late snacks;board game activities, refresh- ticipating businesses," invite Main Street bags sales.This donation funded two months' . ments, special sales and in-person designer organizersworth of free breast and cervical cancer test- appearances, fashion show/tnmk show, in- Jefferson Healthcare Home Health and ing for women in Jefferson County who could store promotions, food samplings and holi- Hospice is one of the event sponsors this not afford testing otherwise. Participating day wrapping demos. Check.Main Street's year; MarinerBank also provides sponsor- merchants,The Susan G.Komen Foundation, website at www.ptguide.com/mainstreet. • • • Quilcene WIC is open every Wednesday, 10 a.m.-noon in the Quilcene Health Department clinic. No appointment needed, just drop in. Call 765-3014 or 385-9400.C131/Ante;ai Rir• q- -Lt2,0412-04 • M:. - fr • Port Townsend&Jefferson County Leader • • Water Dpinions ow • n _. l � as . cos er s rules By Barney Burke —cannot reach agreement on its own. Leader Staff Writer a!/s s�'x,� `st,y 14' ¢ L 60 , 3 4Adelsman talked of progress being � ' l� r ;;� ' made in Eastern Washington, where water There was a lot of applause at the Septi ��1 storage and conservation measures are 20 presentation on proposed new water 10IM,Q�„ r�:'+ � Y ,";; makingmore water available to cattleman. rules, but it wasn't for the Washington tjTlY �� ,10, 9,41 s ikSimilar solutions could be implemented in Department of Ecology. DOE staff mem- SN�� �f.3h� . ' � �V1tC � WRIA 17, she said. bers were continually peppered with quest tr sptg.10 } 0, "The reality is there's not enough water tions and challenges duringthe meetingat F”i a 0 Fir f r r g �y' Ctl�,��'���£���.�sb! �vs�stx�. a��� E in many cases,' said Adelsman. Fort Worden State Park attended by more s""" s; 1�ss s* y�� llx4�st ''� ' than 100 people,most of whom were vis- Legislator observations ibly frustrated. thing,"Nazy said of the water supply and Although the WRIA process was autho- Tuesday night's meeting was an infor- fish issues. rized by the Legislature in 1998, 24th mal presentation on Water Resource No one spoke up in favor of the pro- District Representatives Jim Buck (R- Area 17 (WRIA 17), which includes East posed rules during the boisterous meeting, Joyce) and Lynn Kessler (D-Hoquiam) Jefferson County and part of Clallam which lasted nearly three hours.Some said both said recently that the Legisla County. The rules don't affect existing that they wished DOE would go away and would want to consider changes to the water rights, but they do limit the avail- never come back. if its implications are shown to be unrea- ability of water for those seeking water DOE had planned to release a draft rule sonable. rights in the future. on ground and surface water consump "Everybody wanted to do something Dave Nazy, a DOE hydrogeologist, lion for WRIA 17 on Oct 5, but on Sept. about salmon," said Buck of the 1998 tried to give an overview of how the agen- 20,DOE staff said that a final draft of the legislative session. "But I doubt very seri- cy has analyzed the amount of ground- rule probably wouldn't be available for ously," he said, that the law would have water and surface water available. People months. passed if legislators had known the impli- were as upset with DOE's underlying data Hedia Adelsman, a DOE senior pol- cations being seen today. "These people methodology as with its recommended icy analyst, recapped the history of the have a right to be upset." policies. 1998 legislation that created 62 WRIAs in Kessler said the rules are going to One of those challenging DOE's meth- Washington. have a "great impact" on both agricul- odology was Keith Winters, a well driller. "DOE was accused of not protecting ture and development. And if the WRIA He called DOE's theory of water continu- fish enough," said Adelsman. rule-making process hasn't been "broad ity "junk science," as many of the people The WRIA process allows local corn- enough and inclusive enough," she said, in attendance nodded or muttered in agree- munities to decide how to address the the Legislature more than likely will step ment. issue. Under the law, DOE has the power in and fix the situation. "Do you have any real data that dem- to set stream flows if the local WRIA The draft,DOE rule for WRLA 17 may onstrates the impact of wells on streams?" group—typically comprising stakeholders be viewed online at www.ecy.wa.gov/pro- asked John Garrett of Cape George. such as tribes, conservationists, agricul- grams/wr/instream-flows/quilsnowbasin. "A lot of little things add up to a big tural interests and municipal water systems htinl. S • Wednesday,September 28,2005•B 7 Countyconsid considers writing Infractions for solid waste Jefferson County Public used only as a last resort to Health unveiled new solid and achieve compliance," empha- ha7ardous waste regulations sized McNickle. at the Sept. 15 meeting of the The public has three opportu- Jefferson County Board or nities to discuss the proposed reg- Health. Environmental Health ulations with Jefferson County Director Mike McNickle told Public Health officials.The first the board that the new regu- is an informational meeting from lations are needed to "clarify 4 to 7 p.m. Thursday, Oct. 6 • the issues, promote awareness at Quilcene Community Center. and increase compliance" in The second is another informa- Jefferson County.. ' tional meeting, 4-7 p.m. Friday, The'most significant change Oct. 7 at the Jefferson County is the ability for Jefferson County Courthouse first floor confer- Public Health officials to issue ence room.The third opportunity civil infraction notices. is at 2:30 p.m.Thursday,Oct.20, "Civil infraction notices are when the Board of Health hosts equivalent to traffic tickets," a public hearing on the proposed said McNickle."However,what regulations in the commission- we really want to do is assist ers'chambers at the courthouse. property owners-in comply- The proposed regulations can • ing with state and local solid be reviewed at the Department waste regulations, and volun- of Public Health, 615 Sheridan tary compliance is always the St., or at www.jeffersoncounty- primary goal. Tickets will be publichealth.org. u • ' October 2, 20+05', Judge 's • ru itig -D =-4 g v• 2 ° — . is rT �� c CID 3C • ' ^ OO • ro �C. f f _Ul _ -- 1' i1oncJa ' r� mEyJv ^E 1 ="2 0 — a f r _��J y , °�� a � JJ - =rO j O) V4cC L C j Ow: > T C r 9 � n . f,„�Z iV „,JJ y J _ Lfl 7 _ . _ xr-y� •� u-t ai y� t�'e a"Eto o Y s � '' y ; c x > 3- `• E:_, s ., L o0'm �, a uc • Verser due to firm o v �� o �� .3 yw ,_cnit]aL ^0- _ rt .. c ▪ O L i �. E>�Ed�m � ogE�v�E Eoa .Em�� = `c halt togunfire 7 -.5.E., ,-5_?) J ,L 0 ro u R ,,,,9).,-1, ' � ( 1 � O �.L c9. ui.a O L cC A N �:• 3 O L• '—��L (10 - �L y0 d N NT'a-.;1' U O. .N+ O h �v eD:) :G 9'a 7 -Y .', _•{ � y � D4 O•2(� NL., y 2 0 ,,-E O i._ � - 7 �'O -3 > on Discover' BaY ' o a �cNcn �;.riEaa Qyy �, ` a �° j.-1.'-,E o o.. to a E E y m= y �, ' NroT� � 5m au o a> Nwro nom_ � c BY JEFF CHEW _ q Leo`'E C] a ? � �' v r _ PENINSULA DAILY NEWS c c d ctl C rn v t o ', y = m eo —a ar. N <r ■ O 0 y y C = C O u O > j v. O — O r- .v Tif -.5. - 3- :.J PORT TOWNSEND — A 7 _ o c o 0o oN, o f o m N y o w d•DET— y c y=?— �' .�"'" � y 3' eoy cv � o y o, N ;off c o 7 - SU Superior Court judge is y c0. c = P. co c c0 m'N °.' y m b.D E m y a'=' .y, >?v c, y t L ` 3 P J g ("/ 2 q.� Ey , uvcox = > ' w — N u0.> 3Eo-o S.� _, ` exPected to issue an order , t� i `/J cD o y o -i o a X=c y o 00 ” 00` " 7,-i- E L v Monday morning that specifi ; ‘ S - .4.. ) ....0. a-L u ., y N ca y .4 c...) ° U oUlQ a E C, 3 3 h,„„«,2'P 14, T'D.D O 4-"D F.V'D'D "O Inc✓% ^LJ tally defines his temporary ta° >.T g, ". '0',',1 •= N E _ c 4 N 2 w o = _ -P c L restraining order against a ) t ' . - I m m o y d. �'o u eo J m 4 �'4 j j iisz Gardiner-based homeland 4.3,,,,'"'. a E y y _ c*,:.e ' o � oEQ " oo Q.0 =� 3mc _� nSc security training operation. . ,' U'p a N c.o=T� N-o p, :o o u N t o s) T u u c c E Judge Craddock Verser r N - , �� C � � N c s y y_ 2 2'�3 s v 1� N y LSq>T. CO O u L u pip 3 W — > , >�l „—• J eC heard lawyers arguments Fri- ✓1 u ` 5 Q.,, 8,a'O >A, eo y._ -2— a day afternoon at a court hear"Verser , '.'. .2 °,) E E c = oc y_yo v: c n' N c- t-- 8- . 1 :t,u co 0)0 n by y-O.N 0 s...2,E"� a' = O to s - r � y ing in connection with Jeffer- ca c f5 = 3 y EL L" E • °o Ny 'E' y o L Lson County's lawsuitand'proposed restrain- .,N N E w"o E n ..-1.:,:2, 3F, o F • s ▪em � _ E-order against Security Service Northwest: 0ti a g a „ m- c 2.,_5.',9') 3 Sei.15. c aLJl3 Glenn Amster, Security Services' attorney, N y y m • c - , y • •• -0 = argued that the county's proposed temporary. o -, R• ; . 0 , = o a. E a S' cE- crmJr- , f restraining order was "arbitrary and capriI = ° . go `. roCa ,0c0E ? > EL o. a a m ul r - c = CiOu$. • m ■ . a D c NJ.c > v `w� %.,,, , 2 roy �3• o The order should specifically define what z '' = o °a�= a 3v o= > ` . 3- r J= S jEgi H U ° E �o o .gym o 7O g J �. m co G CD 0• n 4y ,.�,• a gN o < -w5 ° ,..' 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C�o'xo , PPIP DJtri 7/ 5• � XZMco �'b � ,b 0 w•x a'0 a aa,,rnp y `�•°c o `�+ a 0 ° N c o 7' W 1--,O 0"m co p '� v O c+ O m AO - N E �' m ca o o 'b a M y CD `" o CD a a v . AwarenessBreast Cancer Monti). Fundraiser is Thursda ; v mobile mammogram here Oct. 29 October is Breast Cancer to local breast cancer screening and uninsured (or who have a the Port Townsend Community Awareness Month and in recog- programs at Jefferson County high deductible) are eligible Center uptown. Presentations nition there are several commu- Public Health.This year several for a free pap smear and mam- cover everything from pre- nity activities planned, includ- generous donations have been mogram through Jefferson vention to treatment options, ing a breast cancer symposium, made by sponsors, including: County Public Health's Breast from both naturopathic and fundraisers for local breast can- Jefferson Healthcare, Homer and Cervical Health Program allopathic points of view. A cer screening programs,window Smith Insurance, Mariner Bank (BCHP). Women will receive representative from the Cancer decorating, and a mobile mam- and the Komen Foundation. their exam at the health depart- Information Service at the Fred mogram facility offering free ment and a reservation for a Hutchinson Center discusses mammograms for low-income Mobile mammogram mammogram by the Swedish theories as to why Washington women. Later in the month, Jefferson Hospital radiology team. There has one of the country's high- County Public Health and are 20 mammogram appoint- est breast cancer rates. The Girls'Night Out Thursday Soroptimists of Jefferson County ments available. Women unable Komen Foundation's head of The Main Street Program team up for the third year to to obtain an appointment should education teaches self-breast kicks off the month's activi- bring Swedish Hospital's mobile not despair since the Breast exam techniques. ties with its annual Girls'Night mammogram facilities to town. and Cervical Health Program is Uptown businesses are Out, a fun-filled day of shop- This year the specially equipped available year-round at Jefferson actively supporting this event. ping and schmoozing around trailer will be parked at the Port County Public Health. One way is to decorate their downtown and uptown stores. Townsend Community Center windows for Breast Cancer This year's event is Thursday, on Saturday,Oct.29 to coincide ' Breast cancer lectures Awareness Month. Oct. 6. Special goody bags will with an all-day breast cancer Soroptimists are also orga- Call Kate Minta or Margie be available for donation, pro- symposium. nizing a day of breast cancer Boyd for information, 385- ceeds of which will be donated Women who are low-income lectures on Saturday,Oct.29 at 9400. • • • • • 111111 -t) C 12•Wednesday,October 5,2005 ' •Girls Night Out Sales, food, fun on Thursday Sales,activities,food and fun Socks, US Bank, Personalize are in store at the Port Townsend It!, the Jefferson County Health Main Street Program's 2nd Department, Ancestral Spirits, 110 annual "Girls' Night Out" in . The Green Eyeshade, Solum Port Townsend,Thursday,Oct.6 & Herbe, Dolce La Belle, The from 11 a.m.to 8 p.m. Candle Store and others. The A day and night of activi- bags contain socks, candles and ties and in-store events, special other small gifts. sales and snacks will be fea- In recognition of October tured at dozens of participat- as Breast Cancer Awareness ing businesses. Look for spe- Month, organizers encourage cial Girls' Night Out store sig- a $5 donation for the goody nage. The event is sponsored bags. Proceeds will go to the by Jefferson Healthcare Home Washington Breast and Cervical Health and Hospice and Homer Health Program,which provides Smith Insurance. MarinerBank low- to no-cost mammograms and SOS Printing also provide and health exams for local sponsorship assistance. women through the Jefferson Participating are more than County Health Department. 35 stores and businesses repre- This year's schedule includes senting downtown, the Fountain a variety of sales, extended District and from uptown, The hours and in-store promotions. Printery and Uptown Nutrition. Activities abound, including Merchants and Jefferson mini-massages, facials and foot Healthcare worked hard at pro- reflexology, decadent choco- viding Main Street with more lates and sparkly beverages, items for the evening's 500 goody meeting the inventor of a board bags. The bags, which can be game, fashion show, food sam- picked up at several of the partici- piing, holiday bow-making and pating businesses have contribu- wrapping demos and in-person • tions from the Susan B. Komen designer appearances. Breast Cancer Foundation, For details or more infor- Summer House, The Clothes mation call 385-7911 or e-mail Horse,William's Gallery, Ozone ptmainstreet@olympus.net Wednesday,October 5,2005•A 15 �' "' A i f r N p h i:' • ,, P. , _ 1 tw- 'fap' er ��r gPhr z,�fr�'-"�Y�' 4id'il 44 P 4' '{'x I .. J SF r,- .iiii „t �' . Y .: da; P. i'...,-,cJ f$x. t a 4,00 r2 fk M1!f J / e,,,c, ,) J } � P 1. ','fr,PA:74 k', f (h 1 h FA "' i e ��5:S0{ 1/h 0.,,!,/,'"',;40,',,,,,',� } r F4''fid'; F `i4 i u u.'�r,�J rte t{ f dNYA- d e' l ¢0x `fir ` v'llift rjfi, e dd�'r zi0'� ��ftr s...:?fe�Z.M�+'^P7..�: �J�a�'J.',.�.�N'.... --,it,'9 ' : )' j . .' I. ,-. , ') 9J- -- 6-I At ' (7• 1 Is'; 4 1 A, \ ,r, tt- . , . .a .,,.; ..,,, z ..,, c....)...) ri .....) "Women on a Mission" Thursday, October 6,;2005111am to 8pmIIII j *Mini-massages,facials *Decadent chocolates and.sparkly beverages! _ 1 *Special sales *In-person designer appearances j *Fashion/trunk show *In-store promotions and activities *Food sampling *Holiday demos * Extended store hours * Goody bags available for a$5 donation(benefits Jefferson Health Department - Breast&Cervical Health Fund).PICK UP YOUR GOODY BAG AT: MARINERBANK APRIL FOOL&PENNY,TOO 2313 E.Sims Way 725 Water Street HOMER SMITH INSURANCE MARICEE FASHIONS - 840 Water Street 913 Water Street US BANK SPORT TOWNSEND *71 1239 Water Street 1044 Water Street 4 ABOUT TIME THE CLOTHES HORSE 839 Water Street 910 Water Street THE GREEN EYESHADE PERSONALIZE IT! 720 Water Street 1007 Water Street Port Townsend Main Street Program 385-7911 with MarinerBank and SOS Printing • Sponsored by: /` COMPLETE BUSp!ReoNALINSURANCE Jefferson �R t @V1arinerBank. 116',14';''` '''. Healthcare Your on County CommunityBdnk ADVERTISING SUPPLEMENT TO PENINSULA DAILY NEWS PT CHAMBER OF COMMERCE Activities from shopping to symposiums ... abreast Cancer Awareness Month -- 1 '; s,','; BY MAR.JORIE BOYD and unexpected donation equipment and staffed '' JEFFERSON COUNTY from Port Townsend's by a radiology team from BEFORE PHOTO BY JASON TOWLEN.AFTER PHOTO BY MAR HEALTH DEPARTMENT Main Street Program Swedish Hospital in Ngan of Vietnam is one of thousands of October is Breast Can- from their Girls'Night Seattle. children helped through Operation Smile. cer Awareness MonthandOut event. Mammograms are with generous Mohelp from The timely gift cow- available by appointment m tribute to a wonde ered local BCHP services only and are for low- S 1 I 1 i i e cause. two community groups, for the last two months income women enrolled in Each year Ope Jefferson County Public of the fiscal year and the BCHP Program. Continued from 1 Smile, an organize Health will be able to pro- eliminated the need for a Interested women thousands of volui vide breast cancer screen- waiting list. should contact the cleft palates and other surgeons,dentists ing services to more This year the Main health department and facial deformities. specialized health women than ever. Street Program is plan- speak with Kate Minta In Port Townsend, professionals,perf The health depart- ping an even bigger about eligibility and to Dream City Photography surgeries on as m. ment is the local admin- Girls'Night Out and reserve a space. has pledged to con- needy children as istrator of the state's hopes to substantially The breast cancer sym- tribute 10 percent of all funding permits. Breast and Cervical increase their donation. posium is sponsored by portrait sales booked in Because of the i Health Program (BCHP), (See story on Page 4.) the Soroptimists. October to PPA Charities volunteers,it costs a program that provides The second group that It will be a full day of for Operation Smile. $240 to perform a low-income women with has been instrumental in lectures and panels cover- Our studio is actuallyoperation. free pap smears,breast helping is the Soropti- ing topics such as why expanding family portrait To date,they he exams and mammo- mists of Jefferson County. Washington state's breast month to include family, helped more than grams. For example,for the cancer rate is one of the children,headshots, children. Due to budget con- third year,mobile main- highest in the country, engagement portraits,pet For more infori straints and expanding mography services will be naturopathic treatment, photos and such. phone Dream Citi demand for services, provided.Swedish Hospi- nutrition,exercise, Additionally,we are tography at(360) CHP contractors across tars Breast Care Express immune system support, offering special packages 0947 or 888 Magi. iiiie state were forced to will be at the Uptown regional cancer services for groups during this visit www.Dreaml ut women on waiting Community Center as and treatment facilities promotion. Photography.com. lists toward the end of part of an all-day breast and more. So if your company, the last fiscal year as cancer symposium Satur- The event is free and organization or club funds ran out. day,Oct.29. open to everyone! Contact wants their pictures Giving Jefferson County was This huge trailer is Chamber member Nancy taken,this would be a braced to do the same but equipped with state-of- Stelow at 360-301-5308 great time to schedule a Continue received a very generous the-art mammography for details. photo session and con- In some ways, U G^ i story to employee groups. caring for its own. son at a time, positively vails the people o I v The campaign is a The annual campaign impacting our commu- Orleans are suffer great way to build morale is geared to attracting the nity more than most are similar to tho Continued from 1 and a sense of teamwork highest level of commu- know. affecting some of in the workplace. pity involvement by For more information, own neighbors. Business Campaign It lets everyone feel building public awareness to make a contribution Displacement, Committee will be calling good about giving back and inspiring everyone to or request a presenia- health care,food and visiting businesses to our community,know- support our friends and tion,please phone the other essentials and organizations ing the donations are neighbors in need. UGN office at 360-385- existing state of, throughout the county, being well-invested in UGN helps to change 3797 or e-mail for a segment of presenting the UGN the county's tradition of our local world, one per- ugnjeffco@waypoint.com. community, and not forget them. To make a con WWW !hn .r_COf•COm Find out whytion, please phon 385-3797,or ema Jefferson County's Daily Newspaper ugnjeffco@waypoi PENINSULA DAILY NEWS Shirley Rudolph,Associate Broker t . ;,,P f A Top Producer in Port Townsend Area is the Northwest's fastest growing newspaper. Cam ut at the for over 25 years,specializing in Call todayfor a special introductoryhome deliveryoffer P Sunday&Monday Residential and Commercial Sales 360 385 7421 4 pm to 9 pm 360-385-19,42-'-'Advertising • May I be of service to you? Psida its s ; M1 "' Casual Dinitrg iu our 360-379-4556 or 360-316-1041 �`re+- °r'° .'_a• I ! 24..•. ' asst - Dinner entrees fi»rn$1 . Sandwdcl�esserned on or" Ft et*Baked 1l`agr:saes: Tregetarian mom tI Business & Home ,+.r": or 3 w PC Repair, Sales A AnY Yk A MOTORINN Port Townsend&Jefferson County Leader Wednesday,October 5,2005 B 3 • ra S g 33 Pr sZ ::. Community Roundtable on h r t c are Oct heal . 5,: "Health Care: National and. Department of Health,;Office.of Local"is the subject of the inau- 'Community and Rural Health. • gural Community Roundtable : The concept is to have a group discussion intended to bringdiscussion, then split into:..five- together healthcare professionals member "roundtable" groups, to answer questions and generate with.each addressing a specific ideas for resolving problems. issue.Those groups will have a The roundtable is 7-9 p.m. limited time to develop and pres- Wednesday,Oct. 5 at Chimacum ent a response. Grange Hall, across State Route Community roundtables are 19 from Chimacum School. sponsored,`by Port Townsend- This roundtable initiates a Jefferson County Democracy series to be hosted on a bi- for America. Each' meeting is monthly basis. It is a free, non- intended to feature a speaker who partisan effort to learn more can address state and/or national about pressing concerns. aspects of specific issues, and Guest speakers Oct.5 are Jean another who can talk about local Baldwin,director of the Jefferson connections. It is intended to be County Health ,Department, informational, not point-coun- and.Mary Lookeof the state terpoint or political. eD1 = pp H c+" .,pg O O CY CC-G `7 n Ayl ^s c. c.cD 0 fOD Q.O (] Q) (C r} r n f'' f�D 1.y .; -. 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C"YcrrD' p °�" 1a ' 1' d .g. pcD' 'g m $i-ia s.' c+p a m m d m r 6 1 •,- , �-� illull - - - ‘ - C4 :.e ti;0 (g- ..,,:-'''' --7..:4vA:S''''''''',,,',, ' - • g? 0 , a In c . eve one • ere can e a u s e s Flu season is approaching, cards. Allothers $20. Insurance • QFC Pharmacy, 1890 have children's flu vaccines. and it's time for high-risk indi- cannot be billed.Established cli- Irondale Road, Port Hadlock. Up to Oct. 24, state-supplied viduals to get a flu vaccine. ents only. Thursday and Friday, Oct. pediatric flu vaccine is priori- Everyone can benefit from an • Jefferson Medical Group, 13-14 and Thursday, Oct. 27, tized for: all children 6 to 23 annual influenza vaccine, say 834 Sheridan St.,Port Townsend. noon-6 p.m. Medicare and months old (children under age representatives of Jefferson Saturdays, Oct. 15 and 29, 9 Medicaid patients bring your 9 receiving flu vaccine for the County Public Health.For many a.m.-noon. Medicare patients coupon or card.All others, $28 first time need two doses given people it is critical. bring your Medicare cards. All for flu shots, $35 for pneumo- one month apart); children with Influenza can strike anyone others $20. Insurance cannot be nia shots. chronic health conditions such and is especially dangerous for billed. • Safeway Pharmacy, 442 as asthma, diabetes or heart dis- young children and the elderly, • Monroe Street Medical Sims Way,Port Townsend,today, ease; children receiving chronic who are at greater risk for corn- Clinic, 242 Monroe St., Port Wednesday,Oct. 12,9 a.m.More aspirin therapy; children receiv- plications from the flu.At best, Townsend. Limited supply for clinics to be announced. ing immunosuppression therapy; catching the flu may result in high-risk only. $25 per shot. • South County Medical pregnant teens under age 19; fever, cough and a few days Call 385-5658 for an appoint- Clinic, 294843 Highway 101, children less than 19 years who lost from work or school. At ment. No insurance will be Quilcene. Mondays through are household contacts or care- its worst, flu can lead to pneu- billed. Thursdays, 5-6 p.m. for South givers of infants 0 to 23 months, monia, hospitalization and even •Olympic Primary Care,1010 County residents only. Medicare or of children with high-risk death. Sheridan St., Port Townsend. patients bring your Medicare conditions. This year, to help ensure that Saturdays, Oct. 22 and Nov. 5, cards.All others $20. Insurance After Oct. 24, state-supplied people at highest risk for serious 9 a.m.-noon. Medicare patients cannot be billed. Call 765-3111 pediatric flu vaccine is for the complications are vaccinated, bring your Medicare cards. All for an appointment. same groups and also for chil- the Washington Department of others $20. Insurance cannot be dren under 19 years who are Health urges people at high risk billed. High-risk children caregivers or household contacts to get vaccinated now.Beginning • Port Townsend Family The Washington State of any high-risk person. Oct. 24, everyone can get a Physicians, 934 Sheridan, Port Department of Health provides Jefferson County Public flu shot. Based on Centers for Townsend. Saturdays, Oct. 15 flu vaccine for children young- Health will have flu vaccine Disease Control and Prevention and 29, 9 a.m.- noon. Medicare er. than 19 who are high-risk only for priority group children projections, widespread short- patients bring your Medicare or are household contacts of a during walk-in immunization ages are not anticipated. cards. All others $20. Insurance high-risk person. Local clinics clinics, 1-4 p.m. Tuesdays and Those at high risk for coin- cannot be billed. that immunize children also will Thursdays at 615 Sheridan St. plications from the flu who should be vaccinated early include: people 65 years and older; residents of nursing homes or long-term care facili- ties; children and adults ages 2 to 64 years with chronic health ,conditions — including .heart or lung conditions, diabetes, asthma or suppressed immune system; children ages 6 to 23 months; all pregnant women; healthcare personnel who 'pro- vide direct patient care; house- ' hold contacts and out-of-home caregivers of children younger than 6 months. Get your shots • Currently scheduled influ enza immunization clinics:are as follows: • Dr. Richard Lynn, 1136 Water St., Port Townsend. Fridays, Oct. 21, 28 and Nov. 4, 11 and 18,8 a.m.-noon.Medicare ' l o/1 a/O,1— 3patients bring your::Medicare