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File Copy i Jefferson County Board-of 3-CeaCth. .agenda LM mutes March 15, 2007 a i JEFFERSON COUNTY BOARD OF HEALTH Thursday, March 15, 2007 Main Conference Room Jefferson County Public Health 2:30—4:30 PM DRAFTAGENDA I. Approval of Agenda II. Approval of Minutes of February 15, 2007 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Board Correspondence 2. On-site Sewage Operation and Maintenance Update 3. SmileMobile Comes to Port Townsend SV. New Business 1. Public Health Program Performance Measures 2. Legislative Update 3. Public Health Heroes Awards 4. Vibriosis in Puget Sound—2006 Outbreak and Implications for 2007 5. Medical Reserve Corps Recruitment in Jefferson County 6. Green Business Award—Quilcene School VI. Activity Update 1. Public Health Heroes Awards 2:30 pm, April 19,2007 VII. Agenda Planning VIII. Next Scheduled Meeting: April 19,2007 2:30 pm—4:30 pm Main Conference Room Jefferson County Public Health le L4kse1/4 404) JEFFERSON COUNTY BOARD OF HEALTH MINUTES tf Thursday, February 15, 2007 Board Members: Staff Members: Phil Johnson—County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan— County Commissioner District#2 Jean Baldwin,Public Health Services Director John Austin, Vice Chairman—County Commissioner District#3 Julia Dans kin,Nursing Programs Director Jill Buhler—Hospital Commissioner District#2 Mike McNickle,Environmental Health& Geoff Masci—Port Townsend City Council Water Quality Director Sheila Westerman— Citizen at Large (Ciy) Roberta Frissell, Chair—Citizen at Large(Couny) Meeting was called to order at 2:30 pm on February 15, 2007 by Vice Chair Austin in the conference room of Jefferson County Public Health. All Board members were present with the exception of Members Phil Johnson and Roberta Frissell. A quorum was present. APPROVAL OF AGENDA • Member Masci made a motion to approve the Agenda as presented. Board Member Buhler seconded the motion,which passed by unanimous vote. APPROVAL OF MINUTES Board Member Masci moved to approve the minutes of January 18,2007, as written. Board Member Sullivan seconded the motion,which carried by a unanimous vote. PUBLIC COMMENTS None OLD BUSINESS Seasonal Influenza Update Dr. Locke reported that influenza has arrived in the Pacific Northwest. A variety of surveillance indicators for influenza detection are used. School absenteeism rates above 10%, the number of x-rays being taken, and hospitalization rates have all been used as markers for seasonal influenza. There is a network of sentinel physicians who report the numbers of their patients who meet a set of criteria (known as influenza-like illness). School absenteeism rates are up in WA state and the Olympic Peninsula, sentinel physicians in Kitsap County are reporting influenza- . like illness, and King County virus culture tests are running about 30%positive for influenza. It is likely that there will be a rise in the levels of influenza over the next 3-4 weeks. It is possible to see multiple peaks in the season. The two strains of influenza A and one strain of influenza B being seen in Washington State are covered in this year's trivalent influenza vaccine. • Immunization Update for Physican's Offices Lisa McKenzie, Communicable Disease Program Coordinator, spoke to the Board about the meeting she and Jane Kurata, Immunization Program Coordinator, held with clinic nurses and doctors in January. The discussion centered on new vaccinations coming from the State Supplied Vaccine Program and vaccine recommendations. Lisa also spoke about CHILD Profile, a State Immunization Registry, where a child's immunization record can be viewed from a secure website, allowing for easier access and availability to these records by multiple providers. In the near future, all local clinics will be online. In addition to allowing prompt access to immunization records by health care providers, this system will allow JCPH to generate reports on immunization rates for the range of childhood vaccines given. Jean Baldwin added that these new vaccines have new target populations and spoke about the Federal Vaccine for Children Program and costs for various vaccines. Member Westerman suggested that a letter be written to the Department of Health in support of added funding to expand the coverage of the HPV vaccine for underinsured women 19 years and above. Member Buhler asked if Dr. Locke would speak to the Clallam County Board of Health asking for their documented support in expanding the coverage for the HPV vaccine. • 2006 BOH Action Items Thumbnail—Final Copy Jean presented the Board with the final copy of the Action Items and Thumbnail from the 2006 Board of Health meetings. The Thumbnail will be posted on the JCPH website. NEW BUSINESS HB 1825 /SB 5729 (Public Health Funding) Introduced Member Sullivan testified in Olympia on HB 1825 and reported that he spoke briefly to the committee,pointing out that Jefferson County invests at one of the higher rates per capita for local public health services. Much of this local support comes from the County General Fund but it is still not enough to cover increasing costs. Jean Baldwin spoke about Public Health Funding and Accountability Legislation. She reviewed with the Board some of the initial communicable disease prevention outcomes to be achieved with increased financing. Jean pointed out that the increased revenue is 'new' money dedicated to communicable disease investigation and tracking and other unmet public health needs. Other Legislative Issues Dr. Locke reviewed HB 1821 and HB 2012. HB 1821 proposes exemption from state registration for manufacturers of biological remediation technologies for use in on-site sewage disposal systems. HB 2012 creates an exemption from the registration process for proprietary • denitrification devices used in on-site sewage systems. Dr. Locke pointed out public health • concerns about devices that claim to fix failing systems. If the septic system is failing it is discharging infectious waste onto the ground surface or into surface or ground water. Septic systems additives have no proven benefit in preventing system failure or repairing failing systems. New technologies that claim to accomplish this goal need to be carefully evaluated. The two bills being discussed seek to have these two types on on-site sewage devices to be treated like septic system additives, seeking exemption from Department of Health evaluation and registration. Representative Van De Wege is a co-sponsor on HB 2012. Dr. Locke will call to express the Board's concerns. Mike McNickle expressed his concern stating that passage of these bills would make it a county- by-county decision whether or not to approve. Member Masci moved to generate a letter to legislators that states that the Board of Health is adamantly opposed to HB 2012 and HB 1821, enclosing a copy of the response letter dated January 2006 from similar legislation, stating that the Board of Health feels that this is not appropriate at this time and would reconsider in 3-5 years when appropriate science has been accumulated to demonstrate the efficacy of this product and procedures. Absent the science,we cannot support it. The motion was seconded by Member Sullivan. Member Westerman recommended omitting '3 -5 years'. Dr. Locke asked the Board to consider whether or not the Board feels on-site sewage system devices should be regulated or unregulated. • Member Masci amended his motion to read "until such time as adequate science demonstrates efficacy", and added, "as County Board of Health,we adamantly oppose unregulated products, if anything needs to happen it should be regulated based on scientific methodologies". Member Sullivan seconded the amended motion,which passed by unanimous vote. Mike talked to the Board about HB 1650. This bill requires an inventory of all septic systems in the county. Member Masci moved that Mike generate a letter of BOH pointing out that HB1650 is flawed and that it provides an unfunded mandate and is duplicative to previous legislations, ie; Marine Recovery Area legislature and as such should not be supported or passed this session. Member Buhler seconded the motion. During discussion Member Westerman stated that she was not in complete support of the letter as proposed. Member Westerman expressed that she would like the letter to include a funding piece. After in depth discussion it was agreed to rephrase the letter to include, 'the idea behind the proposal is good, as long as adequate funding is provided'. • The amended motion was seconded and approved by unanimous vote. Jean Baldwin spoke briefly about law enforcement officials, led by Seattle Police Chief Gil • Kerlikowske, who spoke at the capital to ask lawmakers to invest more state dollars in the Nurse Family Partnership program. Member Westerman motioned that the Board of Health send a thank you letter to Seattle Police Chief Gil Kerlikowske for his stand on this issue.Police Chief Connor Daily will receive a copy. Member Masci seconded the motion,which carried by unanimous vote. Dr. Locke spoke about the 2006 Annual Report published by the State Board of Health, which summarizes the prior year's efforts and the Washington State Health Report. The purpose of the Washington State Health Report is to propose priorities for the legislature and state agencies to use in making health policy and appropriation decisions. The State Board publishes the report every two years and tries to make it relevant to the people who are making decisions on how state resources should be spent. Member Westerman remarked that she would like the legislature to have direct involvement in the report as opposed to being just an audience. A motion was made and seconded to have Dr. Locke invite a representative from the State Board of Health to speak at a future Jefferson County Board of Health meeting. The vote passed unanimously. Leadership Development at JCPH Jean Baldwin informed the Board that she is joining the Jefferson County Community Network Board, assisting in writing a prevention plan. Issues ahead will include setting priorities and • finding ways to get private and public agencies involved. Jean also spoke briefly about the Collaborative Leadership Skills training series presented to various program leaders at JCPH. Jean said she has gotten positive feedback from staff. Member Masci suggested that Board members become more involved at JCPH, meeting with each division leader, in an effort to become better acquainted with programs thereby becoming an educated advocate for services. On-Site Sewage Operation and Maintenance Privatization Discussion Mike McNickle provided the Board with results from discussions with the PUD regarding the on-site sewage (OSS) Operation&Maintenance (O&M)program. A rough draft was shared with PUD at the meeting in January. There was discussion about the possible transfer of the O&M program to JCPH. Discussion also centered around PUD continuing to perform O&M on all large and community OSS systems in the county, a certification process for the private sector to become O&M Specialists to perform O&M work, the opportunity for homeowners to perform O&M on their own OSS, O&M reporting requirements, and enforcement strategies. Mike stated that PUD would consider this proposal and send a letter of intent to the Board of Health in March. Activity Update The Smile Mobile, sponsored by the Washington Dental Foundation, will be available March 12th — 16th at JCPH. The Smile Mobile provides screening and potential treatment for children 15 years and younger from low-income families. • • Agenda Planning Follow up on On-site Sewage Operation and Maintenance Meeting adjourned at 4:40 pm. Next Board of Health meeting is March 15, 2007. JEFFERSON COUNTY BOARD OF HEALTH Excused Roberta Frissell, Chair Sheila Westerman, Member • John Austin, Vice Chair Geoff Masci, Member David Sullivan, Member Jill Buhler, Member Excused Phil Johnson, Member • 9 Board of 3fealth Old Business .agenda Items # 117., 1 • Board Correspondence March 15, 2007 JEFFERSON COUNTY BOARD OF HEALTH • February 15, 2007 The Honorable Lynn Kessler PO Box 40600 Olympia, WA 98504-0600 Dear Representative Kessler: At the monthly meeting of the Jefferson County Board of Health, the Board discussed two bills seeking to exempt certain on-site sewage devices from registration with the Washington State Department of Health. HB 2012 seeks this exemption for devices sold to reduce nitrogen waste products in on-site sewage effluent. HB 1821 deals with"biological remediation technologies" for use in failing on-site sewage systems. On-site sewage systems play a critical role in assuring the safe disposal of infectious waste and protecting surface and marine waters from contamination. To assure that these systems are correctly designed, installed, and maintained the State Board of Health adopted a comprehensive • revision of on-site sewage system codes (WAC 246-272A) to be enforced by the State Department of Health(DOH) and local health jurisdictions. This code took years to develop and represents the state of the art in evidence-based environmental health practice. HB 2012 and HB 1821 seek to bypass this system of public health protection by allowing unproven, unregulated on-site sewage technologies to be sold and installed based solely on the representations of the device manufacturers. HB 2012 and HB 1821 exempt these devices from DOH evaluation and approval, treating them as simple plumbing fixtures subject only the "interim guide criteria standards"of a national trade organization. The Jefferson County Board of Health voted today to oppose both HB 2012 and HB 1821. Current on-site sewage rules create a fair and impartial system for the evaluation of on-site sewage technologies. Local health jurisdictions depend on DOH to evaluate devices based on these standards. Exempting devices from this evaluation process would seriously compromise the ability of local health jurisdictions to carry out our environmental health protection responsibilities. Please join us in our opposition to these unwise and potentially harmful bills. Sin ly, re J Austin Ve-Chair, Jefferson County Board of Health • 615 Sheridan St.,Port Townsend,WA (360)385-9400 • February 27, 2007 Governor Gregoire PO Box 40002 Olympia, WA 98504-0002 Dear Governor Gregoire: RE: Resolution#2007-06 Support for SHB 1825/SSB 5729-Dedicated Public Health Funding We are writing you today in your role on the House Appropriations Committee to ask for your support of SHB 1825/SSB 5729 to increase state funding for core public health services. In 2005 the Legislature appointed the bipartisan Joint Select Committee on Public Health Financing to explore the adequacy of state support for public health services. The committee concluded that there are serious gaps in our public health system and unanimously recommended$100 million of new funding in an account dedicated for local public health. Jefferson Healthcare and our local public health district work in tandem to provide our community with basic health care services. We can't do it alone. Our health care providers rely . on the Jefferson County Health Department for disease investigations and contact follow-up care for our patients; for technical advice and consultation on TB,rabies and emerging diseases; data on disease trends;and prevention work that reduces the burden on the Jefferson Healthcare system. Moreover, our work together in disaster preparedness is essential to our community. Obviously, effective public health is vital to our community. We know there are many claims on state funds, but Washington State ranks only 44th in per-capita public health funding. We can do better than that. Thank you for considering our viewpoint, and for the work you are doing to make Washington State healthier. We appreciate your help. Sincerely, Jill Buhler Commission President • JEFFERSON COUNTY BOARD OF HEALTH • March 1, 2007 Gil Kerlikowske Seattle Police Department PO Box 34986 Seattle, WA 98124 Dear Chief Kerlikowske, We, of the Jefferson County Board of Health want to thank you and praise you for going to Olympia on January 25, 2007 and testifying about the importance of investing money in home visiting programs for at-risk families. For 5 years our county has invested local dollars in the Nurse Family Partnership, we are feeling the benefit of decreasing child abuse and neglect numbers, improved school readiness, and decreasing welfare dependency. The problem is maintaining these efforts as we continue through a time of competing budget priorities. Thank you for taking time and testifying before the Legislators about the importance of a comprehensive approach to at-risk families to prevent crime, substance abuse, domestic violence • and improving school readiness. Evidence-based prevention programs lead to lasting results for individuals, families and communities, but prevention is a long-range commitment, not a quick-fix result. Prevention planning means fiscal commitments to prevention priorities over the years, and that continues to be difficult for public funding as we look at short term needs and long term programs that work. Thank you again for your time. We appreciate enhancing the partnership with the law and justice community. Sincerely, Roberta Frissell, Chair Phil Johnson, Member John Austin, Vice Chair Sheila Westerman, Member David Sullivan, Member Jill Buhler, Member • Geoff Masci, Member 615 Sheridan• Castle Hill Center• Port Townsend• WA (360)385-9400 • Board of 3-fealth Old Business Agenda Item # 117., 3 SmileNlo6ile Comes to Port 2-"otivnsend • _March 15, 2007 • Board of.7-CeaCth Netiv Business .agenda Item # 'V., 1 • Public Health Program Performance Nleasures NlarcFt 15, 2007 The Washington Dental Service Foundation SmileMobileillr. h. 40 �r �l@ ' s • The new SmileMobile is a modern dental office on wheels i(f) ,,it ,:F'" ® +'/ that brings oral health services to children who have no other ����� options for dental care; traveling across the state since July Zoo '` •.:� 1995. • The SmileMobile, on average,treats 6o children ages 15 and O'r Of sin.`t¢� younger each week. • Working in three dental operatories, a full-time dentist and local volunteer dentists and their staff are providing a range of services, from examinations and preventive services to fillings and minor oral surgery. Children with serious dental problems are referred for appropriate care. • Accept Medicaid and offer a nominal sliding-scale fee for those who are not eligible. Crisis in oral health care • Dental decay is the single most common chronic disease of early childhood, 5 times more than asthma. • • Nearly 60% of elementary school children in Washington have had dental decay. Our two-year olds are more than twice as likely as children nation-wide to have dental decay. • Dental neglect can lead to oral pain, recurring infections,badly decayed and lost teeth, eating disorders, undetected oral cancers and low self-esteem. The SmileMobile partnership • The SmileMobile, which began operating in 1995, is a partnership between Washington Dental Service Foundation, and Children's Hospital and Regional Medical Center. Since it first hit the road, the mobile clinic has treated more that 20,000 children throughout the state. • Coalitions of local health departments, community organizations and state agencies are providing volunteer coordination and support services. • Washington Dental Service Foundation is the state's largest foundation committed to improving oral health. Supported by its parent organization, Washington Dental Service, Washington Dental Service Foundation supports innovative oral health programs focused on preventing oral disease, expanding access to dental care and increasing awareness of the importance of oral health. • For more information, contact KARRI AMUNDSON or MONIKA FORO at WDSF, (206)517-6303 or(800)572-7835 ext 6303. Smile Mobile Port Townsend One week in March • Port Townsend 2004 2005 2006 Children Screened 69 63 49 Encounters 96 98 90 DSHS 55 44 34 Self-Pay 14 19 90 Children Receiving Treatment 15 18 28 Completing Treatment 14 18 25 Referred 7 5 Full Dentist Days 5 4.5 4.5 Volunteers 2 1 1 Days Worked 4 4 4 • • Jefferson County Public Health — Report Performance Measurers 2006 FAMILY SUPPORT •UDGETIPROGRAM: Community Health: Family Support Programs Maternal Child Health(MCH) including newborn follow-up, Child Birth education and Breast Feeding Support, Maternity Support Services (MSS)/Infant Case Management, Best Beginnings/Nurse-Family Partnership (NFP), Children with Special Health Care Needs (CSHCN), Women Infants and Children(WIC), and the Child Protective Services (CPS) Contract Programs: Alternative Response System (ARS), Early Intervention Program (EIP), and Passport. MISSION: The purpose of the Family Support Programs is to provide health and parenting education, skill building, support, and referrals to community resources to pregnant women and families with children. Services also include voluntary home visits to prenatal, post partum families, and families at risk of Child Protective Services involvement. These services are provided so county babies are born with the best opportunity to grow and thrive, the impact of health problems are minimized, and children receive the care and nurturing they need to become functional adults. GOALS FOR FY2006: 1. Maintain the current number of clients served through the Family Nurse Partnership Program (Best Beginnings) for Jefferson County residents. 2. Monitor Nurse Family Partnership Program replication by tracking data on program fidelity. 3. To assess the percentage of pregnant and parenting women receiving Jefferson County Public Health (JCPH) Family Support services, in which depression is an issue. 4. Continue to provide breastfeeding education and support so that all county mothers can provide their children with the physical and emotional benefits of breastfeeding. 5. Prevent nutritional related problems for pregnant women and children under five in Jefferson County. 6. Identify children with special health care needs in Jefferson County and assist families with health and development interventions and referrals as needed. 7. Provide services and information in Jefferson County aimed at preventing Child Abuse and Neglect. 8. Increase awareness and support of the Family Support Program mission through community presentation on the relationship of adverse childhood experiences and adult health problems. OBJECTIVES FOR FY 2006: 1. Support the Nurse-Family Partnership PHN's maintaining caseload intensity by providing opportunities for ongoing support and education both within JCPH and limited travel for other offerings such as the Washington State Consortium for Nurse-Family Partnership. 2. Send client data monthly to Nurse-Family Partnership program head office for assessment and evaluation. 3. Depression screening and education will be offered to all pregnant and parenting women who are participating in JCPH programs and appropriate referrals will be made for those who have a positive screen. 4. Through universal screening of newborns and their families identify those who may need referral to breastfeeding tea party or lactation consultation telephone, office or home-visits. Ongoing collaboration with JGH staff for lactation support will help ensure all families receive the services they need. 5. Provide WIC nutrition education and support to all eligible county women and children. 6. Provide developmental and health screening through JCPH programs including community outreach to Sproviders and the schools to identify children with special health and development needs and assist families in getting further evaluation and intervention services. 1 OF 2 7. Awareness and assessment of risk for child abuse and neglect is an integral component of all Family Support Service Programs. Referrals to CPS/DCFS will be made as appropriate and services will be provided to families at risk or involved in CA/N through the ARS and EIP contracts. 8. Continuing Best Practice Nurse family Partnership (NFP)program to prevent Adverse Childhood • experiences in at risk families to reduce youth and adult tobacco, drug and alcohol use. See Felitti Study. PERFORMANCE INDICATORS: 2005 2006 2006 Actual Planned Actual 1. Number of depression screenings completed 77 70 65 2. Number of newborn screened 135 90 145 3. Number of Home and Office visits provided for NFP, 1280 1500 1144 MSS, MCM, MCH and Breastfeeding consultation _ 4. Yearly report from Family-Nurse Partnership ** ** ** 5. Total number of women infants and children served by 871 900 829 WIC in Jefferson County(from CIMS report) 6. Number of children with special health care needs 89 60 81 receiving Public Health Nurse intervention through JCHHS. 7. Number of families served through CPS/DSHS contract. 16 20 20 ** Report yearly SUMMARY OF KEY FUNDING/SERVICE ISSUES: 2003 Jefferson County Health report published in May 2003 confirmed what the staff in the Family Support Programs has observed in their work in the community: `families with young children are very vulnerable'. Multiple factors contribute to this status: poverty, mental illness, substance abuse, and family abuse/violence. For many families these challenges have been transmitted across generations and now the newborns are vulnerable to these risk factors. Over the years of providing services through programs such as MSS/MCM, WIC, and for the last 8 years,Nurse-Family Partnership, staff has worked to increase knowledge and skills in a• committed effort to prevent and reduce the effects of these conditions. We are now able to effectively serve clients and families who previously were resistant, or too entrenched in complex psychosocial problems to accept services. Working effectively with these families requires a high degree of skill and support. These families, with multi-generational challenges, respond best to consistent, intensive services delivered over a long period of time. In 2005 JCPH received funding from Washington State Department of Social and Health Services,the Office of the Secretary, Dennis Braddock. This funding and a Community Network Grant help sustain Public Health Nurse (PHN) staffing levels in Family Support programs through 2005. JCPH did not receive additional funds in 2006. Maternity Support Services and Infant Case Management reimbursement revenue was reduced in 2005 and continued being reduced in 2006. With these funding reductions and increase staff expenses JCPH did not fill a position that was vacated due to retirement in the summer or 2006. JCPH Family Support Program was able to continue to provide Nurse Family Partnership to clients that qualified and wanted the service. Universal Newborn Follow-up continued as needed. All newborn referrals were contacted and home visits were provided to those who wanted the service. Department of Children and Family Services, Child Protective Services contract: Alternative Response Program and Early Intervention program revenue was down in 2006. Management is reconsidering those contracts for 2007. February 22, 2007411 2 OF 2 Jefferson County Public Health — Report Performance Measurers 2006 POPULATION & PREVENTION SUDGET/PROGRAM: Population & Prevention Programs Raising Healthy Community Grant (HC), Tobacco (TP/C), School Health(S/H), Childcare health and Safety (CC), Peer-In (PI), Oral Health(OH), and Drug and Alcohol prevention (DA) MISSION: The purpose of the Population & Prevention Programs is to provide health education and public health interventions to county residents in order to promote a healthier community, prevent disease and unintentional injury, improve the quality of life and reduce disparities in health. GOALS FOR FY 2006: 1. Improve identified social and health indicators for school-age youth(S/H) 2. Improve air quality for Jefferson County residents in business community(TP/C) 3. Enhance the quality of child care provided in Jefferson County (CC) 4. Enhance the overall health & safety of Jefferson County children(PI) and (OH) 5. Support Healthy Youth Coalition functioning (HC) 6. Reduce favorable attitudes toward problem behavior within the youth and adult communities. (DA) 7. Delay age of initiation of problem behavior. (DA) 8. Reduce adverse childhood experience as measures by reduced CPS referrals (DA) OBJECTIVES FOR FY 2006: 1. Maintain delivery of school in-service/trainings, student health screenings, student health consults, student health care referrals (S/H) • 2. Support Tobacco Smoke Free Doorway initiative in Downtown Business Community(TP/C) 3. Maintain child care provider consultation re: health, immunizations, safety and child development(CC) 4. Peer educators will provide school health classes to middle & high school students (PI); health education classes will be provided to elementary, middle & high school students; and increase Oral Health prevention interventions. 5. Maintain number of Healthy Youth Coalition meetings annually 6. Increase the perception of risk for youth regarding alcohol and marijuana use, especially for 6th, 8th, and 10th grade students.(DA) 7. Increase access to adults with healthy beliefs and clear standards for 4th through 6th grade students in Jefferson county.(DA) 8. Provide Early Intervention services to at risk families to prevent adverse childhood experiences. (DA) See Felitti study showing how adults who had reported greater than 2 Adverse Childhood Experiences had increased health problems including tobacco, drug and alcohol use. See Family Support services program performance measures. PERFORMANCE INDICATORS: 2005 2006 2006 Actual Planned Actual Number of student health screenings 1559 1550 1398 Number of Businesses participating in Smoke Free Doorway 2 6 initiative(TP/C) Number of Peer-In educational presentations 50 50 50 her of school health classes 208 240 240 11111Pber of phone calls to WA State Tobacco Quit line from Jefferson Co. 73 60 70 Number of Healthy Youth Coalition Meetings 8 8 8 Number of classroom presentation/interventions (Drug and Alcohol 136 140 124 preventions) Number of students served in the class room presentations 431 200 317 * December 2006 new law passed prohibiting smoking within 25 feet of doorway to businesses SUMMARY OF KEY FUNDING/SERVICE ISSUES: Jefferson County Public Health(JCPH)delivers programs that promote healthier communities and individuals. A Focusing public funds on prevention programs have proven to be cost effective. JCPH did not find funding in 2006 to continue to collect Assessment data to assist in determining community needs and prioritize services (substance abuse,domestic violence and child abuse and neglect). The Juvenile Justice Grant, Healthy Communities grant was applied for and was awarded to continue in 2006 with in-kind services providing intervention and prevention programs to identified children in vulnerable families. The Grant is up for renewal this spring 2007. These services include work in the schools and supporting Big Brother/Big Sister program. Besides the Healthy Communities grant,the above programs provide universal prevention programs available to all in the community. State prevention health services monies come with extensive evaluation components. Tobacco, Peer-In and Healthy Communities funding have community specific goals and measures that must be met to maintain funding. School funding is based on State School Nurse corp. funds and contracts with school districts. For the 2005-2006 school year administrators at Port Townsend and Chimacum School Districts chose to forgo scoliosis screening on a trial basis but then changed their mind and scoliosis screening continued this past year. There is new legislation that will change this school requirement in the future. Decreasing enrollment caused only slight changes in the number of classroom presentation and the number of students served. Drug and Alcohol prevention services continues to work with Community Health programs providing integrated prevention services. Prevention funds are utilized primarily through the school based,proved effective, Best Practice Programs. These funds allow prevention specialist to reach the vast majority of middle school students. February 20, 2007 Jefferson County Public Health — Report Performance Measures 2006 TARGETED COMMUNITY HEALTH •UDGETIPROGRAM: Targeted Community Health Services Family Planning, Breast and Cervical Health Program, and Foot Care MISSION: The purpose of the Targeted Community Health Services is to provide outreach, access, health education, support treatment to specific populations in Jefferson County in order to improve the health of the community. Specific program purposes are: • Family Planning: to provide reproductive health, clinics, outreach and education for Jefferson County residents in order to promote health and well-being and reduce unintended pregnancies. • Breast and Cervical Health Program: provide public education and health screening services to women age 40-64 with low incomes and no or limited health insurance in order to assure early detection and treatment of breast and cervical cancer. • Foot Care: provide foot care and health outreach to Jefferson County seniors to prevent health complications. GOALS FOR FY 2006: 1. Insure access to breast and cervical health exams to women age 40 to 65 years old. 2. Decrease unintended pregnancy rates in Jefferson County(measure)/Assure Family Planning Services are provided in every community 3. Support seniors' independence by maintaining their mobility OBJECTIVES FOR FY 2006: 1. Track Family Planning usage patterns and produce annual report 2. Maintain breast and cervical health program in Jefferson County 3. Emergency contraception to be provided under standing orders, 5 days per week, and expand community education and clinical services 4. Maintain the current level of community foot care and continue expanding into home care PERFORMANCE INDICATORS: 2005 2006 2006 Actual Projection Actual Number of unduplicated clients served in Family Planning 1242 1600 1257 _ Number of adolescents under 19 served in Family Planning 314 330 332 Number of Breast & Cervical screening exams 116 100 122 Number of foot care contacts 2594 2400 2765 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Jefferson County Public Health (JCPH) provides the only Family Planning program in east Jefferson County. Family Planning is considered a Critical Health Service by the State Board of Health. In 2006 management of Family Planning Clinic changed to a team approach with a lead position coordinating the clinic. Working as a team the staff have come up with creative solutions to clinic flow issues, billing changes, scheduling and client issues. Revenue from Medical assistance decreased slightly and was offset by a slight increase in fees collected. The Breast and Cervical Health Program addresses the need for Cancer screening and early treatment to decrease deaths from breast and cervical cancer in Jefferson County. With a slight increase in funding in 2006 and donation from Port Townsend Main Street Women's Night out we were able to increase current level alservices in BCHP. Jefferson County has a high percent of over age 85 citizens. JCPH Foot Care Program 1ps this population maintain independence and mobility in a rural community. The Foot Care program continues to provide needed services to the Senior population in Jefferson County. January 31, 2007 • Board of 3fealth New Business .Agenda Item #17., 2 • Legislative Ilydate .March 15, 2007 • • i "j-� ;21,:; 1;::,f,:,,,4,, f iii 4; k„:,,::!!!!: ,,:t',:4.1".,,11';1%,,,,r; ,x ;'4,,'::"`1:.1::4'::::.:4,:i;' ;;1';(' '” -P:'14;''''' ` te' woo/ ''-;,.;,''''':O.,:'' . r " �:, e 1// �� '� '�. �. "� r..,,.`9 Vie,, s �..i' �, �i /�� ;� LU February 2007 A publication for the members of the Washington State Medical Association In this issue Asking legislature for major infusion Newsclips 2 Local public health departments: Order your free copies of p Big WSMApatientnewsletter gap between funds and needs today 2006/2007 WSMA By JEAN COLLEY Membership Directories number of county public health departments in this state Washington hospitals agree to discounts for uninsured are being held together with almost the financial equivalent patients of chewing gum and bailing wire. Years of under funding wsMA online Career Center have pushed Washington down to 44th among the states connects you and your staff in per capita spending for public health. with career opportunities THE WSMA, LOBBYING through the jurisdictions.The roundtable is also lobby- . Update from Physicians Public Health Roundtable, is a key propo- ing for a dedicated source of funding— Insurance 4 nent before the 2007 legislature of signifi meaning from a specific ongoing tax— Informed consent: cantly increased state funding to Washing- rather than piecemeal from a general Using the new CMS ton's 35 local county-based health appropriation each biennium. (Public health guidelines ,, is funded from an array of sources, i.e., state 3i WSMA 1.: a.:‘, 1® '9 ; e �11 and local taxes, user fees and federal grants.) Insurance nce h' 1'I to:Orae t. The governor has allocated$10 million is in additional funds for public health in her National Provider Identifier: Midst of Chaosp 2007-2009 proposed budget. However, the Time's running out HE;ANNUAL WSMA.Leadershiroundtable says much more is needed. "To Development Cor ference will be ::: really fulYfill the potential of public health to RiskManagement held Friday,May,= and Saturday;'' help improve the health of this state's Broken glass,appendicitis May 5 at Campbells Lake Chelan population,we need a substantial infusion and lab screens gone awry and Conference Center. of new funds," said Hugh Maloney, MD, Featured speakers will be Jim Rein WSMA president. "We've recently seen a GoodBooks s fist 10 ertsen, MD on'"Physician Leadership drop in lung cancer rates nationally that is and Patient Safe "and Wa ne Sotile attributable to smoking cessation programs Fear of whatever Y and highly visiblepublic health campaigns. PhD on"Resilient Physician Leadership g Y Portraying surgery: Though Difficult Times." We need to keep getting those messages out Ahead of his time Dr. Reinertsen will talk about steps there; local public health departments are that physician leaders can take to achieve essential in that role."Issferl 13safety and high reliability in their organi In fact the Joint Select Committee on zations He will also talk about what was Public Health Financing, a task force Newsmakers 1 learned during the 100,000 Lives created by the legislature to study public campaign and the new'5 Million Lives health needs, recommends a funding ", campaign, both'from the Institute for package valued at$100 million.The Healthcare Improvement. Dr.Reinertsen WSMA supports the joint select commit tee's funding request.The committee, continued on page 2 chaired by Rep. Shay Schual-Berke, MD was a subcommittee member for the continued on page 3 Public health officials say Local public health • continued from page the highest and most urgent (D-Des Moines), spent close to two happen.We know how to contain these priority statewide is to • years studying the status of public diseases, but we don't have the strengthen communicable health in this state. resources to do so consistently through- disease prevention and the "In many respects,we are a leader in out the state.We see the highest disease public health, but the infrastructure of outbreaks where we have least resources response infrastructure. local health departments is crumbling," to contain them." said Rep. Schual-Berke. The goal of public health,he said, is individual, it may take six months "Public health is so _- ,',- to find 95%or more of those cases. "We before the worker is ready to start essential,so critical to don't get anywhere close to that goal." working in the community. If that the well-being of theIn a time when communicable individual is then laid off because of state and so underdiseases can spread from one area of budget cuts, the investment comes to funded that it merits the world to another via a single naught. "It takes time for prevention significant [additional] airplane full of passengers, early case programs to work," said Dr. Locke. funding."The commit- Schual-Berke,MD detection is even more essential, However, the legislature is under tee proposes that the several observers said. intense pressure from other quarters— additional dollars come from tobacco Larry Jecha, MD, public health education proponents as well as other taxes that are not currently dedicated to officer for Benton-Franklin Counties health care groups—to increase their any specific purpose. and interim public health officer for funding. The joint select committee report Spokane Regional Health Department The joint select committee high- concludes that "core public health (and WSMA board member), said that lighted tremendous variability in local functions" should be consistently if local health departments had the spending per capita on public health available statewide.These functions manpower and means to monitor and called for mechanisms to disperse are stopping"communicable disease, emergency room and physician office the additional funding equitably across promoting health, investing in healthy visits they would be able to detect a the state. "It doesn't seem safe for the families, protecting against environ- myriad of communicable disease state as a whole to have such variation mental health risks, and helping outbreaks much earlier. "We should in spending," said Rep. Schual-Berke. • people access care."The report also have a real partnership with commu- The variations reflect differences in tax recommends that local health jurisdic- nity physicians," he said. "We need a bases, differing levels of demand on tions attain an acceptable level of lot stronger surveillance program.And the local public health system (higher performance with respect to core we're in favor of accountability." particularly in areas with large concen- functions in order to receive additional The payoff for a greatly improved trations of low-income and immigrant funds. For instance, they might be public health infrastructure might not populations) and government spending asked to meet targets for higher be apparent for years,however.That on law enforcement,jails and courts. immunization rates or lower commu- makes it a tougher sell with the legisla- If the legislature does approve nicable disease rates. ture,which tends to be more focused additional funding, local governments Public health officials told the joint on immediate needs and demands. would not be off the hook for funding select committee that the highest and most That's also why public health officials public health.The joint committee urgent priority statewide is to strengthen are seeking a stable, dedicated source of recommends that to qualify for the communicable disease prevention and the funding. "We have boom or bust additional state funding, local govern- response infrastructure. program funding right now," said Dr. ments should be required to maintain Tom Locke, MD, public health Locke. "That's especially damaging if at least their current level of spending officer for Clallam and Jefferson you're going to have your greatest for public health. Counties,said that disease case investi- benefits over decades." gations are at the very top of unmet To get the legislature to appropriate local public health needs. Once a public additional money is going to be a"real COMMUNICABLE DISEASE SURVEILLANCE IS health department receives a report of a uphill struggle," he added. "We're only one of the responsibilities of communicable disease—for instance trying to make the argument that public health departments with a chlamydia or gonorrhea—from a lab or public health investments tend to be funding gap. In King County last fall, other source, ideally public health case very cost effective.The communicable only after King County Executive Ron workers find and treat the individual diseases that you fail to prevent are very Simms intervened did the county and their contacts. "That just doesn't costly to treat. By stopping them,you reverse a decision to close two public • happen,"said Dr. Locke. "And it means can reduce medical care costs." health clinics and a dental office for that these communicable diseases But public health programs tend to budgetary reasons. He called the public spread more broadly, have more impact have start-up costs.When a county health system "increasingly fragile" and and affect more lives than needs to hires a communicable disease outreach continued on page 9 16444 REPORTS FEBRUARY 2007 3 Be sure to use your clinical impression as well as the lab Illediately train was on the tracks."They a tad different. results before deciding what notified CPS of the mix-up. Case 1 deals with glass as a possible to do.When the two differ, The Group Health clinician and foreign body. Some authors today urge tend to stick with your clini- the lab director wrote separate letters a radiograph for any glass-related injury cal impression until the lab of apology for the mistake, and the lab (despite the lack of randomized double- director p hand-delivered his letter to blinded controlled trials) except for the results are confirmed. the mother. most superficial ones,like this one However,according to the mother, apparently was. Even visualizing the provided that the original allegation is CPS didn't slow down. On KIRO Radio's bottom of the wound does not neces- not considered to be substantiated. Dave Ross talk show in early January,the sarily exclude a foreign body—and In Cases 5 and 6,remember to use claim was made that CPS files in such some glass specimens simply don't your clinical impression as well as the cases are never closed or destroyed! appear opaque enough to be consis- lab results before deciding what to do. Cases 5 and 6 tently detected. So if you X-ray and the When the two differ,tend to stick with These cases are also from the Washin - findings are negative, urge the patient your clinical impression until the lab ton Poison Center.Just before Christg to return if the pain fails to resolve. results are confirmed. In neither Case 5 ton a middle-aged woman was admit Regarding the disagreement over direct nor Case 6 did the story and the clinical ted after a suspected medication supervision of the PA—the laws vary findings really mesh with the lab by state. In our state, the PA can findings. While the stories were being overdose to a psychiatric facility associ ated with Seattle's Swedish Medical function at locations remote from the checked out again and again,so, too supervising physician. were the lab findings,to the credit of the Center/Providence. Screening revealed a Case 2 raises the question about laboratory leaders and their staffs. therapeutic level of aspirin and nothing imaging—what The next day her aspirin level used to be"flat-plates"of the abdomen and now are CTs.In late What can you do? remained the same.When contacted,I December,the Wall Street Journal ran a Today's clinicians—like those of urged the screeners to look for the yesteryear—still have to be professional story, "Worries Mount Over Excessive ossibility that the patient was taking CAT Scans,"leading with a 23-year-old skeptics as they listen to histories on >irin surreptitiously. But over the next woman who had 9—count them 9!— the one hand and as they review lab two days, the ASA level remained scans in one week.They stopped only data on the other.The trick is to constant and no intake was uncovered. when the parent complained. remain skeptical like I am on Monday During this time, a 60-year-old CT scans increased more than 50% but not to develop cynicism as I man with an observed overdose of between 2000 and 2003 in the U.S. occasionally do by Friday. Most aspirin tablets was brought to the when they hit 57 million. Lots of patients and virtually all labs want to institution's emergency department. communicate the right information to His blood salicylate level was reported activity to reduce the associated g to be 300 mgs%!When I was called, I radiation—and lots of review by us—they really try to do so—but it is up to us to remember the possibility of managed-care institutions followed. said the patient was either dead—or One review discovered that an HMO a mistake in their message. Don't there had been a lab error.The ED patient had had 341 CT scans over an overlook the possibility that the error physician immediately contacted the 18-month period.The patient was was really not theirs but in our percep- lab. The technician and the laboratory exposed to 992 millisievertsf radia- tion of what we heard. So maybe the o director quickly found that aerror in communication was really ours computer adjustment made two weeks tion—clearly, too much. previously had introduced a single Case 3 aims to let the reader know in the first place. • decimal-place error. The man's 300 that the courts abide by what the law Local public health • continued from page 3 says—and if it seems to be unfair, the level was really only 30 (therapeutic range) and the woman's 30 level was court challenges the law to correct any said the state needs to help find a long- errors involved. term stable funding solution. actually only 3, which is simply the g Case 4 reminds us that the behavior Said Dr. Locke, "We're going to see reflection of background noise. As has been our repeated experience, under suspicion—purposeful child another big round of cutbacks and the laborato err el were extremeabuse—has been recognized for only layoffs in local health departments. ry P some 40 years. Suspicion is a sword We've been struggling to han on professional and helpful in their approach gg g g that can cut two ways: to protect the hoping for the best from the joint select and attitudes.The institution,on its own, •iuced charges appropriately. child or to destroy the family. Contrary committee." • to the Dave Ross radio show assertion, Discussion CPS purges its computers of individual The first two cases reiterate traditional records after five years if no other messages to readers while the others are allegations have been made and M444 REPORTS FEBRUARY 2007 9 • Board of aCealth New Business .agenda Item #T., 3 Public 3-feaCth 3-feroes • Awards _Marc( 15, 2007 News Release Public Health Heroes . March 09, 2007 Contact: Jean Baldwin Jefferson County Public Health (360) 385-9400 National Public Health Week is April 2-8; the theme in 2007 is 'Take the First Step! Preparedness & Public Health Threats'. Join us in nominating local Public Health Heroes; tell us their story. Jefferson County Public Health (JCPH) began honoring Public Health Heroes as a way to locally celebrate National Public Health Week. The annual public health awards honor people who live or work in Jefferson County and promote Public Health in their daily lives. Nominations are open to the public through Tuesday, March 27th. Please send in a nomination for an individual, agency or group you feel is making a difference in the health of Jefferson County. Public Health is: Helping communities to be healthy places to live, work and play. Provides reliable information you can use to make healthy choices, protects our communities from hazards in the environment. Public health works to prevent health problems before they occur. The focus is on improving an entire community. Public • health helps people achieve a healthier lifestyle. What is a public health hero? A public health hero is a person or organization that promotes public health in their daily lives. Public Health Hero awards could represent the following categories but is open to others: • Community Health Promotion—The Community Health Promotion award honors individuals or groups whose efforts increase the quality of life in the county. • Public Health Leadership—The Public Health Leadership award honors those in our community who have provided leadership in creating policy solutions that assure, promote, and protect the community health. • Business—Business's merit awards for environmentally sound practices but many make healthy choices in what they sell, how they support employees, and how they promote community health. • Community-Based Organization—Community Based Organization awards recognize those who provide infrastructure and services that promote public health in a variety of ways. • Special Recognition Award—Special Recognition Award for the Public Health Hero who helps us to identify a problem and help the community work towards its resolution, e.g. planting trees, building trails, promoting physical exercise or health diets, or fitting children's car seats. • I know someone in mycommunitywho is a public health hero. How do I nominate • them? The Jefferson County Public Health is taking nomination until March 27, 2007. Nomination forms are available online www.jeffersoncountypublichealth.org or by calling (360) 385-9400. Can I nominate more than one person or group? You can nominate as many deserving people or groups as you like. How do I return the nomination form? Pick it up at the Courthouse, Jefferson County Public Health or down load one at www.jeffersoncountypublichealth.org & return the form: • You can mail it: Jefferson County Public Health, do Public Health Heros, 615 Sheridan St., Port Townsend, WA 98368 • You can download the online form at www.jeffersoncountypublichealth.org • You can email it to www.jeffersoncountypublichealth.org • Or you can fax it to: (360) 385-9401 • • Board of 3leaCth New Business Agenda Item # /V., 4 • 'Vibriosis in Puget Sound .March 15, 2007 • art;` A Monthly Bulletin on Epidemiology and Public Health Practice in Washington State Summertime in Washington Reports of enteric and zoonotic conditions tend to increase in summer months. Two different conditions have been prominent this year in Washington. Vol. 11 No. 8 bris Vibrio parahaemolyticus are bacteria occurring naturally in Pacific coastal waters, particularly during warmer months. Infections are characterized by one to three days of diarrhea,abdominal cramps,vomiting,fever,and chills. Persons with immune deficiency or chronic liver disease may have severe illness. Vibriosis is often associated with consuming raw or undercooked shellfish,with onset of symptoms about 24 hours(range 2 to 48 hours)after consumption. From June through mid-August,2006,Washington State Department of Health received over a hundred reports of V parahaemolyticus infections, the highest number ever reported. For comparison,the state averaged 20 cases of vibriosis annually during 2000- •004. Other states also reported cases with consumption of shellfish from the Pacific Northwest. Unseasonably warm temperatures and afternoon low tides are thought to be y major contributors to this outbreak. Stool testing should be done for patients with acute gastroenteritis and a history of recent shellfish consumption. Request specific culture for Vibrio or vibriosis so that appropriate laboratory methods can be used. Report suspected or confirmed cases to local health jurisdictions: http://www.doh.wa.gov/LHJMap/LHJMap.htm To decrease the risk for vibriosis or other infections,thoroughly cook shellfish(heat oysters to 145°F)and avoid contaminating other food with raw shellfish or their juices. Cooking guidelines vary for each type of shellfish and are available from FDA at http:// www.cfsan.fda.gov/—lyd/seafsafe.html or by telephone(888-723-3366). Some shellfish harvest areas in Washington have been closed as a result of implicated [. z woug.vswer.w.medaf product. Oysters from these areas have been recalled by Washington state shellfish- i Health control authorities. Because vibrios multiply rapidly,even low levels of V. parahaemolyticus can rapidly increase to infectious levels if products are not maintained epiTRENDS at proper temperatures during transport,processing,and storage(i.e., <50°F [<10°C]). P.O. Box 47812 Olympia,WA 98504-7812 Updates on closures of recreational beaches and commercial growing areas can be found under News items on the agency's Web site at: Mary C. selecky Secretary http://www.doh.wa.gov/ Maxine Hayes,MD,MPH !, Information about vibriosis is available at: State Health Officer http://wwdoh.wa.gov/ehp/sf/Pubs/Vibriosis.htm Jo Hofmann,MD w State Epidemiologist for fif report of the outbreak is available at: j Communicable Diseases http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d807a1.htm Deborah Todd,RN,MPH Managing Editor Marcia J.Goldoft,MD,MPH Scientific Editor Continued page 2 brio parahaemolyticus</I>Infections Associated with Consumption of Raw Shellfish--- Three States, 2... Page 1 of 4 • r D•• CDC Home (Search Health Topics A-2 ;,', C August 8, 2006!55(Dispatch);1-2 Vibrio parahaemolyticus Infections Associated with Consumption of Raw Shellfish --- Three States, 2006 During May 20--July 31, 2006, New York City,New York state, Oregon, and Washington health departments reported a total of 177 cases of Vibrio parahaemolyticus infection, of which 122 have been associated with 17 clusters. A cluster has been defined as a group of two or more ill persons who were linked to the same shellfish source (e.g., shared a meal at the same restaurant or obtained shellfish from the same seafood market). Certain clusters were associated with restaurants, certain clusters with seafood markets, and certain clusters with recreational harvesting. Three patients were hospitalized; no fatalities have been reported.No demographic (e.g., age, sex, or race) or medical history(e.g.,predisposing conditions) information is yet available regarding affected persons. A confirmed case of V.parahaemolyticus infection is defined as an infection confirmed by isolation of the organism from a patient's stool. A probable case is defined as gastroenteritis in a person who can be epidemiologically linked to a confirmed case. Of the 177 V.parahaemolyticus cases reported, 72 are confirmed and 105 are probable:New York C4111)(two confirmed, 74 probable), New York state (seven confirmed), Oregon(eight confirmed, eight probable), and Washington(55 confirmed, 23 probable). This incidence of infection is much higher than expected; during May, June, and July 2000--2004, these jurisdictions reported an annual average of 16 laboratory-confirmed V. parahaemolyticus cases to CDC (Figure). The number of confirmed cases in this report(72) is more than the average number reported during May, June, and July, during 2000--2004, in the entire United States (Figure). Subtyping of V.parahaemolyticus isolates has indicated that 18 of 23 isolates tested are serotype O4:K12,which is unrelated to the pandemic strain that was first identified in Asia in 1996 and later emerged in the United States in 1998 (1,2). Traceback investigations have linked contaminated oysters and contaminated clams to harvest areas in Washington and British Columbia, Canada; shellfish from these sources were distributed to seafood markets and restaurants nationwide. Ongoing investigations are being conducted by state and local health departments and regional Food and Drug Administration (FDA) shellfish-control offices to identify additional sources of infection. Additional infections likely have been undetected, underreported, or both. V.parahaemolyticus infection causes acute, self-limited gastroenteritis typically characterized by diarrhea, abdominal cramps, nausea, vomiting, fever, and chills of 1--3 days duration,with onset usually within 24 hours after eating contaminated food. Cases are most commonly reported during warmer months and are often associated with eating raw or undercooked shellfish or other cooked foods that have been cross-contaminated by raw shellfish. Previous local V.parahaemolyticus outbreaks have coincided with large increases in sporadic cases nationally, suggesting that identified clusters are most often manifestations of a wider increase in illness (1). Studies suggest that approximately 20 V.parahaemolyticus illnesses exist for each laboratory-confirmed case reported to CDC (3,4), uiirscoring the need for enhanced national surveillance and control measures. Shellfish harvest areas in the United States and Canada that were previously implicated in V.parahaemolyticus outbreaks are routinely monitored by state shellfish-control agencies to control transmission of these illnesses. ttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d807a1.htm?s_cid=mm55d807a1_e 3/8/2007 'ibrio parahaemolyticus</I>Infections Associated with Consumption of Raw Shellfish--- Three States, 2... Page 2 of 4 Despite acceptable V parahaemolyticus levels detected by routine testing of shellfish in these areas, as of July 31, 2006, eight shellfish harvest areas in Washington had been closed to harvesting because their oysters were associated with this Vibrio illness outbreak. Oysters from these areas have been recalled by Washington state shellfish-control. authorities. Shellfish bed monitoring is an important element of food-safety control but is not sufficient to prevent illnesses caused by Vibrio organisms. Because vibrios multiply rapidly, even low levels of V.parahaemolyticus in harvested products can rapidly increase to infectious levels if not rapidly refrigerated after harvest and maintained at proper temperatures during transport, processing, and storage(i.e., <50 F [<10 C]). Medical providers should request stool specimens from patients with acute gastroenteritis and a history of recent shellfish consumption. The microbiology laboratory analyzing the sample should be notified that Vibrio illness, or vibriosis, is suspected so that appropriate methods (ideally, culture in the selective medium thiosulfate-citrate-bile salts-sucrose [TCBS] agar) can be used to isolate the organisms. Vibrio species grow readily in blood agar,but primary isolation of the organisms from stool samples is problematic because extensive screening is required to differentiate vibrios from other enteric organisms (5). Vibrio species infections should be reported to the appropriate health jurisdiction. Although infection with V. parahaemolyticus is not currently a nationally notifiable disease (as is cholera, the disease caused by cholerigenic strains of Vibrio cholerae),* CDC has conducted voluntary case surveillance for laboratory-confirmed noncholera Vibrio species infection since 1988. In June 2006, the Council of State and Territorial Epidemiologists recommended that all Vibrio species infections be classified as nationally notifiable diseases. The current outbreak underscores the benefits of coordinated national surveillance. Consumption of raw or undercooked shellfish is a recurrent source of human illness, including sporadic infections and widespread outbreaks. In recent years, the most commonly reported pathogens associated with these infections have been V parahaemolyticus, Vibrio vulnificus, and norovirus, but outbreaks of hepatitis A and cholera also hav been reported. To decrease the risk for V.parahaemolyticus infection, shellfish should be thoroughly cooked to kill illness-causing pathogens.t In two of the New York City clusters in this report, vibriosis was associated with cooked seafood (e.g., cooked lobster, scallops, crab, or shrimp) that was eaten in a restaurant, suggesting that the food might have been cross-contaminated by raw shellfish after cooking. Some commercially available oysters have been treated after harvest to reduce the levels of Vibrio bacteria. Improved surveillance for V.parahaemolyticus, in addition to increased use of postharvest treatment to decrease Vibrio species levels, and careful postharvest temperature control of shellfish during transport,processing, and storage are critical to limiting V parahaemolyticus infections. Reported by: S Baiter, HHanson, L Kornstein, L Lee, V Reddy, S Sahl, F Stavinsky, New York City Dept of Health and Mental Hygiene;MFage, G Johnson, New York State Dept of Health. JBancroft, W Keene, Oregon Dept of Human Svcs. JKoepsell, M Williams, Public Health Seattle and King County; K MacDonald, NNapolilli, J Hofmann, Washington State Dept of Health. CBopp, MLynch, KMoore, JPainter, NPuhr, P Yu, Div of Foodborne, Bacterial, and Mycotic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (proposed), CDC. References 1. Daniels NA, Ray B, Easton A, et al. Emergence of a new Vibrio parahaemolyticus serotype in raw oysters: a prevention quandary. JAMA 2000;284:1541--5. 2. Matsumoto C, Okuda J, Ishibashi M, et al. Pandemic spread of an 03:K6 clone of Vibrio parahaemolyticus and emergence of related strains evidenced by arbitrarily primed PCR and toxRS sequence analyses. J Clin Microbiol 2000;38:578--85. 3. Mead PS, Slutsker L, Dietz V. Food-related illness and death in the United States. Emerg Infect Dis • 1999;5:607--25. 4. CDC. Cholera and other Vibrio illness surveillance system. Atlanta, GA: US Department of Health and Human ttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d807a1.htm?s_cid=mm55d807a1_e 3/8/2007 ri brio parahaemolyticus</I> Infections Associated with Consumption of Raw Shellfish --- Three States, 2... Page 3 of 4 Services, CDC. Available at http://www.cdc.gov/foodborneoutbreaks/outbreak_data.htm. 5. Farmer JJ, Janda JM,Birkhead K. Vibrio [Chapter 46]. In: Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, • Yolken RH, eds. Manual of clinical microbiology. 8th ed. Washington, DC: ASM Press; 2003. *The Nationally Notifiable Diseases Surveillance System is a public health surveillance system that collects data on cases of certain diseases.The decision to make a disease nationally notifiable is based on its public health importance(e.g.,number of cases or severity of the disease)and its preventability.The current list of nationally notifiable diseases is available at http://www.cdc.gov/epo/dphsi/phs/infdis.htm. t Cooking guidelines vary for each type of shellfish and are available from FDA at http://www.cfsan.fda.gov/—lyd/seafsafe.html or by telephone(888-723-3366). Figure FIGURE.Number of Vfbrio pamhnmalytiocrs cases*from Now York,i` Oregon, and Washington,§ by month, compared with 5-year average numbers of confirmed cases nationwide and from New York, Oregon,and Washington during 20002004,11 by month 140 I I Pr able New York Otegen.and W ingfat,2$*rz 020 Confirmed Volt°regent aed W avian, 120- .. &leer average ,krgmed ones- New Y Oman,and Wosl gt t,2000.2004 -year of=darned oases United Slates,2000-2004 100 •- e.h Z 60- cig40- 20- Mei .._ '`°W 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dee Month *A confirmed case of 14 patahaemolyticus infection is defined as an infection that is confirmed by isolation of the organism from a patient's stool.A probable case is defined as gasteroenteritis in a person who can t e epidemiologically linked to a confirmed case. Includes health juriscktions of New York state and New York City. .As of July 1,2 . Data from 2005 are not yet available. Return to top. Attrade names and commercial sources is for identification only and does not imply endorsement by the U.S.Department of Health and Human Services. .._......___........................__...._.. ttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d807al.htm?s cid=mm55d807a1 e 3/8/2007 • Board of Health Netiv Business .agenda Item #17., 5 • Medical Reserve Corys Recruitment in Jefferson County .larch 15, 2007 Regional/Local Health Jurisdiction Volunteers System Progress Report Template • Con Con Deliverables under the General Fund-State Activities for Pandemic Influenza Preparedness due 12/31/06 A. Describe the Volunteer Health Personnel Management program being developed. You may also submit any appropriate supportive materials. In a few sentences describe your progress and any challenges you may be encountering in the following areas: • Charter development: Kitsap County Department of Emergency management in partnership with Kitsap County Health District, American Red Cross,Olympic College and the Christian Medical Response Team formed the Kitsap County Medical Reserve Corps in March of 2004. In late 2006 the Kitsap County MRC expanded to include Clallam and Jefferson Counties. The mission of the Medical Reserve Corps (MRC) is to allow local volunteers,focusing on medical and health professionals,to contribute their skills and expertise throughout the year as well as during times of community need. The Region 2 Medical Reserve Corps unit is comprised of medical and non-medical professionals who can assist our community during emergencies, such as an earthquake,influenza epidemic, a chemical spill,or an act of terrorism. • The recruitment plan and process: • The medical community of Homeland Security Region 2 wants to help in any way possible. They identified a need for the development of a response structure. Medical Societies,Local Health Jurisdictions and County Departments of Emergency Management in Region 2 will continue to develop the Homeland Security Region 2 Medical Reserve Corps by: 1. Recruiting medical volunteers will be done via direct mail using existing provider lists supplied by the Medical Societies,Local Public Health, and Washington State Department of Health. 2. Recruiting additional medical volunteers from various health disciplines to include, but not limited to, retirees,plus both active and retired military members. 3. Partner with the medical societies,hospitals,tribal clinics, EMS and Emergency Management to refine medical command and control procedures and pre-positioned sites for medical volunteers to establish and manage when requested through Emergency Support Function(ESF) 8 under each county's Comprehensive Emergency Management Plan(CEMP). 4. Pre-registering all volunteers as Washington State Emergency Workers (this registration also addresses malpractice and liability issues). • Washington State Department of Health Public Health Emergency Preparedness and Response Program C:\Documents and Settings\juliad\Local Settings\Temporary Internet Files\OLK53\Volunteer System Progress Report-Region 2(28Dec06).doc • The local and/or regional approach: Although the MRC is supported regionally,each of the County Emergency Managers and • Health Officers under a Unified Command has control of the volunteers for a local response. • Administrative structure and oversight: Currently MRC volunteer applicants are processed and interviewed by the Kitsap County Department of Emergency Management. When Clallam and Jefferson Counties MRCs have additional training,interviews and the orientation process will become a local responsibility. The Health Jurisdictions in the Region may assign volunteers in advance of emergencies and public health activities. MRC volunteers may be assigned to specific geographic locations to respond to emergencies. The Medical Reserve Corps unit takes assignments and direction from the Regional Emergency Managers and Health Officers. • Implementation of enrollment: Recruiting for the MRC is joint effort between Emergency Management and Public Health. Currently the Regional Public Health Community Liaisons are visiting all physician's offices,clinics and hospitals. They encourage all volunteers,including doctors,nurses and others to pre-register as state emergency workers. MRC brochures and applications are distributed by both organizations in each County. Additionally utilizing a current list of licensed medical providers in the region also allows • additional recruiting efforts in the future. • Training program: Medical Reserve Corps unit leaders have a training checklist to ensure that volunteers who are registered can document the training they have or need. All Medical Reserve Corps volunteer training must include: 1. Medical Reserve Corps orientation 2. Bloodborne Pathogens 3. CPR/First Aid All registered volunteers are expected to participate in orientation prior to starting as a volunteer. Orientation provides a broad overview of expectations,chain of command, services and activities of the Medical Reserve Corps at the local,state&national level. Participating in regular training exercises is encouraged and is an essential element for ensuring readiness. Being ready to respond in an emergency does not just happen—readiness requires planning, organization and practice. Washington State Department of Health • Public Health Emergency Preparedness and Response Program C:\Documents and Settings\juliad\Local Settings\Temporary Internet Files\OLK53\Volunteer System Progress Report-Region 2(28Dec06).doc Homeland Security Region 2 Medical Reserve Corps has regular meetings and drills to • ensure maximum preparedness. These events are coordinated between Emergency Management,Public Health and other organizations as appropriate. Medical volunteers must have appropriate education, training, licensure and experience to perform medical procedures. However, all members of the MRC unit do not need the same education and training,many of the job functions have little to do with the medical field. In addition to the expertise the volunteer possesses the MRC will be trained to: 1. Manage Neighborhood Distribution Centers/Points of Distribution(specified locations to support a mass medication/vaccination strategies). 2. Manage the distribution of the Strategic National Stockpile. 3. Work in overflow treatment areas and field hospitals as needed. • Deployment and implementation process: As registered Washington State emergency workers the MRC is activated and deployable by either the respective County Departments of Emergency Management or Law Enforcement. Based on the decision of the Unified Command the MRC will respond as the situation warrants. • Other associated activities: Depending on the volunteers desires they are encouraged to explore additional volunteer activities. Examples include DMAT teams and Red Cross Disaster Services. • B. Number of active volunteers: Volunteer Type* Applicant Enrolled. Totals Licensed 19 75 94 Unlicensed 6 27 33 Specialized Skills 0 6 6 Totals 25 108 133 Percentage of recruitment goal reached: 54% This percentage is based on the following: 25 volunteers per dispensing site 2 sites in Clallam,1 site in Jefferson and 5 sites in Kitsap. Minimum numbers of volunteers for the region is 200. Currently the majority of these volunteers are located in Kitsap County. *NOTE: Enrolled includes those individuals that have been registered as Washington State Emergency Workers. Licensed includes individuals that have a license from Washington State Department of Health. Specialized skills are individuals that have some certification such as EMT-B/P. Local Health Jurisdiction: Region 2 (Clallam, Jefferson and Kitsap) • Washington State Department of Health Public Health Emergency Preparedness and Response Program C:\Documents and Settings\juliad\Local Settings\Temporary Internet Files\OLK53\Volunteer System Progress Report-Region 2(28Dec06).doc • Board of Health Netiv Business .agenda Item #`V., 6 Green Business Award • QuiCcene SchooC .larch 15, 2007 036' 00G; JEFFERSON COUNTY PUBLIC HEALTH Always Working for a Safer and Healthier Jefferson • 4 -.64 gSHI No'c February 14, 2007 Jefferson County Board of Health PO Box 1220 Port Townsend, WA 98368 Dear Board of Health Members: The Green Business program is proud to announce a new business. Quilcene Schools has become the first school to become a Green Business. This business is going the extra mile to conserve water, energy and other valuable resources. They are leaders in the Community and both businesses have developed unique ways to protect the environment while doing business. I have enclosed a copy of the current Green Businesses. • After signing the award, please return them to: Anita Hicklin Jefferson County Public Health Solid Waste Management Program 615 Sheridan Street Port Townsend, WA 98368 Thank you for your continued support of the Green Business Program! Sincerely, it 46/1...e,...\...„ Anita Hicklin Environmental Health Specialist • 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.jeffersoncountypublichealth.org Jefferson County Certified Green Businesses • Annapurna Center for Self Healing 385-2909 538 Adams St Port Townsend, WA 98368 Auto Works 385-5682 2313 3rd St. Port Townsend, WA 98368 . Bell Tower Art 385-2929 940 Lawrence#200 Port Townsend, WA 98368 Circle and Square 385-2070 10953 Rhody Drive Port Hadlock, WA 98339 The Food Coop 385-2883 414 Kearney Street Port Townsend, WA 98368 Lehani's 385-3961 221 Taylor Street Port Townsend, WA 98368 Monroe Street Clinic 385-5658 • 242 Monroe St. Port Townsend, WA 98368 Monsoon 379-1413 929 Water Street Port Townsend, WA 98368 Pane d'Amore 385-1199 617 Tyler St. Port Townsend, WA 98368 Quilcene School 765-3363 PO Box 420 Quilcene, WA 98376 Silverwater Café 385-6448 237 Taylor Street Port Townsend, WA 98368 Wild Coho 379-1030 1044 Lawrence Street Port Townsend, WA 98368 385-0381 Wholistic Skin Therapy Center 930 Washington St. • Port Townsend, WA 98368 • Board of Health �►�ledia Reyort • March 15, 2007 . Jefferson County Public Health February — March 2007 NEWS ARTICLES 1. "2-1-1- social help line extended statewide", Peninsula Daily News, February 9, 2007 2. "Harrington is new manager", P.T. Leader, February 14, 2007 3. "Flu virus here, top doc says", Peninsula Daily News, February 18, 2007 4. "New kid passport rules", Peninsula Daily News, February 23, 2007 5. "Athletes caught up in school's alcohol policy", (2 pages) P.T. Leader, Feb. 28, 2007 6. "Drug Court has largest class ever"(2 pages), P.T. Leader, February 28, 2007 7. "County nets $30,000 junk-car grant", P.T. Leader, March 7, 2007 . 8. "Childhood Immunization Campaign", Washington Health Foundation, March 8, 2007 • II 2-1-1 social help line extended statewide PENINSULA DAILY NEWS week of Janu- M irk The 2-1-1 non-emergency help thatary,means m` l * line is now live across the state,. a person announced Jody Moss,executive in the Northt director of the United Way of Olympic h , Peninsula "� .i Clallam County. , The 2-1-1 number went live in could contact , 9i'7 - Clallam,Jefferson and Kitsapservice relyageng i :4-- cies for rela counties in October. tives or friends r 4p fi Known as Peninsula's 2-1-1,it in other parts connects callers with a call center • of the state. MOSS in Bremerton that can make The help line,an information social service referrals to agencies and referral line for social ser- near the caller, or find help for a vices, now reaches more than six friend or relative in another part million people in the state,with of the state. P P The statewide cover e of the eight call centers activated,Moss said. Washington Informations Network 2-1-1 line, which began the last TURN TO LINE/A9 Line: It ' s ` free � confidential ' _0 7 , , easy CONTINUED FROM Al line include: your call directly to the organi- within the first quarter of The centers are connected • How can I get help at zation that 2007." to one anotherrand work home for my elderly mother can help." The agency is also working together, morendthan who is ecovering from a bro- Cell phone users, and those on an emergency management h having and ken hip? using Internet phone lines, plan, she said, "especially after 30,000 local,in statehe database,nationalsnII Is there a multiple sclero- have not been able to reach a this winter full of extreme Moss. sis support group in my area? call center through dialing 2-1- weather conditions. ■ I am a low income senior 1 because a network for satel- The 2-1-1 line "is a free, and need free help on my lite and Internet providers had "2-1 1 got a taste of what confidential, and easy to income taxes.How do I find it?. not been set up. the role would be in a much remember information and II Where can I find out Instead, to reach a call cen- larger scale disaster, providing referral hotline for accessing about child care in my area? ter,such users must dial 1-800- an important support system I help, all kinds of help," she. ■ My electricity is about to 627-0335. for first responders and com- said. be turned off. Help! That's due to change by the munity members." "From really critical ser- "When you call 2-1-1, a end of March, according to Moss said she expects a • iik,v,iices like shelter or drug and human being will answer the Moss. meeting later this month • cohol treatment to services phone, help you figure out the "Now, the WIN 2-1-1 office among the Peninsula's 2-1-1 like help with our aging par- real need and provide phone is working on statewide cell employees,the Tri-County 2-1- ents, or help with our teenage numbers to any resources that phone access and an integrated 1 Advisory Committee, local children, 2-1-1 can get us con- exists to address that need," database so users can look up emergency planners and agen- nected." said Moss. resources online," cies to discuss emergency plan- Questions and issues that "Whenever possible,the call said Moss. ning and integration with 2-1- can be addressed through the center employee will transfer "These should be in place 1 during times of disaster. Harrington is new manager Neil Harrington is the new WRIA 17, shellfish safety, lake • project manager for the Water water quality and stream flow Quality Division of Jefferson measurements. County Public Health. The Harrington earned a bach- Water Quality Division, former- elor's degree in biology with ly Natural Resources, focuses a minor in chemistry from the its effort on improving water University of California, Santa quality. • Cruz.He went on to earn a mas- Current projects include ter's degree in marine science. improving water quality in Chimacum Creek, addressing • shellfish growing area closures, Hood Canal nitrogen source iden- • tification, watershed planning, shellfish biotoxin monitoring, Conservation Futures Fund,flood- plain restoration and implement- ing the newly adopted Surface Water Management Plan. Referring to these responsi- bilities, Harrington said, "It's a tall order, but I have a very capable staff." "Neil has a strong background in shellfish and salmon resto- ration," noted Mike McNickle, �. Environmental Health director. The project manager posi- tion is not a new position,clari- fied McNickle. It has been left unfilled for nearly two years. Since joining Jefferson County Public Health in early 2006,Harrington has worked on watershed planning efforts for • 1' t 11-07 • g ,binua • ■ Flu virus re, top PENINSULA DAILY NEWS doc says Flu : Vaccines CONTINUED FROM Al month near Seattle. Doses of the flu vaccine are The flu comes on very Health officer available in Clallam County abruptly. through the Department of Symptoms include highs fevers, body keeps tabs as virus Health and Human Services, for three to five days.ches nd chills 223 East Fourth Street, Suite Creeps to Peninsula 14, Port Angeles. "We're urging people like In Jefferson County, flu that to stay home, not only for shots are available at Jeffer- their sake but for everyone BY RANDY TRICK son Healthcare hospital, 834 else's," Locke said. Sheridan Avenue in Port PENINSULA DAILY NEWS Townsend. The flu season has been Reporter Randy Trick can be reached ached The flu has reached the ;"'"'="';=` at 360-417-3537 or at randy Olympic Peninsula, and "ri' = ~ deadly for two children in peninsuladaitynews.corn county health departments III Taps for Western Washington. ill warn that it is not too late to preventing Eight-year-old Marija get flu shots. the flu for Alumbaugh died in Seattle a You,your week after a 7-year-old girl in With confirmed cases of influenza in Kitsap County, family/A9 Kent. Health Officer Tom Locke said the seasonal virus has reached Jefferson Typical season and Clallam counties. Despite the girls' deaths, County health departments watch for flu health officials in both the outbreaks by tracking absenteeism from North Olympic Peninsula and schools and through a network of physicians Seattle said the flu season called sentinels who report suspect cases and looks typical. test for the virus. The season's first cases of To know when the flu the flu are usually diagnosed has reached the Northern in January or February, Locke Olympic Peninsula, Locke said. said he relies on sentinel The season lasts through 44{ ;,max physicians in Kitsap the winter. ,, County and school absen- "Once it starts up like this, } 1. teeism there. sometimes we'll see flu activ- e x g Some schools in Kitsap activ- ity for two months, and some- times reported up to 30 times we get a double spike," R _a'tt�{, percent of students have Locke said. been absent in recent Locke weeks. On Tuesday, at a monthly "Just in the last day or board of health meeting, he two we're getting the evidence to call it," olanr to address this year's outbr Locke said. • eak. Locke is the health officer for both Jeffer- "It's possible that influenza son and Clallam counties. can kill people of any age "We've been anticipating this for the last group," Locke said. month," Locke said. People who die of complica- • "There was widespread flu on the East tions from the flu are usually Coast after Christmas." elderly, very young or have "It has hit Washington state. We're seeing impaired immune systems. a definite upswing in flu cases." It really is a killer viral infection," Locke said, point- TURN TO FLu/A9 ing to the two fatal cases this • • • • • • be required to ,,171,77--- by Congress in 2004 as a Certified birth certificates response to the terrorist show pass- ports. r„ attacks of Sept. 11, 2001, and OK for ground, water travel Homeland 11 the recommendations by the ," ° ) Security '. >2)." 4.%),0 Sept. 11 commission that bor- ,f4 spokesman der security be tightened. THE ASSOCIATED PRESS groups and under adult super- vision will also be allowed to Russ Last October, Knocke Congress WASHINGTON — Chil- . • said the easing ' passed an amendment spon- drentravel with•only their birth will be exempt from new of rules for sored by Sens. Patrick Leahy, certificates. rules that will require travel- children enter-, D-Vt., and Ted Stevens,Homeland Security R- ersSecre- to show, passports when ing by land or Chertoff Alaska, that would postpone tar Michael Chertoff was ' entering the U.S.at land or sea Y sea was in part the day the land and sea rules borders, the'Bush administra- expected to discuss the relax- the result of talks between the take effect for as long as 17 ation in rules at a speech in tion announced on Thursday. department and Canadians months, till June 2009, if cer- Detroit on Thursday after- The new passport require- and interested state officials. tain conditions have not been • ments will take effect as soon noon. The , department Canada and U.S. border met. as January 2008. In a change described the details in a writ- states have been concerned One of those conditions was from earlier plans, children ten statement. that the passport require- to develop an alternative pro- aged , 15 or younger with Beginning Jan. 23, nearly ments would hurt legitimate cedure for groups of children . parental consent will be all air travelers entering the travel and commerce. traveling across the border allowed to cross-the borders at U.S. who are citizens of When the ,new require- under adult supervision and land and sea entry points with Canada, Mexico, as or ments for travelers crossing with parental consent. certified copies of their birth the Caribbean as well as land and sea borders take Chertoff will meet with • certificates rather than pass- returning American citizens effect, it will bringresidents of local officials in Detroit before ports. — have been required to,dis- Western Hemisphere-nations traveling to 'Ottawa, Cana Children aged 16, through play passports, under the same rules as travel- for meetings Friday with-Fir 18-traveling with school, reli- Children entering the , ers from the rest,of the world. Mexican and Canadian coun- gious, cultural or athletic United States by air will still The rules were mandated terparts. Pp • 360-385-2900 Local News Website: ptleader.com • Athletes cup in school ' s alcohol p PTHS may need to bench 15 due to party attendance By Patrick J.Sullivan Leader Staff Writer PTHS athletic Code Even good kids make mistakes. if a student receives an.MIP they will be In violation of the Sometimes those mistakes are a collision between high athletic code.Athletes found to be in the company ofIndl- school student athletic/activity codes and alcohol. viduals engaging In Illegal activities will be considered In Such a conflict has jolted Port Townsend High School, violation of the athletic code as well.' where at least 15 student-athletes face some suspension from extracurricular activities for their alleged violation of the school district's athletic/activity code involving alcohol at a ing,"said Dave Porter,Chimacum High dean of students and Feb. 17 party. athletic director. "You hope that they're not. But kids have The problem is not new or unique —teenagers do obtain tried drinking since the dawn of time.The biggest problem we alcohol and some partake—against the law,against their par- have is information to know exactly what kids did,where and • ents'wishes, and against school rules. when,so we can decide if the school code was violated." But when underage drinkers are caught, the fallout can be Port Townsend High School,meanwhile,is facing the larg- extensive or not,depending on the circumstances. est potential suspension of student-athletes(15)in almost five A group of Chimacum High students was caught at a party years, said Tom Kent, assistant principal and acting athletic in Port Ludlow on the same weekend as the Port Townsend director. Parents have asked for appeals in at least seven of incident, but so far there has been no school-related fallout those cases,Kent reported.A successful appeal would ensure because not much information is available. the student-athlete is eligible for a spring sport. "I'm not going to fool myself that some kids aren't drink- See ATHLETES,Page 9 2,f-07 • • Y w n 3, o ^ ° °� 6- 9 0 0 y ° vco " 3 5.', 1. — w � ' E aroma = . � A coEP: 9, w4. o O 5' 5' 3 a ,c. E p 3 a tftivk t'. M ° 3 ;' • .» ° • o ° 0 . a. E w ?y C ° a5.x -, �. ay a m ° 3 c� m H a . ,, ,, ° 5 ''' g 07 E •,, v ° 5 ° a c °o_ w w o o co F co N c • F a � ,iii; oma ° c<na �30o0 — � -" , ri.,., , ��,, _, a 5 a �' �' o -, cn S 5 " g o5 iIlliitI ! : c' v' co a 0 p- F��,J, O Off-. (n (aD �i to O C 9. N v'., :"' • • cf2 90 09 o � cao � ° E c co C "' a • ° Y ° ° o o 5 X 5 0 5 can c< ,c. y o co rn y Pa o c 3p• 2 a R E r. 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The grant, accepted Feb. 26 by county commissioners, funds efforts by the county to bring violators into compliance with county solid waste code by investigating complaints of junk cars, issuing violation citations, and providing technical assistance and follow- through with litigation if necessary. The grant extends until December 2008 and requires the county to match it with$7,500, which is generated through fees. The grant is administered through the Jefferson County Public Health Department. r • • ' 4 ij ''' -'" -"tt. -'7,',',4-k.%-w,-xt.:,„:,,,t40:H• e a 1 th y ,,, "y.1; e ritiT ,,,,t1.1_ . 1" ‘ ': ;1 / ,,1,,,,41tf°,:ii,,:***;10::-.;;;,:4F:;*;;:f i .i.' ..‘, '. ,,, „ ,,4---Y1V, a ,. .,14 , ,,,, ., „„4„..„,,,,,, ,,,,,...„.„.,„,,„..,,, . ,„ ,....,, , tt, ,,--t,:,:=,--;;:iiitiv.:,:f1 • ,'`' ,,,,, '`''' Childhood Immunization Campaign Did you know that between birth and age two, your child should receive immunizations to protect against 14 potentially deadly diseases? In a time when global travel allows germs to spread quickly, children need to be immunized for protection against diseases such as polio, hepatitis, chicken pox and measles. Just 77.8 percent of Washington children (ages 19-35 months) are fully immunized with five recommended vaccines, placing Washington 42nd nationally in childhood immunization rates. The Washington Health Foundation, Washington State Medical Association, Washington State Nurses Association and Washington State Department of Health have partnered to air televised Public Service Announcements (PSA) to remind parents of the importance of immunizing their children. The PSA is currently airing statewide throughout the winter and spring on the following channels: KCPQ - Western Washington/Wenatchee/Chelan III KAYU - Spokane KCYU/KFFX - Yakima/Tri-Cities Watch the PSA here and learn more about childhood immunizations at: http://www.whf.org/HSIN/Immunizations/Immunization.asbx. 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