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HomeMy WebLinkAboutBOH M112102 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, November 21, 2002 Board MemberJ~' Dan Titterness, Member - County Commissioner District # 1 Glen Huntingford, Member - County Commissioner Distritt #2 Richard U7 qjt, Member - County Commissioner Distrid #3 Geqffrey Masci, Vice Chairman - Port l'ownJ'end City Coun£il ]ill Buhler, Member - Hospital Commissioner DÙtrict #2 Sheila Westerman, Chairman - Citizen at LArge (City) Roberta rnssell, Member - Citizen at Large (County) StafMembers: Jean Baldwin, Nursing Serviæs Direttor Larry FC!)', Environmental Health Director Thomas Lo¿ke, MD, Health Ojjžcer Chairman Westerman called the meeting to order at 2:35 p.m. All Board and Staff members were present, with the exception of Commissioner Huntingford. There was a quorum. APPROV AL OF AGENDA Commissioner W ojt moved to approve the agenda as presented. Commissioner Titterness seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Commissioner Wojt moved to approve the minutes of October 17,2002. Member Buhler seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT - None OLD BUSINESS AND INFORMATIONAL ITEMS DtaP Vaccination Reauirement Reinstated for School. Preschool. and Child care Attendance: Dr. Tom Locke reported that the vaccine shortage has ended. Referring to Senator Patty Murray's written response to the Board's letter, he believes Boards of Health voicing concerns about the vaccine shortage made a difference. A letter in the packet from the State Department of Health urges Departments to remind parents of the need to have children's vaccinations brought current before returning to school from winter break. Jefferson County only had to delay the 12-18 month booster and did not have to delay those for the four- to five-year-olds entering school. In response to a question by Member Frissell, staff agreed to report back about the County's exemption rate from this tàll. HEALTH BOARD MINUTES - November 21, 2002 Page: 2 West Nile Virus: The Board was interested in an update of birds testing positive for West Nile. Dr. Locke reported there were also positive results from a horse on Whidbey Island and crows in Snohomish and possibly King Counties. State Fundinu: Forecasts and Public Health Svstem Impacts - OFM Report and National Trends: Dr. Locke noted that the packet included a presentation by Wolfgang Opus, the head budget writer from the Washington State Office of Financial Management (OFM), showing budget trends. He described the fundamental businesses of Washington State as education, medication and incarceration, which together now account for appropriately 24% of the budget. In response to a question by Vice Chainnan Masci noting that other curves are moving up whereas education expenses are flattening out, Dr. Locke noted that recessions tend to increase educational expenses because people stay in school due to a lack of jobs. Those out of work tend to go back to school. Another article reported on public health funding; while there is new bio-terrorism funding, state governments are in the process of cutting $58 billion in the next funding cycle. Dr. Locke mentioned that the meeting with the legislators last week was canceled the evening before the meeting. There was Board interest in trying to schedule a meeting on December 10, the same day as the legislators are to meet with the Commissioners, but possibly at a venue other than the courthouse. In response to a question by Chairman Westerman, Dr. Locke eXplained that Washington State's revenue structure was designed on a natural resource-based economy (logging, fishing, etc) and has not changed despite the changed circumstances of those natural resources. As a result, the State has a structural revenue problem and does not have a way to cover its minimum obligations. Chainnan Westerman referred to the recommendations of a new think-tank organized by the Governor that call for a state income tax - getting rid of property tax, while lowering the sales tax to three percent. She believes a public endorsement, such as from those interested in new solutions for maintaining health, would be appropriate. She is interested in lobbying for new solutions. NEW BUSINESS Smallpox Vaccination - Pre-event Immunization of Outbreak Response Teams and Post-event Mass V accination Plannin~ for Jefferson County: Dr. Locke reported that smallpox vaccination is now the number 1 priority of the Centers for Disease Control. The State Department of Health is involved in the rapid development of a comprehensive State smallpox response plan. Although no new threat has been detected, he referred to the Washington Post article, which states that four nations are believed to possess smallpox bacteria. Staff has investigated the feasibility of doing a mass vaccination of all Jefferson County residents over a five-day period. Smallpox planning documents, while open for review by the Board are not publicly disclosable at this stage. Vaccinating everyone in the County - including all educators, nurses, security and traffic flow staffing as well as data and record keeping personnel -- would require a staff of about 640 people. It is believed that there is enough vaccine to immunize the entire U.S. and a new, highly purified vaccine is being manufactured. A Stage I voluntary vaccination could begin as soon as January and would involve 11,000 in the State core response teams. Communicable Disease Coordinator Lisa McKenzie noted that details of federal liability were included in the Homeland Security Bill. HEALTH BOARD MINUTES - November 21, 2002 Page: 3 Vice Chainnan Masci asked about the necessity of training additional staff in order to cover for the corps response teams being vaccinated? The Board noted that the vaccination could be completed within five days. He also asked about the rate of recurrence for those receiving a secondary vaccination. Dr. Locke responded that he has not seen those rates, but the number of serious side effects/life threatening complications are much lower in people who have been previously vaccinated. Member Buhler said it appears that there has been a shift from being concerned about risk to considering the benefits of an aggressive vaccination plan. Dr. Locke agreed that early in the summer the Advisory Committee on Immunization Practices (ACIP) produced a cautious set of recommendations but released a much more aggressive set on October 21. He noted that the sense of risk is different now than 30 years ago. Lisa McKenzie said we are asking people to be vaccinated against a disease that no longer exists naturally in the world and is found only in labs. The risklbenefit is extremely different than if smallpox were actually circulating. The other difference is that now there is a feeling that our population is probably very different than in the 60s or early 70s, with cancer treatment and other medications that affect the immune system. There is also an increased number of the population with HIV and eczema. Dr. Locke reported that he attended a regional meeting regarding the three-way planning being done among Health Departments, hospitals, and emergency medical systems and emergency management. The intent is to divide tasks so as not to overlap responsibilities or allow gaps in planning. Port Townsend Public Water System Update: Larry Fay reported on the water supply shortage that occurred over the last month. At the end of October, the City informed Environmental Health that Lords Lake was empty and expressed concern about Port Townsend Paper's plans to resume normal use of the water supply. They wanted to use 40% of City Lake's capacity before shutting down Mill operations. Although even at 60% full, City Lake would still have enough capacity to operate the City, with both reservoirs depleted, low rainfall could create a high risk of elevated turbidity in both reservoirs and, result in the City enacting cautionary boil water advisory. If the turbidity were to continue, the City would run the risk of losing its waiver for the filtration requirements for a surface water supply. Dr. Locke and Larry met with State Department of Health personnel and City Public Works staffto tour the Lords Lake facility where the Mill had installed a six million gallon-per-day pump to further pump the lake down. There was uncertainty as to the risk of turbidity with this increased pumping. Environmental Health met with Public Works and the Mill to highlight its concerns about this decision, particularly that there did not appear to be any contingency plans in place at the Mill for events such as this. The staff worked with the Mill to come up with a plan for different thresholds and milestones to which everyone could agree, with water quality as the priority. Within 48 hours, Public Works and the Mill had prepared a detailed water emergency plan, which was then reviewed by the State Department of Health. A final plan has now been produced, which the State feels is a very good plan and which will hopefully be incorporated into the City's water system plan for future operations. A key issue during this experience was the involvement by Environmental Health. Larry Fay said that although the State has primary regulatory authority over public water supplies and historically has focused on noncompliance with water quality standards after problems occur, he did not know that they are now positioned to monitor situations for imminent threats and issuing orders as such. Although the Mill was close to shutting down entirely, quantities of rain have remedied many of the risks. City Lake has since filled but with Lords Lake still down and filling slowly, the City will be challenged to manage the water supply. Given typical weather patterns, it would take somewhere HEALTH BOARD MINUTES - November 21,2002 Page: 4 between 100 days to a year to refill the lake. In response to a question from Member Buhler about whether water customers should still be practicing conservancy, Larry Fay said that while residents could cut their use and make a 2% difference on the total water usage, the most noticeable conservation efforts would be those of the Mill. The Mill was able to reduce their 10 million gallons per day to 6 million by shutting down one boiler and one line and laying off 20 people. Commissioner Wojt noted that in an emergency, in addition to conservation by the Mill, we need more storage in town and pointed out that there is a 2 million gallon storage tank on the hill at Fort Worden. Vice Chairman Masci noted that the recent conditions were different from those that caused the Mill to shut down in 1994. He talked about the Mill's turbine, which allows it to sell electricity - even when they shut down the pulp operation, they still generate revenue with the reduced water flow. Kees Kolff recognized that Larry Fay and Dr. Locke were extremely helpful during this short crisis in protecting the public water supply. In response to Chairman Westerman's suggestion that we strive to learn from situations such as this, Kees Kolffrecognized Port Townsend Paper General Manager John Begley's letter to the editor of The Leader about cooperation among entities to solve a tough problem. Environmental Health Policy Issues: Larry Fay reviewed his memo outlining policy matters that will need the Board's consideration over the next year. Staff suggested that the Board schedule a retreat to address agenda planning, policy setting, program prioritization, and establishing ground rules for addressing unforeseen cuts in the State Government and Department of Health. Jean Baldwin said that she also heard from the Board over this past year the desire to know what is going on with the Substance Abuse Board and other health-related Boards. With a full retreat agenda, hearing from those Boards may be something that is addressed under agenda planning. Mr. Fay noted that other additions to the list of Environmental Health issues would be revisions to the State Food Service Regulations and the State On- Site Sewage Code. Chairman Westerman spoke of the need for a clear approach to how the Board would work at the retreat to set policy and prioritize and not get into the specific policies. There was support for Staff preparing an all-day retreat proposal to ensure it meets the Board's criteria. Another suggestion was to list the policy decisions that have to be made as well as issues to be discussed in order to determine policy and priority. This would involve getting broad information. Staff believes a first outline could be ready by the next meeting. Health DeDartment vs. Health District - A Comparison: Following up on last month's discussion of the concept of a Health District, Dr. Locke reviewed his memo on the subject of the future of public health in Jefferson County and the health jurisdiction organizational structure. He noted that there are converging crises impacting the status of community health - in the medical care system (personal health care) and the public health system (population-based health care). Referring to a chart of evaluation criteria, he suggested the Board consider which structure - Health Department or Health District - is the most adaptive, because that is the most important element of maintaining public health services. He noted the next decision of the Board is whether Staff should continue to pursue the idea of a Health District. If so, the next step would be a formal proposal to the Board of County Commissioners. Staff clarified that the third column of the matrix refers to the Cost/Benefit of Changing to a Health District. HEALTH BOARD MINUTES - November 21,2002 Page: 5 Jean Baldwin pointed out several funding pressures: (1) Federal bioterrorism money comes with many associated costs for staff training, equipment, skills, as well as time in partnership meetings, and (2) local governments are having trouble as States and the Federal Government cut back services and leave local entities to determine their priorities. County government will continue to shrink and, as a county agency, so will the Department. This doesn't change the fact that we are still bound financially, but it may change the way we plan. The Department needs to develop a long-term plan and a balanced budget to present to the County for approval but which will then be independent of the County system and therefore more responsive to what we need to be doing. Vice Chairman Masci asked if the bylaws of the district system would permit citizen members to be elected rather than appointed by the Board of County Commissioners as they currently are? Another issue was whether the Board of Health or the County Administrator would have the civil service responsibilities of hiring, firing, etc. He also asked if the district would be part of the County employee group or be separate? He said the only real advantages presented in the cost/benefits chart are additional funding from the City, reduced County liability, and simplified governance. In proposal, they are massaged to look attractive but they might not be as attractive in the execution. He would still like to know whether transitional costs would be a hurdle? Commissioner Titterness said he does not know that additional funding from the City is a real consideration because we are already, to some degree, collecting from the City through the City/County contract. Ultimately, even in a district situation, the County would be liable if the Health District were to default. Jean Baldwin said that when it is penciled out, much would be similar; gains and losses would appear minimal on the financial sheet. Current expenses would equal district expenses (health insurance, benefits), although legal fees could be recouped through some grants through Environmental Health that currently cannot. It is more about liability and responsiveness to the community. Regarding membership, some of this is prescriptive in the RCW and some of it is not. The only real benefit that she could see would be to get rid of some of the politics of being a County Department. One difference between this County and others is that we service the City. To those who prefer that we work to reduce the size of government, this would seem to be a step toward a smaller bureaucracy. Regarding liability, Larry Fay commented that the County is responsible for public health services. There is an accountability that you do not shed by creating a district, but the actions of the Health District would probably be a step removed from the County government in terms of operational liability. Chairman Westerman said that in the public's eye a Health District would not have the political baggage that comes with being a County agency. She said she has always found the City/County dichotomy regrettable. The appeal of a district is the removal of that political stigma from public health issues and the possibility of more flexible regional partnerships. Logistically, it does not look that different to her. Jean Baldwin said it does not look different because we have been a separate budget item since about 1992 and we have had an expanded Board of Health since about 1996. Chairman Westerman agreed that the expansion of the Board laid the groundwork for a District. Dr. Locke noted that the current public health funding system is acknowledged to be broken. The system HEALTH BOARD MINUTES - November 21,2002 Page: 6 prior to 1977 was much better, as was the period before 1996 where there were clearly established responsibilities of the Cities and Counties to do shared funding. This was broken by the Motor Vehicle Excise Tax transfer. Currently there is an unbalanced funding responsibility, which essentially falls to the Counties. Cities have no responsibility temporarily. We will either revert to pre-1996 or move into a dedicated statewide funding source, which would then take counties and cities off the hook. Vice Chairman Masci expressed doubt that the State legislature would be able to fix the problem, to which Dr. Locke said if they do not do something this year, there would be virtual bankruptcy in a number of County Health Departments and, potentially, Health Districts. In response to a question by Kees Kolff about the difference between the Health Department and a Health District in the way it receives its revenue, Dr. Locke said the revenue would not change unless the City voluntarily agreed to contribute to the district. Jean Baldwin said the only difference is that it would allow the Department to be more flexible as it contracts with other counties. Commissioner Titterness asked whether, with a District, revenue would come directly from the Federal government or through the county? Jean Baldwin responded that it would come directly to the Health District. Vice Chairman Masci said if the City wanted something from the Health Department they would negotiate and contract directly with the District. To Commissioner Titterness's question, Larry Fay said the Environmental Health responsibilities would automatically go to the Health District. To the question of whether the Board of County Commissioners would be required to be involved as a Health District member, Dr. Locke said they have to be as the County's legislative authority. Commissioner Tittemess said he does not see how a district would change anything. With the same representatives on the Board he does not think we would de-politicize the process. In response to a question by Kees Kolff about how the politicization of public health prevented the Health Department from providing service, several members spoke that it has not prevented service. However some of the issues can be political (such as septic issues, needle exchange). A district would distance the Commissioners from the ultimate decision-making on public health issues. Vice Chairman Masci said if there seems to be little other benefit to going to a district, then it boils down to whether the three Commissioners are going to see this as a loss or an enhancement to their power. Commissioner Titterness said that if we were to move to a Health District the public would perceive that we were just trying to make another bureaucracy with which they would have to deal. He referred to a possible Parks District and said the only way we can do this is if we talk about City and County consolidation of all ofthese types of agencies. Citizens do not want to see separate districts or expanding government. Vice Chairman Masci said he is proposing this as the easiest of the district creations. The creation of districts enhances public control and were you to create a Health District and create two or three positions that were elected by citizens, then they would have much more control and accountability for those programs. He suggested investigating whether the district could sunset, which would allow the HEALTH BOARD MINUTES - November 21, 2002 Page: 7 opportunity to see if it works. Commissioner Titterness said that while he believes the topic is worthy of discussion, he does not think it is worth pursuing at this point. Commissioner Wojt said the greatest advantage to the overall health of the Health Board is in terms of being able to work the budget in such a way as to have greater facility to react to changing conditions than as part of the total County budget and all of the systems the County is trying to deal with. He believes a district would simplifY and compartmentalize. Commissioner Titterness said, as an elected official that may wind up having to make a decision on this issue, the farthest he would go is to recommend that we ask the public. The Vice Chairman noted that this could be done with an advisory ballot. He believed we would need to educate the public as to what we are doing and why we are doing it and let them decide whether it is in their best interest. MaryAnne Preece commented that she does not believe the public sees Public Health as "Government." Member Prissell said she agrees with Commissioner W ojt. If the only advantage is to create flexibility for the people managing this system, then she believes we need to try it. Jean Baldwin said having flexibility is good, but a greater advantage would be the ability to stay focused on your own priorities. Over the last year, their management team spent more time at the Courthouse on committees, only to come to the bottom line of "give us $150K." Running one management person short most of the time, it continues to be difficult to fit in the County. Our calendars and service delivery are different. Chairman Westerman asked to better understand how districts are working in other areas of similar size. The idea of educating the public enough to be able to vote on this difficult an issue seems daunting. Member Prissell agreed and said she believes the first question the public might ask is what is it going to cost me? Vice Chairman Masci said he believes they would be asking why a change is being proposed. He explained that with an advisory ballot the Commissioners are asking the advice of the electorate. Commissioner W ojt said the real question for the new Commissioners to consider is whether this gives us better service of the County citizens? Dr. Locke summarized that a number of good issues have been raised and Staff would bring back reports of other districts of similar size. He agreed to find out if someone can be elected directly to a Board of Health. It was noted that there was also interest in investigating transitional costs. Vice Chairman Masci asked for a list of the counties that are districts as well as information about their transitions. Commissioner Titterness suggested considering a regional district. He said Staff could tell Clallam County that we are discussing whether or not to do a Health District. Jean Baldwin agreed and also noted HEALTH BOARD MINUTES - November 21,2002 Page: 8 that she believes it would be much more complex to try to structure a multi-county district without having first tried a district. The smaller county feels that they are getting short changed. State of the State ReDort: Jean Baldwin distributed the Executive Summary ofthe State of the State of Washington. Dr. Locke noted that this is interesting in that it asks what we can do about these problems, what sort of interventions have been proven to make a difference. AGENDA CALENDAR / ADJOURN December Agenda Items: Health District Continuation of Discussion, Regular Updates on West Nile and Smallpox and Other Federal Issues. The meeting adjourned at 4:30 p.m. The next meeting will be held on Thursday, December 19,2002 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH ~W4~~~ r * Richard W ojt, Member Y I ;f]h6//;¿¿¿aL¿ Roberta Frissell, Member Sheila Westerman, Chairman ~ C- .: offrey Masci, Vice-Chairm~ (Excused) Glen Huntingford, Member IkfE:bcr - JEFFERSON COUNTY BOARD OF HEALTH Thursday, November 21, 2002 2:30 - 4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of Meetings of October 17, 2002 III. Public Comments IV. Old Business and Informational Items 1. DTaP Vaccination Requirement Reinstated for School, Preschool, and Childcare Attendance 2. State Funding Forecasts and Public Health System Impacts - OFM Report and National Trends V. New Business 1. Smallpox Vaccination -Pre-event Immunization of Outbreak Response Teams and Post-event Mass Vaccination Planning for Jefferson County 2. Port Townsend Public Water System Update 3. Environmental Health Policy Issues - Priority Setting 4. Health Dept. vs Health District - a Comparison VI. Agenda Planning VII. Next Meeting: December 19, 2002, 2:30-4:30 PM Main Conference Room, JHHS Lisa, Tom Larry, Tom Larry Jean, Tom ''''l4 lJrj" . . Fl' JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, October 17, 2002 Board Members.' Dan TÜterness, Member - County Commissioner District # 1 Glen Huntingford, Member - COJlnty Commissioner District #2 RÙ-hard W qjt, Member - County CommiJJ'ioner DÙtrid #3 Geoihy Masci, Vice Chairman - Port Townsend City Council ]ill Buhler, Member - Hospital Commissioner Distrid #2 Sheila U7esterman, Chairman - Citizen at Large (CiM Roberta Frissell, Member - Citizen at Large (County) Staff Members.' Jean Baldwin, Nursing Services Director Larry Fqy, Environmental Health Director ThomaJ' Lorke, MD, Health Officer Vice Chainnan Masci called the meeting to order at 2:30 p.m. All Board and Staff members were present, with the exceptions of Chairman Westerman and Commissioner Tittemess. There was a quorum. APPROV AL OF AGENDA Member Buhler moved to approve the agenda as presented. Commissioner Huntingford seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Commissioner Huntingford moved to approve the minutes of September 19, 2002. Commissioner Wojt seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT - None OLD BUSINESS AND INFORMATIONAL ITEMS Status of Meetin2' Minutes for Aueust 15. 2002: Staff distributed a legal opinion from Deputy Prosecutor David Alvarez in response to the Board's question as to whether an official meeting could be held absent a quorum. Because the August meeting was conducted without a quorum, the "discussion notes" of that gathering would stand as such. To the question whether the Board could begin a meeting awaiting a quorum to be formed, such a meeting would not be official until a quorum is established. When a quorum is lost, the meeting can continue until such a time as a member calls for a count of the quorum, at which time if a quorum is found to be absent the meeting should end. Dr. Tom Locke said generally, meetings of Boards can continue after a quorum is lost, but they take no further action. HEAL TH BOARD MINUTES - October 17, 2002 Page: 2 NEW BUSINESS Local Health Jurisdiction Reoru:anization - JHHS Budeet History and Forecasts: At the request of Vice Chairman Masci, Jean Baldwin and Dr. Locke briefed the Board on Staffs research into health districts. They noted that the agenda packet included cites from the Revised Code of Washington (RCW) and the Washington Administrative Code (WAC) that distinguish between a health district and health board. Dr. Locke talked about the independent legal authority of the Health Board, which is uniquely different from the tract of other departments who receive their authoritY by the Board of County Commissioners. While a Health District would remain the fiscal responsibility of the County, its liability would be reduced ~ 47 employees go away, leaving the Health District and the County both with smaller, easier-to-manage governments. Ms. Baldwin talked about the challenges of being tied to County budgeting. A win-win situation for the County would be for a district to receive a finite amount from the County, City, hospital, etc., from which the Department can do the work. With many rural counties in financial crisis an ongoing, stable funding source is needed. Three funding plans are currently before the legislature. Vice Chainnan Masci, reasoning that management of the Health District would then become the purview of the Board, asked if the voting requirement of needing at least two County Commissioners would still hold true? Larry Fay noted that under RCW 70.46 the resolution or ordinance establishing the district would create the membership and voting. Referring to the listed RCWs, Commissioner Huntingford said he does not see what the County would gain from a district except for the release ofliability. What types of checks and balances are there other than possibly the Health District saying that they need more money? How are we going to negotiate and what are the state guidelines? Dr. Locke noted that, due to lack of use, those guidelines were eliminated 3-4 years ago as part of regulatory reform aimed at cleaning up the WAC. The reason for repeal was that, in reality, the way that it works is through negotiations between the Health District and the County. Commissioner HWltingford noted there would still need to be a source of funding. Jean Baldwin said that with many additional cuts expected, a district would give the Department the flexibility in delivering health services as well as flexibility to make adjustments such as lending staff to Clallam County. Because the Health Department is unique within the County, it would also be easier for some who interact with the Health Department - such as the Auditor, the Treasurer, etc.- if the Department were an outside contractor. Member Frissell asked what a change such as this would mean to the people who use the services? Jean Baldwin said it shouldn't impact services to clients of Environmental Health or nursing, as it is a governance and budgeting issue. Substance abuse would be different in that the Department would have to contract with the County Commissioners. Vice Chairman Masci asked about the concept of accountability. In a district scenario, a service package would be presented to the County Commissioners? The district does not have any barriers to contracting for additional services, such as with the City, which could be individually negotiated. Who ultimately would be in charge, the Board of Health or the County Commissioners? Jean Baldwin noted the Board of Health would be in charge of the District. Lany Fay noted that the accountability to deliver public HEAL TH BOARD MINUTES - October 17, 2002 Page: 3 health service would rest directly with the Board of Health and, ultimately, with the County Commissioners because they are the ones with responsibility for ensuring public health delivery systems are in place. As far as the District negotiating a contract with the City for services peculiar to the City, this is something to be investigated. Dr. Locke noted that the lnterlocal Agreement Act permits the City to contract for specific public health services with the County or any other Country or Tribe. Member Buhler asked how the Hospital District enters into the picture? Dr. Locke noted that the County's legislative authority - the County Commissioners - sets up Health Districts and defines membership of the Board. So the Commissioners would playa dual role in a district; they could be the entire Health District board or part of a larger body (e.g., the current seven member board). In any case, the budget would be developed within the department, approved by the Board of Health and thus pre- approved already, or at least pre-discussed substantial1y by three Health Board Members it would then go to the County Commissioners for fonnal adoption. Jean Baldwin said that Health Districts are not unusual in small counties. One of the other confounders that make us look different from other, county departments is-that while 20% of the. Department's budget is the County general fund, the majority of funding comes from State and federal government and from fees. The goal of getting the Department ongoing funding is to decrease the dependence on local funding and to let the County concentrate on law and justice issues. Vice Chairman Masci noted that if there were a move to a district, the County Commissioners would have to acquiesce to it. He suggested Staff prepare a chart of the advantages and disadvantages to clearly see how the shift could be justified to the public. Commissioner W ojt asked how a district would help save the Health Department from being party to the fact that the County cannot come up with the funds to fulfill its obligations when it balanced the budget? Commissioner Huntingford said the stable funding source, if it happens, would come from the State, but the County would still be a partner. lfthe County has to reduce budgets, the County's funding mayor may not be stable. Dr. Locke agreed that a district structure does not assure stable funding. Health Districts in Washington State are having the same problems as County Departments. The overall problem is the trend toward the downsizing of County governments. Although demand for service is increasing, revenue sources are decreasing. Public health in the State is being dismantled piece by piece and is now in extreme jeopardy. There are some areas of the State that are measurably less safe because of cutbacks in restaurant inspections and drinking water programs. Jean Baldwin noted that the State Department of Health is grappling with whether they now need to go into those Counties. MaryAnn Preece addressed the question of stable funding. A benefit of a district would be the ability to partner with other areas and look to other jurisdictions in the region for sources for financing. It might also be able to partner with Clallam for west end services in order to be more effective and efficient. There are many ways to be more fiscally sound. Jean Baldwin clarified that the Health District would not have any taxing authority. Commissioner Huntingford agreed that a chart might be helpful in comparing the advantages and HEALTH BOARD MINUTES - October 17, 2002 Page: 4 disadvantages of a district. While it sounds appealing to split off the Health Department, he is concerned about responsibility, accountability and liability. MaryAnn Preece explained that the State Auditor would audit a district separately ftom Jefferson County. Other County services, such as County Attorney, would have to be negotiated. Larry Fay added that most of the options that would be available to a district could be done through a continued contract with the County paying the same rates as we have now. Jean Baldwin recognized there is a list of details associated with a Health District that will need further consideration and investigation (e.g., employee benefits, liability insurance, etc.). She noted that in many ways the Health Department is already very different from other departments. Vice Chairman Masci asked to better understand whether the cost of transition would be a big obstacle to a changeover? Dr. Locke recommended Staff first outline the pros and cons of a Health District for the Board's review before costing out the reconfiguration. Commissioner Wojt moved· to direct Staff to gather morejnformationon Health Districts. Member Buhler seconded the motion, which carried by a unanimous vote. National Smallpox Vaccination Plan: Dr. Locke reported that the County is in the process 'of developing a smallpox vaccination plan and briefed the Board on the two types of smallpox vaccinations: pre-event and post-event. There is no disagreement that post-event vaccination is essential; typically the vaccine can be effective if people are vaccinated within three to four days after exposure. There is concern, however, about the number of people that should be vaccinated before exposure. He then talked about some of the reactions to the pre-event vaccination where the risks of the vaccine are high enough that only those most at risk for the disease should be vaccinated. This has become a political issue since the White House and Health and Human Services is considering a plan to vaccinate anywhere from Y:2 to 10 million people. What is most worrisome is that people who have been vaccinated can spread the infection to those unvaccinated for a period of up to 19 days. While the population under 30 is the most vulnerable, everyone is susceptible to smallpox. He then talked about those who should not receive the vaccination, such as those with immuno-deficiencies, because of their susceptibility to complications. From a national defense standpoint, it would make strategic sense to have as many people vaccinated as possible, but the issue is the price for this coverage. He noted that any plan would be implemented at the local level by the local Health Department. Vice Chairman Masci asked how quickly a local policy would need to be established? Dr. Locke said it would likely be necessary to be decided in reaction to national policy and guidelines. He believes most of the public health community would support the Advisory Committee on Immunization Practices (ACIP) recommendations, which are that vaccinations at this point should be very limited, with a focus on a plan to vaccinate quickly in response to exposure. It would be hard to justify thousands of deaths in response to a theoretical concern. Asked by Member Buhler about identifying exposure, Dr. Locke said that while people are minimally infectious until the rash appears, the clock starts ticking from the point of exposure. Jean Baldwin talked about the difficulties of vaccine distribution. She noted staff has gone to trainings about how to get immunization going. Dr. Locke pointed out that the process of vaccinating a population is complicated by the necessity of a detailed screening process. HEALTH BOARD MINUTES - October 17, 2002 Page: 5 Vice Chainnan Masci asked if the Board could receive any information from the ACIP so they could look at who might be considered central personnel such as fire district, emergency room personnel? Mr. Fay noted that JPREP would be receiving a briefing on smallpox from Communicable Disease Coordinator Lisa McKenzie. There was additional discussion of the complications due to vaccinating first responders and the risk of complications from the vaccine. Dr. Locke noted that we live in an era where we believe the risks of vaccines should be close to zero and for this vaccine it is not very close. Newer, safer smallpox vaccines are under development, but would not be available for three to five years. Israel has an ambitious generalized vaccination program and Great Britain has embarked on a healthcare worker vaccination program. Jean Baldwin, noted that smallpox is just one of the possible agents in bio-terrorism preparedness. The Hospital and JPREP did a bio-terrorism surveillance survey last Friday. The Health Department did theirs the week prior. All survey results will be rolled up into a regional evaluation. West Nile Virus Response Plannin~: Dr. Locke reported that the West Nile Virus has made its appearance in the bird population of Washington State. The two human cases in Washington State were contracted in other states. The speed with which this virus has spread across the United States was greater than expected. Four of the mosquito vectors that are favorable for transmission of this virus are present in Jefferson County. Environmental Health response is doing active bird surveillance. Once it spreads into the bird population, it will start jumping into humans, but only about lout of 150 people get sick and of those, 50% would never fully recover and have permanent neurological injury. Commissioner W ojt asked if the symptoms in the majority of those infected are mild, how are they detected. Dr. Locke responded that this is done with antibody testing of a population. The incubation period is a fairly short 7-10 days and the most sensitive test is actually of spinal fluid, which does little good because there is currently no treatment. In the future, West Nile is something that should be vaccine preventable. Jean Baldwin noted that Environmental Health's partners in this issue are local veterinarians. Mr. Fay said that to-date, all results on the many birds tested under the County's bird surveillance have been negative. It is likely that next year Environmental Health will expand its bird surveillance activities to more active surveillance of adult and larval mosquitoes while working to identify and minimize their breeding areas. Noting that some people have already asked about the County's plan for mosquito abatement, he said the County would struggle with differing expectations within the community about environmental protection and the local risk to this disease. The response he has seen across the country has been mostly in the way of public infonnation about minimizing exposure to mosquitoes using insect repellant and reducing breeding areas. While there are known human implications, it is not known how this will impact the bird populations. Public Health Fundin~ Reform: A Proeress Report: Dr. Locke reported that all said district reorganization would not solve the central problem currently challenging all counties and all health districts in the State. Stable, dedicated funding for public health disappeared in the early 1970s and ever since, it has been a scramble from year to year to cobble together funding from a variety of differentesources. Public Health appears increasingly ill suited to the current situation where we have a crash national program to rebuild our public health infrastructure with new problems coming all the time. We HEAL TH BOARD MINUTES - October 17, 2002 Page: 6 are likely to see the roles of the uninsured and those lacking access to medical care swell as healthcare financing problems get worse, which will then cause different types of health problems. There appear to be serious discussions leading toward action going on in Washington State. Noting that the agenda packet included a resolution from the State Public Health Association describing the various issues, he said a more useful resolution from the State Medical Association recently passed was committing them to supporting our legislative proposals. And that is really where this is going to go. The Washington State Association of Counties (WSAC) and Washington Association of County Officials (WACO) have adopted as their top priority the issue of pushing the legislature to find a dedicated statewide funding source this year. There are three different funding proposals being circulated: additional property tax authority, a combination of "sin" taxes, and a utility tax. While the plan is to bring a proposal to the legislature this year, the legislature will likely try to pass it on as a referendum to the people in the next election rather than act on it. Vice Chairman Masci asked if the Board should pass a resolution for forwarding to WACO, who would be doing this lobbying. Commissioner Huntingford said that in order to speak as one voice, he recommends first getting more information from WSAC and WACO. Member Frissell suggested asking legislators for face-to-face meetings with local boards of health. Jean Baldwin noted that a forum involving Clallam, Grays Harbor, and Jefferson Counties might be a possibility. There was Board support for Staff exploring this idea. Data Steerine Committee Update: Jean Baldwin reported that after the last Data Steering Committee meeting, Staff arrived at the "Blueprint for the Future of Assessment and Evaluation" with Community Health as the center. The idea is to create a web page similar in format to the diagram, where citizens can access specific data. Rather than providing links to other sites, Staff would plan to download pieces into this format. Currently, the City is considering how much they might be able to contribute to this website development project, which is now reaching $24K. She explained how the information would be presented in order to provide it in context. She recommended the focus groups, which were discussed after the last meeting, be put on hold until after a prioritization of projects. It is also likely another data steering committee meeting would be needed before focus groups are organized. A hard copy of the data should be available this fall Member Frissell suggested that the web page provide a mechanism for public feedback and ask questions. Member Buhler suggested there be a search function. AGENDA CALENDAR/ADJOURN November Agenda Items: Health District versus Health Board, Review Summary of Upcoming Environmental Health issues, December Meeting with Legislators. Jean Baldwin noted that 8taffalso agreed to draft a letter :&om the Board of Health recommending the Health Department and Hospital offer a breast-feeding in-service. Commissioner Wojt noted that table talk at the Rotary meeting this week was that drug use is prevalent and openly tolerated among the kids at all three district schools. Jean Baldwin noted that the local schools would be conducting a survey in October. Previous surveys have indicated that Jefferson County has had a higher initiation of drug use and a pretty open acceptance of it, but not significantly more than HEALTH BOARD MINUTES - October 17, 2002 Page: 7 other rural districts. Clinical services employees are hearing that there continues to be a lot of methamphetamine use. She noted that the Department recently received another $100,000 grant to continue education in schools. The meeting adjourned at 4:00 p.m. The next meeting will be held on Thursday, November 21,2002 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH (Excused) Sheila Westerman, Chairman Jill Buhler, Member Geoffrey Masci, Vice-Chairman Richard W ojt, Member Glen Huntingford, Member Roberta Frissell, Member (Excused) I>an Titterness,Member STATE OF WASHINGTON DEPARTMENT OF HEALTH Olympia, Washington 98504 ~ RECEIVED OCT 3 1 2002 October 25, 2002 Jefferson County -:aalth & HiJm&n ~ðr'Vic~ Dear Partner in Health: The purpose of this letter is to inform you that diphtheria, tetanus, and pertussis (DTaP) vaccine supplies are approaching normal levels, and, therefore, the minimum requirements for school, preschool, and childcare attendance are reinstated as of November 1, 2002. In a letter dated August 5, 2002, you were informed of action taken by the State Board of Health to extend the length of cçmditional school entry status per Washington Adrrúnistrative Code in order to accommodate children who had not received required immunizations. This was done in order to promote a smooth transition back to school and allow parents and providers sufficient time to bring children's immunizations up to date after vaccine supplies were determined to be adequate. As of November 1, 2002, students attending schools, preschool, and childcare programs will have 60 days to receive any vaccines necessary to bring them up-to-date with state immunization requirements. Sending a reminder to parents of children who need vaccine would be appropriate at this time. Children who have not received the required doses of vaccine upon their return from holiday break in January will be out of compliance with school and childcare requirements under Washington Administrative Code. Thank you for your efforts to ensure all children are appropriately immunized. Sincerely, ~.....;,+ I VA;P Maxine Hayes, MD, MPH State Health Officer ®~1' o PATTY MURRAY WASHINGTON tinítrd ~tatrs ~rnatr COMMITTEES: APPROPRIATIONS BUDGET HEALTH, EDUCATION, LABOR AND PENSIONS VETERANS' AFFAIRS WASHINGTON, DC 20510--4704 September 24, 2002 Ms. Sheila Westerman Chair Jefferson County Board of Health 615 Sheridan St. Port Townsend, Washington 98368-2439 Dear Ms. Westerman: Thank you for contacting me with your concerns about the national shortage in vaccine supplies. It was good to hear from you. As a result of coordinated efforts by the Food and Drug Administration, the Centers for Disease Control and Prevention and vaccine manufacturers, there is currently no national shortage or delays of recommended childhood vaccines. However, as you well know, there is still a backlog of children whose immunization schedule was disrupted. In addition, the manufacture and distribution process is vulnerable. We are only one outbreak away from another crisis. As a Senator, and a mother, I fully understand the importance of vaccinating our children against harmful diseases and developing new vaccines to treat deadly diseases such as AIDS and tuberculosis. I have been a strong supporter for increased funding to the National Institutes of Health and Centers of Disease Control and Prevention so that they might continue to research and develop vaccines for diseases such as HIV/AIDS, malaria, tuberculosis, anthrax, the West Nile Virus and even against bone loss, As a member of the Labor, Health and Human Services, and Education Appropriations Subcommittee, I have also been working with my colleagues to increase funding to the national vaccine stockpile and to provide the Food and Drug Administration (FDA) increased funding so that the regulatory review process might be expedited for new, promising vaccines. However, increased efforts are needed in order to ensure our nation benefits from an adequate, reliable supply of vaccines. As you probably know, vaccine shortages have become an all too common occurrence. Over the past several years, many factors have contributed to the decline in vaccine supplies. These factors include FDA compliance, shortages of raw materials, and a declining number of vaccine manufacturers. In order to better understand the problem, several of my colleagues and I have participated in several hearings on this issue and supported a recent study by the General Accounting Office (GAO) to determine the causes of increasing vaccine shortages and establish new ways to alleviate them. I anticipate the results of this study and am looking forward to implementing the GAO's recommendations. 2930 WETMORE AVENUE SUITE 903 EVERETT. WA 98201-4107 (425) 259-6515 2988 JACKSON FEDERAL 8UILDING 915 2ND AVr-:NUE SEATTLE, WA 98174~1003 (206) 553-5545 601 WEST MAIN AVENUE SUITE 1213 SPOKANE. WA 99201-0613 (509) 624-9515 THE MARSHALL HOUSE" 1323 OFFICf.R'S Row VANCOUVER, WA 98661-3856 (360) 69&-7797 402 EAST YAKIMA AVENUe: SUIT!;: 390 YAKIMA, WA 98901-2760 (509) 453-7462 PRINTED ON RECYCLED PAPER e-mail: sentttor..murrayCÒJmurray.s:eníJte.gov Internet: http://mt ((ay.se.nãte.ç¡ov Senator Kennedy (D-MA), Chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, of which I am a member, has tentatively planned committee action on legislation aimed at· addressing many of the factors that have contributed to current shortages. This legislation will be based in part on the findings and recommendations of the GAO investigation. In addition, I am proud to be a cosponsor ofthe Vaccines for the New Millennium Act, S.895. 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American Medical New Page 1 of 4 - SI>ECIAL SECTION 't THIS'\fVEEK HEALTH & SCIENCE Public health funding: Feds giveth but the states taketh away Public health officials didn't expect budget cuts after government promises to shore up the system following the World Trade Center and anthrax attacks. By Victoria Stagg Elliott, AMNews staff. Oct. 28, 2002. Additional information Public health departments throughout the country are experiencing an infusion of federal funds for bioterrorism preparedness. But in an unexpected twist, that new money may have made it easier for some cash-strapped state and local governments to slash their public health budgets. In many cases, the state and local cuts are completely ovetwhelming the benefit of the federal funds, leaving public health departments in worse shape. For example, in rural Larimer County, Colo., the Dept. of Health and Environment will gain 1.4 positions because of the new bioterrorism funds but will eliminate 15 positions because of state cuts, said Adrienne LeBailly, MD, MPH, the department's director. Her $6 million annual budget will receive $100,000 in federal money but lost $700,000 in state funding. "We're eliminating dollars for public health programs that ... will impact more lives and prevent more deaths and injuries and diseases than will ever happen ftom bioterrorism in our state," she said. The county will hold a referendum later this year to try to raise money to replace the lost state funds, and, if it passes, the cuts will be reversed. But for the time being, the department has just reduced the family planning and childhood immunization programs. More than 200 women will not have access to birth control. One thousand children will not be able to get immunized at the public clinic. ...\AMNews Oct. 28 2002. Public health funding Feds giveth but the states taketh away"". AmerlO/21102 AMNews: Oct. 28, 200...: Feds giveth but the states taketh away... American Medical New Page 2 of 4 -'!', Public health systems in other areas are hurting as well. In Los Angeles County, officials already have closed 11 health centers and four school- based clinics this year and are talking about closing two of their six public hospitals. In Illinois' DuPage County, a suburban area west of Chicago, a substance abuse program for women and an abstinence education program for the schools have been chopped. $1.1 billion in grants to state and local health departments target bioterrorism preparedness. "A lot of our members are reporting that they are experiencing cuts. It reflects overall budget conditions at the state and local level, although it seems anomalous in the face of increased federal resources directçd to public health," said Patrick Libbey, executive director ofthe National Assn. of County and City Health Officials. It wasn't supposed to be this way. In January, the U.S. Dept. of Health and Human Services announced $1.1 billion in grants to state and local health departments for bioterrorism preparedness -- money above and beyond what was already granted for other services. President Bush's proposed 2003 budget includes $940 million for state and local health departments to improve laboratory capacity, epidemiology, disease surveillance, training and communication infrastructure. HHS Secretary Tommy Thompson said the money would rebuild the long-neglected U.S. public health infrastructure so that it could respond to more common public health crises, such as West Nile or influenza, and that local health departments were a vital part of that system. "If we never have another bioterrorism attack, as [Thompson] often says, the silver lining of the 9/11 attacks is that we have the opportunity to build a public health infrastructure second to none," said HHS spokesman Bill Pierce. "Local health departments are critical to this." Lean times drain resources The reasons public health departments are still taking a financial hit are varied, although most are linked to the bleak economy. Tax revenues are down, and nearly every state is struggling with deficits. During lean times, the public health budget is frequently the first in line for the chopping block, but public health officials say this year is worse than others. They say the promised windfall from the federal government has facilitated many states' decisions to cut their funding. ...\AMNews Oct. 28 2002. Public health funding Feds giveth but the states taketh away... AmerlO/21/02 AMNews: Oct. 28,200...: Feds giveth but the states taketh away... American Medical New Page 3 of 4 A weak economy is draining state public health budgets. In addition to budget cuts, an increased demand for services is taking a toll on health departments. The weak economy has created a greater need for services as people lose health insurance along with their jobs. "We've done some really good things with the money for bioterrorism preparedness. We've updated our public health lab and bought vaccines," said John Wallace, director of intergovernmental relations at the Los Angeles County Dept. of Health Services. "But at the same time, we have an overwhelming number of uninsured who need to access our syst()m on a daily basis, and there's just no funding stream to support indigent care in this country." The L.A. County health department is looking at an $800 million deficit over the next three years and has an annual budget of $3 billion. It received more than $28 million for bioterrorism response. Public health officials also say the money granted for bioterrorism does not quite cover what they are expected to do with it, and this is creating another strain on the system. "We have bioterrorism activities an the time, but I'm contributing several times more in staff time than I'm getting in return," said Leland Lewis, executive director ofthe DuPage County Health Dept. "At my level, I'm not seeing a lot of money. I do see some, but I would've hoped that there would have been more." His department received $300,000 for bioterrorism response from the federal government. He blames his department's struggles on rising costs and a $38 million budget that hasn't increased in years. Despite tough times, officials say they'll cope. They're raising fees and trying to squeeze a little bit more out of what they've got. Public health has traditionally been underfunded, and they're used to working this way. But they warn that the system will not be able to respond to bioterrorism if this continues. "I try to run a pretty lean group here, because I want the taxpayer to feel comfortable that every dollar they're sending us is being used wisely," Lewis said. "We'll get through this. The economy will turn around, and some of the funding we've lost will be restored. But it's a strange time to be cutting funding .,. when we're asked to do so much more." And public health officials say this is not what they expected to happen after Sept. 11, 2001, and the ensuing anthrax attacks. "It would have been nice to have the bioterrorism money to enhance the ...\AMNews Oct. 28 2002. Public health funding Feds giveth but the states taketh away... AmerlO/21/02 AMNews: Oct. 28, 200...: Feds giveth but the states taketh away... American Medical New Page 4 of 4 services that we used to have," Dr. LeBailly said. "At this point, I feel like we've been hurt more. I certainly wasn't expecting to have a weaker public health infrastructure than we had before 9/11." ~~~~"t~!~p. ..- ..~. .._~ -.-. _._....~, ~··_w·_~·...~·m·~~_' .,_~.. ADDITIONAL INFORMATION: Federal funding snapshot Amounts that some states and cities have received from the Health and Human Services Dept. for bioterrorism preparedness in 2002: California: $70,779,150 Texas: $59,749,890 New York state: $33,917,260 Michigan: $31,225,867 Illinois: $30,140,755 Los Angeles: $28,250,343 New York City: $26,181,040 Arizona: $18,659,807 Colorado: $16,492,100 Chicago: $12,819,246 Delaware: $7,298,076 Wyoming: $6,540,590 Source: Dept. of Health and Human Services ,ªI!':~!<:...!~...!<?P..~....... """'."".'""""",,,,,,,,..........,..."',,...,,"',,, "..,......"""""".".".......".........,,,...........,........ ...................................................................................................... WebUnk HHS announcement ofbioterrorism preparedness grants to states (http://www.hhs,gov/news/press/2002pres/20020 131 b.html) NACCHO, the National Assn. of County and City Health Officiàls (http://www .naccho .org/) Back to top. ~,~ -------.--. _________..._...__._..._.~.'m~...."..,....~.....,.~,...m..............._...._.__.__.._._.._m______..______ Copyright 2002 American Medical AssocIation, All rights reserved, ...\AMNews OCt. 28 2002. Public health funding Feds giveth but the states taketh away... AmerlO/21/02 4 Nations Thought To Possess Smallpox Iraq, N. Korea Named, Two Officials Say By Barton Gelhnan Washington Post Staff Writer Tuesday, November 5, 2002; Page AOl A Bush administration intelligence review has concluded that four nations -- including Iraq and North Korea -- possess covert stocks ofthe smallpox pathogen, according to two officials who received classified briefings. Records and operations manuals captured this year in Afghanistan and elsewhere, they said, also disclosed that Osama bin Laden devoted money and personnel to pursue smallpox, among otherbiological weapons. These assessments, though unrelated, have helped drive the U.S. government to the brink of a mass vaccination campaign that would be among the costliest steps, financially and politically, in a year-long effort to safeguard the U.S. homeland. Public health authorities in and out of government project that the vaccine itself, widely administered, could kill more Americans -- 300 is a common estimate, and some are higher -- than any terrorist attack save that of Sept. 11, 2001. It has been left to President Bush to resolve a deadlock among his advisers. Vice President Cheney is said by participants in the debate to be pressing for rapid, universal inoculation, while Health and Human Services Secretary Tommy G. Thompson prefers a voluntary program that would wait at least two years for an improved vaccine. In public, the White House has described its smallpox concerns in only hypothetical terms, and until now the gravity of its assessment has not been known. Bush administration officials did not share their evidence with a panel of outside scientists established to advise them on smallpox. Some officials said the reticence results from unwillingness to compromise intelligence sources. Others cited fear of provoking public demands for action the government is not yet prepared to take. Washington's anxiety about smallpox, and limited intelligence-sharing with friendly governments, have prompted urgent requests trom allies in the Middle East -- including Jordan and Kuwait -- for assistance in obtaining vaccine before the outbreak of war with Iraq. The National Security Council's Deputies Committee, a panel of officials just below Cabinet rank, met last Tuesday to weigh the allies' requests. Smallpox, which spreads by respiration and kills roughly one in three of those infected, took hundreds of millions of lives during a recorded history dating to Pharaonic Egypt. The last case was in 1978, and the disease was declared eradicated on May 8, 1980. All but two countries reported by Dec. 9, 1983, that they no longer possessed the virus, but the World Health Organization had no means to verify those reports. Seed cultures are now held officially in only two heavily guarded laboratories, one in Atlanta and the other in Koltsovo, Siberia. The United States renounced germ warfare in 1969 and has undertaken no known offensive program since. An authoritative official said there is "no reason" to believe bin Laden succeeded in obtaining the smallpox pathogen. Bin Laden's efforts are significant chiefly because US. policymakers believe he would use it. "AI Qaeda is interested in acquiring biological weapons, to include smallpox," according to a classified intelligence summary prepared for senior officials debating options on the scope of a preventive vaccination campaign. Officials who read the homeland security briefing said bin Laden's organization spent money on the effort, but gave higher priority to other biological and chemical agents. The "top five list" for al Qaeda, one official said, included anthrax, the nerve agent ricin, and botulinum toxin. The U.S. government has known since the early 1990s about Soviet-era smallpox weapons, and collected circumstantial evidence of programs elsewhere. But substantial new reporting has circulated in recent months. "This is not an issue where once every two years we put out an intelligence estimate," one official said. "There's an ongoing requirement to assess the threat. I see reports on this every other week." The CIA now assesses that four nations n Iraq, North Korea, Russia and, to the surprise of some specialists, France -- have undeclared samples ofthe smallpox virus. The agency's Weapons Intelligence, Nonproliferation and Arms Control Center (WINP AC) described a sliding scale of confidence in those assessments in a briefing prepared last spring. The briefing circulated among senior homeland security, public health and national security officials. Though the quality of its information varied from "very high" to "medium," one official said the report covered only nations for which "we have good evidence." WINP AC placed Russia in the top category, saying that contrary to diplomatic assurances, Russia retains covert stocks of the virus. The Soviet Union produced smallpox by the ton -- a laborious endeavor, since the standard method is to grow cultures in the lining of chicken eggs. Ken Alibek, who was second in command of "black biology" at Biopreparat before he defected in 1992, said in an interview that he supervised production ofthe virus in liquid form, suitable for delivery on intercontinental missiles. US. officials said they generally accept his account. Iraq and France are assessed to have smallpox with high, but not very high, confidence. US. officials said the French program is believed to be defensive in nature, and some of them expressed consternation that its inclusion in the WINP AC report was disclosed to a reporter. It could not be learned whether the Bush administration has objected to, or sought information about, the French program. France is one of five members of the UN. Security Council with a veto, and it is the linchpin of US. diplomatic efforts to establish a legal basis for war with Iraq. Jacques Drucker, who stepped down recently as director of France's National Public Health Surveillance Center, said his country favors research with live smallpox that is forbidden under present conventions. France recently opened one of the world's only Biological Containment Level 4 facilities. Drucker said the Jean Merieux Laboratory in Lyon works with viruses that "could be used for bioterrorist purposes," and mentioned hemorrhagic fevers such as ebola, Marburg and lassa. The lab is "equipped for smallpox," he said, but "I would suspect that if there was variola virus left in France it would be on the military laboratory research facilities." Some of the evidence on Iraq emerged from unpublished discoveries ofthe U.N. Special Commission (UNSCOM), which searched for prohibited weapons after the Persian Gulf War. In 1995, David Kelly, a British inspector, led a team to the maintenance shop of the State Establishment for Medical Appliances on the edge of Baghdad. There he found a freeze drier labeled "smallpox." Two years later, on Oct. 7, 1997; inspector Diane Seaman seized a document on the grounds ofthe Al Rasheed Military Hospital describing vaccines currently in use for Iraqi troops. Third on the list was smallpox. Confronted with other evidence on pox research, Iraq's chiefbioweaponeer, Hazem Ali, told UNSCOM inspectors that he had considered camelpox as a weapon because Iraqis, unlike Americans, spent enough time near camels to be immune. Richard Spertzel, UNSCOM's chief biological inspector, said that explanation was laughable. "Only one person ever died of camelpox," Spertzel said in an interview. Ali was "much too good a scientist to believe the story." On Jan. 14, 1991, the Defense Intelligence Agency said an Iraqi agent described, in medically accurate terms, military smallpox casualties he said he saw in 1985 or 1986. Two weeks later, the Armed Forces Medical Intelligence Center reported that eight of 69 Iraqi prisoners of war whose blood was tested showed current immunity to smallpox, which had not occurred naturally in Iraq for 20 years. The same prisoners had been inoculated for anthrax, a well-established Iraqi bioweapon. More recently, according to the WINP AC report, a fonner Soviet scientist told U.S. officials that his country "transferred [smallpox] technology in the early 1990s to Iraq." Northern Iraq suffered one of the last known smallpox epidemics in 1971-72. The WINP AC report assessed that Iraq "retained samples from the 1971 outbreak." The last country onWINP AC's list is North Korea, which the authors wrote "has a longstanding and active biological weapons program." Though assessing that Pyongyang has the smallpox pathogen, WINP AC said its evidence was of "medium" quality. On March 5, 1993, the Russian Foreign Intelligence Service reported that "North Korea is performing applied military-biological research" with "pathogens for malignant anthrax, cholera, bubonic plague and smallpox." Gordon Oehler, then head of WINP AC, told Congress that the Russian report was "not a bad summary." Much more recently, sources said, the United States has obtained reports of ongoing pox research and manufacture of vaccme. "I've spent a lot oftime trying to understand the biological weapons threat," one policymaker said in an interview, "and I have concluded on a very personal basis that there is a small chance that we will have definitive evidence, smoking gun evidence, for countries like North Korea, very closed societies." Confidence about the smallpox evidence varies somewhat among the 14 U.S. intelligence agencies and departments. "The assessment is, they have it," said one official, speaking as he held his own office's written summaries of evidence on North Korea and Iraq. "We don't say 70 percent certainty. We assess that they have it." Officials who agreed that the evidence is not decisive said few differences exist in the ultimate judgment of national security and homeland defense officials. One person who has access to the compartmented intelligence on smallpox offered to "bet my next year's salary" that the four countries named in WINP AC's report have live seed cultures. Bush administration officials with central roles in smallpox policy said the government- commissioned Advisory Committee on Immunization Practices was unequipped for its ostensible role of balancing the risks of vaccination against the risks of a smallpox attack. The committee recommended against a broad vaccination campaign, but many members said they would change their views if they knew a rogue nation possessed the virus. "They give the scientific assessment of what the risks of vaccination are," a senior administration official said. "They do not have the same amount of information that is circulated around this issue here." Those who disclosed the intelligence assessments described above, speaking on condition of anonymity, were not authorized by the White House to do so. Those assigned to speak for the administration's views, who also declined to be identified, would not discuss intelligence reports. They hewed to their public position, as one ofthem put it, that "there is a concern with regard to North Korea and Iraq that they may have smallpox." u.s. allies' smallpox fears come in part ITom U.S. reports and -- especially in Jordan-- from independent intelligence on the Iraqi threat. In an interview, Kuwaiti ambassador Salem Abdullah Jaber Sabah acknowledged that his government asked for vaccine last summer "in readiness for any eventuality." Two U.S. officials called the requests unlikely to be granted. The scarcity of vaccine, and likely repercussions in domestic and coalition politics, permit Bush to do no more, they said, than offer assurances of help if Iraq's neighbors suffer an outbreak. Cheney, who conrronted biological threats as defense secretary years ago, was energized about smallpox by a videotape and briefing shortly after Sept. 11, 2001. In a war game called Dark Winter, former senator Sam Nunn played a president who failed to contain a fictional smallpox outbreak that began in Oklahoma City. It spread in less than two weeks to 25 states and 15 countries overseas, inflicting "massive civilian casualties." "It's a dramatic briefing," Cheney's chief of staff, I. Lewis Libby, recalled, "but we were well on this road already." Libby said Cheney favors "a forward-leaning position on protecting Americans from this threat," but declined to describe his advice to the president. At Health and Human Services, officials said, Thompson has been influenced by doubts at the Centers for Disease Control and Prevention. "If you look at the vice president's office, they're thinking strategic, not public health," said one debate participant. He cited the swine flu debacle of 1976, when President Gerald Ford had to abandon plans for universal inoculation after people starting dying of the vaccine and others developed Guillain-Barre syndrome, a rare and occasionally fatal paralysis. "If something bad happens, the public is not going to be blaming Dick Cheney, they're going to be blaming Tommy Thompson. And the fact is they're going to be blaming the president. That's why the political people are weighing in, and that's why the decision is still sitting on his desk. " Staff researcher Lucy Shackelford contributed to this report. © 2002 The Washington Post Company n~_,~ 1 _.£':o ~.;; ~~^~~ Hu_L_ L_uu_~_._u m_~_L~~_ .......... .""",,"1"_ .,.&:OI!'I..... 4- U.S"~M_1Jj QM Human Bsna1at8 Agel1ts I!i:Tbl;~ª~5 I'Bioloqical (Listing} I'~,p@ I'SmallDox Basics I'In-Depth Info & Resources I'Diagnosis/ f.'&l\ß!.ti9n I'Exposure Manaqement I'lm~ I'Infection CQntrQl I'Lab Testinq I'PreDaration & ~ I'Reference Materials I'surveillanc~& Investiqation I'Iraininq I'Vaccination I'Chemical (Listinq) I'Radiologis&l Emergencies I'PreDaration & Planninq I'Emergency Response I'Lab Information I'surveillance I'News & Media Relations I'Training I'Resources/Links I'Lab & Health Professionals 1'E8Q I'Páqina PrinciDal de Terrorismo Biolóqico Public Inquiries English (888) 246· 2675 Español (888) 246- 2857 TTY (866) 874-2646 Mon-Fri 8am-llpm EST Sat-Sun lOam-8pm EST Centers for Disease Control and Prevention Health Topics A·l . . '. :" ." . n-:: 'líf .' .. .,' I .' & Response Home ¡ Search I Cont"d U.. SmallDox Home> In-Depth Information & Resources> Vaccination> Summary of October 2002 ACIP Smallpox Vaccination Recommendations (Updated October 21, 2002) CDC asked the ACIP to provide guidance on eight smallpox vaccination implementation issues Now joint ACIP-HICPAC recommendations will be forwarded to COC and DHHS for review and consideration Note: see also the June 2002 Draft Suoolemental Recommendations of the ACIP on the Use of Smalloox (Vaccinia) Vaccine On this page: · Ba~lçgJound · Qpportunity to Establish Smilllpox Health Care Teams . ACIP Recomm.eÐdations: Summary of the Eight Issues 1. Sm a1lQQx.J::I..~.ª.!th"..ǪI-e~ea ms 2. Smallpox Vaccination Site Care 3. .e.dministrative Leave for Vaccinated Health Care Workers 4. 1?_Ç[~.I:;tQj.D..g.JQr Atopic Dermatitis as a ContraindicatlQ!'LfQL..Vªçç.inª!19JJ 5. Screeninq fQX Pregnancv as a Contraindication for Vaccination 6. .2creeninq for HIV Infection as a Contraindication fOI- Vaccination 7 .$J.m.l:!.J.t.ª"Q~Q!J$ Administration of SJ!JÉ.tUQ-º2'-.Yªk.çlD..S!_."wjt.h._.Qlh§.!:....Vª.ç_çiDJª~ 8. Vaccinatiq[1_gf Smallpox Vaccinators Background In June 2001, the Advisory Committee on Immunization Practices (ACIP) made recommendations for the use of smallpox (vaccinia) vaccine to protect persons who work with orthopoxviruses, to prepare for a possible bioterrorism attack, and to respond to an attack involving smallpox. This recommendation was followed in June 2002 with draft supplemental recommendations that extended the ACIP's smallpox vaccination recommendation to include people designated to respond or care for a suspected or confirmed case of smallpox. Specifically, the ACIP recommended voluntary vaccination of people serving on what subsequently have been designated as 1. "Smallpox Public Health Response Teams" and 2. "Smallpox Health Care Teams" The IY.Il.e 2002 draft supplemental smallpox vaccine recommendations also clarified and expanded the primary strategy for control and containment of smallpox in the event of an outbreak. In September, the Centers for Disease Control and Prevention (CDC) asked the ACIP to provide additional guidance on eight smallpox vaccination implementation issues, including the scope and composition of the Smallpox Health Care Teams. The eight issues were: 1. tvpes of healthcare workers that should be included in Smallpox Health Care Teams; 2. care "ºf...t.b.~.2....lJIallpQx vaccination site.; 3. D~~d for administrative leave for vaccînflted_l1ealthcare workers; 4. screenlo..ql.Q..L-ªJopic dermatitis as a contraindication for vaccination; 5. ~çl.§§.D.L1J.9 for Qreqnancv as a CO.D..t.m"tr.Hti.giJtQ!J._.f9J:._~_IJl.C;1JJ.Qº~...Y..ªç.çj.I!ªJ!.Qn; 6. screeninq for HIV infection as a contraindication for smallpox vaccination; 7. simultaneous administration of smallpox vaccines with other vaccines; and 160öcÏiffõñ Rd.w I "..----8.---y_~EçTn-âf¡~ìi· òf;~~líQQX~yªç¿Li}ªtors~--:---L: -". n - -- _mn --- _LL: ---- ". L .LL.J ,,- Atlanta, GA 30333 USA (404) 639-3311 lfÍRSTC'JOV ~"",e"'''''ILL_ n~__ """ _.c~ The ACIP's recommendations reflect consultation with CDC's Hospital Infection Control Practices Advisory Committee (HICPAC) and DHHS's National Vaccine Advisory Committee (NVAC). The ACIP recommendations are being forwarded to HICPAC for their review and consideration on October 22 and 23, 2002. The Healthcare Infection Control Practices Advisory Committee provides advice and guidance to CDC and DHHS regarding infection control practices and strategies for surveillance, prevention, and control of health care- associated infections (e.g., nosocomial infections), antimicrobial resistance and related events in settings where healthcare is provided (e.g., hospitals, long-term care facilities, and home health agencies). In the coming weeks, the joint ACIP-HICPAC recommendations will be forwarded to CDCand DHHS for their review and consideration. Opportunity to Establish Smallpox Health Care Teams The June 2002 Draft Supplemental Smallpox Recommendations recommended that states should designate initial smallpox isolation care facilities (type C facilities) and these facilities, in turn, should pre-designate individuals who would care for smallpox patients for vaccination. However, further discussions with state health officials and hospital administrators identified problems with this approach. It was problematic to designate type C hospitals since suspected smallpox patients are likely to present at the hospitals and health care facilities which are their usual source of care, and not only at designated hospitals. Therefore, health and bio-terrorism officials indicated it was preferable to offer all acute care hospitals the opportunity to establish Smallpox Health Care Teams. ACIP Recommendations: Summary of the Eight Issues (October 17, 2002) 1. Smallpox Health Care Teams The ACIP recommends that in the first stages of a pre-event smallpox vaccination program, each acute care hospital identify a group of healthcare workers who would be vaccinated and trained to provide in-room medical care for the first few smallpox patients requiring hospital admission and to evaluate and manage patients who present to the Emergency Department with suspected smallpox. For the first 7-10 days after patients with smallpox have been identified, this team would be hospital-based and provide care 24 hours a day, using 8-12 hour shifts. Non-essential workers would be restricted from entering into the rooms of patients with smallpox. The ACIP recommends that Smallpox Health Care Teams include: 1. Emergency Room Staff, including both physicians and nurses 2. Intensive Care Unit staff, including physicians, nurses, and in hospitals that care for infants and children, this encompass pediatricians, pediatric intensivists, and pediatric emergency room physicians and nurses 3. General Medical Unit staff, including physicians, internists, pediatricians, obstetricians, and family physicians in institutions where these individuals are the essential providers of primary medical care 4. Medical house staff (i.e., selected medical, pediatric, obstetric, and family physicians) 5. Medical subspecialists, including infectious disease specialists [this may also involve the creation of Regional teams of subspecialists (e.g., local medical consultants with smallpox experience, dermatologists, ophthalmologists, pathologists, surgeons, anesthesiologists in facilities where intensivists are not trained in anesthesia) to deliver consultative services 6. Infection control professionals (ICPs) 7. Respiratory therapists 8. Radiology technicians 9. Security personnel 10. Housekeeping staff (e.g., those staff involved in maintaining the health care _ pnvirnnmpnt ¡:¡nri rip('TPrlc;inn thp ric;k of fomjtp trrlnc;mic;c;Îon '- r"IT'¥r'1 C1___ ~ 11__ _ __ I ~~_n'_ rn ~ ._........ .(".(""\......""....1..--....., ..,....,D()O .A .,'"::~,:T"O~_,.".....J1 v> .-_- .'L-....... _:.u.......J.; _...........:I"...,.. ~ "_o',,"'t"'-E.-.tJ-.J-; rn _ /T T~_ ..J ~ "'- ~...J f""\ _ T\ _ ~ ~ ...." ~.c ~ Overall, each Smallpox Health Care Team might include about 15 emergency room doctors and nurses, 15 intensive care unit doctors and nurses, and a total of 10-15 personnel from the other areas. It is anticipated that the size and composition of a smallpox meQical care team will vary according to the individual institutions and their patient populations. Each hospital should have enough teams to ensure continuity of care. Smallpox vaccination would be voluntary. Clinical laboratory workers are not included in the initial phase of pre-event smallpox vaccination because the quantity of virus likely to be in clinical specimens of blood and body fluids is low. Consistent adherence to standard precautions and ASM/CDC protocols will prevent exposure to virus in clinical specimens. Although it is not recommended that emergency medical technicians (EMTs), as a group, be vaccinated in this first phase, individual hospitals may identify and include hospital-based EMTs (i.e., personnel who would be dispatched to transport patients with suspected smallpox) on their Smallpox Health Care Teams. 2. Smallpox Vaccination Site Care Following smallpox vaccination, the ACIP recommends that health-care workers involved in direct patient care should keep their vaccination sites covered with gauze or a similar absorbent material in order to absorb exudates that would develop. This dressing should, in turn, be covered with a semi-permeable dressing to provide a barrier to vaccinia virus. Use of a semi-permeable dressing alone could cause 1) maceration of the vaccination site and 2) increased prolonged irritation and itching at the site, thereby increasing touching, scratching and contamination of the hands. Products combining an absorbent base with an overlying semi-permeable layer can be used to cover the vaccination site. The vaccination site should be covered during direct patient care until the scab separates. Vaccinia is generally transmitted by direct person-to-person and close contact (within 6 feet), and infection control precautions should be taken to reduce this likelihood. The most critical measure in preventing inadvertent implantation and contact transmission from the vaccinia vaccination site is thorough hand-hygiene after changing the bandage or after any other contact with the vaccination site. Hospitals should include a site-care component to their smallpox vaccination programs in which designated, vaccinated staff would assess dressings for all vaccinated health-care workers daily (whether involved in direct patient care or in other duties), determine if dressings needed changing, and then change the dressing if indicated. This designated staff would assess the vaccination site for local reactions and for vaccine take. They should also use the opportunity to reinforce messages to vaccinees about the need for meticulous hand-hygiene. Transmission of vaccinia is also a concern in other settings when close personal contact with children or other persons is likely-for example, parenting of infants and young children. In these situations, the vaccination site should be covered with gauze or a similar absorbent material, and a shirt or other clothing should be worn, and careful attention to hand hygiene (hand washing) practiced. 3. Administrative Leave for Vaccinated Health Care Workers With respect to administrative leave for health care workers, the ACIP does not believe that health care workers need to be placed on leave because they received a smallpox vaccination. Administrative leave is not required routinely for newly vaccinated healthcare workers unless they are physically unable to work due to systemic signs and symptoms of illness, extensive skin lesions which cannot be adequately covered, or if they do not adhere to the recommended infection control precautions. It is important to realize that the very close contact required for transmission of vaccinia to household contacts is unlikely to occur in the healthcare setting. However, it is also recommended that vaccination of Smallpox Health Care Team members be phased in, starting with a small number of hospitals. Within a single institution, it would be prudent to designate a small proportion, e.g. 20-30% of the candidate healthcare '__ - ,.. ~ 1- _,.. , . I. _ _ _ _,. _... _. ~ . . .. . _ . _ . r<-r.r< "'--- ~ 1'-- ~h "'uWðrRer~ 'T6rtneìlm'þn~Sè'8r"'vacè'narlðh5-rëratiow 'îh5trrurn::ms'tti -gêfJrf"è1<þe'nèrfCe In 'Ptlst-" ~ £' ~ vaccination management. The ACIP recognizes that the incidence of adverse events following vaccination of previously vaccinated persons is substantially less than in primary vaccinees, and therefore recommends that when feasible, previously vaccinated health care workers be included in this stage 1 vaccination program. It is also advisable to stagger vaccination of healthcare workers within an individual patient care unit by three weeks in order to minimize the number of vaccinated individuals who would be on sick leave concurrently in association with systemic effects of the vaccine, which usually occur at days 8-10 after inoculation. 4. Screening for Atopic Dermatitis as a Contraindication for Vaccination Atopic dermatitis, irrespective of disease severity or activity, is a risk factor for developing eczema vaccinatum following smallpox vaccination in either vaccinees or in their close contacts. The majority of providers do not routinely make the distinction between eczema and atopic dermatitis, particularly when describing chronic exfoliative skin conditions in infants and young children. Due to the increased risk for eczema vaccinatum, smallpox (vaccinia) vaccine should not be administered to persons with a history of eczema or atopic dermatitis, irrespective of disease severity or activity. AdçHtionally, persons with household contacts that have a history of eczema or atopic dermatitis, irrespective of disease severity or activity, are not eligible for smallpox (vaccinia) vaccination because of the increased risk that their household contacts may develop eczema vaccinatum. Persons with other acute, chronic, or exfoliative conditions (e.g., burns, impetigo, varicella zoster, herpes, severe acne, or psoriasis) are at higher risk for inadvertent inoculation and should not be vaccinated until the condition resolves. The literature also reports that persons with Darier's disease can develop eczema vaccinatum and therefore should not be vaccinated. To assist providers in identifying persons that should defer smallpox (vaccinia) vaccination, the ACIP offers the following two screening questions: 1) Have you, or a member of your household ever been diagnosed with eczema or atopic dermatitis-if you answered "yes," you may NOT receive the smallpox (vaccinia) vaccine due to the risk that you or your household contact might develop a severe and potentially life-threatening illness called eczema vaccinatum; and 2) Eczema/atopic dermatitis usually is an itchy red, scaly rash that lasts more than 2 weeks and often comes and goes. If you or a member of your household have ever had a rash like this-you should NOT receive the smallpox (vaccinia) vaccine at this time unless you and a healthcare provider are sure that this rash is not atopic dermatitis or eczema. In cases where the dermatological risk factor or diagnosis is uncertain! some organizations, such as the military or CDC, may elect to develop more precise screening tools. These secondary screening tools should weigh the individual's risk of developing an adverse event with the requirement of occupational readiness through safe smallpox vaccination to ensure national security. s. Screening for Pregnancy as a Contraindication for Vaccination Fetal vaccinia is a very rare, but serious, complication of smallpox vaccination during pregnancy or shortly before conception. Therefore, vaccinia vaccine should not be administered in a pre-event setting to pregnant women or to women who are trying to become pregnant. Before vaccination, women of child-bearing age should be asked if they are pregnant or intend to become pregnant in the next 4 weeks; women who respond positively should not be vaccinated. In addition, the potential risk to the fetus should be explained and women who are vaccinated counseled not to become pregnant during the 4 weeks after vaccination. Routine pregnancy testing of women of child-bearing age is not recommended. To further reduce the risk of inadvertently vaccinating a woman who is pregnant! at the time of pre-screening, women of child-bearing age should be educated about fetal vaccinia, and abstinence or contraception to reduce the risk of pregnancy before or within four weeks after vaccination. Any woman who thinks she could be pregnant or who wants additional assurance that she is not pregnant should perform a urine pregnancy test with a "first morning" void urine on the day scheduled for vaccination. Such tests could be made available at the pre-screening and vaccination sites to avoid cost or access barriers to r'i,"""r'1 C1 u ~11.__~r I ("; t.~~~. _r'r\~..._L_~_""^"1"'\ A/""""1rn C;~u_1L~_u "'T~~_~n,~""':~.~ T\~___________...J_-,-:~__~ ITT_~..:J~-,-~....1 f"\._ - - --res mg. n~~_ ~ _.cr If a pregnant woman is inadvertently vaccinated or if she becomes pregnant within 4 weeks after vaccinia vaccination, she should be counseled regarding the basis of concern for the fetus. However, vaccination during pregnancy should not ordinarily be a reason to terminate pregnancy. To expand understanding of the risk of fetal vaccinia and to document whether adverse pregnancy outcome may be associated with vaccination, a pregnancy registry should be maintained and any adverse outcomes carefully investigated. 6. Screening for HIV Infection as a Contraindication for Vaccination Persons with HIV infection or AIDS are at increased risk of progressive vaccinia (vaccinia necrosum) following vaccinia vaccination. Therefore, vaccinia vaccine should not be administered to persons with HIV infection or AIDS. Before vaccination, potential vaccinees should be educated about the risk of severe vaccinial complications among persons with HIV infection or other immunosuppressive conditions; persons who think they may have one of these conditions should not be vaccinated. The ACIP does not recommend mandatory HIV testing prior to smallpox vaccination, but recommends that HIV testing should be readily available to all persons considering smallpox vaccination. HIV testing is recommended for persons who have any history of a risk factor for HIV infection and who are not sure of their HIV infection status. Because known risk factors cannot be identified for some persons with HIV infection, anyone who is concerned that they could have HIV infection also should be tested. HIV testing should be available in a confidential or, where permitted by law, anonymous setting with results communicated to the potential vaccinee before the planned date of vaccination. Persons with a positive test result should be told not to present to the vaccination site for immunization. Information about local testing options should be provided to all potential vaccinees, including sites where testing is performed at no cost. 7. Simultaneous Administration of Smallpox Vaccine with Other Vaccines Vaccinia vaccine may be administered simultaneously with any inactivated vaccine, such as influenza vaccine, to encourage appropriate receipt of all indicated vaccines, e.g., in populations such as health care workers. With the exception of varicella vaccine, vaccinia vaccine may be administered simultaneously with other live virus vaccines. To avoid confusion in ascertaining which vaccine may have caused post-vaccination skin lesions or other adverse events, and facilitate managing such events, varicella vaccine and vaccinia vaccine should only be administered >4 weeks apart. 8. Vaccination of Smallpox Vaccinators In order to minimize the clinical impact of inadvertent inoculation, should it occur, ACIP recommends that persons who will be handling and administering smallpox vaccine in the proposed pre-event smallpox vaccination program be vaccinated. Vaccination of this group will also contribute to preparedness for smallpox response, should a smallpox release occur, with development of a cadre of vaccinated, experienced vaccinators who could immediately be deployed for outbreak response. Home I Search I Contact Us .... D)P....2f..fj!.w: CDC Home I CDC Search I Health TODics A-Z In general, all information presented in these pages and all items available for download are for public use. However, you may encounter some pages that require a login password and 10. If this is the case, you may assume that information presented and items available for download therein are for your authorized access only and not for redistribution by you unless you are otherwise informed. This page last reviewed November 4, 2002 Privacv Policv I Accessibilitv Considerations for Selecting a Smallpox Vaccination Clinic (5 November 2002) Physical Characteristics: · Adequate space for large crowds, under cover and out of the weather. Space enough to contain long lines inside, and able to accommodate the target population with "room to spare." · Ideally, a facility with separate rooms, or room dividers, to accommodate various clinic functions (Reception/greeting, triage/assessment, education, registration, vaccination, post vaccination, administration, and medic~l emergencies). · Heat and air conditioning to maintain temperatures at controlled room temperatures, which is defined as 68-77 degrees F (20 to 25 degrees C), with brief deviations between 59-86 degrees F (15 to 30 degrees C). · Cold storage (refrigerator) for vaccines at appropriate temperatures. · Adequate restrooms (fixed or portable), water, and electricity. · Readily accessible copier, telephone, and fax. · A loading and storage area for large amounts of supplies. · Proper sanitation and storage capacity for large amounts ofbiohazardous waste. · Ample parking at or near the site, and accessible to public transportation · Space for landing a helicopter (only if possible). · Accommodation available for special needs (e.g. wheelchairs). · Security - a site that is secure or can be made so by law enforcement personnel. Other Considerations: · Multiple small sites vs. a few large sites. · Easy public access · Operating hours · Familiar to the public · Commercial & Public options: .:. Public: · Existing clinics · Schools · Community recreation centers · Firehouses · Annories · Poling places · Colleges and universities · Gymnasiums/fitness centers .:. Commercial: · Existing clinics, hospitals, and phannacies. · Malls · Theaters · Gymnasiums/fitness centers Vaccination Clinic Staffing Table (As of 5 November 2002) Qualification Areas of work 1 2 3 4 5 6 100 200 300 400 500 600 Emergency Manager Incident Commander 1 1 1 1 1 1 Logistic Specialist Logistics Chief/ Logistics Staff 1 I 2 2 3 3 Human Resources, Human Resource Coordinator 1 I 1 I 1 1 Personnel Manager/Officer Medical Records Coordinator, Database Coordinator, Clinic Flow Admin/CSR Specialist Lead Monitor, Greeters, Special 17 29 41 53 65 77 Needs Leader, Education Function Leader, Registration Function Leader, Registrars DSHS Certified Interpreter Special Needs Interpreters ® * * * * * * Data Entry Specialist Data Entry Staff 2 3 4 5 6 7 Infonnation Tech IT / Comm. Support 1 1 2 2 3 3 ..,ttMcensed···Medicål Operations Chief, Triage Funcnón 3 3 3 3 3 3 PrQ{i$siQPld .. Leader.. Vaccinatiol} FuncnonLeädc;:r .. Sick Assessment, Medical MD, DO, ARNP,PA Counse lor, PostVacc ination .... 4* 8* 12* 16* 20* 24* · Educator ® ...... . ..... .. Health Screener<D, Eclllcator, ....... ...... .. ........ ....... ... ..... .... · Nurses (RN ,LPN) QtiestÎc)llDesk EducatQr, Po st 8* 16* 24* ·..32* 40* 48* VaccinationEducator® ... Lice11sedto administer ... .. · VaccinatiOI} Assistants,. Vaccinator 6 12 18 24 3f} 36 vaccine .. .. EMTlParamedic Health Screenerill, Medical Aid 4* 6* 8* 10* 14* 16* Health Educator Post Vaccination Educator® 2* 4* 6* 8* 10* 12* First Aid/CPR certified Sick Assessment Assistant 1 1 1 1 1 1 Qualified Counselor (e.g., clergy, crisis or school Mental Health Staff 2 3 4 5 6 7 counselor) Communicable disease Epidemiologic Contact Staff 1 I 2 2 3 3 Investigator Support Personnel Fonns Collectors, Clinic Flow 6 12 16 20 24 28 Monitors, Law Enforcement Officer Security Chief, Security staff, 6 11 15 20 25 30 Supply Fonns Routers, * See note below that corresponds with note number in "Areas of Work" column. CD Health Screener can be Nurses, EMTs, or Paramedics. ® Special Needs Interpreters requirements will vary with the local demographics. GD Post Vaccination Educators can be MDs, RNs. LPNs, ARNPs, PA' s. or Health Educators Numerical columns refer to the number of vaccination stations and the desired throughput per hour. One vaccination station = one table, one vial of vaccine, two nurses, and one line on each side of the table. TO: Jefferson County Board of Health FROM: Larry Fay Environmental Health Director DATE: November 12, 2002 RE: EH Policy Issues/Agenda Calendar Environmental Health has a number of policy matters that need to be brought forward for Board consideration over the upcoming months. The purpose of this memo is to provide brief background information and begin discussion of priority and agenda planning. The issues following are presented in no particular order. · Civil Penalties - Uniform Enforcement Procedures In August the Board saw a draft of the uniform procedures. At this time David Goldsmith is moving this document forward with the goal of creating a standard procedure for all departments under his authority. Therefore, this probably does not warrant Board of Health attention unless the Board feels the need to establish Health Department specific procedures. · Alternative Water Supplies Às discussed in September, there is a need to make some key decisions regarding use and standards for alternative water supplies. Between our existing policy for rainwater catchments (modeled on the San Juan policies) and consideration for hauling water and desalination there are good starting points. However, use of alternative water supplies have not been broadly approved across the state. Key decisions for the Board are whether to continue to approve alternative water supplies and if so, under what conditions and with what limitations. · Update of Solid Waste Regulations Department of Ecology is poised to finally adopt WAC 173-350, replacing 173- 304, "Minimum Functional Standards for Solid Waste Facilities". DOE adoption necessitates an update of our rule. Key issues include scope and breadth of our rule (we could simply adopt by reference) and whether to create special standards for biomedical wastes. (The state rule is silent of biomedical wastes). We have one year from the date of the DOE regulation to update ours. COMMUNITY HEALTH 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 NATURAL RESOURCES 360/385-9444 DEVELOPMENTAL DISABILITIES 360/385-9400 SUBSTANCE ABUSE & PREVENTION 360/385-9400 · BOB Procedural Rules Dr. Locke and I discussed this very briefly with the Board earlier this year. Essentially, this rule would establish a standard procedure for actions and hearings with the Health Officer and/or Board. This is envisioned as being a fÌamework for administrative procedure for all Environmental Health ordinances and as such is probably a priority. · Methamphetamine Lab Rules While environmental health involvement with clandestine meth labs has been fairly limited we anticipate an increase in lab response and clean up activities over the next couple of years. State regulations establish response requirements and clean up standards. The state rules do not provide for penalties for violating property po stings or failure to clean up contaminated property in a timely manner. · Various Standard Operating Policies Several policies are due for update. By our policies these updates are all reviewed and approved by the Board. These include: o Wet season evaluations o Subdivision procedures (with emphasis on boundary line adjustments) o Environmental health review of building permit applications o Two party wells Key issue: Does the Board want to retain its rule in approving operational policy or should this be left to management and the Health Officer? 615SHERIDAN · PORT TOWNSEND, WA 98368 · FAX360-385-9401 November 14,2002 To: Jefferson County Board of Health From: Tom Locke, MD, MPH, Jefferson County Health Officer Re: The Future of Public Health in Jefferson County: Local Health Jurisdiction Organizational Structure, . The U.S. health care systems has two distinct components - a medical care system (personal health care) and a public health system (population-based health care), Both are in crisis. The imbalance in funding is remarkable - over 96% of health care dollars go into medical care services, approximately 1 % support the public health system. The remainder are used to fund research efforts (primarily involving medical care). The system that finances medical care is predicted to "meltdown" in the next 2-3 years that will affect the economic viability of hospitals, physician practices, and the availability of affordable insurance. No broad-based political consensus exists on what should replace it. Disparities in access to basic medical care services are a significant factor adversely impacting community health status. A progressive breakdown in the health care financing system will likely worsen these disparities. Funding for essential public health services has steadily declined in most areas of the U.S. over the past quarter century. This decline is largely due to competing funding priorities (education and criminal justice) and the belief that a massive investment in high technology medical care would make public health largely unnecessary. In Washington, state support of public health has generally declined while local support has remained stable or even increased. As Washington faces a worsening economic crisis, these gains are likely to be precipitously reversed with health departments experiencing significant layoffs of core staff and discontinuation of key program services in the next 2 years. In the post-9/11 era, Congress and the public have discovered the lack of preparedness of the nation's weakened public health system to deal with an expanding range ofthreats. While new federal funding has been appropriated to encourage intensive bioterrorism preparedness planning, its system-wide effects will likely be offset by state and local funding cuts. As with the medical care financing system, the public health funding system has failed to assure an adequate basic level of public health protection. Failures of public health systems have greater potential impacts on community health status than the breakdown of medical care systems. Washington State has a highly decentralized public health system - most ofthe responsibility and expertise in public health protection resides at the local health jurisdiction level. Most rural counties in this state have health departments within local government. A few have banded together into multi-county districts (NE Tri Counties, COMMUNITY HEALTH 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 NATURAL RESOURCES 360/385~9444 DEVELOPMENTAL DISABILITIES 360/385-9400 SUBSTANCE ABUSE & PREVENTION 360/385-9400 Chelan-Douglas, Benton-Franklin) Others have been organized as single county health districts (Yakima, Spokane, Snohomish, Kitsap) or City-County health districts (Seattle- King, Tacoma-Pierce). All are facing financial crises. After 4 years of deep cuts in state budgets (which largely spared public health programs), the Washington State legislature is poised to cut an additional $2,6 billion from the biennial budget. Few are expecting public health funding to be spared in the next round of cuts. Coupled with major cuts in DSHS program funding, these recession-driven budget reductions could virtually shut down county health departments in many areas of the state. Many public health experts believe the future of public health lies in community-based partnerships, regional cooperative efforts, and a dedicated statewide funding source. Intensive efforts are underway in each of these areas. A fundamental question for local public health policy makers is which local health jurisdiction organizational structure is best prepared to navigate the impending crisis in public health funding - the county health department model or the single/multi-county health district model. As summarized in the attached table, the county health department model is the "default" configuration under Washington state law. Jefferson County has already deviated from this model by exercising its option to expand the membership of the local Board of Health. Formation of a Health District would be an additional exercise in county legislative authority and would allow additional customization of the governance, accountability, liability, and internal processes of the local health jurisdiction. Whether this is a change that would help assure that public health has a future in Jefferson County is a policy decision worthy of considerable thought and discussion. 1/ County Health County Health Cost/Benefit Department District Legal Basis Established by RCW Established by County Greater local Legislative Authority control of public health governance model Revenue Source Federal, State, County Federal, State, County, Additional (+ user fees) City (+ user fees) funding from City BOH/BOCC Roles BOCC-budget, fees BOH - budget, fees, Simplified employee performance policy, employee Governance BOR-policy, rules, performance, rules, appeals, fees appeals Legal Responsibility County District Reduced County Liability Budget Process County Budget by BOH adopts budget, Transfer of BOCC, BOH in county/city funding responsibility Advisory Role based on mandates + (Reduced contracts County Workload) Program County oversight of BOH oversight of Consolidated Management Departmental Departmental responsibility Directors, BOH Directors and Health for program Oversight of Health Officer/Delegees management Officer/Delegees Other Services Assigned by BOCC Specific contracts No new costs (Animal Services, within County between County or identified DD, Substance Government State and District Abuse, etc.) Risk Pool W A Counties Risk W A Health Districts Probable Pool Risk Pool additional cost Benefits/Pensions No Change No Change No new costs Public BOCC-Elected BOH-Elected Consolidation Accountability Officials (City/County) + of public BOH-Elected BOCC-appointed accountability (City/County) + members (unless in BOH BOCC-appointed changed in ordinance) members Jefferson County Health and Human Services OCTOBER ~ NOVEMBER 2002 NEWS ARTICLES 1. "Fewer kids get health care", Peninsula Daily News, October II, 2002 2. "Is West Nile virus beading to Peninsula?", Peninsula Daily News, October 13,2002 3. "Licensed child-care worker shortage target ofPT class", Peninsula Daily News, October 15, 2002 4. "Deputies seize meth lab", P.T. LEADER, October 23,2002. 5. "Arms out for flu shot clinics", P.T. LEADER, October 23,2002 6. "Flu shots are still available", P.T. LEADER, October 30,2002 7. "Services expand for mothers, infants", P.T. LEADER, October 30, 2002 8. "PT reservoir levels continue declining", Peninsula Daily News, November 6, 2002 9. AD: ~~There are easier ways to quit", Vigilance, November 2002. Also in Walker Mtn. News, November. 10. AD: "Quit tobacco.", PT. LEADER, November 11,2002 II. "Rain would ease drought conditions", 2 pages, P.T. LEADER, November 6,2002 12. "Vaccine requirements return to normal", P.T. LEADER, November 6,2002 13. "Prevention topic of summit", Peninsula Daily News, November 10,2002 CD Fewer kids get health care Many families kicked off Medicare have yet to sign onto other plans THE AssoCIATED PRESS SEATTLE - When state lawmakers kicked nearly 30,000 immigrants off Medicaid to save money, they promised that those families could join a state-subsidized health insur- ance plan called Basic Health. But so far only 39 percent of those affected, mostly children, have enrolled in Basic Health. An'other39 percent haven't even started the enrollment process. Sixteen percent are still struggling through appli- cations, and 6 percent were able to stay on Medicaid. That means about 15,000 immigrant children have lost their health insurance, accord- ing to the Seattle-based Chil- dren's Alliance, which evalu- ated th'é effects of the health care shuffle in a report released,Thursday. Those who have signed up for the Basic Health Plan will pay more for fewer benefits. 1>DJ· 10-11-02.. "Our budget is" low, . but when it comes to our children we have to do whatever we have to do to pull them through," a woman named Veronica said through a translator. Affording premiums She asked that her family~s last name be withheld because they are illegal immigrants. Veronica"artd her husband Fer- nando sigried up for the Basic Health Plan, with help from the staff at Children's Hospital in Seattle, but worry they won't be able to afford the premiums and copayments. Their l3-year- old daughter needs braces, which Basic Health won't cover, and their 8-year-old son suffers from mysterious seizures. When he found out his chil- dren were losing Medicaid, Fernando said he felt "very sad and powerless." Basic Health spokesman Dave Wasser said the 39 per- cent signup rate - with 16 percent in the pipeline - isn't bad. 'We're pretty pleased' "It's an ongoing process¡" he said. "We're pretty pleased with getting as many as we did on this first round.'! ' The typical premium for one adult and two children runs between $30 and $118 a month, depending on the applicant's income. Miss two premium payments, and you're off the plan and not allowed to - rejoifi for a - year. Basic Health doesn't cover an dental, hearing and vision ser- vices, or some special thera- pies for children. "We're dealing with people who had a better package of benefits they were getting for free," Wasser said. "You can expect there's going to be some hesitancy." The newly uninsured haven't enrolled in Basic Health for a variety of rea- sons. Some, especially migrant farmworkers, may have moved and missed news of the switch. Some have gotten notices in a language they can't read, or haven't realized that they need to act immediateJy. Oth· ers can't afford the sliding- scale premiums and copay- ments that Basic Health charges. "This is a wake-up calJ to state policy-makers who promised health care coverage for these children," said Jon Gould, deputy director of the Children's Alliance. "They should respond in time to pre- vent tragedies for these chil· dren." " ~. œ - :I '" C I- e :. o .. 'OJ) c .- " ca Q) .c fI) :I .. .- > Q) - .- Z .. fI) ~ '" - ~ . <I> ~ - ~ ..2<1>~ ,::~ -iJ Cì.i ..0 ~ 0ij¡ ò. "~t' Þ "'#~ B~a..a ¡s .~ ~ {; . g ~ t' g, :> q¿¡~ ~]~HJ L ~ C,) z [11 '-l æ':: -.[i ~ ~:; ª'~ §] g,:~ 1] ~ ;,:¡¡:t"* g¡j""5!:S~ ~ ~!K ~ ~"s,.C ~~..9! t.~s ~ Z,.C õ 1 >, 8 g,,,,:a a .8BB p-.:Ëi ~.~i·~ § '" ,:: '" .;J ''';> <:> ~.:::¡ a,.C ~.- ~,:: >, I'; 10 !!I 8 u o:s CI) '"' ;: ~ cr; ~.$ 1:1 :.a d'I 0. ..... t.¡....,¡ '" '" 8 .5 z .8 0 ~ ,:: 6 <¡:¡ "', ~ .98 <I> <l>j,:: ~~)~~~·t i~~ -d .sJ -8 :5 ] ª ¿¡ ] ~ ·r '¡¡j] ~ J !i. ~ 0 ~ .5 B ~ ~ j] ~ B ~ Jj .! .~ 1 .::i.'" o:s ~ ~ ~ ~ B ~ ~ ..9! "æ'~ ~.~ ~,.C ~.~~.'~.<1 [ >,'::g<l>.f 1!!1i!'i<l>1:e-¡ ><9..8~'" ~R:Z:~Z<O <I> .... 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U) r=...... -t-JI bD s..:¡ CD q:¡ ... ... gjõ ¿ ;.. g §.9 ~ ë,.C Iê ~ '.;J ,.C 2..0 0 8.'::'1:'. <1>" Q) .q.> Q t:.- "'.... ,:: 15' :;..:.:: "':> (;) ;: 0 s¡"E.... Q)'Q, Q) Q) g '" · 8z <:I:ô -5]-5-5.::i ã OJ ~ OJ ....- ~ (/) ~ (/) OJ .... >-~ xæ OJ 0 C:..c: (/) ...... OJ- ~ a3 u..c: ,:: <I.> !Z :a....J1 ËÆ~ ::! .... '" f~; .. ~ o:s s.t§ ,S....õ Q)- 1¡; -5 C,) - ,:: So! t>¡ ._ ö.9", ","'<:: 2 ~'8 'S: IZ< 13 $ ;az \j - :J o U c:: o '51 OJ 0::: ~ ; ~ oZ Ii r.;¡2; ~f CD Virus: Get ready CONTINUED FROM Al Most of the ~rious . cases have been in people older than 50, Locke said. The virus is untreatable, he said. . At least two people in Wash. ington have been diagnosed with West Nile virus this year. One acquired the infection while visiting Louisiana, the other while visiting Michigan. Next year the Virus is likely to affect the North Olympic PeniIlBula, home to four tyPes of mosquitoes capable of spreading the virus Locke said. ' Birds, especially ravens, crows. jays and magpies, are the main target of the infec- tion. Mosquitoes feed on the 'infected birds and·transfer the ..jnfltction.to. humans. and horses. On the Peninsula and across the state, officials are conducting dead bird counts to monitor the spread of West Nile virus, Locke said. They are also educating people on how to protect them- selves from the Virus. Locke said most prevention tactics are common sense including using insect repel~ lent containing Deet and wear- ing long pants and sleeves in mosquito-infested areas. "People CIU1 really make a difference just around their h.ouse.or property, not creating 8ltuatlons where mosquitoes 'fDJ "People can really make a difference just around their house or property, not . creating situations where mosquitoes can breed." DR. TOM lockE health officer, Clallam and Jefferson counties can breed," Locke said. He advises people to remove all sources of standing water near their homes that can be breeding grounds for mosquitoes. such as old cans and old tires. Cla,Ham and Jefferson coun- ties .have the authority to reduce mosquito populations through spraying or other . .m~thods. "Typically we"' try 'tô'iivóiCi " using insecticides, "..mbocke- said. opting' instead for more environmentally-friendly lar- vacides that kill mosquito lar- vae. Bird hunters should also take precautions when han- dling any . harvested game species, including using rub· ber gloves when cleaning ani- mals. state Department of Fish and Wildlife officials said. The West Nile virus has not been proven to spread from harvested game birds to humans and has not been detected in any state game bird species, Fish and Wildlife officials said. 10 . l3 -0 L CD Licensed child-care worker shortage target of PT class Jefferson system now operating at full capacity BY STUART ELLIOTI' PENINSULA DAILY NEWS ,- PORT TOWNSEND - A shortage of licensed child care providers in Jefferson County is prompting the state Depart· ment of Health and Human Services to hold a workshop for prospective caregivers today. While the county has 320 licensed clùld care slots, the system is continually operating at near capacity, said Susan Langlois, Jefferson County Coordinator for Parent: L1Iie, a child care resource and refétral line. "For a while during the sum· mer, we couldn't find full·time care for one family who had an infant and toddler at the same place in Port Hadlock," Lan· glois said. "You want to have some vacancy in the system." Langlois said the county also has no licensed evening, night or licensed weekend child care providers. "It's particularly hard on low-income working families that are needing that care," she said. As of two weeks ago, there were 23 openings for children in the 320 care slots, Langlois said. But many of the slots aren't ¡O-/~-O;L "real" openings, she said, not- ing they are not full·week slots that a working parent would likely require. There are three licensed cen- ters in Jefferson County. TheFe are also about 25 fam- . ìly homes providing child care in Jefferson CoUtity, including 12 in the Port Townsend ar,ea, three in QUilcene, one in Brin· Vacancy rates non and the rest in the Port Hadlock and Chimacum areas. Langlois, who said there They generally operate at have been similar training sea. capacity, Langlois said. sions in the past but that they "There seems to ?e more of ~ were largely unpublicized, said prefer~nce for family homes, _ she did a study several years she S8Jd. ago that showed King County averaging a 20 percent vacancy rate and Jefferson County with only 4 percent. . "Larger counties have larger vacancy rates,"L811glois said. Parents have alsô faced'diffi. ctÙties recently, LangloÌB said, because the state has replaced local representatives with a statewide call center for child care assistance. About 50 percent of those ÌIl. Jefferson County using licensed child care receive assistance from Social and Health Ser- vices. "It's problematic," Langlois . said. "There is less local. resources. There are people who are eligible, but who are daunted," .by the new proce· dures. "They are falling out of the system, U she said. Workshop slated tOday The ~orkshop for licensed home child care providers will t8.ke'plá:c'e'frÒril 9:30 a.m.' to 4:30 p.m. today at the Jefferson County Housing Authority office, 5210 Kuhn St. Martha Standley, a state Department of Social and Heath Services child care licenser, will present informa. tion on licensing regulations, food programs, applying for state Department of Health and Human Services subsidies, and how to prepare one's home for licensed child care. A family home can have no more than six children, includ· ing no more than two younger than 2. A person running a home care center also has to count their own children in that number. To register, call 360-565·2272. Prospective providers who have questions regarding licensing and home child care can call Parent Line Resource and Referral for Jefferson County at 800·300-1247. The Parent Line number in Clallam County is 360·452·5437. CD Deputies seize "11ieth lab An early morning raid 'lUes- day at a home along Old Gardiner Road led to the seizure of a suspected methamphetamine lab, reported· Jeffêrson CountY . Undei'shcri1f Ken Sukert A search warrant was ex- ecuted about 8 a.m. Oct 21, with thê raid conducted by members òfthe Jefferson County Sheriff's Office, assisted by détectives . with the Olympic Peninsula Nar. cotics Enforcement Team and· a Washington State Patrol State- wide Incident Response Team. The search warrant was based . ;,./ , r:þ" T.lE::A-OGf¿ /0-23-0'2- on infonnation provided byof- ficers working in both Jefferson and Clallam counties, Sukert ' noted. '. 'n1e search resulted in the 'I¡ði- . zure of suspected methamphet- amine; paraphernalia' for using methamphetamine and nwnerous . chemicals, and paraphernalia commonly used in the mannfac- ture of methamphetamine.' A woman living at the pre- nrises, DeriiseJ. Jarrells, 31. was booked into the county jail for possession and manufactúre of controlled substances. . ,. c~~ i / Anns out for· flu shot clinics ./ Flu vaccine clinics will be tak- ing place in a variety oflocations in Jefferson County in the com- ing weeks. People with a high risk for complications if they catch the flu are encouraged to get immunized early. High-risk people who should be immunized in October include: · Anyone 65 or older. · Children and adults with chronic diseases such as heart or lung conditions, asthma, diabe- tes, kidney disease or suppressed immune systems, · Residents of long-tenn care facilities. · Children receiving long~ term aspirin therapy. · Women who will be more than three months pregnant dur- ing the flu season: · Medical providers who,pro- . vide direct care to any of the above persons. · Children under age 9 receiv- ing flu vaccine,£or the first time, Parents or children 6 months through 2 years old are encour- aged to get their children flu shots. Young children who catch the flu are just as likely to need hospitalization as the elderly. November and December are not too late for those who wish to reduce their chance of catch- ing the flu to be vaccinated. Flu vaccine clinics · Dr. Richard Lynn; 1136 Wa- ter St., Port Townsend - Mon- days through Thursdays, 3-5 p.m.; established patients only. . Jefferson General Medical Group, 834 Sheridan St., Port Townsend - Saturday, Oct. 26, 9- 11 :30 a.m. Medicare patients rp;r_ L~A~rZ 10- ~3-o2... please bring your Medicare cards. All others $10. No insur- ance will be billed. . Olympic Primary Care, 10lD Sheridån St., Port Townsend - Saturdays, Nov. 9 and 23, 9 a.m.-noon. Medicare patients please bring your Medi- tare cards. All others $10. No insurance will be billed. · Port Townsend Family Phy- sicians, 934 Sheridan, Port Townsend - Saturdays, Nov. 2 and 16, 9-11 :30 a.m. Medicare patients please bring your Medi- care cards. All 'others $10. No insurance will be billed. · QFC Pharmacy will be hold- ing several clinics throughout the county. Flu shots cost $20. Pneu- monia shots are also available. Medicare and Medicaid clients are asked to bring their Medicare cards or Medicaid coupons. Quilcene Community Center- Thursday, Oct. 24, 10 a.m.-5 p.m, Port Hadlock QFC Store - Friday, Oct. 25, 9 a.m.-5 p.m. Port Ludlow Bay Club - Fri- day, Nov. 8, 9 a.m.-noon. Bay Clinic, Port Hadlock - Friday, Nov. 8,1-5 p.m. · Safeway Pharmacy, 442 Sims Way, Port Townsend - Fri~ day and Saturday, Oct. 25-26, 11 a.m.-5 p.m. while supplies last. Flu shots cost $20; pneumonia shots cost $30. Medicare will be billed. Please bring your Medi- care 'card, . South County Medical Clinic, 294843 Highway 10 I, Quilcene- Mondays through Thursdays, 8~9 a.m. and 5-6 p.m. Please call first, 765-3111. Flu shots $10. Medi- care patients please bring your Medicare cards. ~.~ (G. ) ~~ Flu shots are still available - ..... -..'..'...-.-------------" '. Area clinics are continuing to offer flu shots through Novem- ber for those who wish to de- crease their chance of catching influenza. Those who are at high risk for complications if they get the flu are especially encouraged to get immunized. People considered high-risk include: · Anyone 65 or older. · Children and adults with chronic diseases such as heart or lung conditions, asthma, diabe- tes, kidney disease or suppressed immune systems. · Residents of long-tenn care facilities. · Children receiving long- term aspirin therapy. · Women who will be more than three months pregnant dur- ing the flu season. · Medical providers who pro- vide direct care to any of the above persons. · Children under age 9 re- ceiving flu vaccine for the first time. . Parents of children 6 months througþ.2 years old are urged to get their children flu shots. Young clùldren who catch the flu are just as likely to need hospitalization as the elderly. Flu vaccine clinics · Dr. Richard Lynn, 1136 Water St., Port Townsend - Mondays through Thursdays, 3-5 p.m.; established patients only. · Olympic Primary Care, 10 I 0 Sheridan St., Port Townsend - Saturdays, Nov. 9 and 23, 9 a.m.-noon. Medicare patients please bring your Medi- care cards. All others $10. No insurance will be billed. · Port Townsend Family Physicians, 934 Sheridan, Pon Townsend - Saturdays, Nov. 2 and 16,9-11:30a.m.Medicare patients please bring your L G4-D8Q Alexandria Edouart, LPN, administers a flu Immunization shot Oct. 26 at Port Townsend Safeway. "Drop your shoulder, keep your arm down, and dangle your fingers," she says. And it didn't hurt at aliI Photo by Parrick J. Sullivan Medicare cards. All others $10. No insurance will be billed. · QFC Pharmacy sponsors several clinics throughout the county. Flu shots cost $20. Pneumonia shots are also avail- /0 - :J¿)-() L able. Medicare and Medicaid clients are asked to bring their Medicare cards or Medicaid coupons. Locations: · Port Townsend QFC Store - Monday, Nov. 4, 10 a.m.-S p.m. · Port Ludlow Bay Club - Fri- day, Nov. 8. 9 a.m.-noon · Bay Clinic, Port Hadlock - Friday, Nov. 8,1-5 p.m · Port Townsend QFC Store - Friday, Nov. IS. 10 a.m.-5 p.m ({) Servjc~s"e~pand fO(,J}lºth~r~,:infants Childbirth classêš 'stéirt: Nov.4at 'Jefferson General Enhanced and _expanded ser- vices for pregnant women, families and parents of new babies have been recently implemented through a col- laboration between Jefferson County Health and Human Ser- vices Public Health Nursing Services and Jefferson General Hospital Birth Center, In September, two new ser- vices were started by the hospital's birth center. "Baby Steps" provides an appointment with a labor and delivery nurse to discuss birth plans and re- sources, facilitate preregistration at the hospital, and provide a tour of the birth center, Additionally, a obstetrics nUrse from the birth center is now available 24 hours a day for phone calls to answer questions during pregnancy and after delivery, Newborn home visits to all ne'f mothers and babies is now offered by Public Health Nurs- ing Services, starting Nov, I. Nursing staff will provide infant weight checks, support and infor- mation on services in the com- munity, Other services include breastfeeding consultation and support, and screening for spe- cial needs. Referrals for home visits will come from Jefferson LÐt-OE12-.- /ó -- ';yo- ð?--- General Hospital Birth Center, midwives, health care providers and other delivering hospitals. Families of newborns are wel- come to call for services. Continuing services include prepared childbirth classes, of- iered by the Health Department and relocated to the JGH audito- rium. which meet on Mondays beginning Nov. 4. In addition, both the JOH birth center and the Health Department nursing staff continue to provide breastfeeding education, support and lactation consultants. Over the next year the two health entities will collaborate in creating new classes and services for pregnant women including preparation for breastfeeding classes offered during pregnancy, hypno-birthing classes for ex- pectant parents, weekend child- birth classes and a new parent support group. Current schedule . Prepared Childbirth is a six- week series that meets from 6 to 8 p.m. Mondays at the hospital auditorium. The next series starts Nov. 4, For more information and to sign up call the Health Depart- ment at 385-9400. . Baby Steps: To schedule your individual appointment, caU the hospital's birth center nurse at 385-2200, ext. 3600, · Breastfeeding Tea Party - for all breastfeeding moms and babies, or pregnant women wanting to ,learn about breastfeeding - meets each Wednesday, I :30-3 p.m. at the Health Department, 615 Sheridan in Port Townsend. · Breastfeeding Support and Consultation is available by ap- pointment. Call the Health De- partment at 385-9400 or the birth center at' 385-2200, ext. 3600. Questions are welcome. · Newborn Home Visit: If you are a new mother and haven't received a phone call offering a newborn home visit, or if you have other questions, cal] Carol Hardy or Yuko Umeda at the Health Department, 385-9400. / ,- @~) PT reservoir levels continue declining City turns to lake a£ 40-million-gallon secondary source . .............. BY STuARI' EUJO'IT PENINSULA Dill NEWS PORT TOWNSEND 'Water levels in city reservoirs continued to drop Tuesday, but officials said they are hopeful expected ,rain this week will replenish supplies. Residents are still asked to refrain from using water for outdoor purposes such as watering lawns and washing cars. The city's Lord Lake reser- voir, wlúch has &. capacity of 500 million gallons, has been exhausted, and the city is start- ing to pump water out of a nat- urally existing lake below that reservoir, which contains about 40 million gallons, officials said. The other Port Townsend' reservoir, City Lake, is rela- tively full, with 100 million gal- lons out of a 120 million gallon capacity. Port Townsend Water Oper~ ations Manager Bob '" LaCroix said the city is using about 700,000 gallons daily and the I J -&J -07- Port Townsend Paper Corp. mill is using about 6 million gal- lons per day. Last Friday,. the pulp machine at the mill waS shut down to save water, and mill executives were considering having the paper machine pro- duce p~per from recycled prod- uCts rather then pulp in a more raw form to save water. "We're hoping we don't have . to make the changes," on the paper machine," Mill Manager Bruce McComas said. "With the weather forecasts, the issue probably won't come up again until Monday." j( No predictions It's too early to tell when pulp machine will· be up and running again, McComas said. Forecasters predict a chance of rain every day through next Monday or Tuesday, with heav- ier rain expected late this week. LaCroix said, rain late Mon- day night and Tuesday morn- ing added three-hundredths of an inch to the Big and Little Quilcene rivers, where the " reservoirs get their water. "It helped a little bit," LeCroix said. 'We expect quite a bit over the next few days." ·]L·'!J' .£ -š ~ !t ~ ] .£í ~ =ä ~ ~ .S "'.s Ä ~ È f~ gj, ~ ií a .£í :,ê ~ ¡;¡ ot¡ 0 -ð;a ¡¡ -0 8'¡;¡' ~.:!I ¡f U a 1! !$ '" t'" ..." .........¡" :5 Z ~ '¡; 14 ..-.; '" .Æ 1,J ~ .s 'i.. ~ ~ ;fj -š -0:; ~ £ . . ~ S·:!I c ~ 1- .~fl"ot¡8ia !~.,g-"'I"o~~~f~ ~J~11B~ ..~ rJ ~ ~::¡ z -š >. ~ t; ~ ~ ~ â~ ~ . ~ iä ~ j !if.£ g i:ì - U ~ t3 .Q, .;¡¡ 1:; s. ...; ] 1! .s >. 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Þ'ä ~.g..e,,"~ ¡:¡,s'ã>.~l!Igo·G ~ j-š~ð ~ § ~~~ t9~12i :Q ."õ~"'E--< ~ri ~ ~"õ a- Olj~" ¢> §~È~j~ot¡~~~~.g:j§a.- :g¡ ÇQ .~ c : ~ ] .;; .....¡ ~.M ~ ~ ~.~ ~ go Eg,saªª ~..~~a§~~ , '''~,'' ILl· - .~, ~ I 'I, -51:1 () tI'¡. ;;.-..;:. :ä ~ >. ..... u ~ þ.;--¡ is) !j "3 ~ !:'J ~ 0 .i:J .~ .~ p .¡;:; S S S Š ~ z E) \D~CU t: p;: M ~£;! LO~)~ '«S~'5 ~~ U s:: s:: Is ... ~~ ~ iDi s:: L·- ~ I cucu5~j ~~ CU ~ª :> E ;N O~ u~ . '1"-. '~- ~_...,. q.) --'.'-"-' -".,......- g ..5! æ i '" ~ 'õi .. J ~ .. ... ... ... .. ~ '" - .. .. ] .. ~ "" æ ¡ .. " " IE. :.', :¡. .~. ~ iHUU< · , oise? Monday- Friday 9:00 - 5:00 REOVlRBMEM'S: 1. Must have worked'.around loud noise in w~íijijgton. 2. No statute!óffunitations for retirees. i' ..~ ~';»: "" g? " "." 'YMOUNTAIN VIÊ~ HEARING AID CENTERS":"<t::' ", ,.';"'3) ,.".'-' , 625 No. 5th ,AV~tl43!~~¿,"" Sequlml WA ~83fl2 ;:(:,.... ~ ,~. ,.,.,.; , .............. . "he'right to file -"Claim for your -, Ö~4ß,'7:..0292 "'~8;:f~4481 :. .; ~ - ":: - ,..' '. . .). ~u ',--r..~:W'. l-.~,:. . - ,~~.t",:~.-tr~,·..,~,·,~,1 _ ~~i.. \,_'1.;::-. ...".: ~ ~ '_ \' ¡ ,OM. ~'--J:/,.-.;~t.-'.·~,".,. ~::,~~}I_ ~"" Leader Classifieds 360-385-2900 classifieds@olympus.net The Leader reserves the right to edit copy to ensure tompliance with Fair Housing and Content Standards. The Leader is 'not liable for erTOI'S that are not brought to our attention àfter the first publication of the ad. aassified advertising must be paid for In advance, cash, checks & credit ca~ accepted. No refunds. , \~!î~play Ads Deadline "":,a'p~Friday ClaSSjfj~DiSPlaY Ads $10.70 column inch Call the Expert · Services Directory . . 13 week (minimu~twith no copy changes' 1 colu1~~~t 1 inch ad 13 Wee\<$. $120 . 26l~ $230 · 52 Weeb $400 P~lic Notices per,J1IJrim inch $9.50 t~ewide Classifieds oré tJFili,~1;46O homes in 106 Washington cCl'!lmú!:ijty::i'!ewspapefs, One week, up to 25 word$ $f95,:additional words, $8. each. , Autos . ,,'~,.,'., .. . ' , ; . .' J , ' ' Autos . - ' . . .,' . . . . Autolfmck . Recreational Vehicles . Debt Consolidation . Personal · Boats VICKY GntmEllGal Brr1l'ich Manager Ass;"lant Vice-ProsiMnl , " Personals ..' ' ,.' . , ' FEDERAL FAIR HOUSING ACT tit , ' '0'* ''''', 07N~' '"\1 ,--0 "'iC' ",; . "/,, <~0 "'''\~ '; , "@t!d;;'\%'- ì""' ' I t>~ ~ "D' 'Id, h' -\'t, <:"11 "C /' ',' ~y ;;;1 "\ \ , ,§"qr', " .' rl i "",.'" ' J . _n! - I[),\ 0 I P 1::ì'f) 0, 0 }O 'f {1 bl''é)C~," '.:/' ",,^';U~ "'.1 I&.J U" I W'?" ¡ ^ ~*- ~ ¡t, y~ ":C~, ' .. All real estate advertised· herein is subject to the Federal Fair Hous- ing Act, which makes it illegal to adVertise any prefereilce, limitac tion or discrimination based on race, color, religion, sex, handi- cap, familial status or national on- . gin, or intention to make·any such preferences, limitatioO$ or di$Crim- inatlon. The Leader will not know- ingly açcept any advertising for ra-, aJ estate which is in violation of the law. All persoO$ are hereby inc formed that all dwellings adver- tised are available on an equal opportunity basis within the limits of the act. .. Personals , ' QUIT TOBACCO. It'S,hever to easy to t1uit. For free, persona ized help from people who'~ been there, call 1-877-270-$t( or ,ViSit,qUit,I,ine,.com,th, e wa"shi!i, i, ' ton State Tobacco Quitline. /' WANT TO ND A FRIEND, long term relationship in . Jefferson countY? Then place your ad in "GET CONNECTEP." Prices: one week, $10 up to . words, 22¢ each additior word. AU information will ,be '. confidß tial. Written responses 1.vi1l· I mailed once a week to advert er. No responses will be tak over the telephone. Mail to 2 Adams St, Port Townsend, V 98368. To place ad ( (360)385-2900. Abbreviations that you can us Single- S, Divorced-D, wido~ --W, Male- M, Female-F, Gay' White--W, Black-B, ,Asian- A,,~ panic-H, Disabled Person- I In search of· ISO, Long term lationship-- LTR, Height Wei Proportionate- HWP, Protes nal- P, Non smoking- NS, I drinking- NO, light smoker- light drinl<er- LD, Religious- R Seeking Women 48 HWP P. Artist, L, TR with per love & devotion. Holiday! coming, let's not be 10 GC#5279, c/o The Leader, Adams St., Port Townsend, 98368. Seeking Men WPF, YOUNGER In spirit body, at least most otthe than my 5Öish years foretell the same in a male counte who enjoys the Indoors, a! as out, communicating, lau! dancing, and relaxing in tew and fleeting moments life feels generous, G~' the Leader, 226 Adams St. Townsend, WA 98368. Lost & Found , ' LOSTBNACELET, Monda' 28, gold and diamond br: Reward offered. Call JI (360)895-8342. LOST CAT; small gray t~ with buff undertones, gold answers to Maggie, R (360)385-0994. I nl:;T nOG: "Boots.' Las Rain would ease drought conditions By Philip L Watne5s leader Staff Writer though no sununer watering restrictions were applied this year, consumers are nOw being asked to conserve in any way possible. . Conservation measures at PT Paper have reduced daily water consumption from 12 million gallons to six million gallons. bUI it can 'I go much lower with~ Oul shunfhg down more production ma- chinery. PT Paper has already laid off 20 employees. "If we don't gel rain this week, we would have to shut down further," PT Paper President John Begley said Thes~ day. "Pray for rain." See WATER. Page A 16 With Jefferson Counly water r6Ser~ voirs"l\l historic lows, rain in the weather foreçast for the next few days could save Port Townsend Paper Corp. from hav- ing 10 lay ofr'inore workers. But 100 much rain could do harm in the form of turbidity that could lead to water contamination, according to both health officials and city representatives. City of Port Townsend water custom- .s consume about 700,000 gallons daily, compared 10 a summer daily peak of more than 1.5 million gallons. AI- ../ ,. A 16 . Wednesda , November 6, 2002 Water: Conserve Continued from Page A 1 The city's official watershed precipitation gauge is on Mount Craig, located between the Dosewallips River drainage and the Big Quilcene River. The yearly precipitation aVer~ age is 70 inches; the average for the month of October is 6.5 inchës. During October 2002, the measured amount was a scant seven~tenths of an inch of precipitation. City Water Resources Man- ager Ian Jablonski said the annual precipitation through September was slightly above average, so the reservoir woes can be attrib- uted to a dry October. Now, salmon streams on the Olympic Peninsula are in trouble, and res- ervoirs are low. The city's water system draws most of its water from the Big Quilcene River. Two reservoirs are readily available: Lord's Lake (500 million gal- lons) near Quilcene and City Lake (120 million gallons) near Eaglemount. PT Paper, which maintains tord's Lake and the water sys- tem serving both city and mill, draws water from diversion dams at the Big Quilcene and Little Quilcene rivers. It stopped draw- ing water from those sources last month to preserve river flow for fish. Now, Lord's Lake is in un- charted territory. When full, Lord's Lake maintains a depth of 34 feet above the origin31lake level. As of Nov. I, the reservoir had dropped to within 2 feet, 2 inches of its original level - so low a new measuring stick needed to be added downward. The water is well below the lower of the two intakes, so a submers- ible pump is used. As of Nov. 5, Lord's Lake res- ervoir had been drawn down to the original lake level, leaving an estimated 40 million gallons. This is apparently as low as it's been in the reservoir's 55-year history. PT Paper needs rain IT Paper continues to rtIøke impressive conservation ef- forts. The company has re- duced its daily usage by half, to about six million gallons. Company officials had ex- pected to cut usage to only eight million gallons a day. "We are doing a lot better than we thought we could with conservation measures, and a lot better than we thought his~ tori cally possible," said John i Begley. "The employees have found many ways to reduce our water usage." Last Friday, Nov. 1, they shut down half the pulp mill, one pa- per machine and the utiÍities that support them. "It went well," said Begley. As of this week, PT Paper's management team doesn't plan to limit any other production. Even if production stops, the mill still needs about 800,000 gallons daily to ensure fire protection and steam pressure. Since companies can't in- sure against drought, PT Paper can't recoup any of its finan- ciallosses from this shutdown, Begley confinned. Drinking water Without rain - and soon ~ any sizable draw on City Lake could also affect drinking water qual- ity, city and health department officials said. A few inches of City Lake water were used last week. "We'd like to see the water level in City Lake maintained as full as possible," said Jerrod Davis, regional engineer for the Washington State Department of Health (DOH). City Manager David Timmons met with Davis, mill officials and Jefferson County Environmental Health Director Larry Fay on Oct. 31 to discuss contingency plans for water us- age. The stakes for Port Townsend are high because the city is exempt from treating its drinking water supplies. That could change if the supplies are contaminated twice in one cal- .. \... .,1' ...." ... r.' ,.., I - endái ÿcát. The DOH: coüld · ® Port Townsend & Jefferson County leader Lord's Lake Reservoir, pictured Nov. 1, Is now at its lowest level since the reservoir was bul" In the late 195Os. The raft at left supports a submersible pump to feed the water system, now that the water level Is below the Intake tower. Photos by Patricl< J. Sullivan "If we see elevated turbidity issues, there may be a health ad- visory," Davis said. "For in- stance, a boil-water advisory could be issued, and that's the worst-case scenario." Timmons said resid~~ts need to curtail their use of water for non-drinking needs, such as washing a car. "The issue is relative because of the sheer volume of water used at the mill in comparison to the city,"Timmons said, "but I see it as a good gesture of support for the efforts of the mill to cut back its use. Even though it's not consequential, it's a show of support." Environmental Health Direc- tor Larry Fay said county, state, city and mill officials have vary- ing opinions regarding how much water can be drawn off City Lake before the public's health could be impacted, but they all agree that point shouldn't be reached. "There's a lot of water if you're only running the city," Fay said. "How long you can safely divert water to the mill and still protect the public health is the question. State and local health officials are watch- ing it closely. There are a lot of things being done that look like they would work, but we're asking what are the contingen- ,cies if they don't." (Leader staff writers Janet Huck and Patrick J. Sullivan con- 'trlbi.ltedW thf$ swrv.1 then require Port Townsend to build a water filtration facility at a cost of millions of dollars. , " "Under the state rules, it's proscriptive that if you have repeat violations, you have to install filtration," Timmons said. "That's a very expensive proposition for the city. I ulti- mately see us getting there, but do we do it with a gun to our heads or at a more leisurely pace." Contamination could come in the fonn of bacteria or in, muddy water, both conditions which are exacerbated when reservoirs are drawn down. When the rains do come, the manner in which they pour has a direct effect on reservoir con- ditions. Too much rain can wash dirt. twigs and bacteria into the water, so the low Lord's Lake could be unu§able for drinking water until the material settles out. That's why keeping City Lake at Eagleinoûnt topped up is so crucial to healthy drink- ing water for residents. While residential water usage is mini~ mal in comparison to that of PT Paper, drawing it down would also lead to a situation in which contaminants could produce unhealthy water. If that hap~ pened, thepOH would prob- '··ábly acNiSellìe city to issue a "boil water" alert, telling res i- deiit"S'f¿tbóî1 any water used for cooking or drinking to kill ·-'bacteria. =: '.,~ These two water intakes on the Lord's Lake tower are both left hlg~ . ,_ and dry. A new measurement stick has been added because the old one wasnJ!ow enougþ, Œ/~ Vaccine requirements return to nonnal / The state Department of Health is reinstating minimum immunization requirements for children in school or licensed childcare. . Last August, state health of- ficer Dr. Maxine Hayes granted a statewide extension of the vac- cine requirements in response to a shortage of the diphtheria, teta- nus and pertussis (DTaP) vac- "cine. The extension made it possible for children to enter and attend school, preschool and childcare even if they were not completely immunized. Vaccine supplies in the state are now sufficient to immunize children who had to delay get- ting shots earlier this year. As of Nov. 1, the extension is no longer in effect. Families have 60 days to make sure their children re- ceive any vaccines necessary to bring them up to date with state inununization requirements. The Department of Health expects children to be fully immunized ~hen they return to school after Jan. 1,2003. "Now that the shortage of DTaP is over, it is very impor- tant that parents make sure their children are fully immu- nized," according to Hayes. "Diphtheria, tetanus. and per- tussis can be very serious ill- nesses, but they can be easily prevented with immunization." Vaccination exemptions can be granted, but accordi~g to " state law, children who are not in compliance or in the process of becoming compliant with minimum vaccine require- ments can be excluded from school if an outbreak of illness occurs. To skip the required immu- nizations, a child's parent or guardian can request from the school district an.exemption form. Reasons for exemptions may be medical, religious or personal. No detailed explana- tion is required. "Parents, if they so wish, can sign this exemption form and the children are still eligible for par- ticipation in school," according to a previous report by Dr. Tom Locke,the county's public health officer. "There are consequences for this, however. If an outbreak occurs, all·the exemption chil- dren have to be excluded from school until the outbreak is over." Jefferson County's rate for exemption from immunization has been three times the state average, and the second highest in the state. The DTaP vaccine is admin- istered in a series of five doses between the ages of2 months and 4 to 6 years. A complete series of vaccinations is important to ensure the best protection pos- sible. Parents who don't know if their children are fully immu- nized should check with their child's healthcare provider. /1--(:; - 0 d--. cpr'f: LGADBfC "./"~""",'"U"""" ,// J3 ') l ' / ,.,/l ..," -- Prevention topic of summit 3 Jamestown S'Klallam teens head to Yakima PENINSULA DAlLY NEWS BLYN - Three Jamestown S'Klallam. teenagers partici- pated in this year's three-day Washington State Prevention Summit in Yakima last month along with tribal youth pre- vention specialist Kim Kettel. The Oct. 24 summit focused on preventing violence and alcohol, tobacco and drug abuse by youngsters in the state. Lt. Gov. Brad Owen partici- pated in the summit. Tribal teenagers at the event included Hattie Nowak, Khia Donahue and Lacy Cooper. "1 learned that it is good to teach drug and alcohol preven- tion in communities, because we need to get to kids while they arë young," Nowak said. D9Jlahue, the granddaugh- ter of tribal Elder Elaine Grin- nell, agreed the summit was educational. "1 learned a great deal about rape, and how prevalent it is," she said. "Few rapes are reported, less are further investigated. Even fewer go to court, and a minimal number of those actually result in con- victions. " Cooper, also a Makah tribal member, said the summit tl-(O.-.D2- ~ JMŒSTOWN S'KLALLAM TR!!!E The Washington State Prevention Summit in Yakima gave tribal youth prevention counselor Kim Kettel, from left, and Jamestown S'Klallam members Hattie Nowak, Khia Donahue, second from right and Lacy Cooper, right, the chance to network with people involved in stopping violence and drug, alcohol and tobacco abuse, such as state Lt. Gov. Brad Owen, center. offered youngsters great net~ working opportunities. "1 was able to expand my tobacco prevention contacts and build a larger network of people to work with," she said. "1 am currently serving on the National Youth Board of the American Legacy Tobacco Pre- vention Program in Washing- ton, DC., so building contacts at the state level is important. Kettel said she was proud of local teenagers who att¡:mded the program. "The young ladies I chaper- oned for this trip were such excellent role models and rep- resentatives of the tribe," she said. "We are so fortunate to have such fine young leader- ship and individuals who care deeply about the future of their tribe."