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2015- May
94sot'C Public Healt • Board of Health Meeting May 21 , 2015 Jefferson County • Public Health Agenda Minutes 447 .��n Public Healt May 21 , 2015 JEFFERSON COUNTY BOARD OF HEALTH . May 21, 2015 Jefferson County Public Health 615 Sheridan Port Townsend, WA 2:30 - 4:30 PM AGENDA I. Approval of Agenda II. Board of Health Meeting Approval of Minutes of March 19, 2015 III. Old Business and Informational Items 1. Public Health Outstanding Food safety awards 2. Update on PSP Closures, Sewage Spills, Beach Closures, and Lake Algae Levels IV. New Business 1. 2014 Community Health Performance Measures: Prevention • 2. 2014 Communicable Disease Performance Measures, 2015 Updates for Gonorrhea and Pertussis 3. 2014 Syringe Exchange Annual & CDC Health Advisory Re: Syringe Exchange Program 4. Application for Substance Abuse Advisory Board 5. EH Fee Update for New Hourly Rate for 2015 6. Articles of Note V. Activity Update VI. Public Comments VII. Agenda Planning Calendar: ACH VIII. Next Scheduled Meeting: June 18, 2015 2:30 - 4:30 pm Jefferson County Public Health 615 Sheridan St. • Port Townsend, WA 98368 JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, March 19, 2015 Jefferson County Public Health, 615 Sheridan Street, Port Townsend WA 98368 DRAFT 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 Dir Kathleen Kler, County Commissioner,District#3 Julia Danskin,Public Health Manager Kris Nelson,Port Townsend City Council Jared Keefer,Environ. Health Dir Sheila Westerman, Chair, Citizen at large Veronica Shaw,Public Health Deputy Dir Jill Buhler,Hospital Commissioner,District#2 Chair Westerman called the March 19, 2015 meeting of the Jefferson County Board of Health to order at 2:29 p.m. A quorum was present. Members Present: David Sullivan, Jill Buhler, Sheila Westerman, Kathleen Kler, Phil Johnson, Kris Nelson Staff Present: Tom Locke, Jean Baldwin, Jared Keefer, Julia Danskin • APPROVAL OF AGENDA Chair Westerman asked that Item 1 of new business be moved to the top of the agenda. Chair Westerman called for the approval of the agenda for the 03/19/2015 meeting of the Board of Health. Member Buhler moved to approve the agenda; the motion was seconded by Member Nelson. The motion passed unanimously. APPROVAL OF MINUTES Chair Westerman called for approval of the minutes of the 02/19/2015 meeting of the Board of Health. Member Sullivan moved to approve the minutes as presented; the motion was seconded by Member Buhler. No further discussion. The motion passed unanimously. PUBLIC COMMENT There was no public comment. • IF► The remaining Board members expressed no concern with Member Nelson voting. • Member Sullivan moved that the changes to the Environmental Health Fees be adopted; Member Johnson seconded the motion.No further discussion. The motion passed unanimously. 2. 2014 Environmental Health and Water Quality Performance Measures Mr.Keefer provided the Board with performance measures for the Onsite Sewage(OSS) and Septic Operations & Monitoring(O&M), Drinking Water, and Food Safety Programs. Mr. Keefer informed the Board that Solid Waste will be reviewed at the next Board meeting. Mr. Keefer pointed out to the Board the following: in areas of pass/fail, the goals will continue to be listed until they are passed. If a goal is partially complete it is listed as a fail, even if it is on track. 83% of monitoring inspections resulted in some maintenance needed, including 23.3% needing significant maintenance or repair. While the online Homeowner Authorization Program is not up and running yet, three classes were held for 81 individuals with 75 getting authorization to inspect their OSS. When the online Homeowner Authorization Program is running eslt thatll send are currentlylc sent out.ers to In In 2014,the homeowners,rather than generalized remind Drinking Water Program had a lack of funding, available time, and staffing. 2015 is already showing much improvement with a review turnaround food workersf days, and d a focus on cross-training for staff in water quality. A total • both in person and online. The number of temporary food service permits is 185, compared to 273 the prior year. This is due to two vendors getting mobile units and no longer needing temporary permits. Mr. Keefer will correct the formatting/editing issues pointed out by Chair Westerman. 3. Measles Outbreak Update Dr. Locke reported to the Board that no positive measles cases have occurred in Jefferson County; Clallam County has five cases. All Clallam County cases are linked to the original case. Clallam County is still in a state of heightened surveillance mode until two cycles of incubation are over, which will be in April. Dr. Locke reported an increase in interest for vaccines, and pointed out to the Board that clinics are offering extended hours. 4. School Entry Vaccination Levels—Jefferson County Dr. Locke reviewed the School Entry Vaccination Levels for Jefferson County. He informed the Board that all states require vaccines, but the exemptions allowed for religious, philosophical/personal, and medical exemptions vary between states. Immunization levels in Jefferson County schools were reviewed with the Board. 5. Vaccine Hesitancy—State and National Efforts to Increase Community Immunization Levels Dr. Locke provided the Board with the following articles about vaccines and the science of vaccine hesitancy: Bills Banning Most Vaccine Exemptions Fail in Northwest, What • 4 • David Sullivan, Member Sheila Westerman, Chair Kris Nelson, Member Kathleen Kler, Member Respectfully Submitted: Natalie Crump • • Board of Health III Old Business Item 1 Outstanding Food Safety Awards A414 aellason Public Healt • May 21 , 2015 Board of Health III Old Business Item 2 PSP Closures Update I dePeAson Public Healt May 21 , 2015 ry 615 Sheridan Street )dsfn Port Townsend, WA 98368 CPwity www.JeffersonCountyPublicHealth.org Public Health • May 14, 2015 For Immediate Release Contact: Michael Dawson Jefferson County Environmental Health (360) 385-9444 Sewage Discharge at Port Ludlow Bay Port Townsend — Olympic Water and Sewer officials reported a release of sewage at the Port Ludlow Wastewater Treatment Plant on Wednesday, May 13, due to a mechanical failure. Approximately 72,000 gallons of inadequately treated effluent were discharged from the outfall. Repairs were made and the problem corrected Wednesday afternoon. Jefferson County Public Health has issued a "No Contact" Health Advisory for Port Ludlow Bay and posted warning signs. The health advisory remains in effect until Wednesday, May 20. The public is advised to avoid any contact with the water in Port Ludlow Bay, including swimming, kayaking, fishing, and harvesting of shellfish and seaweed. The harvesting of shellfish is always closed in Port Ludlow due to the proximity of the sewage treatment plant outfall and marina. • For more information on this advisory, contact Jefferson County Public Health's Water Quality Program at (360) 385-9444 or visit our webpage at www.jeffersoncountypublichealth.org. Beach goers can view current beach advisories at the BEACH program website: https://fortress.wa.gov/ecy/coastalatlas/Tools/BeachClosure.aspx. Recreational shellfish harvesters can get current information about closures anywhere in Washington State at the DOH website at http://www.doh.wa.gov/shellfishsafety or by calling the DOH Biotoxin Hotline at 1-800-562-5632. Shellfish harvesters should also consult Washington Fish and Wildlife rules, regulations, and seasons at wdfw.wa.gov. ### Always working for a safer and healthier community • Community Health Developmental Disabilities Environmental Health Water 360-385-9400 360-3 Quality 85-9444 360-385-9401 (1) Always working for a safer and healthier community (f) 360-379-4487 615 Sheridan Street ems, . A-, � ' Port Townsend, WA 98368 t ( rxt5€ritz www.JeffersonCountyPublicHealth.org j Public Heat i Ill April 30, 2015 For Immediate Release Contact: Michael Dawson Jefferson County Environmental Health (360) 385-9444 Dabob and Quilcene Bay Beaches Closed to the Recreational Harvest of Shellfish Due to Marine Biotoxins Port Townsend— Marine biotoxins that cause Paralytic Shellfish Poisoning (PSP) have recently been detected at elevated levels in shellfish samples collected from Hood Canal. As a result,the Washington State Department of Health (DOH) Quilcene and Dabob Bays.and should be safe to ealtfish harvested commercially are tested for toxin prior to distribution Danger signs are being posted at high-use beaches, mussels,warning pcalpopss and other speciesle not to consume eolf'sh from this area.The closure includes clams, oysters, molluscan shellfish. This closure does not apply to shrimp. Crabmeat is not known to contain the biotoxin but the guts can contain unsafe levels.To be safe, clean crab thoroughly and discard the guts (butter). • Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish contaminated with the naturally occurring marine algae containing toxins harmful to humans. Symptoms of PSP can appear within minutes rb hours d fficutyy breausually t bng ,ins with and potentilally lips and tongue, moving to the hands and feet, followed Y death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions call 911. and must e In most cases the algae that contain the toxins harbe vesters,shou d chebk the newdDOH using laboratory testing. Therefore, recreational shellfish clickable map with a mobile friendly version for smartphones at www.doh.wa.gov/ShellfishSafety.htm or call the DOH Biotoxin Hotline at 1-800-562-5632 before harvesting shellfish anywhere in Washingtoht�;ate\.NRdfW Recreational neSters shellfish shouldalso check Fish and Wildlife regulations and seasons at Shellfish Rule Change Hotline 1-866-880-5431. NW Always Working for a Safer & Healthier Jefferson County • Environmental Health Community Health Water Cxuality Developmental Disabilities ater Q 360-385-9444 360-385-9400 f 360-375- 444 360-385-9401 (t) Always working for a safer and healthier community ( ) / 615 Sheridan Street �'/ �cs€ 'z Port Townsend, WA 98368 j)to ? www.JeftersonCountyPublicHealth.org Public Health • May 7, 2015 For Immediate Release Contact: Michael Dawson Jefferson County Environmental Health (360) 385-9444 Anderson Lake Closed Due to Toxin Port Townsend— High levels of the potent nerve toxin anatoxin-a were detected in a water sample taken from Anderson Lake on Monday, May 4. The toxin level climbed to 17.8 micrograms per liter, which is above the Washington State recreational criteria of 1 microgram per liter. Trace amounts of the toxin microcystin were also found. The bloom of bluegreen algae in the lake contains three toxin-producing species: Anabaena, Aphanizomenon and Microcystis. Anatoxin-a can result in illness and death in people and animals. Washington State Parks has closed the lake for recreation including fishing, boating, and swimming. Visitors are also urged to keep pets out of the water. The rest of Anderson Lake • State Park remains open for hiking, biking, and horseback riding. Lake Leland and Gibbs Lake have not shown signs of bluegreen algae so far this year. Jefferson County Public Health (JCPH) has monitored local lakes for bluegreen algae since 2007. Anderson Lake was opened for recreational fishing on April 25 by the Washington Department of Fish and Wildlife and anglers enjoyed some successful early season trout fishing. Toxin levels had remained below recreational criteria in April, however the bloom of bluegreen algae steadily got worse this season resulting in the closure. To check the status of Jefferson County Lakes and learn more about toxic cyanobacteria monitoring, consult the JCPH website at www.ieffersoncountypublichealth.org/index.php?lake- water-quality or call (360) 385-9444. For fishing seasons and regulations see the Washington Department of Fish and Wildlife website www.wdfw.wa.gov/fishing. Information on visiting Anderson Lake State Park is available at www.parks.wa.gov/240/Anderson-Lake. ### Always Working for a Safer & Healthier Jefferson County • Community Health Developmental Disabilities Environmental Health 360-385-9400 Water Quality 360-385-9401 (f) Always working for a safer and healthier communif 360-379-44 y (f) 360-379-44877 615 Sheridan Street t Port Townsend, WA 98368 411,Ldeffilson www.JeffersonCountyPublicHealth.org tfiuntY Public Health May 7, 2015 • For Immediate Release Contact: Michael Dawson Jefferson County Environmental Health (360) 385-9444 Brinnon Area Shellfish Beaches Closed Due to Marine Biotoxins; Special Meeting to be Held Port Townsend —Shellfish samples from Hood Canal have been found to contain elevated levels of marine biotoxins that cause Paralytic Shellfish Poisoning (PSP). As a result, the Washington State Department of Health (DOH) has extended the previous closure of Quilcene and Dabob Bays to include Hood Canal south to the Jefferson/Mason Stat County Parksilamong otherine. This s. Sh Iles bish lic beaches at Seal Rock and Dosewallips and Triton Cove harvested commercially are tested for toxin prior to distribution and should be safe to eat. A special meeting has been scheduled at the Quilcene Community Center,Thursday, May 14th at 6:30 pm to discuss the dangers of biotoxins and harmful algae blooms. Clara Hard from DOH • will give a presentation and be available to answer questions. Danger signs are being posted at high-use beaches,mussels,warning pcalpops and other spec'esle not to consume eolf'sh from this area. The closure includes clams, oysters, molluscan shellfish. This closure does not apply to shrimp. be safebclean crab thoroughly and eat is not known to contain the biotoxin but the guts can contain unsafe levels discard the guts (also known as the "butter"). Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish contaminated with the naturally occurring marine algae containing toxins harmful to humans. Symptoms of PSP can appear within minutes rb hours d fficuland ty breathbng,lns with and potengling ally lips and tongue, moving to the hands and feet, followed Y death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions call 911. In most cases the algae that contain the toxins cannot be seen, and must be detected using laboratory testing. Therefore, recreational shellfish harvesters should check the DOH Shellfish Safety Map at doh.wa.gov/ShellfishSafety or call the DOH Biotoxin Hotline at 1-800-562-5632 before harvesting shellfish anywhere in Washington State. Recreational harvesters should also check Fish and Wildlife regulations and seasons at wdfw.wa.gov/fishin or or call the Shellfish Rule Change Hotline 1-866-880-5431. Environmental Health Community Health Water Quality Developmental Disabilities 360-385-9444ater 360-385-9400 (1) 360-375-9444 360-385-9401 (t) Always working for a safer and healthier community Board of Health IV New Business Item 1 2014 Community Health a.47-N-1„ff.son Public Healt Measures: Prevention • May 21 , 2015 • Pon iaNTsa(1H a Jgelorcon cover. lomlur. We are made to walk, so let's spring W �,�.�3 walkingp g shows how - -» 11► Z •-_- 4 '' > ----- �__._ ..,..._ long it takes to ''" '' ' Pod f Townsend i ihk 0100 0(0.$40•1 appionimate hovel get from here ,, wd ktng.lmi ,nncrp to there r' t *► Fc e i W rr()Lit , nrnsk aa Greta tom t"h�w" nus* as .. 0 Sfc.fe:dark wayfocameo'maedaway of BY Samantha Thomas 1 +P we d off s no mph.aaad on an Special to the Leader • CoPPY s Trails 2 well-being,connectst tea fait There are few thingspeople to 3 I. basic to humanmore their community and keeps Tt —.—„mare____________ ii life than more money in the local ' to walking: economy. Rut townwna Over the last several de- Walkable communities Ma- a . ® rg1r _ sehoo1 cades,we have made walking prove accessibility for every- t ` unnatural.What once was an one,makingmoving t 0 ' easy 2O-minute walk has now, the easy,affordable,fun and ny " � r Pea 1Ij for many reasons,been engi- attractive choice. a`"""�" < i �+ r° neared out of our lives. Walkable communities are rqst j The design of our built en- not just an urban,or b' 4 ant—our citystreets, 'g me' 3 o»+ thing.Thriving communities �/ en spaces,even the of any size share a common • Qaw1e' W p�� our buildings positioning of trait They are human-scale, 1 sa.r inIllir fluences our Putting people first in the de- � , ei9 ail.tom " everyday lives by either en- sign of their city. j F 1 +..N.+.... wuraging or discouraging us Walking will not come V y 1 to move naturally. by building6 *' N.T ,, more sidewalks; r `"` The good news:The simple it calls for many details,in- ----------------] act of walking offers huge eluding street connectivity, , benefits to our health,our low vehicle speeds and place @g�f)d vitality and prosperity of our making.W +1a' o,.o a aa■. Z alhability calls for a..,emom�..sa,,w0.9..w.w... —,-- saz community.For example, holistic and complete town. +nwr a.w�`""'"""' 9.... converting one trip a day,or making by which: ; week,to start will likelyhal There ..i.v.~""aor�m" �+ ,— """"" you enjoy p are destinations Thus Port T W n9 provides nl y more energy,expe- that are accessible destinations in a walk- hair.Sauce:esend0/20 al�loximate travel time,on rience less stress and anxiety, able scale. soal between �'Ttraea are estimated based on an average speed of 3 miles per and feel more creative.You'll 'There is diversity, There• is proximity tot know your neighbors and of uses—living,retail, r mix transit •tY ing or riding horses and that To start,check out the con- visit for neighbor neighbors better.Simply ce clinics, connect to key destinations ceptual w your daily needs.The j P Y 135iv schools—located enceur ere are incentives that —downtown,Uptown the walking times map at intent of the ofuh 1 put,you'll have more fun. on a walkable scale. L2020.org.Located in the map to help walking(or biking hospital and schools. website's< remind each us that many The walking boom has •There isl density or a • or transit use);for example, But as a comma the'Transportation"created trips fall within a 5-to 30-min- arrived. sufficient number of better Its'could section, map was created People so managed pm we write a community"pre by the Transportation Lab,a walk.More than le to 1 mile) We know that walkable that coats are contained.ofp seople o"to encourage more Local 20/2 action More than a quarter of communities provide great There is Place making Port Townsend has many people to walk(or roll on a group of the coins.Walking provide gracontributes to through of these characteristics,from bike or take transit)?What Local The P tripe made nby ear are within a a cleaner Walking environment, design,creating low-speed streets to more would this look like? mapmile of home.Pick one of these im- places where people want to than 22 miles of off-street illustrates ap- trips and convert it to a oc- proveswalk- individual health and come and linger longer. foo bee travel time on ing trip. trails for people walking,bik- SPRING IN YOUR STEP fogs between pointe connect- W c ing main districts— Walking can be a social places to See WALK,Page 4? c, III G 4.wedneslay.Apo 22.2015 I '*,".. , r ", .. py9�' k' ''''.'m G.S *, , v. • 4e I px. i` . k. Samantha Thomas,project manager for the Walkable and Livable Communities Institute,based in Port Townsend, chats with Dan Burden,cofounder and(tractor of the Institute.Burden was honored last year at the White House as -e Champion of Change by the U.S.Department of Transportation.Photo by Allison Arthur Walk: Bike to school May 6 .7Continued from page 3 den. With more than 25 District and starts her day casion as much as it can be an community gardens in Port with .Her favite walkexercise regime. Townsend, they are a greatthrough er o et I' The point is, there are way to get out, move,connect to the beach.) many steps we can take to with neighbors and grow your start to shift our behaviors own food. ' m and make moving naturally, ' • Park once and shop untilL. ' f ` well,natural again. you drop. /' O�'Ct ` t+ • Breathe in the salty sea corner A FEW OTHER STEPS air by parking once, perhaps fr! I t 1 • Form a walking (or bik- a little farther away,and then orid ing)group. strolling to and from the shops • Invite family and friends on your list. T l i,i0 l PO for a walk, perhaps followed Enjoy setting afoot. by lunch, coffee, dinner or a (Samantha Thomas has Chi(, eh, movie. • Convert coffee breaks or lived in Port Townsend for manure: ar. meetings into strolls: four years.She works at Blue ' • Recruit your coworkers Zones, supporting communi- some1 -for a jaunt around the block,a ties in becoming more walk. 5equim a great way to relax during your able. She lives in the Uptown red worm „day or get the creative juices casts! flowing to solve that problem w + , on your mind. SOLAR HO 1 ATE 4 >, ,�;�' •"Walk 'n' roll" your kids :to school,a fun family routine of walking or biking to school. Can't do it every day?Collabo- 'r''r: rate with other parents and r the school to create "walking ® school buses." lisp FOODO• • Mark your calen1110- dars: May 6 is National Bike FROM • to School Day and Oct. 7 isH R� 9�m r N National Walk to School Day. (360)301-9870 9122 Rhody Drive,Chimacem,WA , • Join a community gar- wsc1.1sotnaHw92oos 360.732.0107 chlmacumcarner.com ,,, PUBLIC HEALTH • IS AT THE ROOT OF OUR HEALTH CARE SYSTEM ., 0 . _ , . ,,. ...„.k: f--, mmw FOOD INSPECTIONS NS SAFE STARTS WATER -'' DISASTER RESPONSE CLEAN AIR V' VACCINES DISEASE HEALTH PREVENTION ALERTS 11101 EPublic Health keeps our families safe - and is so effective, we don 't think twice _ n , , ) 111 about potential safety risks as Ili S S we go about our day. 4 WSALPHO WASHINGTON STATE ASSOCIATION OF PUBLIC HEALTH OFFICIALS Local PublicSystem Annual Report to the L • q12 Public Health Prevent. Promote. Protect. 2014 A WSALPHO Publication • WSALPHO • 206 Tenth Ave SE. Olympia. WA 98501 • www.wsalpho.org } S4 PUBLIC HEALTH • Table of Contents INTRODUCTION 5 PUBLIC HEALTH SYSTEM IN WASHINGTON STATE 5 GOVERNANCE 6 ORGANIZATION OF LOCAL HEALTH JURISDICTIONS 6 FUNDING FOR LOCAL HEALTH JURISDICTIONS 8 PUBLIC HEALTH DATA TRACKING 10 SUMMARIZATION OF PUBLIC HEALTH FUNDING ISSUES 12 STORIES FROM LOCAL HEALTH JURISDICTIONS 14 SNOHOMISH REGIONAL HEALTH DISTRICT:RESPONDING TO THE SR 530 MUDSLIDE 15 GRANT COUNTY HEALTH DISTRICT:PERTUSSIS OUTBREAK IN A MIGRANT POPULATION 16 LINCOLN COUNTY HEALTH DEPARTMENT:POPULATION HEALTH PREVENTION STRATEGIES 17 SPOKANE REGIONAL HEALTH DISTRICT(SRHD): NEIGHBORHOODS MATTER PROGRAM 18 GRAYS HARBOR PUBLIC HEALTH&SOCIAL SERVICES:RESPONDING TO A FIRE 19 FUTURE OF THE PUBLIC HEALTH SYSTEM IN WASHINGTON STATE 20 CONCLUSION 21 • WSALPHO • WASHINGTON STATE ASSOCIATION OF LOCAL PUBLIC HEALTH OFFICIALS November 2014 To:The Washington State Legislature Re: County Public Health Assistance funds Dear Honorable members of the Legislature, Washington state has long been a leader in protecting the public's health. This is due, in part,to financial support from the legislature each year.This year,we present our inaugural report outlining the work of Washington State's 35 Local Health Jurisdictions (LHJs). Since this is the first report of its kind,we have provided a general introduction to the laws that guide our work;a description of how we are organized;as well as a historical context of how state funding has changed over time. In addition,we provide both the data to provide a snapshot of what we do as well as stories from several LHJs showcasing a few instances of how County Public Health Assistance funds are used to deliver improved health outcomes. • Public health has been in the news a lot lately—from Pertussis and Measles to Ebola and E. coli and from legalized marijuana to the rise of youth use of electronic cigarettes. The Ebola situation is typical in many ways of what has happened in public health in recent years.When something critical comes along,public health workers are determined to do what is necessary no matter what it takes.At the same time,in agencies that are barely able to do the basics in normal times,the system is stretched to the breaking point. Our public health system is incredibly fragile and we need a re-investment in the system to ensure that we can continue to protect the public's health. We thank you for the opportunity to create this report and look forward to continuing to work with you so together we may ensure a robust governmental public health system in Washington State. Respectfully submitted, J wA \ Jefferson Ketchel,WSALPHO President Grant County Health District Administrator i w, � ; PUBLIC ..., . r } Sun ^`` :. Y -;;i �,''' s . i x HEALTHL_ ^ '1rs Cd w • Introduction Washington State's public health system is nationally recognized as a leader in the field of public health. Some of our accomplishments include being one of the first states in the nation to develop a Public Health Improvement Plan,' creating an Agenda for Change,' and identifying foundational public health services that should be available in every community in the state. In addition,from October 2013 to September 2014, 11 Local Health Jurisdictions (LHJs)have helped enroll over 170,00 clients into the health care system and helped make Washington a model for other states. State funding has significantly contributed to these successes. This report provides the legislature with a description of the public health system in Washington State and an account of what the LHJs are doing with the County Public Health Assistance funds (commonly called state flexible funds) received from the State. Since the funds are flexible,many LHJs use these dollars for basic operational costs. Because of this, County Public Health Assistance funds create a foundation for the work done by LHJs and therefore this report provides an overview as well including activities funded by other sources such as fees or federal funds. Public Health System in Washington State . Washington State law(RCW 70.05, 70.08, 70.46)gives primary responsibility for the health and safety of Washington residents to 39 county governments. It charges the counties'legislative authorities with establishin eith department or a health district to assure the public's health. $ er a county The decentralized governmental public health system consists of 35 local public health agencies that work with the state Department of Health.In three cases, county legislative authorities have formed multi-county health districts. The system also includes the state Board of Health,tribal governments and other partners. This is further illustrated in the graphic below. InUS DEPARTMENT OF HEALTH ri .,,. AND HUMAN SERVICES iHHSI TRIBES � lirl i (Y tt. t Y lbw foe WA0 Htv F irse3 tt „-,.f s,+# w,rt tb.t .r.,zr. r c i k AR 'S DEP11 I P L 1 C: LOCAL HEALTH OE HEALTH N E A 1.T H IPA JURISDICTIONS (LHJ) WASHINGTON . .tY>•ri1 ..a e. ....tri 4 1 Y ...), <r.. .x.. DOMESTIC GLOBAL LOBAL PUBLIC "*";:::.t.11 PUBLIC HEALTH PARTNERS HEALTH PARTNERS i, fig..YS (.iii I♦,,� . r, r I { i 1e i ... ., ., .. .� :�,. � rEF., lr „ ,.t, „.. ,,„„„c:2N:14''':',3,416-144,rePtiZIPMPArTi<ekt,.5,:ift4,:,-,- ,, f v 4.fi iY r'±,,0 :::.: 1 k;"Yi A`7.GeV Fd ;.;; . aF �.'�”, a _., _ ,. .. .. _� sc_�2 vtile,luua' C34+�fn&..;'rr1.�+?'+ .' v.� PUBLIC �i 4 #¢f � �k k, I �,,,;,sk `�, ���t�}l2-fi/�"�,3' i: .� r ,✓ ,S . � � . ui+Ry.4.l�:i,.E3m;.�5��+ � 77;:c°Yb, HEALTH Governance Each county legislative authority must establish a local board of health,which"shall have supervision over all matters pertaining to the preservation of the life and health of the people within its jurisdiction" (RCW 70.05.060). Local Boards of Health approve the budgets,programs,and policies of local public health agencies and may also appoint the agency administrator. Board members include county s1must always make upmissioners r ethe of the county council and may include elected or non-elected officials. Elected official majority of the voting membership. Organization of Local Health Jurisdictions Local Health Jurisdictions are organized into three different types: Department of County Government Twenty-three LHJs are departments of county government of adepartment nt o their county commissioners,anthat includes health and human se vice using county infrastructure.Thirteen of these LHJs arep Partme s and the other ten are standalone departments. City/County Health Department • 2 LHJs (Public Health- Seattle &King County and Tacoma-Pierce County Health Department) operate under a charter agreement between the city and county. The charter spells out their governance structure and other operational agreements. Health Districts Ten LHJs are quasi-autonomous health districts with no taxing authority and must arrange their own infrastruc- ture. 7 of these serve a single county and 3 districts serve multiple counties. The following map illustrates the great variety of population and size of staffing for LHJs. PUBLIC HEALTH Washington State LHJs vary along many dimensions 5/23/2014 ANIMI Across Washington,LHJs come in a range of sizes;both in terms of population served and in terms of area covered(square miles), Some LHJ5 report to county government,while others are jointly chartered with cities.Still others are quasi-autonomous health districts with no taxing authority, Pop'205,800 FTE:74 (Nonagon Son Juan rear 2 04 _ r5 sq.ani. Pop:41,515 ' f� Pop: 16,000 Area:5,315 sq.mi. Area:621 sq an V% Skagit FIE: 17 FTE 24 IslS Pop: 118,600 FTE 35 Pop:79,70! Area: 1,920 sq.mi. Clallom Area:517 Pop:72,350 TE:3 Snc�trornixh Northeast Tri-County LHJ Area:2,670 sq,mL �) ! • Pop:730,500 FTE: 180 Pop: 64,600 FTE:25 Area:2,196 sq.mi. helon-Dovg • Area: 6,223 sq. mi, Jefferson Pop: 112,880 FTE: 28 Pop:30,275 Area: 4,843sq mi. Area:2,184 sq.mi. wp'{f Seattle& King County FTE: 30 Lincoln Spokane, E:32 i /P..:2 . Pop:480,000 rays Harbor n.'5::,f Pop: 1,481 900 Pop: 10,675 73 200 MasonArea: 2,307 sq.mi Area:2,340 sq.mi. Area: 1,781 Ar:. 2,224 Pop:61,:•0 r' FTE 1,1 38 FIB 7 sq.mi. sq.ml. 'rea:1051 Kittitas FTE;217 FTE 35 sq' -; Pop:41,900 Grant Adams Tacoma-Pierce County* Area:2,333 sq.mi. Pop:91,800 p 19,200 Whitman4 • .1 Thurston Pop:814,500 FTE:i 4 Area,2,791 sq.ml. Pop:46,000 Pop'260,1 r r pTE 20 Area: 01,930 sq.ml •rem 2,178 sq.mi• Area,774 ea:1,806 sq.mi. �'ne . TE:269 FTE 18 ••:21,000 Lewis • ea:1,224 Pop:76,200 FTE:27 Yakima Garfael I )1 i sq.mi. Area:2,436 sq.ml. Pop:247,250 as Pop:2,250 Area:4,312 sq.mi. nton-Franklin LHJ" Columbia ea:71 WoIkiakum Cowlitz FTE:29 •p: 268,200 FTE:91 Poo;4.100 O. op 103,300 Skomaatoalfa Walls ea' B in Pop:4,020 Arc,.1,166 sq.mi. trs11.300 rea:3,025 sq. • Area:287 sq.mi. .684 re 59,500 sq.mi. 4 'op:21,8ss FTE:S FTE: FTE:S Area:641 sq.ml. Klickttat Arem 1,299 .,m C ork FTE:7 Pop:20,700 FTEs i 3 FTE:25 FTE: 1 1 q mi. P•.,435,500 Area:1,904 , • A 656 ra Departments-Public Health&Human Services 1111 FTE Departments-Public Health II Washington State Total Population 4J2013:6,882,400 District-Single County Total Area:71,362 sq.mi. District-Multi County Source for FT&.Washington Stat,Auditor's Office Budget Accounting sled Reporting Systole(BARS),2017 *Agency is led by full-time physician health officer 2 • _..-.. ... ..,.,_..t..� li* M_. . '`" ' e- #Lg' a !Y z�.: tri 4 ;' t''' PUBLIC HEALTH Funding for Local Health Jurisdictions Historically,a combination of local,state,and federal resources has financed services provided by Local Health Jurisdic- tions.These include: • Local funds:county general funds,city funds,licenses,permits,and fees for services • State funds:contracts for specific programs,flexible funds to meet local needs,and reimbursement for performing specific services(i.e.,Medicaid reimbursement) • Federal funds:contracts for specific programs and reimbursement for performing specific services (most of this funding is passed through the state Department of Health) • Other funding:such as federal or private grants,often one-time awards The mix of these funds and the conditions attached to their use has changed over time.The timeline below gives a histori- cal perspective of Public Health funding in Washington State. 1930s-1970s Millage Property Levy-a percentage of the local property tax was dedicated to general public health and tuberculosis control(repealed by the state Legislature in 1970s) 1970s-1992 Per capita public health spending varies widely depending on local government choices 1993 Health Services Act of 1993 passed-established MVET(approx.$50M per biennium)and Local Capacity Development Fund(LCDF)-$10M per biennium • 2.95%of Motor Vehicle Excise Tax(MVET)revenues dedicated to core public health funding • 1995 LCDF increased to$16M per biennium 1999 Voters approve I-695 repealing MVET 2000 Legislature upholds MVET repeal-approx.$49M per biennium loss for Local Health Jurisdictions 2001 Legislature creates MVET backfill account for Public Health-$48M per biennium 2005/6 Legislature convenes Joint Select Committee on Public Health Finance to study public health funding;its report finds$315M shortfall in public health funding 2007 Governor's Blue Ribbon Commission on Health Care Costs and Access calls for investment in public health. Legislature creates"Blue Ribbon Public Health Fund"to support local public health-$20M per biennium 2009 Legislature cuts"Blue Ribbon Public Health Fund"-now $16M per biennium 2011 Legislature cuts"Blue Ribbon Public Health Fund"-now$10M per biennium 2013 Legislature combines MVET backfill,LCDF and"Blue Ribbon Public Health Fund"into"County Public Health Assistance funds"-$72M per biennium The current funding categories supporting local public health are shown in the following pie chart based on 2013 data and compiled by the State Department of Health:3 PUBLIC HEA LTH All Local Health Jurisdictions Revenue Source by Type,2013 Misc/Fund Balance/Other 3.0% Revenue from TM State 44-44 19.4% 44.W44Ci.. Licenses. :414 ,4444444 - ' Permits& Fees 34.8°/a . Revenue from Federal 22.6% SLocal Government Contribution 20.2% Revenue Source Type Amount Revenue from State Revenue from Federal 71,956,641 Revenue from Local 83,581,214 Local Government Contribution 74,842,361 Licenses, Permits &Fees Misc./Fund Balance/Other 128,942,255 Total 11,155,916 370,478,387 In 2013, the legislature combined the three funding sources for Local Public Health Jurisdictions (MVET back- fill,LCDF and Blue Ribbon Public Health Fund) into one funding source that is distributed through the Depart- ment of Revenue, called the "County Public Health Assistance fund."This is currently funded at just under$72 M per biennium. This funding is generally used to: • Stop communicable diseases before theyspread Protect the safety of drinking water and air • Reduce the impact of chronic disease Invest in healthy families Use health information to guide decisions, and 4111) • Help people get the health care services they need. a ..� &3 `"•, b., 1?e.p"s,'� .vx`u,�'. ,ai '�`**<. ,vxars " wed . �. 4 ' PUBLIC E � 14:‘�� HEALTH This funding is typically LHJs' only discretionary funding source.This means that there is more flexibility than is possible with other funding sources. Public Health Data Tracking Public health tracks their work through the Washington Public Health Activities and Services Data Base. This database now has five complete years of data from across all 35 local health jurisdictions.The data is tracked by the following major categories: 1. Communicable Disease 2. Prevention and Health Promotion 3. Environmental Public Health 4. Maternal Child Health 5. Access to Care It should be noted that the activities listed below are not exclusively funded by County Public Health Assistance funds. Some of these activities (such as food service inspections) are almost entirely covered by fees. Other activ- ities are funded by federal grants such as Ryan White for HIV prevention and treatment activities. Some exam- ples of work done in 2012 includes: . 1. Communicable Disease Prevention: • Thirty LHJs administered 78,889 doses of childhood vaccines. • LHJs did 583 site visits to community providers to assure safe storage and handling of vaccines • Twenty six LHJs did 11,311 STD partner notifications and followed 10,158 STD contacts • Twenty six LHJs provided HIV counseling and testing to 8,866 clients • All LHJs reported 4,935 cases of Pertussis which is up from 962 in 2011 2. Prevention and Health Promotion: • Twenty four LHJs had an initiative to increase access to healthy foods • Twenty one LHJs had an initiative to increase child physical activity • Twenty seven LHJs had a tobacco free initiative and did 1,281 tobacco retailer compliance checks 3. Environmental Public Health: Environmental Public Health programs across the State: • Issued 34,912 permanent food service permits • Conducted 54,184 permanent food service routine inspections • Issued 273,519 food worker cards • Issued 4,576 onsite sewage system permits • Conducted 1,879 solid waste facility inspections • Collected 3,199 samples of shellfish to assure safe shellfish consumption PUBLIC HEALTH ? -14 • 4. Maternal Child Health: • Twelve LHJs have a Nurse Family Partnership Program which served a total of 1,539 families • Twenty four LHJs provided maternity support services (MSS) and Infant Case Management(ICM ser- vices and served 36,612 MSS patients and provided ICM to 13,673 infants ) • Ten LHJs provided WIC services to 136,256 clients. The value of WIC Program food checks redeemed in local grocery stores was$48,940,294 and the value of fruit and vegetable checks was $4,119,820.00 5. Access to Care: • Twenty eight LHJs are in a community coalition to improve access to care • Twelve LHJs provide behavioral health services and served 8516 clients • Twenty-four LHJs conducted a community health assessment to assist the agency and communi ro- viders in using health information to guide decisions. 'P More data is available at the Department of Health's website for Local Public Health Indicators.4 41111 • _ _ � �., PUBLIC HEALTH 4 ,..- ' � ,` ., saemK. '�, . .c._,r,. , a+z- ��� ,� .�:, , Summarization of Public Health Funding Issues The"County Public Health Assistance funds" approach has increased the flexibility of public health dollars but there are still several issues with current public health funding: • It is inadequate to meet the current RCW required services as well as emerging 21st century health issues. • Much of the state funding remains categorical in nature. • Most federal funding is highly categorical. Over time,the majority of state funding has remained stagnant, despite population growth and inflation.The following chart shows how aggregate spending by LHJs changed from 1998 to 2011 in inflation-adjusted dollars and in comparison to Washington state population. Total LHJ Spending by Funding Source (1998-2011, in 2013 dollars) .M so 376M 396M 390M 391M 39104 38704 39104 375M 70 M 37SM 361M 356M 340M 339M 346" iM 601 iM II � � _ , „.„, ,m 1 1 _rX , , . , . - - , 40 M30 3 2 M 20 1 1Q �M 0 104 2006 2407 240$ 3009 3014 2411 1999 1999 2000 2001 2002 2003 2004 2405 MO total Licenses,Fees,Permits tom Loc.Misceeant+ws MO LOCiI Government ..�.State Otheri State DOH MSS State Flexible • t 12 PUBLIC: aex, + :x ::« :, � r 4iM� :; a, .�' r7 �� f� HEALTH q o In addition, the following chart shows the vast differences between LHJs in per capita spending as well as the percent change from 2003 to 2011. Overall, it may seem that the funding hasn't changed much but this chart allows us to examine the local story more closely. Nearly all of the LHJs have seen a decrease in per capita spending and several LHJs have had dramatic cuts. By comparing per capita spending, the chart allows us to examine the overall funding situation in a way that makes comparison between ver differently sized jurisdictions possible. It should also be noted that these numbers don't include in kind contributions. For example, some jurisdictions have large contributions to their budget such as free facilities rent that aren't included in the following numbers. Per COPita Spending,2003 and 2011,rn 2013 dodCars l►%A KC Percent'Change Tacoma-Pierce Snohomishr�s z496 Spokane w 20011 Par Crp;w zs% t. Clack s+ a(2013 S1 3. Banton-Franklin % Tail a 2.0313 PerCapita3 6% Tail'SUM �_R2096 CL. K i is a p Spur/Intro.'s(2,01331$4 Widow -3296 go What cornougunig -ismmamgmmiumum }y liimmagggegimium x • SikaIt 2396 mmagiggimmit 411 I Chelan-Douglas / . 1 °Dye i tz %i _ ��� 4496 Grant aw smaim' I. biawesdinlmagmmmmiO = t zz Lewis GIays Harbor -2646 ellamenaleamalleele Chia lam rawartmaraternanamea ME Tri i ariammtamgmam (Mason tammusammeeinim Wada Walla S3, 2596 masimaggsgeass Whitman amara Kitttlt+ss — atamogaggima Okanogan 6sl4 z»6 v S' rso n it Asoti n c Pactric .. + 16% Kl i ck hot 1% 496 Adams d16% 3ivan is% Skas aitiaciiiii --- ^-^-----�, i41ti Co/vwibir "` ise. W a h ki a k um --�...'".—„^^^^-,.— ---..,.�,�.,,_,...,,, ¢ 4 }' Ss23 Seo STs $100 % Snu,c 5125 Stsa 043115.2CO3-2G31:an.d 661K_20316. Despite the limitations of public health funding, Local Health Jurisdictions across the state continue to do some amazing work. The following stories depict how the public health system in Washington w io to improve the health of the population and keep Washingtonians safe. g orks ► N HEALTH a < ri a d c F µ `°_ ' l ? . .., , , , ' . x�..,�u,�fi ems,.A ,,.0�..��.. k a.�,�o-��'�' � ';�rF Stories from Local Health Jurisdictions Local Health Jurisdictions perform a variety of functions to protect the public's health-both everyday duties such as vaccinations as well as responding to urgent public health threats like disease outbreaks and longer term issues like the obesity epidemic.To showcase the variety of ways that LHJs utilize the County Public Health As- sistance funds provided by the state to meet RCW requirements as well as address additional community needs, this report includes profiles and stories from 5 LHJs.These jurisdictions vary in size and population but they all have the common thread of using state funds to protect the public's health.They also show how public health is the convener that plays a unique role in bringing organizations and jurisdictions together to solve problems effectively. County Public Health Assistance funds play a unique role in LHJ budgets by affording the ability to respond to local issues and needs.This increases their capacity to respond to emerging health threats as illustrat- ed in several of the following stories. LH} Population Operating Budget FTEs County Public Heath Assistance/ %of budgets $18,339,383 164.5 $3,619,636 Snohomish Health 730,050 19.7% • District Grant County 91,800 $2,026,774 22.7 $337,218 16.6% Health District 6.8 $146,729 Lincoln County 10,675 $559,06126.2% Health Department $20,710,147 191.1 $3,203,788 Spokane Regional 480,000 15.5% Health District $2,709,530 40.3 $262,406 Grays Harbor 73,200 9.7% County Public Health&Social Services 110 ,,, - -,,,,,,lf,44mt,, 14 :,,,,,,,t ,.,4,, ,, PUBLIC �� � HEALTH Snohomish Health District: Responding to the SR 530 Mudslide (Oso) On March 22, 2014, a mudslide occurred near Oso,WA. The mile-long slide completely stopped the flow on the North Fork of the Stillaguamish River,covered a section of SR 530, and cut off access to Darrington,WA. In total,the impact of the slide was: • 36 homes completely destroyed; • 9 homes sustained damage due to flooding; and • 42 fatalities and 17 injuries. The majority of the funding for the Snohomish Health District (SHD) SR 530 mudslide response was from County Public Health Assistance funds. While staff time was redirected to the response efforts, only their overtime pay was eligible for the FEMA reimbursement percentage. Their regular pay was not charged against other programs because they were working outside the guidelines of those programs. SHD pulled together and adequately staffed the agency Incident Command Structure on Monday,March 24, 2014. The Health District quickly provided tetanus and pertussis (Tdap) vaccine and N95 respirator masks to protect responders and volunteers. They were also asked to create a mental health plan, to coordinate Critical 40 Incident Stress Management (CISM) teams, and to ensure that the mental health needs of the ie. community,responders,and volunteers were being met. The Environmental Health response was crucial to operations. Their duties included providing:• support and technical guidance where personal property was being cleaned and fi µ stored, V. ;fir; ; , _.. • . food safety and hygiene information quickly to incident command posts, �c • information to families with flooded homes regarding well safety and post- flood cleaning, sr • technical support and service to a wide range of response organizations,and • participating in debris clearing and recovery task force groups. SHD also provided staff to the Medical Examiner's Office to assist with contacting the families of the victims. They reached out to Public Health — Seattle &King County to request technical assistance and additional medical examiner personnel though a mutual aid contract that was already in place. 40 Overall,the experience of responding to this natural disaster showcased the important role that a local health department can play in emergency response. P—LIBIAC t$ zst?Y9 S HEALTH Grant County Health District: Pertussis Outbreak in a Migrant Population On the July 3rd,2014, Grant County Health District (GCHD) staff were notified of a case of pertussis in a migrant farm worker in south Grant County. Grant County is a mid-size local health jurisdiction serving 91,800 people,where more than 38% are Hispanic and 20%live below the federal poverty level. That July,pertussis was identified in an agricultural area where 95% of the population is Hispanic and was specifically found in migrant workers living on and near orchards. County Public Health Assistance dollars funded the intense response to the Pertussis outbreak that lasted more than three weeks. The cost of the response to GCHD totaled$15,000.What isn't included in that amount is the years of relationship building with local such as thesehcare,city officials, ore effective and less neighboring This lic outbrehealth ak,aaencies, and others that make responses to outbreaks is often found, also crossed county lines and necessitated multiple public health agencies responding as a unified public health system. By the end of the outbreak, 26 people were confirmed to have pertussis and 231 people had been contacted by GCHD staff in an effort to control and prevent further spread of the disease. Besides interviewing the cases and contacts (most in Spanish), • GCHD also secured adequate supplies of antibiotics (over 200 filled prescriptions) and vaccine (300 shots given). GCHD also conducted a large public information campaign using local media(radio and newspapers) to communicate critical messages about disease prevention and what to do if you were potentially exposed. In the end GCHD and its partners were able to respond and put a quick end to this outbreak due to the agency capacity afforded by the County Public Health Assistance funds. Public Health Nurse Lois Swenson and By the end of the outbreak, 26 people were confirmed to have Bilingual Public Health Associate Laura pertussis and 231 people had been contacted by GCHD staff in an GrantCarmona County Faew a carrker Pertussis e contact in the 2014 effort to control and prevent further spread of the disease. Besides break interviewing the cases and contacts (most in Spanish), GCHD also secured adequate supplies of antibiotics (over 200 filled prescriptions) and vaccine (300 shots given). GCHD also conducted a large public information campaign using local media(radio and newspapers) to communicate critical messages about disease prevention and what to do if you were potentially exposed. In the end GCHD and its partners were able to respond and put a quick end to this outbreak due to the agency capacity afforded by the County Public Health Assistance funds. • 16 �� a PUBLIC . , �� � � HEALTH Lincoln County Health Department: Population Health Prevention Strategies In 1993, Lincoln County identified the need to work with community partners to achieve sustainable improvements in health status. The Lincoln County Health Department joined with the Lincoln Public Hospital District#3, serving north Lincoln County and the Odessa Public Hospital District#1, serving south Lincoln County, through an intergovernmental agreement to form the Lincoln County Public Health Coalition. The mission of the Coalition is to improve the health status of Lincoln County. Since its inception,the Lincoln County Public Health Coalition has utilized health data and community input to develop population health prevention strategies that improve our health status. This work,initially supported by a Rural Health Outreach Grant from the Health Resources Services Administration has had to transition to non-categorical,flexible funding from state and local sources, as well as grant support when available. The first priority identified by the Coalition was Breast Cancer. The Lincoln County breast cancer mortality rate exceeded state rates because cancers were being diagnosed in late stages. A coordinated outreach effort to the community, matched with increased provider awareness and improved imagery has resulted in earlier detection of breast cancers and a reduction in mortality to below state rate levels. • A second priority was addressing childhood obesity. In 2005, the Coalition began assessing eryday! childhood obesity rates through BMI measurements innim'"N of kindergarten through 7th grade in all 8 school districts serving Lincoln. It was found that 33% oandf Lincothatlnthis Countyratehas youth been areconsistent overweightsince or 2005.obese S X 1 Let'' Go isnCI The Coalition created the 5,4,3,2,1 Let's Go LinCo! °° campaign.Let's Go is a community campaign that influences healthy behaviors at all levels. The messages are shared by the Health Department,Health Clinics, Hospitals, Schools and businesses throughout Lincoln County. Smarter Lunchroom Design strategies have been in 8 schoolto in students to make healthy food choices. In support of the effort to pflu ncetlidfestyle,three healthtclinics flarence working to include patient centered healthy weight counseling during clinic visits with healthcare providers. As a result, County Public Health Assistance funds has allowed the Health Department to work with the Coalition and our community partners to develop community strategies to improve Lincoln County lifestyles to include healthy behaviors. • �+ `# .. ...{., ,.# a�.�t.s k aF ..r_ h.,* x ,e«�„2 ......... ...,,...✓ .., s.a . „.. .a. ,....a..i+.hsv YY�w,a<n. .k `aWNas#"u� a.:J HEALTH �� MILK Spokane Regional Health District (SRHD): Neighborhoods Matter Program SRHD utilized County Public Health Assistance dollars to fund a NACCHO (National Association of County and City Health Officials)best practices population-based Maternal Child Health program called Neighborhoods Matter (NM).The program is designed to address inequities and disparities at the neighborhood level. It utilizes a community engagement, asset based community model. SRHD staff work with residents of the community to identify issues/concerns as well as possible solutions. The Neighborhoods Matter project is in its 5th year and has contributed to: • Increased community connectivity through community cafes and community gardens • Increased safety through demolition of a drug house and park cleanupsr • Decrease in food insecurity especially in the refugee population • Expansion of the alcohol impact area to include the targeted neighborhood • Continuation of library services in the neighborhood as well as expanded library hours hff • An impact on Marijuana retail zoning • A portion of the neighborhood was chosen by the city as a Targeted Improvement Pilot Project A return on investment study has been done on this project and for every dollar invested our return was$4.07. Additionally this project contributes to policies and activities that support healthy families which is good for all of us. _ 4. I _ a • ��� xr_$H;����.:�.�� ��,xPUBLIC � ,�,: � �� s i � „.. HEALTH Grays Harbor Public Health &Social Services: Responding to a Fire On February 25th, 2014, a fire occurred in a three-story building that housed 55 people who were aged and disabled. While the fire was extinguished quickly, the sprinkler system had caused water damage throughout the building. Water,sewage and,potentially asbestos material,were seeping through ceilings and floors. Residents had to vacate immediately.Many residents had physical health conditions that required special accommodaton. ' Some experience chronic mental illness and needed expert support in managing a dramatic chap e that occur without warning. g red d Health department emergency preparedness staff and social services staff teamed up for a quick response, convening many of our local partners and out-of-county experts to devise a plan for safely transferring people to p new locations that fit their individual needs. Over the next 24 and 48 hours,participants included local church that provided overnight housing,hotel and motel owners who found spaces and agreed to reserve them fores unknown period of time,the Coastal Community Action program who arranged meals and assisted in locat n housing,County Commissioners who authorized emergency funds to assure that costs would be covered ng the Red Cross who helped with logistics. Every resident was safely housed within 48 hours.A regional Rei and Cross worker said: "In 16 years,I have never seen such a coordinated,smooth community response as this It is amazing and inspiring"In the days that followed, contractors cleaned the building,removed asbestos and • restored these homes to safety. Residents returned to their homes in 27 days. This effort was only possible because of County Public Health Assistance funds that allowed staff to stop their regular work and respond to a local emergency. None of the categorical funding used by the health de arme could cover the staff time needed to make calls, convene meetings and facilitate logistics planning amonnt partners. Without the swift coordination and consistent follow-up, the event would have disrupted lives g for much longer. I 19 • HEALTH «a c Future of the Public Health System in Washington State The Washington governmental public health system faces many challenges in a time of shifting contexts. Even with our successes life expectancy is predicted to be decreasing for the first time in a generation.Washington state currently ranks 14th in the nation according to America's Health Ranking compiled by the United Health Foundation.6 If we are going to improve health outcomes,public health must make a seismic shift- one that moves away from a targeted focus on individuals to a much broader emphasis on improving population health. We must move beyond the traditional disease specific paradigm tpermeates neighborh000rhood level ds,homes, schools anderventions that on system level change.We must create a culture of healthp workplaces. Addressing these challenges will require new approaches.We have a public health funding and delivery system that was designed in and for the 20th century, and it needs to be redesigned to meet 21st century needs. It is essential to look at potential funding and structure changes to Washington's governmental public health network for three key reasons: 1. Washington communities have ongoing needs for preparation and protection against traditional public health threats, including communicable diseases, environmental toxins,and natural disasters. Funding tional public health services challenges combined with growing •populations have eroded to the point wherel basic RCW required protections throughout the state. Public health services for the public's health and safety are threatened. 2. Preventable illness and death from injuries and chronic disease (e.g. diabetes, ,heart disease, stroke,taddress these conditioner ) are harming Washington families,business and society.We cannot continue after they occur.We must move up stream with our approaches and tackle the root causes of these problems such as Adverse Childhood Experiences (ACEs). ACEs are traumatic stressors that occur in childhood that can negatively impact the developing brain and body.ACEs include such experiences as abuse,neglect and household mental health and substance abuse. Adversity in childhood has been identified as the nation's number one public health problem and is common in Washington State with 62% of WA adults reporting at least 1 ACE and 26.5% reporting 3 or more.' Childhood experiences may be the most powerful determinant of health yet resources for an adequate response are missing. 3. Residents in Washington State should be able to count on receiving a basic set and adequate level of public health services no matter where they live. Currently,there are disparities in the level of services offered in different jurisdictions, in some cases a service is delivered in some jurisdictions but not others. • PUBLIC *4, �un. ,�� sem ' '�. ,� �' , 4 � `` � : $ tet H EA LT • H N tit: Conclusion Every person in Washington State has the right to expect a strong public health system. An effectiveub infrastructure is essential to prevent, and when necessary,swiftly respond to and stop communicable di he health threats,improve overall population health by reducing chronic disease and ensuring that our families disease and our children are healthy and ready to learn. are strong The public health system must work in tandem with State and local policy makers to refresh outdated and statutes as well as ensure adequate resources are invested into the public health system in order to ach ievevee consistency of public health services and improved health outcomes for all Washingtonians.Ebola is a good ach example of the fact that good old-fashioned public health work,which is invisible in normal times to o people, is a critical part of the public safety infrastructure in our state and counties. The state's Count Public Health Assistance funds are crucial in maintaining those basic services. y ulic 'Public Health Improvement Plan 2012. Accessed at:http://www.doh.wa.gov/Portals/l/Documents/Pubs/822- Aikis/Pubs/822 •2Agenda for Change Action Plan for Washington's Public Health Networ wa.gov/Portals/1/Documents/1200/A4C-APsummary.pdf k 2012.Accessed at:http://www.doh. 'Department of Health 2013 Revenue Report for Local Health Jurisdictions. Accessed at:htt :/ doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServicew Funding/2013RevenueReport s/ 'Local Public Health Indicators. Accessed at:http://www.doh.wa.gov/ForPublicHealthandHealt PublicHealthSystemResourcesandServices/Indicators hcareProviders/ 'Department of Health 2013 Revenue Report for Local Health Jurisdictions. Accessed at:http://www. doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandSer vices Funding/2013RevenueReport s/ 6America's Health Rankings. Accessed at: http://wwwamericashealthrankings.org/WA 'Foundation for Healthy Generations, Health&Resilience:Foundations for Health Equity q ty conf erence,Fall 2014. • Jefferson County Public Health 2015 Community Health budget HTH 120 Nursing Admin 219,614 11% Illkopulation and Prevention HAD 210 Drug and Alcohol preveniton HAD 215 Drug and Alcohol preveniton 53,39,058927 2% HAD 212 Healthy Communities-community Transformation 26,000 3% HTH 445 Tobacco prevention 1% additions to HTH 290 School Health 5,000 0% 2015 budget* HTH 125 Health Care Access 71,669 4% 0% Targeted Clinical Health Services 195,654 10% HTH 260 Family Planning state and fees HTH 262 SBC Family Planning7312,959 16% HTH 270 Family Planning Federal 27,60 HTH 291 Foot Care 27,60330 % 1 1% HTH 292 SBC Primay Care 48,277 3% HTH 430 Breast and Cervical Health Program 61,63 1,63881 0% 0% 527,598 27% Family Support Services HTH 220 Maternity Support Services HTH 222 Child protective services 73,420 4% HTH 225 NFP other 37,848 2% WITH 228 Nurse Family Partnership 176,471 9% TH 250 Children with Special Health Care Needs 118 6 HTH 252 MCHBG Con Con -ACES work 10,4465 % HTH 280 WIC 18'8644 1% 1 1% HTH 281 WIC Breatfeeding 124,937 6% 4,830 0% Communicable Disease Prevention 575,104 30% HTH 320 Immunization children HTH 321 Adult Immunizations-Travelers 95,2365% HTH 322 Immunization Con Con 98,3722 5% HTH 325 Immunization Public Health 8,6 % HTH 330 Sexually Transmitted Disease 1 ,7449 HTH 340 TB 177'7655 1% 2 1% HTH 352 Syringe Exchange program 9,637 0% HTH 390 Communicable Disease 3,360 0% 82HTH 395 Communicable Disease PH 29,4532 2 2% ,47 % HTH 880 PH Emergency Preparedness 2 HTH 888 Emergency response- Ebola 34,653 2% 0% 410,147 21% Total Community Health Budget 2015 1,928417 100% * with additions • listed above April 16, 2015 h 1 s v, , t,1 R 'ci m 7z, n ufc'i' 5' o g 0 w 7� o- ,..,,.-n w o o O :L.,-- ca.. c� a; 0 .o o a' v1 0 O Pr m = o: Or R R �' 0 w ', to O p pi W p .R+ (D (aD CSD N _ p P� < �.�. o C) o • co n n tocp O <O p O" (Op Q a`2' ` ' 'Co— O N O. 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The free tetanus, diphtheria, pertussis (Tdap) vaccine from Sanofi/AmeriCares is for low income uninsured clients who have contact with infants less than 1 year of age, 6 doses were administered in 2014. ifigH also had free State supplied Tdap vaccine for uninsured adults, 17 doses were administered. Clinics refer ily members of pregnant women to JCPH for this program and clients have been identified through our WIC program. The State supplied a limited number of doses of free Hepatitis A/B vaccine for high risk clients, five doses were administered. Three doses of Human Papillomavirus (HPV) Vaccine and 4 doses of varicella vaccine were provided to uninsured low income adults through Merck's Patient Assistance Program. Since most clients are now enrolled in health care insurance the number needing free vaccines has significantly decreased. STD The Family Planning and STD clinics follow the CDC screening recommendations for high risk age groups. The percent of female Family Planning clients screened for chlamydia increased from 60.4% in 2013 to 63.4% in 2014. In 2012, the national screening rate for women in this age range was 49.2% for those covered by commercial health insurance and 59.9% for those with Medicaid. In WA, in 2012, 44.3% of women in this age range who were covered by commercial health insurance were screened, and in 2011-2012, 48% covered by Medicaid were screened. The number of chlamydia cases reported has increased over the past two years, with 76 cases in 2014 and 78 cases in 2013, up from 48-58 cases per year in the previous 5 years. The increase in reported cases may partially reflect increased testing but may also be a true increase in incidence. As discussed above, the number of gonorrhea cases increased significantly in 2014. JCHP staff continue increased outreach and testing for both chlamydia and gonorrhea. HIV Prevention OThe syringe exchange program (SEP) success is not easily measured in disease prevention numbers but the ber of clients seen and syringes exchanged reflects the disease transmission prevention capacity of this program. SEP utilization increased significantly in 2014, with 350 visits, up from 185 visits in 2013. The number of syringes dispensed was 42,809, up from 24,596 in 2013. Fifty new clients visited the SEP in 2014. New clients are coming to SEP rather than relying on other exchangers to supply them with syringes through secondary exchange. This allows SEP staff to offer disease prevention services and referrals to more individuals. Continued education in safer practices during each SEP visit is important for continuing the disease prevention mission of this program. See the 2014 Annual SEP report for details and more in depth discussion. The number of free HIV tests sent to the State Public Health Lab has decreased as more clients have been enrolled in health insurance. The number of tests sent to Quest, a commercial lab, has increased. Public Health Emergency Preparation and Response Staff participated in Regional Healthcare Preparedness meetings, local Healthcare Coalition meetings, JPREP and DEM meetings, and worked with neighborhood preparedness groups. Staff participated in State training webinars and meetings with Jefferson Healthcare regarding Ebola preparedness. The Regional Duty Officer 24/7 contact system for Public Health was replaced in November 2014 with an answering service serving the 3 counties in the Region. The JCPH phone message now gives an after-hours option to be connected to the answering service. The answering service calls the JCPH manager on call, who then calls the subject matter expert for the issue prompting the call. This new system has been working well most of the time, but some issues have been identified by the 3 counties. Kitsap County is the lead county working with the answering service for improvements in service. • 8 5/8/2015 . y The Jefferson Healthcare clinics started stocking more private supply adult vaccines for their patients in 2014. In the past, adults were referred to JCPH for most vaccines. This shift may have an ongoing affect on the number of adult doses administered by JCPH. . By the end of 2014 all clinics using State supplied vaccines were orderings erd ec viby DOvHcine Immkingation inventory, and reporting monthly doses administered through WAIIS, as q Program Coordinator provided the clinics training and technical assistance n these ble esehogland o modules ahrowith t the year. These modules, have had frequent technical glitches requiring the WAIIS staff. One clinic discontinued offering State supplied vaccines in 2014; Jefferson rso nomHeathcare Walk-in and Internal noow State supplied vaccines; Medicine. Another clinic joined the Vaccines for Children program Jefferson Healthcare Madrona Family Medicine. There are 5 Jefferson Healthcare clinics participating in this vaccine program, in addition to JCPH. A 11/7/13 CDC report on the percentage of children under age six having 2 r morefodoses of Thea vaccine er recorded rded in a State Immunization Information System registry gives a national rate of 8County rate was 87% in 2012, 88% in 2013, and 89% in 2014. The CDC National Immunization Survey has been used for many years to track national and state immunization Thi rates. This is a telephone survey of parents and immunization records are rthe recommended by clinical series review. i 2013,sup survey reports 71% of Washington State children under age 3 completed from 65% in 2012. The national rate was 70%in 2013, up from 68% in 2012. The County View Reports, available in WAIIS, allow JCPH staff efto series completion rate for children under assess immunization rates for Jefferson County children using the immunization records in WAIIS. T age 3 was 56% in 2014, up from 53% in 2013. WAIIS is populated by immunization records entered by health g database at birth. 41)care providers and insurance plans. All children born in WA Statrecord is entered. The children's Children moving into the state are not in the registry until an immunization who records available to JCPH for this assessment are those who are residents of ts who receive n County immunizations ns from received d immunizations frd mrs providers availableerson County. At for the reports run this y Local Health Department staff. of-county providers are no Twopfossible causes for the improvement since 2011, in the Jefferson County immunization zo tionindirate, re:clii proved completeness of immunization records in WAIIS, and evaluation andgiven resulting in increased efforts in the clinics to remind parents when children o are e for immunizations,for assesnand to g administer all recommended ferent populations in Jefferson Countyy visit. We will . explore immunization rate The 2011 school immunization exemption law may have had an effectl 5 9% in theion rates.fallof 2010he t 9.5%ption in 2011e for Jefferson County students entering kindergarten decreased f the e 12.4% in 2012 and 11.7% in 2013. The Washington State rate ecdonvenienced from °exemptonsc'v _and ho much period. It is not known how much of the decrease was due to reduced was due to parents making different choices after having a risk/benefit discussion ssiolate spring immunizations with a health care provider. DOH will publish the 2014-2015 school yearreport In Jefferson County, the number of students who are reported as ` Out of or ' vccomplete records at to be an issue. These are students that are either not up-to-date on required immunizations, the school. This rate for Jefferson County kindergarteners was 36.9% in the fall of 2011, 31.9% in 2012 and d 11.2% in 2013. 40JCPH staff continued to provide information to schools about the dOn thee fall website of 2012 than hafor reporting cdho any data, mous remind schools about the reporting deadline. More schools reports year, 11 out of 14 schools. This increased to 13 out of 14 schools in 2013 and all 14 in 2014. 7 appropriate testing and testing data collection. The new EMR program, EMDs, will be assessed for the types of data reports available. HIV Prevention /AIDS case management services are provided by Clallam County Health Department for the two counties. Ilk/AIDS funding guidelines focus on HIV Prevention Programs for high risk populations, based on HIV prevalence in the local area. Jefferson County is classified as a low prevalence county. Since 2012 HIV prevention funding has not included funding for low risk counties. The State Public Health Lab continues to do a limited number of free tests for high risk clients but there is no funding for staff time for counseling and testing services. JCPH staff will continue to provide free HIV testing services for low income high risk clients with no medical coverage. Others requesting testing will be tested through Quest lab and billed for the cost of testing. JCPH staff will continue to provide SEP services. For the past two years DOH has provided a one-time bulk purchase of SEP supplies to supplement our program. Public Health Emergency Preparedness and Response (PHEPR) Federal funding includes developing response capacity for all hazards emergency response. Response capacity is developed in coordination with Region 2 PHEPR partners Kitsap and Clallam Counties, local emergency response agencies, Jefferson Healthcare, and other health care providers. Public Health staff have been trained in and use National Incident Management System protocols during communicable disease outbreaks. The roles, responsibilities and training have been invaluable for managing communicable disease outbreaks. JCPH participates in the Regional Duty Officer 24/7 contact system for Public Health with Kitsap and Clallam Counties' staff, responding to after-hours calls and triaging them to the appropriate Public Health professional if necessary. This allows JCPH to share call time and standardizes regional response to Public Health issues. PHEPR funds were reduced by 15% for the 2011-2012 Federal funding cycle and will remain at that level for 2013-2014. *eased funding for any program would result in scaling back on services. The Board of Health would be i olved in deciding which services would be impacted. 2014 STUDY/ANALYSIS OF RESULTS: Communicable Disease There was an increase in gonorrhea cases in 2014, with 21 cases reported, up from 1-6 cases per year in the previous 10 years. Nurses began offering gonorrhea/chlamydia testing to all clients coming in for syringe exchange. SEP clients were asked to share flyers about the outbreak, and free testing, with their friends. If repeated efforts to encourage partners of a case to come in for testing were not working, medication was provided to the case to be given to the exposed partners. This treatment protocol is through a longstanding DOH STD program called Expedited Partner Therapy, with medication provided by the State. State funding for the JCPH Communicable Disease and Immunization programs was reduced by$21,000 for 2010-2011 and by another$22,000 for 2012 - 2013, continuing at this level for 2014. This funding supports staff positions. The CD/Immunization program decreased staffing hours in 2012, 2013, and again in 2014. Immunizations The number of doses of publicly funded vaccine administered to children in Jefferson County was fairly stable from 2010—2012 and decreased in 2013 and 2014 to 4,613 doses. The WAIIS doses administered report has had issues with accuracy, so the accuracy of the reported number of State supplied pediatric doses administered in 2014 is not assured. The percent of the pediatric vaccines that were administered at JCPH increased in 2014 w ile the percent administered in the Jefferson Healthcare clinics decreased. The value of vaccines supplied by tate to Jefferson County in 2014 was $254,119. 6 SUMMARY OF KEY FUNDING/SERVICE ISSUES: (From plan written 8/27/13) Communicable Disease/Immunizationsle disease JCPH CD programs address locally identified and defined public was returned from the state to h problems. counties for TB • prevention is primarily a locally funded program, county milage control. Immunization funds from the state are primarily in the form of vaccin,this vacci cine pis provid event, ide d oy and primary care clinics that care for children. County funding providesprofessionalh respond to disease outbreaks and immunization staff that work with the hospital,tion stahf althi e carerproviders, the schools, and local groups sponsoring trips abroad for students. Im utine immunization clinics and international travelers clinics. Staff respond to public requests for uke CD team continues tation a out communicable diseases and screen for reportable illnesses in the process. strengthening the notifiable conditions reporting system through outreach to the Jefferson Healthcare lab, ER, Infection Control Committee, and local health care providers. State funding for the JCPH Communicable Disease and Immunization programsvel for was educFunde g d y supports or 2010-2011 and by another$22,000 for 2012 - 2013, continuing at this positions in these programs. Due to reduced funding, the CD/Immunization program decreased staffing hours in 2012 and 2013 by reassigning staff hours, funding shortfalls were TreasurDeress Officerarryov . The funding will shift in 2014 from the DOH Consolidated Contract to a State Jefferson County rates for Cryptosporidiosis and Giardiasis,both waterborne to our PM indicator table frequently above the 2. State average. We are monitoring these, looking for trends, and added these The number of infants seen in the JCPH immunization clinic has been decreasing shift appears toinfants have stabilized seen for over immunizations by their primary care providers in their medical homes past . This twoyears. The immunization team will continue to monitor vaccine usage Systemacross the County.(WAIIS) will The new the • County View reports module in the Washington State Immunization Information more information on county wide immunization rates. The JCPH Immunization Program staff provides technical assistance to the clinics,rs in imthelininizcs, a ion pdmet of ates, vaccine refrigeration incident follow-up,training of new vaccine immunization rates for clinic patients and vaccine program quality uCe asseshone and information. Te cliis visit or numbers do not reflect the daily work with the clinics. Many contacts are Y mailed to clinics. All clinics receiving State supplied vaccines participate in the Washington ashi gtoImmunization noraInformation (WAIIS)registry.New WAIIS functions allow direct electronic ordering, ry tracking training ec sistance and monthly doses administered reporting. JCPH will continue to provide for chandrt use cal asmodnlesto all clinics in the use of these functions. DOH requests clinics receiving vaccine e The Juyon 1 2011 State law requiring most parents wishing to exempt their children frod om the r eqt red school exemption e immunizations to get risk/benefittonf ation arisons on the eom a medical xemption ratest as Jefferson County has not had rovider may have hrates. It is difficult to make year year comparisons 100% of schools reporting, and the individual schools reporting each year has varied. JCPH will continue to provide encouragement and information to all schools about the required State report. to The Immunization team will also continue to update the school secretaries'of Immunization use g WAIIS on figet The immunization records for students who do not have a complete Certificate immunization team participates in the annual school secretary orientation discussing updates in school immunization requirements. • STD The Family Planning and STD clinics follow the CDC's STD • lto monitor and explore waysho assure groups. 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To date 17 cases have been diagnosed in Jefferson County including high school, middle school, and elementary school students. In 2012, Washington had an epidemic with nearly 5,000 cases. 3 years later,pertussis is on the rise again statewide. So far this year there have been 319 reported cases of pertussis compared to 49 during the same time period last year. Pertussis is a highly contagious bacterial infection that causes coughing with little or no fever. Pertussis is spread when infected people cough and other people are near them. Severe illness is more common in young children who have not been immunized. Older immunized children or adults with pertussis often have milder symptoms but can still be contagious to others. Young infants are at highest risk for severe complications and death. Pregnant women, the elderly and individuals who have weakened immune systems are also at higher risk. Public Health control efforts for pertussis focus on protecting infants and pregnant women from exposure to active cases of pertussis. Vaccination and early detection of pertussis cases are the best ways to prevent life threatening illness in infants. Pertussis vaccines are available in a pediatric form(DTaP)and one used for adolescents and adults(Tdap). Children should have a series of 5 DTap vaccines beginning as early as 6 weeks after birth. Adolescents and adults should have at least one Tdap. Among adults,the highest prioritygroups for g P vaccination are.pregnant women (who should be vaccinated with every pregnancy), caretakers of infants, and health care workers who provide care to infants and pregnant women. Pertussis should be suspected in infants with worsening cough illness, in older children and adults who have cough over 7 days duration who have severe fits of coughing followed by vomiting and/or the "whooping"sound that gives pertussis its common name. Cough illness of any duration without alternate explanation occurring in pregnant women or those who have contact with pregnant women or infants should be investigated for pertussis. Finally, pertussis should be suspected in anyone with a cough lasting longer than 2 weeks. Pertussis is treated with antibiotics. Children with pertussis are excluded from daycare and schools until they have taken antibiotics for 5 days or 21 days have passes since the start of the cough. Adults with pertussis should avoid contact with infants and pregnant women until non-contagious. The best ways to prevent pertussis are to follow vaccination recommendations and practice good respiratory hygiene(frequent hand washing, cover your cough, and stay home when you are sick). More pertussis information: http://www.doh.wa.gov/YouandYourFamily/Il lnessandDisease/WhoopingCough or contact Lisa McKenzie, PHN Communicable Disease Program 360-385-9400 • Community Health Developmental Disabilities Environmental Health 360-385-9400 Water Quality 360-385-9401 (f) Always working for a safer and healthier communit 360-385-9444 y (f)360-379-4487 Board of Health IV New Business Item 3 2014 Syringe Exchange Annual & ,9e_vrson Public Healt IA CDC Health Advisory RE: Syringe Exchange nge Program May 21 , 2015 • Jefferson County Syringe Exchange Program (SEP) Annual Report 2014 • Jefferson County Public Health has provided a Syringe Exchange Program (SEP) since 2000 as part of a State effort to reduce the risk of HIV and other blood-borne infections among injection drug users, their families, and communities. SEP services include access to clean syringes, disposal of used syringes, prevention supplies, risk reduction education, and referral services. Education includes verbal and printed information on HIV, hepatitis, STDs, overdose prevention, encouraging one time use of needles, health alerts (for example, wound botulism and recent heroin overdoses/deaths), and immunizations. Internal referrals include STD, HIV, and Hepatitis C screening and counseling, tuberculosis screening, family planning, and immunizations. External referrals include drug and alcohol treatment, medical care, mental health care, domestic violence, food, clothing, and shelter. JCPH funded the SEP from 2000—2011 with State HIV prevention dollars. The CDC guidelines shifted in 2011 to focus funding for HIV Prevention Programs on high risk populations based on local HIV prevalence. Jefferson County is classified as a low prevalence county so it does not qualify for funding. There has been no State funding available since 2011. There is some discussion at the State level about finding a way to reinstitute funding for SEPs statewide. The State has provided one bulk order of su li for county SEPs once each year since 2012. Pp es Syringe exchange program success is not easily measured in disease prevention numbers but the number of clients seen and syringes exchanged reflects the disease transmission prevention capacity of this program. SEP utilization increased significantly in 2014, with 350 visits, up from 185 visits in 2013. The number of syringes dispensed was 42,809, up from 24,596 in 2013. The number of IDU prevention 1/1 materials dispensed increased from 15,984 to 18,373. See tables and graphs on following pages. The State Public Health Lab provides a limited number of free HIV tests for high risk clients. Though there is no state funding for staff time for HIV counseling and testing services, JCPH staff continues to offer this service for low income high risk clients with no medical coverage. Others requesting testing will w'll be tested through the Quest lab and the cost of the testing will be billed to the client/insurance. Throughout 2014 staff encouraged uninsured clients to sign up for health insurance through www.wahealthnlanfinder.or and offered appointments to assist clients. During the last 4 months of 2014, in response to an increase in gonorrhea cases in the community, all clients were encouraged to be tested for gonorrhea/chlamydia while at SEP. The 2014 Comm SEP Disease Program Performance Measures Report contains a discussion of this outbreak. umcable Funding for State and federal programs for free Hepatitis C testing for high risk clients ended in 2012. The State piloted a new Hepatitis C testing program in a few counties in 2014. JCPH plans to offer this testing in 2015. Five doses of State supplied Hepatitis A/B vaccine were administered 2014. at no charge in Naloxone is a medication used to reverse opioid overdose and provide time for transportation to the ER for additional overdose treatment. Naloxone is available to injection drug users, their friends, and families in eight or more Washington counties at SEPs or through partnerships with pharmacies. JCPH staff contacted local pharmacies to ask about willingness to stock naloxone. This was followed up by a letter from the Health Officer and Board of Health encouraging pharmacies to stock naloxone and the nasal atomizers for nasal spray administration. One pharmacy has expressed interest in this program. JCPH wil continue to set up protocols and training needed for this program so that naloxone will be available1 Jefferson County in mid-2015. in Syringe Exchange Utilization, 2000-2014 400 Jefferson County Washington 45,000 D Number of client visits 42,809 350 - 40,000 • 350 — —Number of syringes exchaneed 35,000 ao . 5 ▪ 300 – - 30,000 t ▪ 250 – 24,585 24,596 25,000 W u 21,133 17,726 j a� 0 2• 00 – 17,405 20,000 c ,. 18,060 17,905 •L �°J i\w/1 14,044 15,000 '^ 1• 50 – ,1 •0 0 9,156 Z 9,222 13,716 10,000 a� 100 – 4,206 .3 64 65 70 65 506 2,076 41 — 36 5— 1 i8 - 5,000 Z 50 _ 14 16 _ _ MANI 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Jefferson County SEP Clinics/Demographics Male SEP New Returning Secondary Visits' Clients Client Exchange Client Client Visits' Visits' Visits Visits 300 227 199 145 • 2014 350 50 70 2013 185 28 157 126 11570 96 NA 2012 150 18 132 NA NA 2011 142 19 123 110 NA NA 2010 81 13 68 40 NA 35 NA NA 12 53 2009 65 NA 2008 68 6 64 67 NA NA 2007 65 9 56 58 NA 50 49 NA NA 2006 54 8 30 29 NA NA 2005 36 6 48 45 NA NA 2004 64 12 55 53 NA NA 2003 63 9 NA 2002 41 11 29 25 NA NA 2001 16 6 9 5 NA 7 3 NA NA 2000 14 3 Note: 'Represents duplicate clients New Client Visits by Age Total Total Female Female Female Male 0r Male r 3Maler FFemale Male < 20 r 20 -29 r 30+ r 2 7 11 3 2 18 29 2014 20 4 3 2 6 7 2013 13 15 6 Total Client Visits by Age 30+years . < 20 years 20 29 years 53 (15%) 100(29%) 191 (56%) 2014 2013 23 (12/0 0 ) 77 (42%) 84(46%) 1 * 2011 —2014 SEP Clinic Participant Visits by Zip Code 70% 59% 60% 59% • 60% 57/ 50% 40% •41% 38% III 2011 30% 29% ; ' ■ 1 2012 20% u a2013 10% • filiv°41 4.61; w. 11% ■2014 0% Ill 3°° 2% Ni, 98368 . Other within Jefferson Cty Outside Jefferson Cty 2011 —2014 SEP Clinic Participant Reported Syringe Use 80% 70% ,. •67% 60% 49% 50% $e" ilr 40% ■2011 • 30% 1111 ° ■2012 20% • 21% ... ° . . 2013 10% 7% III 2014 0% • . :."*1 11111fitiagal :. Each syringe used Each syringe used 2- Each syringe used Unknown once 5 times 6+times 2011 —2014 SEP Clinic Participant Secondary Exchange 60% 50% 49%47% 40% 38° 39% 32%31% • 30% Inu, "` Illen ®2011 20% 22% , :4Y4.„rmil P::,':'rr,o,'i,'°.i_'.,.l. .,, m l ."1,.".7,„", r ° 11° ■2012 10% 9/ . , I„ _ ■ •° 10%8% 2013 0% ■ 1%1% ■2014 No secondary Exchanging for Exchanging for Exchanging for Unknown • exchange one other 2-5 other 6+other people person people Materials Distributed by Jefferson County SEP Syringes IDU Condoms/ HIV Tests Educational Provided Outreach Exchanged Prevention Latex Offered Materials3 Referral Educations Materials' Barriers2 Information4 III 52 139 177 2014 42,809 18,373 625 114 2013 24,596 15,984 377 90 28 128 18 129 10577 2012 17,405 11,535 406 49 90 2011 17,726 16,512 319 41 10 142 867 67 29 2010 9,156 11,024 102 36 31 26 51 33 2009 14,044 7,098 271 2008 21,330 7,941 140 27 32 35 32 18 23 32 2007 24,585 9,988 20 22 3 2 2 N/R 2006 17,905 9,000 0 2 311 N/R 2005 13,716 7,611 20 0 6_ N/R 2004 18,060 7,265 228 N/06 48 11 N/R 2003 9,222 1424 800 N/O 50 18NA N/R 2002 4,206 1,026 427 N/0 9 5 N/R 2001 2,076 3 14 N/0 2000 506 11 33 N/O 10 2 N/R Notes 1 IDU Prevention Materials include:Tourniquets,cookers, cottons,sterile water, sharps containers,alcohol preps,antibiotic ointment, band aids and sterile pads for wounds,tape. Individual items are given on an as needed basis. 2This number is for condoms dispensed in SEP only,condoms may also be picked up in the lobby. 'Educational Materials include information on hepatitis, HIV,STDs,health alerts(ex.wound botulism,overdose),care of abscesses,street drugs,tattoo safety,needle reuse, IDU safety,domestic violence, immunizations. • 4 Referrals: Internal referrals include STD, HIV and Hepatitis C screening and counseling,tuberculosis screening,family planning and immunizations. External referrals include drug treatment, medical care, mental health care,domestic violence, food,clothing and shelter. 'Outreach education is defined as face-to-face education on blood borne pathogens, risk reduction methods,safe injecting practices,vein care,and other as needed. 6 N/O:Not offered 7N/R: Not reported 2015 Goals • Continue anonymous, safe services to reduce the risk of HIV infection in our communities by promoting revisits by clients and to encourage clients to tell others about SEP. • Continue to educate clients on the importance and rational of using each syringe one time only. • Continue development of program for overdose prevention and naloxone availability. • Continue to inform clients at each visit of resources available at JCPH and in the community. • Continue to offer free HIV testing and counseling at each visit through the State laboratory for high risk clients without medical coverage. • Encourage uninsured clients to sign up for health insurance through www wahealthplanfinder.or • Resume offering free Hepatitis C testing when State has new program in place; continue offering Hepatitis A& B vaccine. • Continue dialog with clients regarding improvement of SEP services. • Prioritize supplies to be stocked, keeping only those deemed necessary to maintain safe practices among IDU clients. Inform clients of alternative safe materials, such as using soda bottles for the collection of . used needles in lieu of sharps containers. 3/20/2015 • This s an official CDC HEALTH ADVISORY Distributed via the CDC Health Alert Network April 24, 2015, 11:00 (11:00 AM ET) CDCHAN-377 Outbreak of Recent HIV and HCV Infections among Persons Who Inject Drugs Summary The Indiana State Department of Health(ISDH) and the Centers for Disease Control and Prevention (CDC) are investigating a large outbreak of recent human immunodeficiency virus(HIV)infections among persons who inject drugs(PWID). Many of the HIV-infected individuals in this outbreak are co-infected with hepatitis C virus (HCV). The purpose of this HAN Advisory is to alert public health departments and healthcare providers of the possibility of HIV outbreaks among PWID and to provide guidance to assist in the identification and prevention of such outbreaks. Background • From November 2014 to January 2015, ISDH identified 11 new HIV infections in a rural southeastern county where fewer than 5 infections have been identified annually in the past. As of April 21, 2015, an on-going investigation by ISDH with assistance from CDC has identified 135 persons with newly diagnosed HIV infections in a community of 4,200 people; 84% were also HCV infected. Among 112 persons interviewed thus far, 108 (96%) injected drugs; all reported dissolving and injecting tablets of the prescription-type opioid oxymorphone (OPANA®ER) using shared drug preparation and injection equipment.' This HIV outbreak was first recognized by a local disease intervention specialist. In late 2014, interviews conducted with three persons newly diagnosed with HIV infections in three separate venues (i.e., an outpatient clinic, a drug rehabilitation program, during a hospitalization) indicated that two of these persons had recently injected drugs and had numerous syringe-sharing and sexual partners. Contact tracing identified eight additional HIV infections leading to the current outbreak investigation, which has demonstrated that HIV had spread recently and rapidly through the local network of PWID. Without an attentive health department, active case finding, and additional testing provided as part of this investigation, this cluster may not have been identified. Urgent action is needed to prevent further HIV and HCV transmission in this area and to investigate and control any similar outbreaks in other communities. Injection drug use accounts for an estimated 8%2 of the approximate 50,000 annual new HIV infections in the United States.3 HCV infection is the most common blood-borne infection in the United States and percutaneous exposure via drug-injecting equipment contaminated with HCV-infected blood is the most frequent mode of transmission. Nationally, acute HCV infections have increased 150%from 2010 to 2013,4 and over 70% of long-term PWID may be infected with HCV.S Abuse of prescription-type opioids is increasing nationallys and opioid-analgesic poisoning deaths have nearly quadrupled from 1999 through 2011.7 Rates of acute HCV infection are increasing, especially among young nonurban PWID, often in association with abuse of injected prescription-type opioids. These increases have been most • substantial in nonurban counties east of the Mississippi River.8 • Recommendations for Health Departments • Review the most recent sources of data on HIV diagnoses, HCV diagnoses (acute as well as past or present), overdose deaths, admissions for drug treatment, and drug arrests. Attributes of communities at risk for unrecognized clusters of HIV and HCV infection include the following: o Recent increases in the: • Number of HIV infections attributed to injection drug use, • Number of HCV infections, particularly among persons aged < 35 years; o High rates of injection drug use and especially prescription-type opioid abuse, drug- related overdose, drug treatment admission, or drug arrests. • Ensure complete contact tracing for all new HIV diagnoses and testing of all contacts for HIV and HCV infection. • Ensure persons actively injecting drugs or at high-risk of drug injection (e.g., in substitution programs, receiving substance abuse counseling or treatment, recentlypcurrentlyor' gdg incarcerated) have access to integrated prevention services,9 and specifically: o Are tested regularly for HIV and HCV infection (consider more frequent testing based on frequency of injection drug usage or sharing of injection equipment); o If diagnosed with HIV or HCV infection: • Are rapidly linked to care and treatment services; If actively injecting drugs: • Have access to medication-assisted therapy(e.g., opioid substitution therapy) as well as other substance abuse services, if not already engaged, • Are counseled not to share needles and syringes or drug preparation equipment(e.g., cookers, water, filters), • Have access to sterile injection equipment from a reliable source. a If not HIV infected but actively injecting drugs: • Are referred for consideration of HIV pre-exposure prophylaxis10 and if potentially exposed within the past 72 hours (e.g., shared drug preparation or injection equipment with a known or potentially HIV-infected person) HIV post- exposure prophylaxis11,12 • Remind venues that may encounter unrecognized infections, such as emergency departments and community-based clinical practices (e.g., family medicine, general medicine, prenatal care) of the importance of routine opt-out HIV testing as well as HCV testing per current • recommendationsl3-15 • • Local health departments should notify their state health department and CDC of any suspected clusters of recent HIV or HCV infection. Recommendations for Healthcare Providers • Ensure all persons diagnosed with HCV infection are tested for HIV infection,76 and that all persons diagnosed with HIV infection are tested for HCV infection.17 • Ensure persons receiving treatment for HIV and/or HCV infection adhere to prescribed therapy and are engaged in ongoing care. • Encourage HIV and HCV testing of syringe-sharing and sexual partners of persons diagnosed with either infection. • Report all newly diagnosed HIV and HCV infections to the health department. • For all persons with substance abuse problems: o Refer them for medication-assisted treatment(e.g., opioid substitution therapy) counseling services, and o Use effective treatments (e.g., methadone, buprenorphine), as appropriately indicated. • • For any persons for whom opioids are under consideration for pain management: c> Discuss the risks and benefits of all pain treatment options, including ones that do not involve prescription analgesics. o Note that long-term opioid therapy is not associated with reduced chronic pain.18 • Contact the state or local health department to report suspected clusters of recent HIV or HCV infection. For more information: • Centers for Disease Control and Prevention. Integrated Prevention Services for HIV Infection, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis for Persons Who Use Drugs Illicitly: Summary Guidance from CDC and the U.S. Department of Health and Human Services. 2012: htt•://www.cdc.•ov/mmwr/.review/mmwrhtml/rr6105a1.htm?s cid=rr6105a1 w. • Centers for Disease Control and Prevention. HIV and Injection Drug Use fact sheet. (htt•://www.cdc.•ov/h iv/.df/.-I/cdc-hiv-id u-fact-sheet..df • Centers for Disease Control and Prevention. Revised Recommendations for HIV Testin of Adults,Adolescents, and Pregnant Women in Health-Care Settings. 2006; g htt•://www.cdc.•ov/mmwr/.review/mmwrhtm 1/rr5514a 1.htm. • • • Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations. htt•://dx.doi.or./10.15620/cdc.23447 • Centers for Disease Control and Prevention. Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep. May 10 2013;62(18):362-365. • Centers for Disease Control and Prevention. MMWR Integrated Services Report. (htt•.//www.cdc.•ov/mmwr/.review/mmwrhtml/rr6105a1.htm?s cid=rr6105a1 w) • Centers for Disease Control and Prevention. HIV and Injection Drug Use fact sheet. (htt.://www.cdc.•ov/h iv/.df/•-I/cdc-h iv-id u-fact-sheet.•df) • US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States-2014 clinical practice guideline. 2014; http://www.cdc.aov/hiv/pdf/p repguidelines2n14 pdf. • Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. 2015; htt.://www.aidsinfo.nih..ov/ContentFiles/AdultandAdolescentGL..df. • AASLD/IDSA/IAS—USA. HCV testing and linkage to care. Recommendations for testing, managing, and treating hepatitis C. htt•://www.hcv•uidelines.or./full-re.ort/hcv-testin•-and- linka a-care. References 1. Spiller MW, Broz D, Wejnert C, Nerlander L, Paz-Bailey G. HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs -20 Cities, United States, 2012. MMWR Morb Mortal Wkly Rep. Mar 20 2015;64(10):270-275. 2. Centers for Disease Control and Prevention. HIV Surveillance Report, 2013; vol. 25. htt•://www.cdc.•ov/hiv/fibra /re.orts/surveillance/, last accessed April 22, 2015. 3. Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006-2009. PLoS ONE. 2011;6(8):e17502. 4. Hagan H, Des Jarlais DC, Stern R, et al. HCV synthesis project: preliminary analyses of HCV prevalence in relation to age and duration of injection. The International journal on drug policy. Oct 2007;18(5):341-351. 5. Maxwell JC. The prescription drug epidemic in the United States: a perfect storm. Drug and alcohol review. May 2011;30(3):264-270. 6. Chen LH HH, Warner M. Drug-poisoning deaths involving opioid analgesics: United States, 1999-2011. NCHS data brief, no 166. Hyattsville, MD: National Center for Health Statistics. 2014. 7. Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2012. Clin Infect Dis. Nov 15 2014;59(10):1411-1419. 8. Centers for Disease Control and Prevention. Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services. MMWR Recomm Rep. Nov 9 2012;61(Rr-5):1-40. 9. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States-2014 clinical practice guideline. 2014; • http://www.cdc qov/hiv/pdf/prepauidelines2014 pdf. • 10. Centers for Disease Control and Prevention.Antiretroviral Postexposure rophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in he United States Recommendations from the U.S. Department of Health and Human Services. 2005; http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm. 11. Kuhar DT, Henderson DK, Struble KA, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infection control and hospital epidemiology. Sep 2013;34(9):875- 892. 12. Centers for Disease Control and Prevention. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. 2006; http:l/www.cdc.gov/mmwr/preview/mmwrhtmi/rr5514a1.htm.Accessed April 22, 2015. 13. Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations. http://dx.doi.orq/10.15620/cdc.23447.Accessed April 22, 2015. 14. Centers for Disease Control and Prevention. Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep. May 10 2013;62(18):362-365. 15. AASLD/IDSA/IAS—USA. HCV testing and linkage to care. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvquidelines.org/full-report/hcv-testing-and- linkage-care. Accessed April 22, 2015. 16. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. 2015; http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed April 22, 2015. 17. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. 2015; http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.Accessed • 18. April 22, 2015. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. Feb 17 2015;162(4):276-286. The Centers for Disease Control and Prevention(CDC)protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations. Categories of Health Alert Network messages: Health Alert Requires immediate action or attention; highest level of importance Health Advisory May not require immediate action; provides important information for a specific incident or situation Health Update Unlikely to require immediate action; provides updated information regarding an incident or situation HAN Info Service Does not require immediate action;provides general public health information ##This message was distributed to state and local health officers, state and local epidemiologist, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations## Board of Health IV New Business Item 4 Application for Substance Abuse Advisory Board Public Healt tA � May 21 , 2015 JEFFERSON MENIAL HEALTH SERVICES • Community Supported Outpatient Care for East Jefferson County Children,Adolescents,Adults and Older Adults-24 Hour Crisis PO Box 565 884 W.Park Avenue Pod Townsend, WA 98368 Phone, 360-385-0321 1-877-410-4803 Fax'360-379-5534 Date: March 11, 2015 Re: JMHS Board Membership with SAAB Jefferson County Board of Health 0/0 Julia Danskin Jefferson County Public Health 615 Sheridan Port Townsend, WA 98368 To Whom It May Concern: I am writing to express my interest in becoming a member of the Substance Abuse Advisory Board. I feel I am a good candidate for the Board as I am currently the Executive Director for Jefferson Mental Health Services the only licensed Mental Health agency in East Jefferson County serving individuals with co-occurring Mental Health and Substance Abuse disorders. I am Healthcare Senior Executive, Driven Innovator, and Intrapreneurial Strategist with many years of public and private sector healthcare multi-site administration and management, business and program development building integrated behavioral healthcare and physical . healthcare systems, project managing revenue and client diversification and technology advancement, contract administration, establishing behavioral health homes and accountable care community creation, earning trust through starting out in direct service care coordination, inspiring enthusiasm, communicating effectively, building volume, maintaining a positive bottom line, recruiting clinicians and physicians, designing and deploying new service lines, enhancing community and government relations, and strengthening healthcare public policy through civic and state association participation, and through legislative action. Specifically I have designed and deployed outpatient mental health and substance abuse/chemical dependency service lines when I served as the Executive Vice President of UCP of Maine and have extensive experience, education and expertise serving individuals with dual-diagnosis over the course of my career in healthcare. I believe my experience, education and expertise in behavioral healthcare service delivery matches with SAABs mission, vision and values. If my background is of any interest please feel free to contact me at your earliest convenience. Than ou2kindly, //Am Ad_ acquis, MBA, ACHE efferscn Mental Health Services Executi e irector 884 W. ar Ave. / P.O. Box 565 • Port Tow end, WA 98368 Board of Health IV New Business Item 5 Environmental Health Fee Update: New Hourly Rate for 2015 deV, -N.0,7. Public Healt May 21 , 2015 • JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH 2015 GENERAL Additional Fees and Other Information Health Officer Administrative Hearing - Administrative Hearing Appeal 314.00 314.00 Technical Assistance/Plan Review-Minimum Technical Assistance/Plan Review-Per Hour 86.00 Filing Fee 86.00 • 54.00Recording Fee Notice to Title Rescission 65.00 Plus the Auditors Office recording fee ONSITE SEWAGE DISPOSAL 525.00 Sewa.a Dis•osat Permits New Conventional New Alternative 569.00 Valid for 3 years New septic tankmg:and/or pump chamber only 829.00 Valid for 3 ears Issued in conjunction with an existing sewage disposal 340.0_inmormmarsommommEz0 s stem or communi s stem 719.00 Base Fee-Valid for 3 ears 919.00 OMEMBMIll Development and Review Financial Assurance and System 90.00 Add to base•ermit fee Operation A.reements Se.tic Permit with SPUD conventional 86.00 Per Hour Se•tic Permit with SPUD alternative 307.00 569.00 Repair Applies to existing installed sewage disposal system;the 50%of fee Technical Assistance/Plan Review hourly rate will be charged for repairs where the applicants require additional Modification or Reserve Area Desi•nation assistance 258.00 538.00 • •• 172.00 A••lies to•endin.or active but not installed Evaluation of Existin.S stem/Monitorin,Ins•ection 215.00 REMErmarnmaminum 334.00 377.00 On Site Sewa.e•Buildin.and Plannin• 17200IMINIMEMEMEMENNEEmminl OnSite-Site Plan Advanced A.•royal Determination SPUD 397.00 516.00 112311132 -- - 202.00 Per lot fee 202.00 90.00 For Subdivision Review,Boundaray Line Adjustment and • Planned Rural Residential Develo.ment Review fees Densi •exem•tionreviewfee 202.00 per Hotomil...mm.mmm...._MINIMINIMINimm.m...1 Field Work for Densi Exem•tionReview 129.00 ganzigrjEng Residential-Individual OSS Commercial-Individual OSS 129.00 -- Communi OSS 111111111111.111.1111.1.111.1.1111111111111111111 258.00 -- 258.00 Other 65.00 = • 237.00 387.00 538.00 86.00 Installer Pum•er,O•erator maintenance.arson 538.00 215.00 Annum ceftikiatei3erlewimmill=122121 10.00 Delinquent Renewal after January 31 299.00 FOOD SERVICE ES ABUSHMENT FEES PERMIT FEES Annual Permit 538.00 Restaurants/Take-Out Based on menu corn•lex' &seatin,-menu than..es ma than•e date.o 0-25 seats Limited Menu 0-25 seats Com.lex Menu 191.00 _ 26-50 seats 339.00 51-100 seats 340.00 101-150 seats 407.00 462.00 149.00 ECAMME 149.00 191.00 w/commissa orcaterin•-onl kitchen w/restaurant,additional fee for saten• 339.00 191.00 Etraz 149.00 149.00 meawish191.00 - - _ 462.00 Ira 339.00 mair 191.00 339.00 IMEIZEI 339.00 191.00 50%of fee 50%of Annual Permit Fee 1111111 Additional Event Same Menu Onl) 107.00 - -- 0 .anized Recurrin.Event e.•.Farmers Market 61.00 • 107.00 142.00 Ad _ Late Fee for Temporary Permits +50%of fee ditional( aid when application is submitted less than 7 Other Food Fees days pr or to the event) IC -• 41.00 1121. . 11111111111.1 ,f,„7,,2 _______12111 86.00 112232721.1.1.1.......11.1111.11111111111111 231.00 1 oft 1 ENVIRONMENTAL HEALTH 2015 Additional Fees and Other Information 86.00 Per Hour milii 86.00 86.00 Per Hour 1.01.123 95.00 163.00 10.00 Reissue Unexpired Food Handler Card 1.111.11.1.11.1111111101.11111111111111111111111.1 SOLID WASTE 557.00 .. ..m.............11111.11111111 • 489.00 .2222 353.00 353.00 1 .111111 ill Other Solid Waste Facilities 163.00 Dro.Boxes 448.00 353.00 345.00 *586.00/hour for>4 hours 50%of fee '- - Plan,Document and WaiverNariance Review Inspection of well construction,decommission& 163.00 reconstruction Application Fee Tech Assist and Doecument Review is billed at the hourly Determination of Adequate Water Supply base fee 129.00 rate Wjammommummimell Ins•ection&Water Sam.le for Loan 137326..0000 mmmmm...m..1.11111.111.111111"11111111.111111.... 1.1.111111.11.11111.1 Well Site Ins•ection-Pro•osed public water suppl L.zzaziaima Water Recreation Facilities 0•eration Permit.11 286.00 299.00 ICIFERTEMMEmmenzming 259.00 29000 2149..0 IIMMWacimarri 377.00 • �, 107.00 ElbT7 162.00 Each Additional Swim,Spa,or Wading Pool(in operation for<6 64.00 months of the ear Each Additional Swim,Spa,or Wading Pool(in operation for a 6 85.00 months of the ear 86.00 Per Hour•lus associated lab costs Reins•ection 86.00 Per Hour nirccriIndoor Air Tobacco 86.00 Per Hour 80.00 EMEDMI• 160.00 Note 2014 Fees have been adjusted per Ordinance 12-1209-96,Section 4-Annual Fee Indexing:Fixed amount fees established by this ordinance shall be adjusted annually on the first business day of January(Adjusted Date)by the amount of the increase in the Consumer Price Index(CPIW).The CPI W is the Consumer Price Index-US City Average for All Urban Wage Earners and Clerical Workers,published by the Bureau of Labor Statistcs for the United States Department of Labor. as Tate be increased by the percentage increase thhe annual lee adjustment shall be e month of September preceding the cAdjustmentoDate Increasesch fee lwill be rounded to the nearest dotern effect immediately prior to the usA fee tshag not will be reduced by reason of such calculation.Hn toweverlyfee increases forn IIIaccordance with this calculation shall not exceed 5 percent per year. • . • III 2 of 2 JEFFERSON COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION(Proposed Fees) Health Officer Administrative ENVIRONMENTALHearinHEALTH 2015 Additional Fees and Other Information Administrative Hearin.A•.eal 333.00 333.00 Technicastarimimmasinall 86.00 86.00 • 65-00 1112111 65.00 Plus the Auditors Office recordin.fee antztrIL, • 525.00 sommommomminnom Sewar e Dis•au/Permits New Conventional 569.00 valid foleariTIEEZEMZIMMEMEMEEnniminil immoinie 829.00 Issued in conjunction with an existing sewage disposal M. 340.00 s stem or communit s stem IMMER • 719.00 CEMOMEIZI llEEM �cc Tined I 919.00 Development and Review Financial Assurance and System 90.00 Add to base.ermit fee O•eration A.reements Ell Se.tic Permit with SPAAD conventional 86.00 Septic Permit with SPAAD alternative 307.00 569.00 1.111111. 1111 Repair Applies to existing installed sewage disposal system;the 50%of fee Technical Assistance/Plan Review hourly rate will be charged for repairs where the applicants require additional tiModification or Reserve Area Desi•nation assistance ••^�ca258.00 '-'yr T 538.00 � i. 172.00 A.•lies to.endin.or active but not installed Evaluation of Exjstm. S stem4Nonnorn.Ins•action 215.00 17 334.00 377.00 On Site Sewa.e-Buiidin•and Piannin. 172.00 Onsite-Site Plan Advanced A.proval Determination SPAAD 397.00 ounds Me ad ustment or Lot Certification base review fee 516.00 B Planned rural residential develo.ment review fee 202.00 202.00 imm in STA For Subdivision Review,Boundaray Line Adjustment and rrrwwmLa- �...�.... 90.00 Planned Rural Residential Develo•ment Review fees 111111111.11111111111111111111111111111111 examreview fee tion 202.00 Field Work for Densit fee ion Review 129.00 Densit• ' Per Hour • Residential Individual OSS Commercial-Individual OSS 129.00 -- - Communit OSS 258.00 - _ _ --- 258.00 -• - - -- • IIMEMEESEIMME Other 65.00 Review of resubmission before Buildin.Permit is issued 237.00 387.00 General environmental health review fee 538.00 86.00 Per Hour Installer,Pum.ermaintenance,O•erator Inst.. .erson 538.00 215.00 •'1!" 10.00 Dalin•uent Renewal after Janus 31 299.00 _ Jan 538.00 .e r :r- AMU*''"771ENIMMONEN Restaurants/Take-Out =ased on menu corn•l menu chs es ma than.a tate•o 0-25 seats Limited Menu 0-25 seats Com.lex Menu 191.00 No coolin•or reheatin. 26-50 seats 339.00 Coolin.and reheatin•allowed 51-100 seats 340.00 101-150 seats 407.00 ' 462.00 i� 149.00 EMETE 149.00 191.00 w/commissa or caterin•-onl kitchen w/restaurant,additional fee for caterin. 399.00 Concession/Commercial Kitchen/Church 191.00 149.00 149.00 «nom«(ilielm 191.00462.00 Ma serve.re-•acka.ed baked.00ds • Inn. .21..................:::::::1 339.00 ilEll 313991:0000 No coolin.or reheatin. - yr«r r ■.__ 339.00 INIMEMOMMINIMENEmmonni 191.00 Annual Permit Issued after September 1 50%of fee 50%of Annual Permit Fee �nwe Additional Event(Same Menu Onl 107.00 CIMZEirmum Or.anized Recurrin.Event e...Farmers Market 61.00 Not to exceed 21 da s at our location • 1111111�m n¢77,q 129.00 Not to exceed 3 da s a week at a sin.le location 172.00 IIMMIZEMMEME v50%of fee Additional(Paid when application is submitted less than 7 Other Food Fees days prior to the event) 41.00 rte... 86.00 - 86.00 231.00 1 of2 2015 Additional Fees and Other Information ENVIRONMENTAL HEALTH 86.00 86.00 imitt .1122 86.00 IZEII 95.00 IllEgillinel 163.00 10.00 Reissue Unexpired Food Handler Card . ®LIS WASTE Annual Permit Fees 688.00 Landfills re.uirin•environmental monito n•mors688.00 430.00 430.00 Other Solid Waste Facilities 2035.00 Drop Boxes INEMinairri 566.00 430.00 50%of fee 11111111.11111.........1111111111.111 345.00 +$86.00/hour for>4 hours Plan,Document and WaiverNanance Review - WATER Inspection of well construction,decommission& 206.00 reconstruction • 129.00 Tech Assist and Document Review is billed at the hourly I base fe Determination of Adequate Water Supp y e 17200 rate 111.1111111111111111111111.11111111111111.11 •- • 40900. Well Site Inspection-Pro•osed•ublicwater su.pl ;' :I;G ENVIRON.*7 J"'; Water Recreation Facilities 0•era tion Permit 296.00. 377.00 � 25900 �,�I 377.00 Y711tn� 214.00 377.00 �Qj '�'{j' tUi] 107.00 182.00 1 64.00 Each A l��,Spa,or Wading Pool(in operation for<6 months of the ear Each Additional Swim,Spa,or Wading Pool(In operation for>_6 86.00 IIIINNIIIINIIIIIIIII months of the ear 86.00=El rat Reins•ect on 86.00 86.00 86.00 12 21111 172.00 Note:2014 Fees have been adjusted per Ordinance 12-1209-96,Section 4 Annual Fee Indexing:Fixed amount fees established by this ordinance shall be adjusted annually on the first busin rss day of Jan ary(Adju published sted Date)by the y he amount of of tincrease Labor r Statistics in fore Co suited Prates Department(CPI ),The Labor.IW is the Consumer Price Index-US City Average for All Urban Wage the Earn nd Wo ker b u the month of SeptThe annual fee ember mber precedlibe calculated as ng the Adjustment Date Increases will be roundedimmediately he nare t dollaror to the llu Ani etsDate hall notwill be reduced by reason of such calculation.However,increase Hthe owever,fagnc eases infor •accordance with this calculation shall not exceed 5 percent per year. • • 2 of 2 Board of Health IV New Business Item 6 Articles of Note 'Jason Public Health May 21 , 2015 Executive Constantine proposes strategy to put every child in King County on path towar... Page 1 of 10 • kg King County Executive Constantine proposes strategy to put every child in King County on path toward lifelong success King County BEST STARTS FOR dt, ,,I • To learn more, visit the Best Starts for Kids website. In his annual State of the County address, King County Executive Dow Constantine proposed strategies to help every child in King County get off to a strong start in life and reach adulthood healthy and able to reach his or her full potential. The proposed six-year levy for the November ballot—called Best Starts for Kids—would fund prevention and early intervention based on the latest brain science being conducted here at the University of Washington. This approach seeks to break the connection between incomes and outcomes, and reverse demand for high cost, crisis-focused services. "The crisis of income inequality is not unique to King County, and many of its causes are beyond our local control," said Executive Constantine. "But income inequality puts our future prosperity at risk by denying more of our children the opportunity to fully contribute as part of a well-educated middle class. The ultimate goal of Best Starts for Kids is to sever the link between incomes and outcomes—to create a King County where the circumstance of one's birth no longer defines the course of one's life." S http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 Executive Constantine proposes strategy to put every child in King County on path towar... Page 2 of 10 The proposal Executive Constantine presented to the Metropolitan King County Council • includes a six-year levy lid increase of 14 cents per $1,000 of assessed property value, which would raise $58 million in the first year. The cost to the average King County homeowner would be about $56 per year, or about a dollar a week. King County is the first jurisdiction in the nation to bring together a set of proven and promising strategies, driven by science, to ensure all children can develop the cognitive, emotional, and social skills necessary to succeed in life and be able to contribute: • Invest heavily in a child's first 5 years, starting with prenatal services. • Invest at key developmental milestones on a child's journey to adulthood. • Create healthy communities, in partnership with The Seattle Foundation, that support strong families, reinforce progress, and sustain the gain. While many jurisdictions provide individual programs such as universal pre-kindergarten, no other metropolitan region in the country has ever created a unified, comprehensive approach. Severing the link between income and outcomes EARLY CHILDHOOD DEVELOPMENT IS A • SMART INVESTMENT The earlier the investment, the greater the return :'° + Prenatal programs t 4 Programs targeted toward the earliest years -Preschool programs • - Schooling p 1 �,( �� —Job Training co, � . X11 o • Prenatal 0-3 4-5 School Post-School Source: James Heckman,an„ Nobel Laureate in Economics http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 Executive Constantine proposes strategy to put every child in King County on path towar... Page 3 of 10 Learn more about James Heckman's research on the great gains to be had by • investing in early development. Best Starts for Kids is supported by the research of Nobel Prize-winning economist James Heckman, which shows that early investment in a child's development—starting with prenatal support—delivers the greatest returns. King County's existing revenues cannot support extensive investments in child development, as about 75 percent of its General Fund must be devoted to the "bad outcomes" of law enforcement, courts, and jails in the criminal justice system. Best Starts for Kids is designed to confront the region's growing inequity by providing parents, caregivers, and childcare professionals with tools to ensure every child in King County develops the basic skills necessary to thrive as adults. Examples of Best Starts for Kids strategies include: • Universal access to developmental screenings for very young children, when it is proven to be most effective at helping infants and toddlers prepare for school. • Increase access to mental-health screenings for middle school-age youth. • Nurse home visitations for first-time mothers—from pregnancy through a child's first two years—to make sure they get off to a strong, healthy start. • Flexible funding for families to prevent homelessness. For example, helping a . working mother keep her transportation so she can make it to work and not lose her job, decreasing the likelihood that she and her family become homeless. Science confirms what we already know The proposal delivers on the pledge made in Executive Constantine's most recent budget address to define regional investments that will improve the health of residents and communities through prevention and early intervention. Over the past seven months, the advisory group he convened created the framework for Best Starts for Kids based on the latest available science, including groundbreaking research by the UW's Institute for Learning and Brain Sciences. Emerging neuroscience shows that 85 percent of the human brain develops by age three. Many of the basic skills people need to succeed as adults—including the ability to manage incoming information, as well as attention and distraction control—are developed by age five. According to the National Institute of Mental Health, adolescence provides the greatest opportunity to help youth develop impulse control and the ability to plan ahead. King County has great prosperity and disparity • While King County is one of the most prosperous counties in the state and the nation, with an unemployment rate of less than 4.5 percent and a median household income of $69,000, it also shares some of the greatest disparities: http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 Executive Constantine proposes strategy to put every child in King County on path towar... Page 4 of 10 • Of the 85,000 net new households n King County since 2000, less than four • percent are middle-income. The rest are split evenly between those earning $125,000 a year and those earning under $35,000. • The number of children 5 and younger who live in poverty is as low at 4.7 percent in some areas and as high as 26 percent in others. • Infant mortality is four times higher in some areas of King County compared to others. "The sad truth in America today is that a top predictor of a child's success in life is the income of the household in which that child is raised," said Executive Constantine. "Income inequality has forced its way into the public arena, but here in King County we are fortunate to have both the wealth and the willingness to confront it head-on—by investing in our people, by investing in our communities, and by giving all our children the best start in life we can." Relevant links READ: Full text of the 2015 State of the County address WATCH: Best Starts for Kids video El CLIP Download the Best Starts for Kids infographic ® PDF Best Starts for Kids fact sheet ® PDF • The Heckman Curve: early childhood development is a smart investment Transforming our health and human services system King County's Youth Action Plan Creating the best-run government in the United States High-resolution photo of Executive Constantine (for media use) El IMAGE WATCH: Full-length State of the County address (24:22) El CLIP Read the entire State of the County speech ... in tweets • http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 Executive Constantine proposes strategy to put every child in King County on path towar... Page 5 of 10 Quotes • I 66 The crisis of income inequality is not unique to King County, and many of its causes are beyond our local control. But income inequality puts our future prosperity at risk by denying more of our children the opportunity to fully contribute as part of a well-educated middle class. The ultimate goal of Best Starts for Kids is to sever that link between income and outcomes—to create a King County where the circumstance of one's birth no longer defines the course of one's life. The sad truth in America today is that a top predictor of a child's success in life is the income of the household in which that child is raised. Income inequality has forced its way into the public arena, but here in King County we are fortunate to have both the wealth and the willingness to confront it head-on—by investing in our people, by • investing in our communities, and by giving all our children the best start in life we can. Dow Constantine, King County Executive I am very excited about the possibilities Best Starts for 6 Kids provides for King County and especially for Auburn. i The fact that services provided at our local Public Health center would be funded is reason enough to be supportive, but there is so much more than that for our communities. The proactive approach is exactly what we need to have a healthy future. Nancy Backus, Mayor of Auburn • http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 Executive Constantine proposes strategy to put every child in King County on path towar... Page 6 of 10 • The Best Starts initiative for kids represents an investment in our f6 uture. These well-researched initiatives provide children at an early age the needed developmental skills and the opportunity to maximize their full potential. This investment in our children is essential and a critical step in reducing societal costs in our community. Jim Ferrell, Mayor of Federal Way 6 In light of 13 years serving as an elected official, I cannot think of any other public investment that promises such a powerful, positive, and long-lasting return for our children and our region. Matt Larson, Mayor of Snoqualmie • Children's earliest years provide a critical foundation for all 6 future learning. When babies babble to an attentive caregiver, they are learning important language skills, and when toddlers imitate their caregiver's actions, they are forming important interpersonal connections. These building blocks prepare them for a lifetime of positive social relationships and learning. Sarah Roseberry Lytle, Ph.D., Director of Outreach and Education, Institute for Learning and Brain Sciences • http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 Executive Constantine proposes strategy to put every child in King County on path towar... Page 7 of 10 King County has lots of high-paying jobs that have • attracted highly educated people from all around the country and the world. To maintain and share that prosperity more widely, the County should invest in its own kids to help them reach their full potential and be full participants in a successful regional economy. Alan Berube, Senior Fellow and Deputy Director of Metropolitan Policy Program, The Brookings Institute We are experiencing incredible economic growth in our 6 region, yet we know that this prosperity is not shared amongst all of our residents and is creating stark inequities, particularly for our children. Best Starts for Kids is a step towards closing this gap and forging a path for them to lifelong success. IPTony Mestres, President and CEO, The Seattle Foundation 66 Thousands of children in our community experience sexual assault, abuse, or domestic violence. Families and 1 communities where violence is present are not only unsafe for children and youth, but also contribute to a range of other negative social, emotional, behavioral, and health problems. The Best Starts for Kids levy will allow us to invest in prevention and early intervention programs that are effective in minimizing these negative impacts and preventing future violence. Merril Cousin, Executive Director, King County Coalition Against Domestic Violence • http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 Executive Constantine proposes strategy to put every child in King County on path towar... Page 8 of 10 As registered nurses, we know first-hand the importance of • prevention. Early intervention means a bright future for our children and strong return on investment. The Washington State Nurses Association is excited to be part of this exciting effort to preserve and promote important public health and human services in King County. Judy Huntington, MN, RN, Executive Director, Washington State Nurses Association 6 The research is quite emphatic—eighty-five percent of an individual's brain growth occurs by age three. That's a mere 1,100 days to make a significant difference in a child's development. We must not lose a precious moment. E Mimi Siegel, Executive Director, Kindering • 1 What high-paying, innovative companies need more than 6 anything else is a healthy, talented, skilled, and motivated workforce—and that's what Best Starts for Kids will help deliver. By having more youth reach adulthood ready to contribute and reach their full potential, our region will remain competitive in the increasingly global economy. Bob Watt, Retired Vice President of Global Corporate Citizenship and State and Local Government Relations, Boeing • http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 Executive Constantine proposes strategy to put every child in King County on path towar... Page 9 of 10 III care We have a ybmof enadeeply at plabuilding- positiveased del relationshipsotachig withstff who children and an engaged parent community. Yet, we have no systematic way to ensure kids who need extra support or developmental screening don't fall through the cracks. Our teachers are hungry for training and skills that this initiative will help support. Johnny Otto, Executive Director, Small Faces Child Development Center FOR MORE INFORMATION, CONTACT: Chad Lewis, Executive Office, 206-263-1250 • Executive Office 401 5th Ave. Suite 800 Seattle, WA 98104 Main phone: 206-263-9600 TTY: Relay: 711 FAX: 206-296-0194 Get directions 11/ • • King County Executive Dow Constantine --- i ii • ,, > ,-• .4,, http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 Executive Constantine proposes strategy to put every child in King County on path tow... Page 10 of 10 Read the Executive's biography • Last Updated April 27, 2015 • • http://www.kingcounty.gov/elected/executive/constantine/News/release/2015/April/27-state... 5/8/2015 GROW Healthy Kids& Communities • 2014 Community Action Team Projects Mid-term report Port Townsend WA Blue Heron Middle School Bike Shelter The Port Townsend HEAL MAPPS Community Report identified active transportation barriers including lack of bike shelters and lack of physical activity initiatives such as Safe Routes to School. The community stakeholder group decided to use GROW HKC implementation funds to construct a cover for the Blue Heron Middle School Bike rack. The overall goal of the project is to increase the number of students(Grades 4 through 8) at Blue Heron School who use active transportation modes to travel to and from school. Key community partners included: WSU Extension GROW HKC project,Jefferson County Public Health, Port Townsend Active Transportation Board,the Port Townsend School District and Port Townsend ReCyclery. A multitude of community partners contributed to the construction of the bike shelter. The construction plans for the bike shelter started upon completion of the Community Action Team Implementation application. The$2500 implementation funds were used as seed money,the ReCyclery guaranteed additional funds required for construction, with the intent to conduct fundraising campaign to meet construction costs. imos , ' rte November 2014 • Bike Shelter design was contributed by Terrapin Architecture • Quadra Engineering contributed engineering design. • City of Port Townsend waived building fees. • Port Townsend School District Board and school leadership approved the plan. December 2014 • Teen leaders were recruited to support the construction project as well as promote Bike to School Activities. One teen leader took on the Bike Shelter as his senior project. The Students for Sustainability Club supported the promotion of Bike to School Day at the High School. • Encouraged schools register for Bike to School Day at National Center for Safe ,..............: _ „oat ir-""1"ilirtogi4t0"., ';'..1...''' • Routes to School program. http://www.saferoutesinfo.org/ ti r • Purchased prizes for youth participating in = * the Bike to School Day event. "' 4 • Volunteers were recruited for the Bike to - s School Day event including parents, Active ,� Transportation trails volunteers and Port Townsend Volunteer Police. Parents were encouraged to form Bike Trains to ride together to school. • On May 6, 2015 youth were greeted at each school as they rode or bike to school. Each youth that rode to school received stickers and a bike light. Results: Bike Shelter completed. Estimated materials cost for the shelter were$7000. Fifteen local businesses, residents and government entities have donated labor and materials worth more than $10,000. A bike count completed the week of April 22, prior to Bike to School Promotion indicated 25 students rode their bikes to Blue Heron Middle School; 2 bikes at Grant Street Elementary School; and 4 bikes at Port Townsend High School. On Bike to School Day 75 students rode to Blue Heron Middle School,42 students rode to Grant Street Elementary School and 15 students rode to Port Townsend High School. i 6 4 .. � "•Wo-, r ,;�,�►"� yea--- �"` t4 , r - _' - ( .- -4. 44 Next Steps: Work with school leadership to promote Walk/ Bike to School Day in October 2015 and ongoing. http://www.ptleader.com/building-the-bike-shelter/image 8b868042-edf7-11e4-932a-b7d966a75fde.html http://www.ptleader.com/news/wednesday-is-national-bike-to-school-day/article ec5a6c64-c765-513a-accb- 40 ca27fa4b1653.html WAS ESIK i Bike to School Da —PTSD50— M 6 2015 411 TO SCHOOL' Y a ' • Grant Street:42 bikes in the bike rack on May 6th Al . f' 101 ' , f r pit \:\p„,,,,.'" r ,A x120 total participated -some parents brought bikes to school to ride around a course set up by PTA for those who live too far to bike. The bused students were encouraged to walk around the playground to participate. A couple bike trains were observed at Grant Street. Some students arrived via walking. o Survey in April showed only 2 bikes in the bike rack on a school day. o Grant Street efforts were organized by Grant St. PTA and Non-motorized trails committee- Lys Burden • Blue Heron: over 75 bikes in the bike racks on May 6th ., with at least 10 students who walked • ' ' —: ' -4 ..,„,_ .S , o Survey in April showed only 25 bikes in the bike rack on a school day. o WSU Extension &Jefferson County Public Health coordinated Bike to School Day efforts at Blue Heron. • Port Townsend High School: 15 bikes in racks on May 6th za _ o Survey in April showed only 4 bikes in rack o Students for Sustainability and The ReCyclery coordinated the Bike to School Day efforts at PTHS. o Jefferson County Public Health and WSU Extension offered expertise to Wellness Committee in updating PTSD50 Wellness Policy to include working with community groups to promote Walk/Bike to School Day twice per year. o Participation in WSU Cooperative Extension regional obesity prevention project brought$2500 in funding to the Blue Heron bike shelter This was a wonderful display of community involvement&great turn out of students arriving to school via active transportation! The Port Townsend Police Department sent traffic volunteers to the schools. This exciting day and the many May Bike Month activities sparked interest in many Blue Heron Students to continue riding to school for the rest of the school year. • Media Review deffason Public Healt Jefferson County Public Health • April/May 2015 NEWS ARTICLES 1. "Hadlock Medical Center sold," Port Townsend Leader, April 15th, 2015. 2. "Like vaccinations, fluoridation is vital to public health," The Seattle Times, April 19th, 2015. 3. "Now it's whooping cough as measles fades as an outbreak on Peninsula," Peninsula Daily News, April 19th, 2015. 4. "No new whooping cough cases in Clallam, Jefferson counties," Peninsula Daily News, April 23rd, 2015. 5. "Clallam measles outbreak officially ends, Board of Health declares," Peninsula Daily News, April 23rd, 2015. 6. "OUTDOORS: Trout stocked for Saturday's lowland lakes opener," Peninsula Daily News, April 23rd, 2015. 7. "Anderson Lake open, state's lowland lake fishing season starts," Port Townsend Leader, April 23rd, 2015. 8. "Beleaguered Anderson Lake clears toxin testing, opens for fishing season —and the trout are biting," Peninsula Daily News, April 26th, 2015. 9. "Underage drinking, drugging talk in May 11," Port Townsend Leader, April 29tH 2015. • 10. "Jefferson County food council debuts," Port Townsend Leader, April 29th, 2015 11. "Dabob, Quilcene beaches closes to shellfish harvest due to marine biotoxins," Port Townsend Leader, May 1, 2015. 12. "As whooping cough grows, study finds vaccine wanes," Seattle Times, May 3rd 2015. 13. "Quilcene, Dabob closed to recreational shellfish harvesting because of biotoxin fears," Peninsula Daily News, May 3rd, 2015. 14. "Jefferson County whooping cough cases climb to 20," Peninsula Daily News, May 6th, 2015. 15. "Gonorrhea on rise in Washington state," Peninsula Daily News, May 6th, 2015. 16. "Anderson Lake closed due to toxin," Port Townsend Leader, May 8th, 2015. 17. "Potentially lethal toxin closes Anderson Lake in Jefferson County," Peninsula Daily News, May 8th, 2015. 18. "Brinnon area beaches closed to recreational shellfish harvest because of high levels of potentially deadly biotoxin," Peninsula Daily News, May 8th, 2015. 19. "Brinnon-area shellfish beaches closed due to marine biotoxins," Port Townsend Leader, May 8th, 2015. 20. "Hearing set May 20 on Jefferson County marijuana rules," Port Townsend Leader, May 13th, 2015. • Jefferson County Public Health April/May 2015 NEWS ARTICLES 1. "Hadlock Medical Center sold," Port Townsend Leader, April 15th, 2015. 2. "Like vaccinations, fluoridation is vital to public health," The Seattle Times, April 19th, 2015. 3. "Now it's whooping cough as measles fades as an outbreak on Peninsula," Peninsula Daily News, April 19th, 2015. 4. "No new whooping cough cases in Clallam, Jefferson counties," Peninsula Daily News, April 23rd, 2015. 5. "Clallam measles outbreak officially ends, Board of Health declares," Peninsula Daily News, April 23rd, 2015. 6. "OUTDOORS: Trout stocked for Saturday's lowland lakes opener," Peninsula Daily News, April 23rd, 2015. 7. "Anderson Lake open, state's lowland lake fishing season starts," Port Townsend Leader, April 23rd, 2015. 8. "Beleaguered Anderson Lake clears toxin testing, opens for fishing season — and the trout are biting," Peninsula Daily News, April 26th, 2015. 9. "Underage drinking, drugging talk in May 11," Port Townsend Leader, April 29th, • 2015. 10. "Jefferson County food council debuts," Port Townsend Leader, April 29th, 2015 11. "Dabob, Quilcene beaches closes to shellfish harvest due to marine biotoxins," Port Townsend Leader, May 1, 2015. 12. "As whooping cough grows, study finds vaccine wanes," Seattle Times, May 3rd 2015. 13. "Quilcene, Dabob closed to recreational shellfish harvesting because of biotoxin fears," Peninsula Daily News, May 3rd, 2015. 14. "Jefferson County whooping cough cases climb to 20," Peninsula Daily News, May 6th, 2015. 15. "Gonorrhea on rise in Washington state," Peninsula Daily News, May 6th, 2015. 16. "Anderson Lake closed due to toxin," Port Townsend Leader, May 8th, 2015. 17. "Potentially lethal toxin closes Anderson Lake in Jefferson County," Peninsula Daily News, May 8th, 2015. 18. "Brinnon area beaches closed to recreational shellfish harvest because of high levels of potentially deadly biotoxin," Peninsula Daily News, May 8th, 2015. 19. "Brinnon-area shellfish beaches closed due to marine biotoxins," Port Townsend Leader, May 8th, 2015. 20. "Hearing set May 20 on Jefferson County marijuana rules," Port Townsend Leader, May 13th, 2015. . Hadlock Medical Center sold OBy Allison Arthur, Port TownsendLeader I April 15, 2015 3:00 am 11 Ilittrit*k Y a S —i • Port Hadlock Medical Clinic The Port Hadlock Medical Center remains at 121 Oak Bay Road in Port Hadlock. It is the only private medical clinic in Jefferson County that is outside of Port Townsend. The clinic has four exam rooms. Photo by Allison Arthur The Port Hadlock Medical Clinic, the only private medical clinic in rural Jefferson County, is off life support. Dr. Asif Malik, a psychiatrist based in Spokane, has purchased the Port Hadlock Medical Center in Kively Center from Peg Carlyle-Carlson, who had been ready to shut the business. "I am very relieved," Carlyle-Carlson said Monday. "Closing was an option I couldn't stomach." Claire Lah, who owns Practice Management Assistance, LLC, a billing service in Port Townsend, has •invested in the business as well, and will serve as chief operating officer. She lives in Quilcene. It was Lah, who does work for Malik's clinic in Silverdale, Central Kitsap Urgent Care, who connected Carlyle-Carlson with Malik. Both the Hadlock and Silverdale clinics are operated by Cascade Health Services, PLLC, which Malik owns. "She said this is a clinic that has been in the community for a very long time," Malik said Tuesday morning from Spokane. He said his passion is in behavioral health, that he focuses on medication management, is interested in telemedicine and believes small community clinics are important and can offer a safety net for patients that large corporate providers can't offer well. "When I spoke to Claire she said there was a large active database of patients," Malik said. Carlyle-Carlson said several weeks ago she had a patient caseload of some 3,000 between Jefferson, Clallam and Kitsap counties. She said her problem keeping the Hadlock clinic open isn't that she didn't have patients, but that she couldn't afford to attract any new practitioners. Jefferson County is in what what federal officials call a "health professional shortage area." CHANGES BEGIN Lah said she's already making changes to the clinic, getting it cleaned and painted, rewired in some areas, adding new computers and bringing back some practitioners, one of whom said she needed supplies. "He has good connections and we're hoping to get a new provider fairly soon. We're hoping to expand other areas, including women's health," Lah said. The sale was closed April 6 and within the first week of operating the clinic Lah said, "We were able to double the patient load." Carlyle-Carlson acknowledged in late March that she was down to operating the clinic two days a week, and had taken down an urgent-care sign because it was false advertising. She told the Port Townsend & Jefferson County Leader that if she didn't sell the clinic soon, or get help, she expected it to close within a few months. •Lah said ARNP Jeanne Battenberg is filling in and ARNP Linda Pedersen also is still working so the clinic is open five days a week and fully staffed for three days. "That's a big improvement from a week ago," Lah said. Artwork from local artists that had been in the main lobby and on walls in exam rooms has been taken down and returned for now, Lah said, adding she didn't want anything damaged while walls were being painted. "And I've done everything locally as much as possible," Lah said of using McCrorie Carpet One, Double D Electric, and Dailey Computer Consulting, Inc. COMING HERE SOON "I really hope we can make the clinic grow and succeed," said Malik, 39, who came to the United States from Pakistan to study medicine. He studied in Pakistan, did his residency at the University of North Dakota and attended Yale University. He's currently working as a locum at Providence Health Care in Spokane. He also provides telemedicine services to the state of California. Malik said he and some colleagues are interested in providing some care in Jefferson County via telemedicine. "It's a matter of getting the patients in and the word out about people in crisis that we would be able to see," he said. Malik's wife is about to give birth to their third child in Spokane so he said he wants to wait for that big event before coming to visit the Port Hadlock clinic and setting up any new services. .From field work he has done, Malik said he has learned that it's hard for providers to deliver medical care if they don't understand the community needs. He believes that a small, intimate clinic like the one in Hadlock allows patients and providers to get to know each other. As for finances, he said, "Even if it's not extremely busy we can provide services to the community." He said the clinic in Silverdale is doing well financially in its first year of operation. Malik said he and Carlyle-Carlson signed a nondisclosure agreement so he can't say how much he paid for the patient database and equipment. Carlyle-Carlson had been renting the space in Kivley Center. NEED FOR PRACTITIONERS Carlyle-Carlson bought the clinic a decade ago when it was on the brink of closure. "They were going to close it and I couldn't see it going away," she said of the clinic's status back then. Like other small — and even large — healthcare facilities, Carlyle-Carlson says there is stiff competition for providers and practitioners. She estimated it would have cost her $10,000 to bring a new practitioner. "The main issue is I don't have the extra funds to attract a new practitioner. I just don't have the big bucks. The big facilities do, but they are having trouble, too," she said in March. One of her practitioners attended a seminar not long ago and came back and told her that recruiters were "throwing cards at everybody saying 'I need a practitioner."' Carlyle-Carlson said one of her practitioners retired four times and didn't want to return. By the end of March, she had one practitioner who was working two days a week. •When she started a decade ago, she had four practitioners and at one time had a doctor full-time. "I bought this to serve the community. I jokingly say that my husband and I knew we wouldn't become millionaires, but 'thousandaires' would be nice," she said before selling the clinic to Malik. NO SHORTAGE While there is a shortage of providers, Carlyle-Carlson said there is no shortage of people seeking healthcare these days. W"We're turning people away every day, even when we have a practitioner. It's criminal what's happening, not just here, but everywhere," she said of people not having access to care. "We're getting a lot of 20-year-olds," she noted. Under Carlyle-Carlson, the clinic took Medicare and Medicaid, but also gave a 30-percent discount for cash for those without insurance, she said. HOPE TO GROW In 2007, Carlyle-Carlson was looking to the future and looking to grow and build a new clinic. She and her contractor husband, Steve, who used to build custom homes, brought property across the highway, hoping to construct a 4,000-square-foot, two-story building with parking. They estimated the cost of that clinic to be about $750,000 and she had her eyes on opening it in 2009. "It's permitted for a nice building and we could lay ground tomorrow, but the economy went poo poo and no more loans," she said. OTHER CONNECTIONS When it became apparent she had more patients than practitioners, Carlyle-Carlson said she reached out to larger healthcare facilities in Clallam, Jefferson and Kitsap, but she said there "was no interest at this time" in any of the larger facilities offering services in Port Hadlock. While the Hadlock clinic has now been sold to Malik, Jefferson Healthcare is moving forward with a new 3,500-square foot clinic down the road in Port Ludlow. The new facility is to be built this summer by Port *Ludlow Associates, then leased back to Jefferson Healthcare. • • Like vaccinations, fluoridation is vital to public health Originally published April 19, 2015 at 4:05 pm Updated April 17, 2015 at 5:20 pm By Tom Locke Special to The Seattle Times �i6 u Dr. Tom Locke is health officer for Jefferson County, deputy health officer for Clallam County and is chair of the Washington Dental Service Foundation board. The recent measles outbreak that has infected more than 100 people nationwide, including eight cases in Washington state, is a wake-up call regarding the value of prevention and the • high costs of neglecting it. As a health officer and primary-care doctor on the Olympic Peninsula, the site of five confirmed measles cases, I and other health-care professionals have been working hard to contain this highly contagious disease. Controlling this outbreak has been costly and time-consuming, further stressing already depleted public-health budgets. Prevention is always preferable to treating sickness, and proven measures that ward off disease save both lives and money. Like vaccinations, community water fluoridation is a proven safe and effective public-health tool. Throughout 70 years of practical application in this country, fluoridation has been shown to reduce cavities by up to 25 percent and help combat oral disease safely and effectively. Despite the tremendous amount of evidence that supports its safety and efficacy, fluoridated water is not available for more than one-third of the people in Washington state. Fluoridation, like vaccination, has been the relentless target of misinformation campaigns and fear mongering that run contrary to decades of scientific research supporting its safety. Those who oppose water fluoridation have made inaccurate claims about it, some of them similar to the arguments used against vaccinations. Those arguments do not hold up under scientific scrutiny. Dental problems are a leading cause of absenteeism among young children in school and can have serious long-term impacts on quality of life. Cavity treatment also can be costly, and tooth decay has been linked to serious health problems including heart disease, stroke and diabetes. • Forward-thinking community leaders in cities such as Seattle, Tacoma and Everett demonstrated their commitment to building a healthy community years ago by adding fluoride to the water. If you live in Renton, Oak Harbor, Vancouver, Pullman or Kent, you have long enjoyed the benefits of fluoride and better oral health. However, cities such as Olympia, Enumclaw, Bellingham, Spokane, Walla Walla and Federal Way, which gets its water from the Lakehaven Utility District, do not have fluoridated water. That's because the decision to fluoridate is made at the local level. In these and similar communities, health professionals, civic leaders and families should urge their water purveyors to make a positive investment in oral-health disease prevention and advocate for community water fluoridation. To find out if your water system has enough fluoride, visit the state Department of Health's webpage on fluoride. Community water fluoridation, like widespread vaccination, is regarded as one of the top 10 greatest public-health achievements of the last century by the Centers for Disease Control and Prevention because it is safe and it works. State fluoridation guidelines, which include requiring water utilities to monitor fluoride concentrations daily, ensure optimum oral-health protection at recommended levels. Highly respected health organizations, including the American Medical Association, American Dental Association and American Public Health Association, also support fluoridation. With increased awareness of the dangers of failing to invest in prevention, now is an opportune time to reconsider the benefits of fluoridation and to recognize that it too plays an important role in maintaining the public's health. Tooth cavities are a preventable, epidemic disease just like measles, mumps and a number of other vaccine-preventable diseases. Whether we choose to invest in prevention or not is a choice we make as individuals and as a community. Failure to invest in prevention is always costly. It results in unnecessary pain and suffering, and, in the case of some communicable diseases, can have fatal consequences. • Now it's whooping cough as measles fades as an outbreak on Peninsula By James Casey, Peninsula Daily News,April 19,2015 RFs 409P2- 4 • TAW' 111,0 Illustration by The New York Times News Service What you should do ■ Get vaccinated, especially if you are pregnant or have a baby or young child in your home, or if you care for an infant. The vaccine takes about two weeks to become fully effective. • Vaccinate your children. Children should start a series of five vaccinations starting at 6 weeks of age. In Jefferson County, immunizations are available at Jefferson Public Health from 1 p.m.to 4 p.m.Tuesdays and Thursdays at 615 Sheridan St., Port Townsend. Call 360 385 9400. In Clallam County, they are available from 11 a.m.to 4 p.m.Wednesdays at the Health and Human Services clinic, 111 E. Third St., Port Angeles. Call 360-417-2274. • Suspect pertussis in infants who have a worsening cough and in older children and adults whose • coughing exceeds a week's duration with severe coughing fits followed by vomiting and/or the"whooping" sound. • If you get sick, stay home. Pertussis'period of contagion lasts 21 days but only five days if you follow a prescribed regimen of antibiotics. Children should be kept home from school or day care until they've received antibiotics for five days or 21 days pass after coughing starts. • Practice"respiratory etiquette": Cover your cough and wash your hands or use an alcohol gel frequently. Sneezes and coughs can spread pertussis bacteria through the air as far as 3 feet, and germs can linger on environmental surfaces. • Educate yourself about the disease. Information is available on the whooping cough page at www.doh.wa.gov. Peninsula Daily News PORT TOWNSEND— No sooner does the threat of measles in Clallam County fade than cases of whooping cough shoot up in neighboring Jefferson County. Pertussis, which causes severe coughing that accounts for its common name, likely is on its way across the North Olympic Peninsula, health officials say. As of mid-April, 17 cases of whooping cough had been reported in Jefferson County among its 29,300 people, said Dr. Tom Locke, county health officer, on Friday. On April11, the state Department of Health reported 11 cases in Jefferson County. That made the county esecond in the state per capita, with a rate of 37.5 out of 100,000 people. It was just behind Walla Walla County, which had 28 cases reported for a rate of 47 out of 100,000. Other leading counties in terms of total cases included Kitsap (85), King (41), Clark (39), Pierce (30) and Snohomish (28). The contagion period for the most recent case among five linked diagnoses of measles in Clallam County "lends today. The first case was diagnosed Feb. 1. No cases were confirmed in Jefferson County. Measles is the most contagious viral disease known to doctors, Locke said, while pertussis holds that distinction among bacterial infections. "If people are susceptible, they have a very high probability of getting it," he said. As with measles, whooping cough is largely preventable through vaccinations and is thought of as a childhood disease, though it has deadly outcomes among infants. Both Jefferson and Clallam counties lag in the percentage of youngsters who have immunity to tetanus, diphtheria and pertussis (DTaP vaccine for children, Tdap shots for adolescents and adults). According to the latest figures available from the state health department, Port Townsend schools had a 10.5 percent exemption rate—mostly for personal reasons—from DTaP and Tdap vaccinations in 2014. In Port Angeles, 4.1 percent of students were exempt. Exemption rates for tetanus, diphtheria and pertussis in other North Olympic Peninsula districts: • Brinnon, Chimacum: Both 8.6 percent. • Cape Flattery: 2.6 percent. i■ Crescent: 9.9 percent. • Quilcene: 2.9 percent. • Quillayute Valley: 0.9 percent. • Sequim: 7 percent. Pertussis can be deadly to infants and young children, as well as to elders and people with damaged immune systems. Pregnant women especially should get vaccinated, Locke said, and be revaccinated every time they become pregnant. The vaccine's antibodies are transmitted to the developing fetus, Locke said, and the repeated vaccinations build the mother's immunity. In our region, Locke said, the pertussis outbreak started in Kitsap County, spread to Jefferson and will come to Clallam, which as of Friday had reported no cases. Pertussis rears up in three-to four-year cycles, he said. Although there are vaccines against the illness, "a reservoir of mild pertussis" lingers in the adolescent and adult populations, and breaks out roughly with the same frequency as measles. Pertussis spreads through droplets sneezed or coughed by sufferers that others can inhale from up to 3 feet away. Pertussis germs also linger on surfaces. These characteristics make it important to cover coughs and wash hands frequently, Locke said. The vaccine doesn't offer perfect protection against pertussis—only about 70 percent, according to the federal Centers for Disease Control and Prevention— but it drastically reduces symptoms and the danger of death in people who catch it, he said. It's a relatively mild ailment for adults, although it's renowned for its trademark cough. "Even if you're not'whooping,' everyone who has pertussis has one of the most severe coughs they can remember," Locke said. "You can cough for months after a case ofp ertussis." Because it is a "notifiable condition," county health departments learn of each case of pertussis, find out whom sufferers have contacted and treat sufferers and, in some cases, their contacts with antibiotics. Antibiotic drugs reduce a patient's period of contagiousness from 21 to five days, Locke said. Most of the Jefferson County cases have been among elementary, middle and high school students, he said, but health officials' emphasis is on infants and pregnant women because newborns and infants younger than 6 weeks old suffer the highest percentage of fatalities from pertussis. Other elements in Jefferson County's pertussis education program include teaching the "respiratory hygiene" of covering one's cough, washing one's hands and staying home if sick; encouraging vaccinations; and protecting at-risk people. Vaccination targets include caretakers of infants and young children. "Parents, baby-sitters, grandparents—anybody who's going to be around an infant—should be vaccinated • for pertussis," Locke said. Although no cases had been reported in Clallam County as last week ended, Dr. Jeanette Stehr-Green, health officer, had sent"a blast fax to all of our providers outlining pertussis, what to look for and how to treat it," said Iva Burks, county Health and Human Services director. Burks urged parents to check their vaccination records and said people with infants should have them vaccinated as soon as possible. "We don't want to lose any babies to pertussis, for heaven's sake," she said. Pertussis wasn't epidemic during the past few years. Clallam County reported 20 cases to the Department of Health in 2014; Jefferson county had one case. In 2013, Clallam County had 13 cases, and Jefferson reported none. But in 2012, pertussis cases totaled 25 in each county, while cases across the state spiked at 2,520 in June of that year and eventually reached 4,916. So far this year, the state has received reports of 319 cases compared with 49 in 2014. With whooping cough making a comeback on the heels of a measles outbreak, "it looks like it's going to be a bad year," Locke said, "at least from a human standpoint. "From the microbe standpoint, they're having a grand old time." 4110 Reporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcasey(a�peninsuladailynews.com. Last modified:April 18.2015 7:38PM No new whooping cough cases in Clallam, Jefferson counties Peninsula Daily News, April 23rd, 2015 No new cases of whooping cough had been reported as of Wednesday in Clallam or Jefferson counties. Last week, Dr. Tom Locke, Jefferson County public health officer, said 17 cases of pertussis, better known as whooping cough for its hallmark symptom, had been reported to Jefferson County Public Health. The outbreak began in Kitsap County, Locke said, where 142 cases were reported from June 2014 to mid-April 2015. That was 10 times its usual annual number of cases. So far, it has not been seen in Clallam County. `Doesn't respect borders' But Dr. Jeannette Stehr-Green, Clallam County public health officer, expects to see it spread to the county neighboring Jefferson. "The illness doesn't respect borders well," she told the Clallam County Board of Health on Tuesday. "This could be the next issue on the horizon." The state Department of Health says young children should get the first of a series of five doses of the vaccine known as DTap (diphtheria, tetanus, pertussis) beginning at 2 months old and continuing through 4-6 years old. Children 7-10 years old who didn't receive the full series when they were younger and youths 11-18 years old should have single doses of the shot known as Tdap. Middle school- or high school-age youths should have another Tdap vaccination, as should adults who didn't get a booster as teenagers and women each time they become pregnant. Waning immunity "There's waning immunity" from the vaccine, Stehr-Green said. Effectiveness declines from 98 percent after the first five doses to 70 percent for teenagers and adults and perhaps even lower with age, according to the state health department. In Jefferson County, immunizations are available at Jefferson Public Health from 1 p.m. to 4 p.m. Tuesdays and Thursdays at 615 Sheridan St., Port Townsend. Call 360-385-9400. In Clallam County, they are available from 11 a.m. to 4 p.m. Wednesdays at the Health and Human Services clinic, 111 E. Third St., Port Angeles. Call 360-417-2274. Last modified:April 22. 2015 5:37PM • • Clallam measles outbreak officially ends, Board of Health declares By James Casey, Peninsula Daily News, April 23, 2015 PORT ANGELES — It's not over till it's over, but for now, at least, it's over. It's measles, of course. The Clallam County Board of Health on Tuesday officially ended the public health emergency it declared Feb. 17, about two weeks after the first in a string of five measles cases surfaced in Port Angeles. No cases were confirmed elsewhere in the county or in neighboring Jefferson County. As of Sunday, the interval of two full 21-day periods of contagion had passed since the final case was diagnosed. That's the time that must expire before the Centers for Disease Control and Prevention considers a measles outbreak to have run its course. Measles-free Before it was over, said Dr. Jeanette Stehr-Green, interim county health officer, employees of Clallam County Health and Human Services had contacted 257 people who'd had possible • measles exposure, conducted 30 no-cost vaccination clinics and given some 500 shots of the measles, mumps, rubella and varicella (MMRV) vaccine. "We are officially measles-free," she told health commissioners at their regular monthly meeting. "For now," chimed in Christina Hurst, public health program director. Hurst's point was that, had more people been immunized before the outbreak, the disease might not have hit its first victim, a 52-year-old Port Angeles man diagnosed and hospitalized Feb. 1 at Olympic Medical Center. He passed on the disease to a 5-year-old girl, who, besides infecting her 14-year-old sibling, sparked a quarantine of several students at Olympic Christian School. Later, two other men were diagnosed with measles, one of whom had received a less-effective vaccine that last was given 44 years ago. All recovered All the people who had measles have recovered. According to records from the state Department of Health, 12.5 percent of Port Townsend schoolchildren, 10.3 percent of Chimacum children and 9.9 percent of Crescent students were • exempted by their parents or guardians — nearly all for philosophical reasons —from MMR immunizations. 111/ The CDC says 90 percent immunization is needed to prevent an epidemic of a communicable disease. Despite the outbreak, a bill sponsored by 24th District state Rep. Steve Tharinger that would have closed the exemption to all except religious or medical reasons failed to pass the state House of Representatives. Similar bills had similar deaths in Oregon and California —where measles first surfaced nationally with an outbreak traced to a visitor to Disneyland in December. California health authorities declared their measles outbreak over last Friday, according to The Associated Press. National attention Clallam County received widespread attention during its response to the outbreak, Stehr-Green said. "The whole nation watched us," she said. Stehr-Green called it "an amazing journey" — amazing that measles struck Clallam County with a strain that investigators said was common to Asia and the Philippines but amazing, too, that the highly infectious viral disease spread to only five people. Stehr-Green said the public expense of the outbreak in terms of the no-cost immunizations, health workers' overtime to administer them and the work that was postponed during the crisis had yet to be counted. Peninsula Children's Clinic, OMC and private physicians also played key roles in controlling the outbreak, she said. "We will continue to analyze what went on, what lessons we've learned, what happened and what should have happened," she said. "We will be doing an analysis of the cost of this, which has been significant." Reporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcasey©peninsuladailynews.com. • OUTDOORS: Trout stocked for Saturday's lowland lakes opener By Michael Carman , Peninsula Daily News, April 23, 2015 •WITH STEELHEAD AND salmon rightfully attracting the bulk of angling affection and attention on the North Olympic Peninsula, lake fishing often gets short shrift. But for one special day every year, the fourth Saturday in April, the opening day of lowland lake fishing steps into the spotlight. That day is this Saturday, and lakes across the North Olympic Peninsula should be ready for their seasonal debut after a number of recent trout plants. State Department of Fish and Wildlife fish hatchery crews have been stocking nearly 17.5 million trout and kokanee in lakes statewide, but just a fraction of those, 17,809, were planted in Jefferson and Clallam counties. Lake Leland best bet Jefferson County lakes received the bigger share. Lake Leland received 6,000 small rainbow trout at the end of March. Lake Leland, located of U.S. Highway 101 about 5 miles north of Quilcene, is a year-round lake. The fishing has warmed up recently on the lake's 107.8 acres. "Fishing in Lake Leland is good for catchable trout off the bank and at the pier," said Ward Norden, a `fishing tackle wholesaler and former fishery biologist who lives in Quilcene. "Some of the successful anglers have complained about the smaller size of the fish, but that is because they have been spoiled by the larger trout they have been catching all winter. "The recent plant was of normal, pan-size trout." Anderson open for now Anderson Lake, a 57.3-acre body of water on Anderson Lake Road between state routes 19 and 20 near Chimacum, is a troubled body of water. It routinely closes when blooms of blue-green algae begin to produce harmful toxins. Based on test results from April 13, and despite the presence of an algae bloom, Anderson Lake is still likely to open Saturday. "Anderson Lake does have a bloom that has started this year already," said Michael Dawson, the environmental health lead for the Jefferson County Department of Public Health's water quality program. "We have toxic algae there, but so far they haven't been producing toxins, except for a very trace amount. "State parks has taken down the closed signs, and for now the lake is at the caution stage." II/At that stage, Dawson recommends to not drink or swim in the lake, avoid fishing in patches of algae scum and clean fish thoroughly, disposing all fish guts. "A sample was taken on April 20 and we don't have results yet," Dawson said. "Things still could change between now and Saturday." • Dawson plans to monitor and sample the lake each week and post results on the Jefferson County water quality website at tinyurl.com/PDN-JeffCoLakes each Friday. "If we receive the results from the April 20 sample, we will post those on the site, and if toxins are present in high enough amounts, we will close the lake and notify the public," Dawson said. Dawson said Gibbs Lake, a catch-and-release trout lake near Chimacum, has a light bloom of algae, but so far it's not the harmful, blue-green variety. "Gibbs Lake has a very light bloom that we can see, but it doesn't have the appearance of blue-green algae," Dawson said. "But there may be some there, we have them every year. "It's clear now." Gibbs received 810 rainbow trout and 50 larger cutthroat in recent plantings. Horseshoe Lake, an 11.4-acre lake 4 miles southwest of Port Ludlow, was planted with 260 rainbows on March 31. There's no minimum size limit, but anglers are limited to one trout on the lake, where internal combustion motors are prohibited. •Ludlow Lake, a 15.2-acre lake 4.5 miles west of Port Ludlow, was planted with 950 smaller rainbows. Daily limit is five trout, including two over 14 inches. Access the lake via private Olympic Resources property. These gates are likely to be open through Oct. 31, the end of the six-month lower lake season. Sandy Shore Lake, a 34.9-acre lake 5 miles southwest of Port Ludlow, is found off Sandy Shore Road from state Highway 104. The lake has a public boat ramp. Anglers have a five trout daily limit, including two over 14 inches. Sandy Shore received 2,340 rainbows, with 130 of them 1.5 pounds and above. Anglers need a boat to fish Tarboo Lake, a 20.3-acre lake 3 miles north of Quilcene. There's no size minimum. The daily limit is five trout, including two over 14 inches. Teal Lake, a 15-acre lake 2 miles south of Port Ludlow, was stocked with 330 rainbow trout and 50 cutthroat. There's no minimum size for trout on Teal Lake. The daily limit is one trout, and selective-gear rules are in place. •There's not much fishable shoreline on the lake, so it could get crowded on the dock for anglers who don't have a float tube. Silent Lake, a 10.7-acre lake on the Coyle Peninsula 5 miles southeast of Quilcene, offers little bank access, but there is a boat ramp. This lake was planted with 800 rainbows in late March. 110 Clallam County lakes Clallam County saw only one lake, Wentworth, receive a trout plant. Wentworth is tough to find, tucked away off of commercial timber lands between the Dickey River's west and east forks off a series of logging roads north of Forks. There's no shore fishing, so a small boat or float tube is the method of approach. Despite its remote location and lack of amenities, the state Department of Fish and Wildlife continues to stock the 48-acre lake. A total of 4,380 small rainbow trout reared at the nearby Sol Duc Hatchery were stocked in the lake during two plants on March 10 and April 7. Beaver Lake, 3 miles northeast of Sappho and 16 miles northeast of Forks, is a 36.3-acre lake that allows a daily limit of five trout, with no minimum size and a 12-inch maximum. Lake Pleasant, 5 miles off U.S. Highway 101, west of Sappho and 10 miles north of Forks, is a 492.6- acre lake with a public boat ramp, loading and mooring docks, accessible restrooms, parking and a playground. Lake Pleasant has no minimum size and a five-trout daily limit. •There is a 6-inch minimum and 18-inch maximum for kokanee. Lake Sutherland, 10 miles west of Port Angeles, off U.S. Highway 101, is a 351.3-acre lake excellent for the tasty kokanee. There's a public boat ramp as well. Minimum size is 6 inches, maximum is 18 inches, and there is a five-fish daily limit for trout and kokanee. S Anderson Lake open, state's lowland lake fishing season •starts By Port Townsend Leader Staff Posted: Thursday, April 23, 2015 6:00 pm 010si,44 Yr�' �a 4a'+ •0 co40.4r,,,,i,t4:1;p:,e,4,‘,4,,,,!, i� ,,,,,,.,„.,,„.,,,,,,,,.:::. .....„ .„,,,,,„,..„,,„„,,,, ,„,„,,,„,,,,,,,,,,. '‘vht,Itk4,i dad x IT to oietaovkTi,,,r44,, �y„3 3 S,3Yk'.' !M stepS `x. 3 ¢ 4,11 4a fl' ,.,may.< +� �S - . L of -¢ a Rit�� 3s` �• u,�r.� y� kik 7''k Gibbs Lake Gibbs Lake is one of seven lowland lakes in East Jefferson County where the Washington Department of Fish and Wildlife has planted trout in advance of the 2015 recreational fishing season,which opens April 25. Photo by Patrick J. Sullivan,flight by Tailspin Tommy's Trout fishing in Washington hits full speed Saturday, April 25, when several hundred lowland lakes — stocked with millions of fish — open for a six-month season. Anglers have already been taking advantage of good spring fishing opportunities on year-round lakes, but the fourth Saturday in April marks the traditional start of the lowland lake fishing season. di the last few months, the Washington Department of Fish and Wildlife (WDFW) has planted rainbow trout and cutthroat trout in Gibbs Lake and Lake Leland, and rainbows in Ludlow, Sandy Shore, Silent and Tarboo and Teal lake. The greatest single number planted was 1,100 rainbow trout in Tarboo Lake on April 14. No fish were planted in Anderson Lake, which has the most severe toxic algae problems of any lake in Jefferson County. As of Thursday, April 23, Anderson Lake State Park is open for fishing starting on Saturday, according to a Washington State Parks spokesperson. Jefferson County Public Health has a "caution" tag on Anderson Lake where a heavy bloom is visible and toxin is detected at low levels. The "caution" warning means to not drink the lake water (people, pets or livestock), to clean fish well and to discard fish guts. Boaters are to avoid areas of scum. Last year, Anderson Lake was made available to anglers starting opening day, and was closed May 8 due to increased levels of the potent nerve toxin Anatoxin-a, blamed for the May 2006 death of two dogs who drank from the lake. Gibbs and Leland lakes are rated clear of algae blooms, as of April 13. STATE LICENSE Anglers eyeing the lakes must have a current Washington freshwater fishing license valid through March 31, 2016. Licenses can be purchased online at fish hunt.dfw.wa.gov; •by telephone at 1-866-246-9453; or at hundreds of license dealers across the state. For details on license vendor locations, visit the WDFW website at wdfw.wa.gov/licensing/vendors. Freshwater fishing licenses cost $29.50 for resident adults, ages 16 to 69. Fifteen-year-olds can buy a license for $8.50, and seniors ages 70 and older can buy an annual freshwater fishing license for$7.50. Children age 14 and younger do not need a fishing license. •WDFW fish hatchery crews have been stocking nearly 17.5 million trout and kokanee in lakes statewide. Fish stocking details, by county and lake, are available in the annual stocking plan on WDFW's website, wdfw.wa.gov/fishing/plants/statewide. STATE RULES Donley encourages anglers to check the "Fish Washington" feature at the department's homepage (wdfw.wa.gov/fishing/washington) for details on lake fishing opportunities. The map-based webpage includes fishing information by county, lake and fish species throughout the state. Anglers parking at WDFW water-access sites are required to display the WDFW Vehicle Access Pass on their vehicle. This pass is provided free with every annual fishing license purchased. The passes are transferable between two vehicles. Anglers who use Washington State Parks or Department of Natural Resource areas need a Discover Pass. Information on the pass can be found at discoverpass.wa.gov. Before heading out, anglers should check fishing regulations on WDFW's webpage at wdfw.wa.gov/fishing/regulations. Unlike in past years, the current fishing rules pamphlet remains valid through June 30, 2015. • Beleaguered Anderson Lake clears toxin testing, opens for fishing season —and the trout are biting By Leah Leach, Peninsula Daily News,April 26, 2015 III a-; ' 0,,,,,,,,. ...;,,s.,:t ...,. 1 ,- ...,„,,,.. ,, , d 9 a '' " � ' ® 3 \k^ - i L rr �F;=' _;' oma '0 ' 1 Christopher DeAscentiis of Hansville shows off the six trout he caught in the first hour of opening day for fishing Saturday at Anderson Lake in Chimacum.—Photo by Steve Mullensky/for Peninsula Daily News PORT TOWNSEND—Anderson Lake, which was closed for all but two weeks of the fishing season last year, opened Saturday for the start of the season with about 100 people arriving early to catch trout. "I heard that a lot caught their limit," said State Park Ranger Aaron Terada, operations manager for the Fort Flagler area, which includes Anderson Lake between Port Townsend and Chimacum. "Bait fishing was better than lure fishing because the water was a little murky," he said. Anderson Lake was not stocked with fish this year. Gibbs, Horseshoe, Ludlow Lake, Sandy Shore, Teal and *Silent lakes were stocked with trout. The lake in the 410-acre Anderson Lake State Park has been plagued with intermittently high levels of dangerous toxins from blue-green algae since two dogs died after drinking the water on Memorial Day weekend in 2006. Testing for toxins began in 2007, and the levels—and subsequent closures and reopenings— have yo-yoed each season. In 2008, the lake had the dubious distinction of containing the highest level of anatoxin-a, a potentially lethal nerve toxin, ever recorded in the world: 172,640 micrograms per liter. Last season, the lake was open to the public only for two weeks after the beginning of the lowland lakes fishing season, which is always on the last Saturday of April. So far this year, it looks good, said Michael Dawson, lead environmental health specialist for the Jefferson County Water Quality Program. The county agency tests lakes for toxin levels. If toxins are above recommended levels for safety, it will close county lakes. Since Anderson is a state lake, decisions for closures are made by state park rangers. The county has been testing for toxins in Anderson Lake weekly since April 6, and all test results have shown they are well below allowable levels. The latest test, which was last week, found a barely detectable trace of anatoxin-a. The amount—0.058 •micrograms per liter of water—was well below the state recreational guideline of 1 microgram per liter. Microcystin, a toxin that can lead to liver damage if consumed over a long period of time, was not found at all. However, a yellow caution sign marks the edge of the lake because of an algae bloom in the water. "I would urge people to be on the lookout for a surface scum that's bright-green and avoid those areas," Dawson said. 40"Sometimes the toxins can be concentrated in those areas." Those who use the lake are counseled not to drink or swim in the water, keep pets and livestock away, and clean fish well, discarding the guts. The county will test the lake this week and report findings by Friday at http://tinyurl.com/PDN-JeffCoLakes. The county has not sampled Gibbs Lake, a catch-and-release trout lake near Chimacum, nor Lake Leland, near Quilcene, this year. Both look clear, Dawson said. Although Gibbs has a light algae bloom, it's not the harmful blue-green variety. This year, the county agency is monitoring the lakes with reduced funds. It lost state funding for freshwater algae control that typically brought in $15,000 to $20,000 annually, Dawson said. The state does pay for the testing of samples, while the county funds personnel and the costs of shipping samples and getting the word out. "We are looking for other options to be able to keep this going in the future," Dawson said. "We have a lot of concern about the lakes and a lot of desire to keep people informed." Aik County personnel will test for toxins when a lake has a blue-green algae bloom. "It's not going to happen if there isn't an obvious bloom," he said. Blue-green algae, which occurs naturally, can begin at times to produce toxins in a process researchers still don't understand. Toxins can be present only after an initial bloom, Dawson said; however, a bloom can die off and leave a poisoned lake. "The bloom can start to look better, and the toxins can continue to get worse for a while," Dawson said. However, "the visual is the first clue." As to why Anderson Lake can become badly toxic, "we're still evaluating last year's results"from nutrient sampling, Dawson said. The lake has a high level of nutrients such as phosphorus that fuel algae growth. If the lake is closed later in the season, which ends Oct. 31, then the monitoring schedule will decrease, probably to monthly rather than weekly, Dawson said. Teal, Leland and Gibbs lakes are open year-round. Toxin-producing blue-green algae has not been spotted in Clallam County. Report algae blooms in Clallam County by phoning 360-417-2258. • Managing Editor/News Leah Leach can be reached at 360-417-3531 or at Leah.leach[a7peninsuladailynews.com. Last modified:April 25. 2015 6:02PM Underage drinking, drugging talk is May 11 Port Townsend Leader, Wednesday, April 29, 2015 3:00 am Chimacum Prevention Coalition's key leader orientation meeting and panel presentation is set for 6-8 p.m. Monday, May 11 at the Chimacum High School library. The coalition shares this year's revisions to the prevention strategic plan, and hosts a panel presentation on the "Legal and Financial Implication of Underage Drinking and Drugging." Panelists are Barbara Carr, an administrator for Jefferson County Juvenile and Family Services, Scott Charlton, a public defender with Jefferson Associated Counsel and Gary Baird, an agent with Farmers Insurance. Dave Cunningham with KPTZ radio news facilitates the presentation, which focuses on the possible far-reaching legal and financial impacts underage drinking and drug use can have on individual youth, families and the community. The presentation is sponsored by the Chimacum Prevention Coalition, Jefferson County Public Health, Chimacum School District, Jefferson County 4-H, Olympic Education Service District 114 and the Division of Behavioral Health and Recovery. For information about the Chimacum Prevention Coalition visit the Jefferson County Public Health website jeffersoncountypublichealth.org/ or contact Kelly Matlock at 360-379-4476 and Julia Danskin 360-385-9420 at Jefferson County Public Health. • Jefferson County food council debuts By Allison Arthur of the Port Townsend Leader I Wednesday, April 29, 2015 7 xrq. sib Food Council Judy Farmer Roger Short(left) looks on as Jefferson County Local Food System Council organizer Judy Alexander talks about potential projects for the council that members voted on using sticky tags.A top priority listed is to increase the market for local food. Photo by Allison Arthur Jefferson County now has a local food system council. A what? It's a group of people from public and private sectors of the community that are dedicated to "working together to create, expand, and strengthen a local food system that is accessible, healthy, sustainable and economically vibrant." *he group is so new that not every member has committed that mission statement to heart. At a meeting April 24 at the Jefferson County Public Library, founder, facilitator and food advocate Judith Alexander offered an apple to anyone who had it memorized. No one did, so she ate the apple. The idea for a food system council has been simmering for some time, growing as concerns about the future of food also have grown —from the lack of commercial kitchens and freezer space to concerns about government regulations and a lack of markets for farm products. Alexander, a community food activist with Local 20/20, is one of the founders of the group and has been leading the group to fruition. Alexander expects to make a presentation Monday, May 4 at the Jefferson County Chamber of Commerce meeting. It's a public debut of sorts for the group, which only recently became officially incorporated as a nonprofit organization under Washington law. INCORPORATION Attorney Denis Stearns, who learned about food-safety issues firsthand as an attorney representing Jack in the Box restaurants in one of the first major food poisoning lawsuits, is now an adjunct professor of law at Seattle School of Law. Stearns joined Bill Marler, an attorney who sued Jack in the Box, to create Marler Clark, LLP, PS, touted as the first firm in the county to represent people injured by unsafe food. And it was Stearns, who set up a practice in Port Townsend last year, who helped the nonprofit Jefferson County Local Food System Council become official this year, on March 24, 2015, to be exact. "'Stearns gave a brief presentation on the meaning of that incorporation. ON THE COUNCIL The council members are a "who's who" of food experts, educators, advocates and producers in Jefferson County. All answered a call late last year when Alexander solicited for members. 40 Council members include Stearns and Alexander, Laura Lewis, director of Washington State University (WSU) Extension; Chimacum Valley farmer Roger Short, who produces grass-fed beef and "Magical Soil"; Shirley Moss, manager of the Port Townsend Food Bank; and Jared Keefer, director of environmental health and water quality for Jefferson County Public Health. Chimacum Valley Dairy owner Amy Rose Dubin, farmer-educator Catherine Durkin, dietitian-educator Laura Eggerichs, nutritionist-food producer Heather Graham, educator Bekka Bloom, and waste resource management expert Lisa Crosby. Jeannette Martens, owner of The Hungry Elephant, Brendon O'Shea with the Food Coop, and Hanni Witzig, assistant manger of the Kraut Kitchen at Midori Farm, also are on the council. Kellie Henwood, farm coordinator for WSU Extension, shares a seat on the board with Lewis and health educator Karen Obermeyer, who works for public health, shares a seat on the board with Keefer. Eric Toews, a land-use planner and attorney, also is on the council. The members were picked to represent a variety of sectors —education, institutional food, restaurants, waste/resources, farming, value-added production, food security, nutrition, government and retail. THE ISSUES The council expects to meet monthly this year to get its feet on the ground with issues it wants to tackle. At the meeting April 23, a "magic wand" — as in "if I had a magic wand, here's what I'd do" — list was pared to a handful of ideas of projects the council may work on initially. • Increasing local food markets and outlets for food producers as well as enlisting local government support for local food expansion emerged as top issues. Providing a sanctuary for beekeeping, building a food forest and edible landscapes, supporting a community kitchen, creating access for capital for projects, growing a local seed bank, reducing regulations that are barriers to agriculture, and building a slaughterhouse also were on the wish list. Not everyone was present at the meeting, so more votes will be tallied before a final list of top projects emerges. The group, which is not associated with any government agency, plans.to meet next month in Port Townsend and, in the future, in Chimacum. PRESENTATION Laura Lewis, director of WSU Extension office, gave a talk about all the projects her office is working on in Jefferson County. Although there are not that many small farms in Jefferson County, compared to other counties in the state, Lewis said Jefferson County has one of the largest farm-education programs in the state. She attributed that willingness to offer farm internships to the number of highly educated farmers in Jefferson County. Lewis also said that very few of the farm interns actually come from Jefferson County; most are from out of state. Dabob, Quilcene beaches closes to shellfish harvest due to marine biotoxins Port Townsend Leader, Friday, May 1, 2015 11:13 am The presence of elevated levels of marine biotoxins have led the state Department of Health to close Quilcene Bay and Dabob Bay beaches to the recreational harvest of shellfish, effective May 1 . According to the Jefferson County Public Health, marine biotoxins that cause Paralytic Shellfish Poisoning (PSP) were detected at elevated levels in shellfish samples collected on April 29. As a result, the state implemented a recreational shellfish harvest closure. The closure zone extends south to Zelatched Point on the Toandos Peninsula and across Dabob Bay to just north of Seal Rock on Hood Canal. Much of this area was also closed, for the same reason, from late July through October, 2014. Shellfish harvested commercially are tested for toxin prior to distribution and should be safe to eat, according to Jefferson County Public Health. Danger signs are being posted at high-use beaches, warning people not to consume shellfish from this area. The closure includes clams, oysters, mussels, scallops and other *species of molluscan shellfish. This closure does not apply to shrimp — the state's recreational shrimp season opens May 2. Crabmeat is not known to contain the biotoxin but the guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts (also known as the "butter"). Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish contaminated with the naturally occurring marine algae containing toxins harmful to humans. Symptoms of PSP can appear within minutes or hours and usually begins with tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing, and potentially death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions call 911 . In most cases the algae that contain the toxins cannot be seen, and must be detected using laboratory testing. Therefore, recreational shellfish harvesters should check the DOH Shellfish Safety Map at doh.wa.gov/ShellfishSafety or call the DOH Biotoxin Hotline at 1-800-562-5632 before harvesting shellfish anywhere in Washington State. Recreational harvesters should also check Fish and Wildlife regulations and seasons at 410ivdfw.wa.gov/fishing/shellfish or call the Shellfish Rule Change Hotline 1-866-880-5431 . As whooping cough grows, study finds vaccine *wanes O`igInally p" Nta 2015 t r,; 214 pm An analysis of Washington state's 2012 pertussis epidemic, the worst since 1942, found that the vaccine to prevent the disease waned sharply and quickly in teens who were fully inoculated. By JoNel Aleccia Seattle Times health reporter The last time Washington state had an outbreak of whooping cough, it was 2012 and nearly 5,000 people — mostly babies and young teens —got sick. Now, a new analysis of that epidemic finds the vaccine used to prevent pertussis waned quickly and sharply in adolescents, likely contributing to a surge of cases among those who already had their shots. Effectiveness of the Tdap vaccine —tetanus, diphtheria and acellular pertussis —was only about 64 percent overall, and it dropped to about 34 percent within two to four years after it was given, according to a study led by Dr. Anna Acosta, an epidemiologist with the Centers for Disease Control and Prevention (CDC). Who needs a vaccine? CDC recommendations call for children to get five doses of the childhood DtaP vaccine — Diphtheria, Tetanus, acellular Pertussis — at 2 months, 4 months, 6 months, 15-18 months and 4 to 6 years. Kids ages 11 to 18 should receive a single dose of Tdap vaccine — Tetanus, diphtheria, acellular pertussis. One dose of Tdap is also recommended for adults aged 19 and older who didn't get Tdap as adolescents. Tdap also should be given to kids aged 7 to 10 who are not fully protected against the disease, the CDC says. Pregnant women should get a pertussis vaccination in the third trimester of every pregnancy. Centers for Disease Control and Prevention That helps explain why even kids who received all the CDC-recommended doses by age 11 were part of a spike in cases during the epidemic, the worst in Washington since 1942. "Basically, there was this huge uptick," said Acosta, who is with the CDC's National Center for Immunization and Respiratory Diseases. "We saw a rise in cases in 13- and 14-year-olds. This outbreak really let us take a look at why that might be happening." The study, published Monday in the journal Pediatrics, comes just as Washington state is seeing another uptick in pertussis. As of April 25, nearly 400 cases had been reported statewide, compared with nearly 90 at the same time last year, health officials reported. Despite the waning protection, Acosta and other health officials said pertussis immunization remains important. It reduces the severity of illness when people do get sick and, when given to pregnant women, can induce immunity in newborns who are most likely to develop serious complications. "We immunize against pertussis to protect babies," said Dr. Ed Marcuse, a professor emeritus of pediatrics and a vaccine expert at the University of Washington. "Babies under three months of age die from this disease." II/The new study is one of the largest case-controlled studies to date to examine the effectiveness of the Tdap vaccine, Acosta said. It required 60 researchers working frantically for four weeks during the epidemic to track down records for all pertussis cases reported from Jan. 1, 2012, to June 30, 2012, in the seven Washington state counties with the most cases. "It was a huge collaborative effort," Acosta said. "We were very fortunate. The Washington state Department of Health is a great partner." Researchers found that in 450 adolescents who got pertussis during the outbreak, compared with 1,246 kids who didn't get sick, the overall vaccine effectiveness was about 64 percent. It was 73 percent effective in the first year— but declined to 34 percent effective in years two through four. The study confirms what others suggested, that a switch from whole-cell pertussis vaccine to acellular types in 1997 took a toll on the vaccine efficacy. The change was made because there was an "unacceptably high" level of reactions to the whole-cell shots, including febrile seizures, Marcuse said. "We do have a safer vaccine, and it's a vaccine that works, but it doesn't work for very long," he said. Vaccine critics like Michael Belkin of Bainbridge Island question the wisdom of giving people shots with limited efficacy. "The push for more and more doses of the failed pertussis vaccine brings to mind the quote attributed to Albert Einstein: The definition of insanity is "doing the same thing over and over again and expecting different results." "But Marcuse emphasized that some coverage is far better than none. "While we're seeing more cases now than when we had whole cell vaccine, we're seeing far fewer cases than when we didn't have a vaccine," he said. Until a better vaccine is developed, families should follow the CDC guidelines, with an emphasis on pertussis vaccination in the third trimester of pregnancy every time a woman is pregnant, Marcuse added. Only about 14 percent of pregnant women get the pertussis vaccine, according to a 2014 study in Michigan, a CDC report found. Washington rates are likely similar, Marcuse said. Pertussis is a highly contagious disease that causes severe coughing that can make it difficult to breathe. It's often characterized by a distinctive "whooping" sound made by children trying to get air, leading to the nickname "whooping cough." Health providers don't expect this year's outbreak to rival the last epidemic, said Chas DeBolt, senior epidemiologist for vaccine preventable diseases with the department of health. But they're gearing up just the same. "We certainly are watching it very carefully," she said, "We're trying to be prepared in case of repeat of 2012. JoNel Aleccia: 206-464-2906 or jalecciaa seattletimes.corn. On Twitter •©JoNeLAleccia Quilcene, Dabob bays closed to recreational shellfish harvesting because of biotoxin fears Peninsula Daily News, May 3 2015 40, PORT TOWNSEND — Dabob Bay and Quilcene Bay beaches have been closed to the recreational harvest of shellfish because of high levels of a potentially deadly biotoxin. Shellfish samples taken Wednesday were found to contain dangerous amounts of the biotoxin that causes paralytic shellfish poisoning (PSP), said Michael Dawson, lead environmental health specialist for the Jefferson County Water Quality Program. Shellfish harvesting He spoke Friday after the state Department of Health closed the bays for harvesting of all species of shellfish. Any amount of PSP toxin over 80 micrograms per 100 grams of shellfish can be deadly. The sample from Quilcene Bay contained 213 micrograms, while the Dabob Bay sample had 183 micrograms. The closure applies only to recreational harvesting. Shellfish harvested commercially are tested for toxin prior to distribution and should be safe to eat, the state health department said. New closure zone The new closure zone extends south to Zelatched Point on the Toandos Peninsula and across Dabob Bay to just north of Seal Rock on Hood Canal. Danger signs are being posted at high-use beaches to warn people not to consume shellfish from this area. The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. It does not apply to shrimp. Crabmeat is not known to contain the biotoxin, but the guts can contain unsafe levels. To be safe, clean crab thoroughly and discard the guts (also known as the "butter"). Already in effect 4I/The new closures are in addition to those that were already in effect. The Strait of Juan de Fuca from Cape Flattery east to the Jefferson County line are closed to the recreational harvest of all species —except in Sequim Bay and Discovery Bay. In those bays, only butter clams and varnish clams are off limits. Also closed to the harvesting of butter clams and varnish clams is Kilisut Harbor, including Mystery Bay, and Port Ludlow, including Mats Mats Bay. Ocean beaches Ocean beaches in both counties are presently closed for the season for harvesting of all species of shellfish. PSP can sicken and possibly kill people with marine toxins that are not destroyed by cooking or freezing. In most cases, the algae that contains the poisons cannot be seen and must be detected by laboratory testing. PSP symptoms Symptoms of PSP can appear within minutes or hours and usually begin with tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing and possible death. Anyone experiencing such symptoms should contact a health care provider immediately and call 9-1-1 in extreme cases. 1.Before gathering shellfish, check the safety map at www.doh.wa.gov/ShellfishSafety.htm or call 800-562- 5632. Recreational shellfishers also should check state regulations at www.wdfw.wa.gov/fishing/shellfish. • Jefferson County whooping cough cases climb to 20 By James Casey, Peninsula Daily News, May 6th, 2015 • Clallam County has escaped the whooping cough epidemic reported in Washington state so far, while cases in Jefferson County had climbed to 20 last week from the 17 reported April 16, health authorities in each county said. Jefferson's figure exceeds the 13 cases reported by the state Department of Health because they may have been diagnosed early before a full two weeks of coughing, according to Denis Langlois, Jefferson Public Health spokesman. Kitsap County topped the state count of cases with 85 as of last week. That number of cases equaled the entire state's total for 2014, according to The Associated Press. This year, whooping cough is at epidemic proportions statewide. Statewide cases of pertussis — better known as whooping cough for its trademark severe symptom — totaled 387 as of Tuesday, the latest date reported. Health officials said babies too young for vaccination and teens with waning protection were particularly at risk. Pertussis rates range widely among counties, with Walla Walla, Jefferson and Kitsap counties reporting at least 34 per 100,000 people and King County reporting only 2.7 cases per 100,000 people. Fifteen *counties have seen no cases of pertussis. None in Clallam An outbreak in 2012 ended with almost 5,000 reported cases and one death. So far, it has not been seen in Clallam County. Although Clallam has had no cases of whooping cough so far, Dr. Jeanette Stehr-Green, Clallam County public health officer, warned that it could spread from neighboring Jefferson. "This could be the next issue on the horizon," she said recently. Public health officials have suggestions for taking measures against whooping cough: • Get vaccinated, especially if you are pregnant or have a baby or young child in your home, or if you care for an infant. The vaccine takes about two weeks to become fully effective, the state Department of Health says. • Vaccinate your children. Children should start a series of five vaccinations starting at 6 weeks of age. In Jefferson County, immunizations are available at Jefferson Public Health from 1 p.m. to 4 p.m. Tuesdays and Thursdays at 615 Sheridan St., Port Townsend. Phone 360-385-9400. In Clallam County, they are available from 11 a.m. to 4 p.m. Wednesdays at the Health and Human Services clinic, 111 E. Third St., Port Angeles. Phone 360-417-2274. • If you get sick, see your health care provider, then stay at home. *Whooping cough's period of contagion can last 21 days. That period is cut to five days for those who follow a prescribed regimen of antibiotics. Children should be kept home from school or day care until they've received antibiotic medications for five days or until 21 days have passed after coughing started. • Practice "respiratory etiquette": Cover your cough and wash your hands or use an alcohol gel frequently. Sneezes and coughs can spread pertussis bacteria 3 feet away, and germs can linger on environmental surfaces. To learn more about the disease, visit http://tinyurl.com/PDN-DOHwhoopingcough. Reporter James Casey can be reached at 360-452-2345, ext. 5074, or at jcasey(a)peninsuladailynews.com. S • Gonorrhea on rise in Washington state Peninsula Daily News and The Associated Press, May 6th, 2015 •OLYMPIA— Health officials say gonorrhea, the second most common sexually transmitted disease in the state, is spreading. The number of gonorrhea cases diagnosed rose by nearly 40 percent in 2014—from 4,395 in 2013 to 6,136 in 2014. Health officials also reported a 33 percent increase from 2012 to 2013. A spike was seen in the disease on the North Olympic Peninsula as well last year. For all of 2014, Clallam had 13 cases of gonorrhea, said Iva Burks, director of the county's Health and Human Services. In all of 2014, Jefferson County had 21 cases of gonorrhea. So far in 2015, Jefferson County has recorded six cases of gonorrhea, compared with from one to six cases annually most years in the past 10. Three cases of gonorrhea have been reported in Clallam County for 2015, compared with seven at this time in 2014, four in 2013 and none for the same period in 2012, Burks said. Unprotected sex Burks said last year's spike in gonorrhea was due to people having unprotected sex, improperly using •condoms or having sex with more than one partner frequently. "What we would recommend is, if you're having sex with one partner who is stable, good," Burks said. "But if you're having sex with more than one partner, then you should get tested for gonorrhea by your health care professional." Rates of infection have been climbing since 2009, according to The Associated Press, when 34 people per 100,000 contracted gonorrhea statewide. The rate soared to 88 per 100,000 people in 2014. According to the state, young adults are the likeliest to catch gonorrhea, although the disease has been reported in both men and women of various age groups. Last modified: May 05. 2015 9:12PM • •i Anderson Lake closed due to toxin No a gae broblems yetatela , Gibbs lakes Port Townsend Leader, Friday, May 8, 2015 The lake at Anderson Lake State Park is closed again to public use in what has become an annual decision since toxic algae became a known problem in 2006. Washington State Parks closed the park on the Quimper Peninsula in Jefferson County after high levels of the potent nerve toxin antitoxin-a were detected in a water sample taken May 4, according to a press release May 7 from Jefferson County Public Health. The lake is closed to fishing, boating and swimming, and pets should not be allowed to contact or drink the water. Anderson Lake State Park remains open for hiking, biking, and horseback riding. Jefferson County Public Health has been monitoring Anderson Lake since the death of two dogs, who had consumed lake water, in late May 2006. Anderson Lake may not have been open a full fishing season since, with toxin levels seeming to increase as temperatures warm. This year, Washington State Parks opened Anderson Lake with the statewide lowland lake fishing opening on April 25, and fishing has been good. Toxin levels had remained below recreational criteria in April. However, the toxin level climbed to 17.8 micrograms per liter, which is above the Washington State recreational criteria of 1 microgram per liter, said Michael Dawson of Jefferson County Environmental Health in a press release. Trace amounts of the toxin microcystin were also found. The bloom of bluegreen algae in the lake contains three toxin-producing species: Anabaena, Aphanizomenon and Microcystis. Anatoxin-a can result in illness and death in people and animals, Dawson noted. Lake Leland and Gibbs Lake have not shown signs of bluegreen algae so far this year, Dawson noted. To check the status of Jefferson County Lakes and learn more about toxic cyanobacteria monitoring, consult the JCPH website at www.jeffersoncountypublichith.orq/index prlake__ water-quality or call 360-385-9444. For fishing seasons and regulations see the Washington Department of Fish and Wildlife website www.wdfw.wagpv/fishing. Information on visiting Anderson Lake State Park is available at www.par .wa.cgov/240/Anderson--Lake. Potentially lethal toxin closes Anderson Lake in Jefferson County Peninsula Daily News, May 8t'', 2015 Charlie BermanUPeninsula Daily News Robbie Kessler,left and Matt Laballe, both of Kingston, were out early on Anderson Lake in April 2014.State Parks closed the lake Thursday after testing found high levels of a potent nerve toxin. PORT TOWNSEND —Anderson Lake has been closed because of high levels of a potent nerve toxin. Washington State Parks closed the lake Thursday, the Jefferson County Public Health Department announced in a news release. The lake is closed to all recreation, including fishing, boating and swimming. Visitors are urged to keep pets out of the water. The rest of Anderson Lake State Park remains open for hiking, biking and horseback riding. A sample taken from Anderson Lake on Monday was found to contain 17.8 micrograms per liter of anatoxin-a, a nerve poison that can kill within 4 minutes of ingestion. •1he state recreational criteria is 1 microgram per liter. Trace amounts of the toxin microcystin were also found, the county health department said. Microcystin is a toxin from blue-green algae that can lead to liver damage if consumed over a long period of time. Heavy bloom The lake has a heavy bloom of blue-green algae, according to Michael Dawson, lead environmental health specialist for the Jefferson County Water Quality Program. The bloom contains three toxin-producing species: anabaena, aphanizomenon and microcystis. The county has not sampled Gibbs Lake, a catch-and-release trout lake near Chimacum, nor Lake Leland, near Quilcene, this year, as they have not shown signs of blue-green algae so far. The lake in the 410-acre Anderson Lake State Park has been plagued with intermittently high levels of dangerous toxins from blue-green algae since two dogs died after drinking the water on Memorial Day weekend in 2006. The county health department has monitored area lakes for blue-green algae since 2007. Opened in late April • The state Department of Fish and Wildlife opened Anderson Lake for recreational fishing April 25, and anglers enjoyed trout-fishing there until Thursday's closure. Toxin levels had remained below recreational criteria in April. However, the bloom of blue-green algae steadily worsened, Dawson said. • Blue-green algae, which occurs naturally, can begin at times to produce toxins in a process researchers still don't understand. To check the status of Jefferson County lakes, see http://tinyurl.com/PDN-JeffCoLakes or call 360-385- 9444. For fishing seasons and regulations see the state Department of Fish and Wildlife website at www.wdfw.wa.ctov/fishing. Toxin-producing blue-green algae has not been spotted in Clallam County. Report algae blooms in Clallam County by phoning 360-417-2258. For more on Anderson Lake State Park, see www.parks.wa.gov/240/Anderson-Lake. Last modified: May 07.2015 7:31 PM • • Brinnon area beaches closed to recreational shellfish harvest because of high levels of potentially deadly biotoxin Peninsula Daily News staff, May 8th, 2015 •PORT TOWNSEND — Brinnon area beaches now are off limits to recreational shellfish harvesters, and a public meeting has been set to explain why. High levels of marine biotoxin that causes the potentially deadly Paralytic Shellfish Poisoning (PSP) were found in shellfish samples from the Hood Canal, the Jefferson County Public Health Department announced late Thursday. The state Department of Health extended a previous closure of Quilcene and Dabob bays to include Hood Canal from Seal Rock south to the Jefferson-Mason County line. This includes public beaches at Seal Rock and Dosewallips and Triton Cove State Parks, among others. The closure applies only to recreational harvesting. Shellfish harvested commercially are tested for toxin prior to distribution and should be safe to eat, the state health department said. A special meeting has been scheduled at the Quilcene Community Center, 294952 U.S. Highway 101 at 6:30 p.m. next Thursday to discuss the causes of closures last fall and now. Clara Hard, public health adviser from the state health department, will talk about why the areas are closed, the program that monitors harmful algae blooms and the health risks of the different biotoxins. She will answer questions from the audience. •Dabob Bay and Quilcene Bay beaches were closed May 1. That closure extended south to Zelatched Point on the Toandos Peninsula and across Dabob Bay to just north of Seal Rock on Hood Canal. In Clallam County, the Strait of Juan de Fuca from Cape Flattery east to the Jefferson County line already had been closed to the recreational harvest of all species—except in Sequim Bay and Discovery Bay. In those bays, only butter clams and varnish clams are off limits. In Jefferson County, Kilisut Harbor, including Mystery Bay, and Port Ludlow, including Mats Mats Bay, also are closed to butter clam ad varnish clam harvesting. Ocean beaches in both counties are presently closed for the season for harvesting of all species of shellfish. Danger signs are being posted at high-use beaches, warning people not to consume shellfish from this area. The closure includes clams, oysters, mussels, scallops and other species of molluscan shellfish. It does not apply to shrimp. Crab meat is not known to contain the biotoxin, but the guts can contain unsafe levels. To be safe, clean •crab thoroughly and discard the guts (also known as the "butter"). PSP can sicken and possibly kill people with marine toxins that are not destroyed by cooking or freezing. In most cases, the algae that contains the poisons cannot be seen and must be detected by laboratory testing. AlkSymptoms of PSP can appear within minutes or hours and usually begin with tingling lips and tongue, moving to the hands and feet, followed by difficulty breathing and possible death. Anyone experiencing such symptoms should contact a health care provider immediately and call 9-1-1 in extreme cases. Before gathering shellfish, check the safety map at www.doh.wa.gov/ShellfishSafety.htm or call 800-562- 5632. Recreational shellfishers also should check state regulations at www.wdfw.wa.gov/fishing/shellfish. Last modified: May 07.2015 6:49PM • • Brinnon-area shellfish beaches closed due to marine biotoxins Port Townsend Leader, Friday, May 8, 2015 3:17 pm Shellfish samples from Hood Canal have been found to contain elevated levels of marine biotoxins that cause paralytic shellfish poisoning (PSP). Washington State Department of Health (DOH) has now extended the previous closure of Quilcene and Dabob bays to include Hood Canal from Seal Rock south to the Jefferson/Mason county line. This closure includes public beaches at Seal Rock and at Dosewallips and Triton Cove state parks, among others. Shellfish harvested commercially are tested for toxins prior to distribution and should be safe to eat. A special meeting is set for 6:30 p.m., Thursday, May 14 at the Quilcene Community Center to discuss what is causing the current closures and those of last fall. Clara Hard from DOH talks about why the areas are closed, the program that monitors harmful algae blooms and the health risks of the different biotoxins. Danger signs are being posted at high-use beaches, warning people not to consume shellfish from this area, including clams, oysters, mussels, scallops and other species of molluscan shellfish. • This closure does not apply to shrimp, and while crabmeat is not known to contain the biotoxin, the guts (also known as the "butter") can contain unsafe levels. Crab meat should be cleaned thoroughly, and the guts discarded. Marine biotoxins are not destroyed by cooking or freezing. People can become ill from eating shellfish contaminated with the naturally occurring marine algae containing toxins harmful to humans. Symptoms of PSP can appear within minutes or hours and usually begins with tingling lips and tongue, moving to the hands and feet, followed by difficulty with breathing, and potentially death. Anyone experiencing these symptoms should contact a health care provider immediately. For extreme reactions, call 911. In most cases, the algae that contain the toxins cannot be seen, and must be detected using laboratory testing. Therefore, recreational shellfish harvesters should check the DOH Shellfish Safety Map or call the DOH Biotoxin Hotline at 800-562-5632 before harvesting shellfish anywhere in Washington state. Recreational harvesters should also check Department of Fish and Wildlife regulations and seasons or call the Shellfish Rule Change Hotline, 866-880-5431. • Hearing set May 20 on Jefferson County marijuana rules oBy Nicholas Johnson of the Port Townsend Leader I May 13, 2015 Having held five meetings since Jefferson County's commissioners extended a moratorium on marijuana businesses in February, members of the county's planning commission are now taking public comments on proposed land-use rules for such businesses. A public hearing is set for 6:30 p.m., May 20 at the Tri-Area Community Center, 10 W. Valley Road, Chimacum, during which both oral and written comments will be accepted, according to county Department of Community Development (DCD) staff. Following public testimony, planning commissioners expect to finalize their land-use rules and recommend them to the board of county commissioners (BOCC), whose extended moratorium ends June 11. The BOCC does not have to accept the planning commission's recommendation. If it chooses to make its own revisions, it would also hold a public hearing before taking final action. BACKGROUND Though less restrictive than the original six-month moratorium that began in August 2014, the current one similarly limits marijuana growing and processing businesses to agricultural, forest and industrial areas, but deviates in also allowing either indoor or outdoor growing on any rural residential lot greater than 5 acres and allowing processing on any rural residential lot at least 1 acre in size, so long as the business has a county cottage-industry permit. In early March, BOCC chair David Sullivan introduced to planning commissioners an approach he and .his fellow commissioners supported that would treat marijuana growing and processing like any other agricultural activity by tying it in to the county's existing agriculture code, thus any revisions would apply to all agricultural activity. Concern from county farmers caused the planning commissioners to ditch that approach and return to an earlier one regulating marijuana business activity separately. PROPOSED RULES Now, planning commissioners want to allow growing on industrial and agricultural lands, while such activity on forest and residential lands would be subject to county review and conditions, such as limits on building sizes and requirements for setbacks. Growing would not be allowed on commercial and public lands, among others. Processing of marijuana would be allowed outright on industrial lands, while such activity on agriculture, forest and residential lands would be subject to conditions and require a cottage-industry permit. Processing would not be allowed on commercial or public lands, among others. The rules also address retail marijuana businesses, allowing those on industrial and commercial lands, except in areas zoned convenience crossroads, which are intended for stores offering daily necessities to the local and traveling public. Regarding growing on residential lands, the planning commissioners want to allow outdoor growing of any scale while limiting the size of temporary and permanent growing structures to five percent of a parcel's total square footage, meaning the larger an applicant's land area, the bigger their production facility can be. diWith a cottage-industry permit, processing facilities would be allowed 5,000 square feet, independent of limits on growing structures. Written comments postmarked by May 20 should be sent to DCD at 621 Sheridan St., Port Townsend, WA 98368 and marked "Attn. MLA14-066," or emailed to plancomm@co.jefferson.wa.us.