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Home My WebLink About09 September JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, September 20,2001 Board Members: Dan Titterness, Member - County Commissioner District #1 Glen Huntingftrd, Member - CounfY CommÙJÌoner DiJtrid #2 Richard Wqjt:. Member - County Commissioner District #3 Geoffr~y Masci, Member - Port Townsend City Council ]ill Buhler. Chairman - Hospital Commissioner District #2 Sheila Westerman, Vice Chairman - Citizen at Large (City) Roberta Frissell - Citizen at Large (County) Staff Members: Jean Baldwin, Nursing Sen;iæs Director Larry Fqy, Environmental Healtb Diredor Thomas Locke, MD, Health qlficer Chairman Buhler called the meeting to order at 2:30 p.m. All Board and Staff members were present. The agenda was amended to include Old Business item "PUD Saltwater Intrusion Monitoring Program" and New Business item "Access to Baby and Child Dentistry (ABCD)." Member Masci moved to approve the agenda as amended. Commissioner Wojt seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Masci moved to approve the minutes of August 16,2001. Commissioner Wojt seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT Dale Wurtsmith expressed his concern that operations and monitoring inspections by the PUD exclude examination of the septic tank. He asked that a resolution be created requiring that all on-site septic systems have EES inspections prior to any sale of the property. He also believes people should have the right to choose who they want to monitor their alternative system. He agrees with the amendments to the On-Site Sewage Code as proposed. Chairman Buhler welcomed health services consultant Sherry Harry, RN to the meeting. Member Masci said Ms. Harry brings a lot of experience to the community through her work with First Choice Health Systems. HEALTH BOARD MINUTES - September 20,2001 Page: 2 OLD BUSINESS 4th Annual Local Board of Health Leadership Workshop: Chairman Buhler encouraged Board members to consider attending the October 25-26 conference at SeaTac. When asked whether the topic of biological weapons will be on the agenda given the recent terrorist attacks in New York City, Dr. Tom Locke said he believes bio-terrorism will be discussed. Jean Baldwin agreed to forward information and registration materials to the Board. Letter to Senator Maria Cantwell: Chairman Buhler said the letter to Senator Cantwell reviews the issues raised during her July visit with community leaders. Public Utilitv District No.1 Saltwater Intrusion Monitorine: Proe:ram: County Administrator Charles Saddler distributed a copy of the PUD's response to the Joint Resolution between the PUD, Board of Health, and Board of County Commissioners. The resolution, discussed by the Health Board last month, would establish a program to conduct systematic groundwater monitoring to assess whether seawater intrusion may be affecting water quality. While it appears the PUD is interested in monitoring, they are concerned that addressing this issue now may delay the WRIA 17 watershed planning process. In their opinion, the severity of seawater intrusion has not yet been demonstrated. Mr. County Administrator Saddler argued that under State statute, the WRIA planning process provides the only real mechanism for addressing the issue. County Administrator Saddler will address this topic with the Board of County Commissioners, but it is not expected that the they will adopt this resolution or propose a substitute soon. Commissioner Wojt questioned whether the Water Utility Coordinating Committee might be able to put forward a recommendation on the issue? Communicable Disease Update - Pertussis. Chronic Hepatitis Reporting. 2000 .Jefferson County STD Profile: Public Health Nurse Lisa McKenzie said the report included in the agenda packet was sent to local health care providers to update them on the summer pertussis outbreak and other communicable diseases. She noted that 12 of the 14 reported measles cases in Washington State were in King County where the outbreak cost $60,000 - most of which was for 125 rash illness investigations to rule out measles. It was noted that half of the pertussis occurred in a susceptible population. Dr. Locke added that there appears to be widespread under reporting on STDs and that it is difficult to improve the rates of reporting communicable disease. NEW BUSINESS Public Health Law 101 - Rules. Policies. Waivers. and Appeals: Dr. Locke referred to his memo in the agenda packet, which was meant to remind the Board of its many options under rules that have been passed. Rule changes and appeals are intended to be considered only after policies and waivers have been employed. HEALTH BOARD MINUTES - September 20, 2001 Page: 3 Onsite Sewage Code Rule Revision - Action Item: Dr. Locke reviewed the Board's action at the last meeting directing staff to prepare amendments to the Onsite Sewage Code to address O&M specialist qualifications and scope of practice. He noted that in addition to the language provided, Staff proposed the addition of two clauses for consideration, one of which would enable the department to respond to additional, unanticipated technical issues with policy changes rather than through continued amendment to the rule. The other would allow "other experience" to be considered on a case-by-case basis through an expedited waiver process. Staff is still trying to define appropriate qualifications for performing the latter, but he noted that the rule will be implemented primarily by monitoring the performance of O&M specialists. There were requests for clarification of the difference between approval by the "health officer" and approval by the "health division." Dr. Locke said the health officer has the power to waive regulations under the State codes where divisions or departments do not. Also, since the health officer is appointed, they may delegate the responsibility to whomever they choose. Regarding 8.15.150(6)(b), Member Masci asked why, in the absence of a local engineer, would the list of those who may perform an initial inspection not include a certified monitoring specialist or certified installer? He also asked why individuals with advanced degrees are required and why the owner of a conventional system would even need such a technical initial inspection? Commissioner Titterness mentioned Eric Page as a licensed professional engineer who provides the service in the County. Vice Chairman Westerman asked to understand the difference between an initial inspection and an O&M monitoring inspection? Linda Atkins explained that the reason for having a highly trained person perform initial inspections is to achieve a greater level of detail. Because many installers install only certain systems they may have a limited understanding of all components of various systems. She also discussed the different skills and qualifications brought by someone with an advanced degree. In explaining the level of training and licensing, she added that PUD staff can do initial inspections if they are licensed. Dr. Locke then reviewed the Board's options which were to leave the ordinance as adopted and previously amended; adopt the amendments as presented, including the Health Officer language; or adopt the ordinance as originally amended, striking staff's recommended additional language. It is Staff's recommendation that the Board adopt the amendments with the Health Officer language. Commissioner Titterness suggested the Board may choose to adopt the modifications as submitted, but also propose additional changes. Commissioner Titterness moved to adopt the amendments to the On-site Sewage Code as presented editing 6(c) to read "Owners of all onsite sewage systems (conventional, alternative and proprietary systems) may obtain operations and monitoring inspections from a Certified Monitoring Specialist (after meeting manufacturers training requirements) in lieu of the Health Division, Licensed Designer or Licensed Professional Engineer for the following inspection." Member Masci seconded the motion, which carried by unanimous vote. HEALTH BOARD MINUTES - September 20, 2001 Page: 4 Commissioner Huntingford wondered about the eventual need for compliance officers to oversee training compliance. He expressed frustration with what appear to be increasingly complex and possibly unnecessary aspects of the septic code. Linda Atkins explained the registry system which ensures training compliance and how the public can obtain referrals to trained individuals. County Administrator Saddler referred to the WAC 246.272, adopted in 1995, which is the basis for this code. Commissioner Huntingford said his difficulty is not with the intent to protect public health, but with a process so complex and confusing that some people either cannot afford to comply or simply refuse to comply. He questioned whether septic inspections tied to a building permit on an unrelated project was something the public really wanted. He suggested that the code be reviewed annually to see if it can be simplified. Several Board members spoke about the Board's extensive work in drafting the ordinance. While there was some concern that it has been difficult for the Board to track the issues surrounding the code, most felt it is a work in process and that the Board will continue to address issues as they come to their attention. Regarding the concerns expressed by Dale Wurtsmith, Vice Chairman Westerman asked whether it would be necessary for the Board to take action? Linda Atkins explained that staff is currently modifying this process with the PUD. Until September 2000, it was clear on the form that the owner was responsible for having the septic tank inspected. She noted, however, that even on systems where there has been continuous monitoring, there would be no requirement for an inspection at the time of sale. Vice Chairman Westerman expressed interest in receiving more information on what is involved in an initial inspection. Member Masci and Vice Chairman Westerman agreed to meet with Linda Atkins and report back to the Board. There was also Board interest in having Staff present background on the organization of the O&M program at the October meeting. Joint Board Access Project: Dr. Locke reviewed a list that he and Vic Dirksen generated following the Joint Board meetings of possible activities to improve access. Some of these activities were: better coordination of services among providers, ensuring that people in need of services are accurately evaluated for eligibility, looking for ways to increase insurance coverage for uninsured populations, and adding insurance products. They believe a steering group other than the Health Access Summit work group could attend a single meeting to scope out short and medium-range projects that the Washington Health Foundation could fund. He envisions including representatives from the different boards as well as several individuals who would be involved in those projects that are determined to be feasible. Depending on the project, they might be service providers, health department staff or hospital staff. Dr. Locke then referred to the Menu of Critical Health Services adopted by the State, noting that this list reflects minimum standards. He suggested that in order to compare assessment data with this minimal HEALTH BOARD MINUTES - September 20, 2001 Page: 5 set of critical health services and determine where gaps exist, the Board needs to first outline a process for determining how to arrive at a locally-adopted list. Discussion ensued about coordinating a follow-up summit. Several members understood from a previous meeting that the Access Group would be presenting to the Board some solid ideas for discussion at the next summit. It was suggested that the minimum standards would easily fold into the work of the Access Group. Dr. Locke supported reconstituting the Access Work Group if a follow-up summit were to be held. While the original goal of the summit was to discuss innovative ideas for healthcare financing, he doubted the achievability of such a solution and suggested that other potential options might not warrant another summit. He does not believe the Joint Board came to a resolution to pursue a local health authority model. The Health Board may have been interested in a system-wide approach, but the Hospital preferred several discrete projects to improve access. He asked if the Board wants to reach consensus with the Joint Board? Following several members of the Board expressing interest in holding a follow-up summit, Member Masci proposed convening several meetings of the Access Committee to discuss in what form and how such a presentation might be structured? He believes three to five choices could be presented to at least the leadership group assembled at the last Health Access Summit. Chairman Buhler and Vice Chairman Westerman felt there was agreement among the Joint Board that the Access Committee should meet to discuss next steps and make a recommendation to the Joint Board. Jean Baldwin mentioned that all Health Board and Hospital Commission members were interested in being notified of the Access meeting in the event they want to attend. .Jefferson County Strate2ic Plan: Commissioner Titterness distributed a copy of the adopted vision, mission statement and goals. He suggested the Health Board, as a gesture of support, could choose to support specific goals or the Jefferson County Strategic plan in its entirety. County Administrator Saddler explained the process by which the County Law and Justice Council created their own strategic plans, goals and objectives. He asked whether the Board of Health may want to take a similar course to develop its own goals and objectives? Commissioner Titterness suggested the Board might look at the strategies already developed by Law and Justice and use the parallel goals as the basis for the Board of Health exercise. Jean Baldwin suggested the Board of Health strategic goals integrate with the Department's goals and objectives. Vice Chairman Westerman said she is supportive of the goals and objectives process, but wants the Board to stay focused on the Health Access Summit issues and long-range goals. Member Masci moved that County Administrator Saddler and David Goldsmith facilitate a strategic planning exercise with the Board of Health. Member Frissell seconded the motion which HEALTH BOARD MINUTES - September 20, 2001 Page: 6 carried by a unanimous vote. There was interest in starting the next meeting at 1:30 for this purpose. Access to Babv and Child Dentistry Pr02rams (ABCD): In response to a request from Member Masci, Jean Baldwin explained that dental services for Jefferson County residents are offered infrequently via a long distance phone call to Clallam County. She agreed to forward her suggestions for improvements to the OlyCAP Board. It was noted that OlyCAP is trying to arrange a permanent base for dental services at a Brinnon facility and that oral health access are important to include in health access discussions. AGENDA CALENDAR / ADJOURN 2001 AGENDA ITEMS 1. CONTINUED STABLE FUNDING TO REPLACE MVET 2. ACCESS HEALTH CARE 3. PROGRAM MEASURES (Genetic Research and Public Health Implications) 4. METHAMPHETAMINE SUMMIT 5. PERFORMANCE STANDARDS & COMMUNITY ASSESSMENT 6. TOBACCO PREVENTION AND COALITION 7. FLUORIDE 8. TRANSIT AND PUBLIC HOUSING 9. BIOTERRORISM READINESS & PLAN 10. AGING POPULATION 11. WATER 12. MATERNAL CHILD PREVENTION GOALS (0-3) The meeting adjourned at 4:32 p.m. The next meeting will be held on Thursday, October 18, 2001 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH ç .'ßJ 0Ll/;,-Á___ 1 Buhler, Chairman i¡~VJ~~ Sheila Westerman, Vice-Chair an &tingfora, r ¡)~.~ Dan ~êrñe;s, Member Ric WOJt, Member 1./1 , ~; /tM~{:t;¿Á.l~e Roberta Frissell, Member JEFFERSON COUNTY BOARD OF HEALTH Thursday, September 20, 2001 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 August 16, 2001 III. Public Comments IV. Old Business and Informational Items 1. 4th Annual Local Board of Health Leadership Workshop October 25-26, Radisson Hotel, SeaTac 2. Letter to Senator Marie Cantwell V. New Business 1. Public Health Law 101- Rules, Policies, Waivers, and Appeals Tom (10 min) 2. On-Site Sewage Code Rule Revision - Action Item Tom (15 min) 3. Communicable Disease Update - Pertussis, Chronic Hepatitis Reporting, 2000 Jefferson County STD Profile Lisa (15 min) 4. Joint Board Access Project- Update and Framework for Local Board of Health Involvement Tom (15 min) 5. Jefferson County Strategic Plan - Potential Role of Jefferson County Board of Health Dan (15 min) VI. Agenda Planning 1. Future Agenda Topics VII. Adjourn Next Meeting: October 18,2001 - 2:30 - 4:30 PM Main Conference Room Jefferson Health and Human Services i'EFFERSON COUNTY BOARD OF HEALTH oRþ.r ThU~~~¡;:' 2001 ~/0, Board lviembm: Dan Titterness, J.viember - Coun!}' Commissioner District #1 Glen Huntingford, Member - Coun!} CommÙÚoner DÙtriä #:.: Richard W'qjt.lVIember - County Commissioner District #3 Geo.ff~¡ Masd, Member - Port Townsend Ciry Council lill Buhler. Chairman - Hospital Commissioner District #2 Sheila W':sterman, Vice Chairman - Citizen at UlJte (Ciry) Roberta Frissel/ - Citizen at ur;ge (County) Staff Memberr: J eall Baidwin. Nllrsin..g S en;ices Director Lz~! FC!}', Environmental Healtf; Dirr:t'tor Thomas Locke. ¡'vID. Health O.lficcr DRAFT Chairman Buhler called the meeting to order at 2:35 p.m. All Board and Staff members were present with the exception of Commissioner Huntingford. Member Masci moved to approve the agenda. Commissioner Wojt seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Masci moved to approve the minutes of July 19,2001. Commissioner Wojt seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT Dale Wurtsmith spoke about the On-Site Sewage Ordinance adopted by the Board on May 17,2001. He requested that the provisional licenses for Operation and Maintenance (O&M) of conventional systems be expanded to include alternative systems. As a member of the Washington On-Site Sewage Association (WOSSA), he noted that most of his training relates to alternative systems. He has submitted an application to be licensed and understands that the permanent licensing test will likely be given at WOSSA and that it will be roughly six months to a year before a class is designed. He expressed concern that the PUD inspection does not include opening and inspecting the septic tank. He has heard that one third of alternative systems fail within the first five years and wonders if it is due to a lack of inspection. Testing for temperature, PH, and dissolved oxygen may be able to prevent a collapse or other expensive repairs. He also proposed that the language in the current ordinance be changed to allow for excavating. In his opinion people should have the option of choosing who they want to monitor their alternative system. If the PUD continues doing their light monitoring, he would suggest having another individual inspect the tank and give the citizens a credit for that portion of the field that was inspected. Chuck Molisky of Goodman Sanitation said that at the March 2001 Health Board meeting there was discussion about revising the Evaluation of Existing System Ordinance to allow anyone demonstrating a HEALTH BOARD MINUTES - August 16,2001 Page: :: ~ertain level of competency to perform inspections. Those individuals would be required to become lIcensed once a test became available. Although. he has been providing monitoring services. he is no longer qualified to perform inspections under the ordinance because he is nor a åesÎ!mer. installer. or a monitoring specialist and does not have a year of experience under a monitoring emir". He also questioned why he has to pay $200 to apply for a license when he is alread" in busin;ss in Jefferson County. Because the County has placed the PUD in a position of monitori~g all alternative engineered systems, the consumer is under the impression that they do not have to do the operation and maintenance until periodically told to do so. He understood it was the Board's intent to open up the monitoring to qualified persons. An amendment to the ordinance's monitoring terminology would allow him to monitor conventional systems. To protect their investment, he believes his customers would like the opportunity to choose who provides their monitoring, maintenance and ongoing service. Vice Chair Westerman clarified that it was the Board's intent to create a way for other individuals to do the monitoring of both conventional and alternative systems. Board members concurred. Commissioner Wojt commented that whoever does the inspection, there has to be a c1earunderstanding of the need for centralized record keeping. OLD BUSINESS Provisional Certification Onsite Sewa2e O&M Specialists: Discussion of Expedited Rule Changes Adopted 5/17/01: Larry Fay reported that he and Dale Wurtsmith met and discussed the issues and concerns he raised today. The PUD has specific statutory authority to conduct maintenance and monitoring inspections of on-site sewage and community sewage systems. Because the PUD inspections are focused on the secondary treatment process involved with alternative systems, they have not included inspecting the septic rank. In those cases, the Health Department may need to go back and inspect the tanks. He believes it would be a disservice to discount the work the PUD has done over the last 15 years in monitoring alternative systems in Jefferson County. The inspections were not intended to be diagnostic, but to identify major system failures. If the PUD discovers a problem, homeowners would be notified and referred to an O&M specialist to perform a more detailed analysis. With respect to conventional systems, he noted that the Board worked on an ordinance for provisional licensing as a pathway to further testing and certification under development by WOSSA. While the full license would take the place of a provisional license and adopted Sections would no longer apply, the core O&M responsibilities would remain. Aside from minor changes made in May, no major changes were made from the original direction before Board adoption. Commissioner Titterness said he believes it was the Board's intent that a person with expertise in the field be allowed to receive a provisional license. Larry Fay said he understood that the Board and staff were looking for a mix of work experience and formal training for licensed installers, licensed pumpers, and licensed O&M people. To be a licensed O&M person, you have to have had some work experience either with a designer, installer, or an O&M person, plus training. While Chuck Molisky has been in the pumping business for years but has not worked with an installer or designer, the question for the Board is whether to amend the ordinance. HEALTH BOARD MINUTES - August 16.2001 Page: :. Historicallv. in Jefferson County. those who have done O&M are designers. installers and pumpers. The Board couÍd choose to state that Mr. Molisky' s years of experience as a pumper in Jefferson County constitutes the needed work experience. Chuck Molisky apologized for giving the impression that the PUD has not been doing their job. He believes that given their limited mandate they have been doing their job. His position is that others besides the PUD should be allowed to do the monitoring. The 15 years of data could be the basis for other monitoring entities if individual homeowners chose that path. He also believes the PUD standards should be updated to improve the database. Member Masci agreed that the Board's intent was to pass provisional licensing to conduct inspections for those people doing the work. However, before adoption the Board failed to realize that the new language in Section 8.15.150(6)c did not include all sewage systems. He believes the tapes of the previous meeting will show the Board was talking about all systems, both conventional and alternative. He was under the impression that Messrs. Molisky and Wurtsmith and possibly others in the County had extensive WOSSA training and had spent a lot of money on course training. He suggested that the Department review the PUD contract to ensure similar training of their inspectors. He proposed that newly adopted Sections 8.15.150(6)(c) and 8.15.140(4)(b) and (c) be modified with the suggested wording provided in the Health Board packet titled "Dear Honorable Geoff Masci." He believes these changes reflect the Board's original intent. He also suggested adding to the list of qualified inspectors, "installers and service provision companies." He does not believe anyone, including staff did anything egreglOus. Dr. Tom Locke reviewed the Board of Health's process of adopting this ordinance. To modify the rule, the Board would need to present new language and publish it for comment before adoption. Member Masci moved that Staff present to the Board amendatory language to Sections 8.15.150(6)(c) and 8.15.140(4)(b) and (c) as exists in Items 1 and 2 of the correspondence titled "Dear Honorable Geoff Masci" and bring it forth at the next meeting for discussion. Member Frissell seconded the motion. Commissioner Wojt commented that the County has contracted with the PUD which as a public entity will stay in business whether or not they make a profit for these services. As a public entity, the PUD also has the longevity to keep the records. Any inspectors would need to have a legal obligation to track inspections. Vice Chairman Westerman said she was unaware that this legal obligation was included in the ordinance. Larry Fay said that the contract with the PUD is to perform O&M tracking and records management to verify the recipient of the report, to verify inspection has occurred, and notify Environmental Health of any system problems. Although record keeping is important, it is more of an administrative than ordinance issue. Member Masci said the intent of the motion is to allow provisional monitoring certificates to be issued HEALTH BOARD MINUTES - August 16.2001 Page: 4 so the work can be done. He expressed concern about additional delays. Larry Fay said typically a draft is reviewed by the Board to be followed by the advertisement. however. he may be able to expedite the process by making the suggested amendments and immediately placing the advertisement. Member Masci asked to revise his m~tion. Member Masci moved that Staff expedite revisions to the On-Site Sewage Ordinance Sections 8.15.150(6)(c) and 8.15.140(4)(b) and (c) consistent with the changes as suggested in Items 1 and 2 of the correspondence titled 'Dear Honorable Geoff Masci.'" Member Frissell seconded the motion. Larry Fay asked if the work qualifications should be modified to include one year's work experience with a licensed pumper? The concern is that pumping septic tanks is different than doing O&M of alternative systems and requires an additional training component. Commissioner Wojt asked where in the ordinance it states the requirements for record keeping? Larry Fay responded that he believes it is in two sections. Vice Chair Westerman expæssed interest in the Board having a future discussion about record keeping by the PUD. The motion carried. Commissioner W ojt abstained. Member Masci moved that Staff present before the Board the qualifications of the Certified Monitoring Specialist to include "licensed pumper" to the possible O&M service providers currently listed as licensed designer, licensed installer, and licensed O&M specialist. Commissioner Titterness seconded the motion, which carried by a unanimous vote. Member Masci moved that the Board discuss at an upcoming meeting not to exceed 60 days from today, the topic of "PUD record keeping, retention and custodianship." Commissioner Wojt seconded the motion, which carried by a unanimous vote. Commissioner Titterness suggested the PUD be invited to attend this discussion. Staff agreed to follow- up. Larry Fay circulated the signature page for the Board's May 17,2001 On-site Sewage Code amendment, which the Board is now proposing to amend. NEW BUSINESS .Joint Resolution - Seawater Intrusion Monitorilll!: Larry Fay reviewed the Joint Resolution which would establish a program to conduct systematic groundwater monitoring to assess whether seawater intrusion may be occurring in Jefferson County and affecting water quality. He provided background on I-E ,L\~ TH BO .:\RD MINL -T:::S - Augus: 1 C, :00: PagE: ~ the appeaL.. tc, tht' uniÍÏeè Dcvdcmment Code last faU regarding whether or not me Count' provided adequatt:' DfoteCtlOn of aauiÎer~ near marine shorelines or. on Marrowstont Islane;. from over apDfopriatior:, Two ordmances which the City. Public Environmentai Council. and the Shine. Community Action Council have appealed have been discussed. The City and County reached an agreement that Jefferson County be the data managers for water quality information. The PUD was interested in positioning themselves to implement a long-term monitoring program. This resolution would formalize the roles of the County. PUD and Board of Health in developing a rational monitoring program. in cooperation with the State Departments of Ecology and Health. which the PUD would then implement. The role of the Department of Health would be to assist in developing the methodology. The financial responsibility for implementation would reside with the PUD. Member Masci moved that the Board accept the .Joint Resolution for Developing a Countywide Seawater Intrusion Monitoring Program between the .Jefferson County Board of County Commissioners. the .Jefferson County Board of Health, and the .Jefferson County PUD No. 1. Member Frissell seconded the motion. During discussion of the motion. Vice Chair Westerman said that, given the importance of this issue, she does not believe this is an area where the County should try to save money, She suggested eliminating the words "already strapped" from the second paragraph of the resolution. Dr. Locke noted that because this is a joint resolution already adopted by the Jeîferson County Board of Commissioners, it cannot be modified. Commissioner Wojt said in other counties saltwater intrusion is dealt with by public purveyors of water, as opposed to individual homeowners. The PCD, as the largest water purveyor in the County, ha:. agreed to make its water system data available to others in the County. - - .tvfember Masci explained that during UDC appeal settlement negotiations, the City became aware that the County's data collection was limited to public water systems. With the pending sale of the Tri-Area water system to the PUD, the PUD will become subject to more stringent State standards. Larry Fay said the PUD is contemplating not only monitoring the public water supply wells but, at least in some strategic areas, thinking about dedicated monitoring wells using proactive groundv.:ater monitoring. Commissioner Titterness said that given that there has been nothing inaccuiate noted in the resolution, he proposed that the Board proceed with it. The motion carried b~' a unanimous vote. H:::,'\:_TF BC>ARI:" ¡\II1'"TTES - August 1 C:. :O(J; Pag:;: r, AGENDA CALENDAR ADJOUR1\ Th:: ag::nda iten; "Draft Policy Pertaining to Building Permit R::Dair"' wiU ìx' presented at the next . . meeting. Commissioner Titterness suggested tnar the topic of "Treatment and Prevention" be high on this yea;-'s Health Board agenda. Jean Baldwin agreed to provide a preliminary report in October. 2001 AGENDA ITEMS 1. CONTINUED STABLE FUNDING TO REPLACE l\-fVET 2. ACCESS HEALTH CARE 3. PROGRAl\tI MEASURES (Genetic Research and Public Health Implications) 4. METHA..MPHETAMINE SUMMIT 5. PERFORMt\NCE STANDARDS & COMMUNITY ASSESSMENT 6. TOBACCO PREVENTION AND COALITION 7. FLUORIDE 8. TR~NSIT AND PUBLIC HOUSING 9. BIOTERRORISM READINESS & PLA1~ 10. AGING POPULATION 11. "VATER 12. Ivl4.TER.'\AL CHILD PREVENTION GOALS (0-3) The meeting adjourned at 3:35 p,m. The next meeting will be held on Thursday, September 20.2001 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUKTY BOARD OF HEALTH Jill Buhler. Chairman Geoffrey Masci, Member Sheila \Vesrerman. Vice-Chairman Richard Wojt, Member (Excused Absence) Glen Hunringford. \'1ember Roberta Frissell. Member Dan Titterness. Member LOCAL BOARD OF HEALTH LEADERSHIP WORKSHOP OCTOBER 25-26, 2001 RADISSON HOTEL SEAT AC, WA. DRAFT AGENDA "EMERGING ISSUES IN PUBLIC HEALTH" Thursday. October 25th 9:00 Registration and Refreshment 1 0:00 Tom Milne, Executive Director, National Association of County & City Health Officials a. National Perspective on Public Health b. Public Health Funding c. National Perspective on 4 main topic areas: a. Emerging Diseases b. Water and Waste Water c. Early Intervention d. Illegal Drug Labs Mary Selecky, Secretary, Washington Department of Health a. State Perspective on Public Health b. Public Health Funding c. State Perspective on 4 main topic areas: a. Emerging Diseases b. Water and Waste Water c. Early Intervention d. Illegal Drug Labs 12:00 LUNCH 1 :00 Plenary Session: a. Water and Waste Water - Background information on Issue and introduction of Case Study b. Early Intervention - Background information on Issue and introduction of Case Study. 1 :30 Roundtables on Water and Waste Water and Early Intervention a. What is the Board of Health Role? b. How would you know if you made a difference? c. Who else will you have to enlist to address the issue? d. What should be done next? In your County.....? Collectively/state- wide.......? e. What are the barriers to action? 3:00 BREAK 3:30 Switch Roundtables (Same as above) 5:00 BREAK 6:00 No-host bar and Hosted Dinner a. Fireside Chat a. Wrap-up and Discussion of Day b. Exchange between Local Board members, Mary Selecky and Tom Milne Fridav. October 26th 7:30 Continental Breakfast 8:00 Plenary Session: a. Emerging Diseases - Background information and introduction of Case Study b. Illegal Drug Labs - Background information and introduction of Case Study 8:30 Roundtables on Emerging Diseases and Illegal Drug Labs a. What is the Board of Health Role? b. How will you know if you made a difference? c. Who else will you have to enlist to address the issue? d. What should be done next? In your county... ..? Collectively/State- wide...... ? e. What are the barriers to action? 10:00 BREAK 10:30 Switch Roundtables (Same as above) NOON Lunch and Closing Plenary Wrap-Up and Action Plan for Next Steps 2:00 Adjourn ~~~ CASTLE HILL CENTER · 615 SHERIDAN · PORT TOWNSEND, WA 98368 August 16,2001 The Honorable Maria Cantwell United States Senate Washington, DC 20510 Dear Senator Cantwell: On behalf of the Jefferson County Board of Health and the people of Jefferson County, I would like to thank you for your visit to Port Townsend on July 21,2001. Your meeting with community leaders concerning the deteriorating state of rural health care access shows your concern for this important issue. The Board of Health, in partnership with the Jefferson General Hospital Board of Commissioners, has embarked on an ambitious project to develop both short and long-range solutions to regional health care access problems. We sincerely appreciate your support ofthese efforts. Among the other issues discussed, assuring an adequate supply of essential public health vaccines and medications is a growing problem. Delays in influenza vaccine production and outright shortages of diphtheria-tetanus vaccine are only the most recent examples of this problem. Anti-tuberculosis medications and antibiotics used to treat sexually transmitted diseases are also being discontinued by their manufacturers due to low profit margins. A national strategy to assure adequate supplies of essential public health biologics and pharmaceuticals is urgently needed. The Nurse Family Partnership ("Best Beginnings") program, intensive home visiting to first time at-risk families, is another vital service. Based on the well researched Dr. Olds' preventive family health intervention model, this program has the potential to significantly decrease violence, substance abuse and unintended pregnancy as well as their associated social costs. Assuring adequate funding for these proven early interventions is essential to our efforts to improve community health and control escalating law and justice costs. And finally, we can not overstate the need for Congress to follow through on the full funding of the Frist-Kennedy Bill (The Public Health Threats and Emergencies Act of 2000). Efforts to increase federal and state disaster response capability are certainly important but the greatest vulnerability of our national public health system exists at the local level. There is strong consensus among bioterrorism and infectious disease experts that prompt, effective local response to a biologic disaster offers the best hope of successful containment. This capacity is largely non-existent at the local level. The HEALTH DEPARTMENT 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 DEVELOPMENTAL DISABILITIES 360/385-9400 ALCOHOUDRUG ABUSE CENTER 360/385-9435 FAX 360/385-9401 Frist-Kennedy Bill offers a strategy for addressing this problem but will require substantial resources to deal with the longstanding neglect of local public health capacity needs. Thank you again for your visit to Jefferson County. We are deeply appreciative of your concern for our community and leadership on the many crucial public health issues discussed. Sincerely, ~~~~'^'b Thomas Locke, MD, MPH Jefferson County Health Officer cc: Jefferson County Board of Health >~-U~ :-,,:__ CE~n=::;' ' ~)'-F=:¡:;¡CAÌ'j· :::CPT T(J\';>iSEì\JD. '!VA 98368 September 9.2001 To: Jefferson County Board of Health From: Tom Locke. MD, MPH, Health Ot1ìcer ~:;'-:::' Re: Rules, Policies, Waivers. and Appeals Statutorv boards (such as boards of health) have specitìc legal powers that are delegated to them -by state legislatures. These powers are often categorized as quasi-executive, quasi-legislative. or quasi-judicial. Under this classitìcation system, the rules adopted by a local board of health are an exercise of quasi-legislative power. This process is designed to be deliberative and to maximize opportunities for public review. Rules of a board of health have the "force of statute" and can carry civil andior criminal penalties for violation. Policies adopted by a board are an exercise of quasi-executive authority. Ideally, a policy should act to clarify and implement the legislative intent of a rule or statute. Policies, in themselves, should not break new ground legislatively. Instead they should facilitate the implementation of an existing rule by clearly explaining enforcement procedures and applying those procedures, when appropriate, to specitìc circumstances. Policies are designed to be much more flexible than rules and can be adopted \vithout mandatory public notice. review, or waiting periods. They can be amended or repealed at the \vill of a majority of the board. Waivers are an administrative mechanism built into many rules to adjust the rule to individual circumstances that cannot readily be addressed in either rule or policy. A waiver process is of particular value in highly technical rules where regulatory guidelines at times clash with real world realities. Criteria for granting specitic waivers are usually contained within the rule. In general, the key consideration in granting a waiver is whether the tùndamental intent of the rule can be achieved even when certain technical criteria cannot be met. Public health protection is poorly served by rigid codes that restrict activities that have no adverse public health impact. \Vaivers allo\v the intent of the law to be given a higher priority than the letter of the law. Waivers also establish precedents for code enforcement. Once a waiver of a rule has been granted, anyone subject to that rule has a legitimate expectation of receiving the same waiver in similar circumstance. Judicious use of waivers promotes fairness and regulatory compliance. Careless granting of waivers can dilute the authority of the rule and render it less effective in fultìl1ing its intent. Dc;::O!","':;',=,¡- 360. J¡:;.s- g4iJC t-ic,L\L-::--1 DEVELOPMENTAL DISABILITiES 360/385-9400 ALCOHOUDRUG .fI,BUSE CENTER 360/385-9435 FAX 360/385-9401 H E/ÄLiH i:N\ iRONME[\IT,fI,L 360/385-9444 And finally, boards of health are called upon to exercise their quasi-judicial authority through an appeal process. Appeals of public health codes challenge the administrative interpretation and implementation of a particular code. Anyone aggrieved by a decision ofa public health official can appeal that decision to a board of health. The board's power to affirm or reverse the decision of its administrative officers is a final check against the misuse of the board's authority and a means by which the board retains the "final say" on what the intent of the rule truly is. A highly functional board of health uses all of these available strategies to carry out its statutory responsibilities. Rulemaking and appeals are, hopefully, the least frequent strategies. Policies and waivers, the most frequent. If this balance is reversed, it suggests that problems exist in the rule, its enforcement, or both. Jefferson County Board of Health Agenda Item Information / Description Regular Business For Month of: Septembe:::, 200::' Description - _L~:T', e :--~j~:-,~ e !1 t s t:: the Onsite Sewage Code addressing 0&1\] spe cia 1 i s ts . 0&;'-'] Special is ts .., . ,.., , qtlâ 1- ~:t l ca 'Clons -3:-,;.d =: ~:ope ~ç ...}1- '0ractice of Issue - Jljri~g :~e A1~g~st BeE meecing the board directed staff to prepare several dme~-~~e~:s ~: the County Onsite Sewage Code. The Board provided speci:ic language :'Jr -:.:-:'e a:nencrnents. The board language has been incorporated im:o the draft ord~~~nce ame~ding t~e adopted code and the board is also provided with the text of -:.:-:'e effec-:.ed ordi~ance sections. Staff has incorporated the board language v;~__t some adiitions. The board amendments are shown in bold print, staff recc~Iended changes in bold italicized print. Sc~ff has made the recoITIDendation to include the phrase "or as approved by the rteal-:.:-:' Officer" in order to enable the department to respond to additional u~~~~iclpaLed technical lssues through policy rather than through co~~i~ued aLe~i~ent of ~he rule. Opportunity Analysis - Th::_s ---' '-.....,;. -3:-= 2..,-:n 1 tern. The range .---. F OptlOns 2'lailable to the Board. :':-.:.clu,:J.e: · Leave -~~ 0rdi~anC2 as adopted and previously anended · Aàop-:. L~e amenQuents as presented · 3tr:'>:e -:je sta== recornrnenàed ·::hange.s a:1C~ ad.op~ as orì'gil1a:l~l d.-=-:-s:c:.ed Specific Departmental Recommendation - Aàcp-:. the amendments with the staff recommendations included Th~s reco~~e~daticn is maàe because, if implementeà, it reflects ~he i~ten~ ^- :he ;:,:'ar,d re':-:;·rnrneY'lderj arrtend."TIer~ts b'...:.t offers the flexibility tc respcr_:: to =~3~;~n? i2T~~ds O~ <nowledge thrct:gr1 the s i:r~D 1 er process , , PCll',:y yo;::--;""'o-,.- - -... ..~..~,_.... -Ch2:1 . . . , ~eWC~<lng ~~2 r~~es. Ordinance No. AMENDING ORDINANCE NO. 08-0921-00 JEFFERSO'\í COUNTY HEALTH AND HUMAN SERVICES DEPART\t1E0iT RULES AND REGULATIONS ON-SITE SEWAGE DISPOSAL SYSTEMS .Jefferson County Ordinance 0io. 08-0921-00 . relating to the County Health and Human Services Department and sewage disposal systems, is hereby amended as follows: Amend: 8.15.140(3)( c) to read: Written proof showing a minimum of one-year experience under the direct sllpen'ision of a Certitied Installer. Designer, Operation and Monitoring Specialist, Pumper or other experience as approved by the Health Officer. CompletIOn of classroom training specitic to on-site sewage system operation and maintenance as approved by the Health Division may be substituted for up to six months work experience. Add: 8.15.140(4 )(b)(v) Excavate for purposes of aftïxing sweeping 45 degree angle lateral ends and removable end caps on manifolds and lateral lines, for purposes of maintenance, such as t1ushing, jetting and brushing. Add: 8.15. 140(b)( vi) Or other as approved by the health oftïcer. Amend: 8.15 .140( 4 )(c)( iv) to read: Alter or replace any portion of the subsurface disposal component or pretreatment components. EXCEPT as stated in 8.15.l40(b) (v) and EXCEPT in the case \vhere he/she also holds a valid Installer's Certificate and a permit has been obtained for such work; or Amend 8.l5.150( 6)( c) to read: Owners of all onsite sewage systems (conventional, alternative and proprietary systems after meeting manutàcturers training requirements) may obtain operations and monitoring inspectIOns from a Certified \tlonitoring Specialists in lieu of the Health Division, Licensed Designer or licensed professional engineer for the following inspection: (i) Routine O&\tl í ii) The sale or transfer of a property (Iii) The application for a building permit that is not classified as an expansion. APPROVED .JEFFERS00i COl~TY BOARD OF HEALTH .Jill Buhler. Chaim1an Dan Tittemess. \tlember Sheila Westerman, Vice Chairman --_.,-.,,-----'.._-_..,- ------- Glen Hllntmgford. Member Geoffrey Masci. Member Roberta Frissell. \tlember Richard Woj!. )'lember SEAL ATTEST: Lorna Delaney. Clerk of the Board Bold = ne,," text Bold Italics = lieII' tcxt lidded by HClIlth Depll/'tIllCllt statl 8.15.140 OPERATION AND MONITORING SPECIALIST (3) Requirements for Monitoring Specialist Certificate shall include all of the following: (a) Application shall be made on forms provided by the Health Officer. (b) Certificate and/or application fees as set forth in the Fee Schedule shail be payable to the Health Division. (c) Written proof showing a minimum of one-year experience under the direct supervision of a Certified Installer, Designer, Operation and Monitoring Specialist, Pumper or other experience as approved by the Health Officer. Completion of classroom training specific to on-site sewage system operation and maintenance as approved by the Health Division may be substituted for up to six months work experience. (d) Written proof of completion of a minimum of sixteen (16) hours of training in on-site wastewater treatment, operation and maintenance at the Northwest On- site Wastewater Training Center or equivalent. (e) Take and pass a written examination to determine the applicant's knowledge of the operation and monitoring requirements for the on-site sewage systems approved by the Washington State Department of Health, excepting those proprietary devices requiring a special authorization from the system proprietor. (b) The Operations and Monitoring Specialist may complete the following if authorized by the homeowner: (i) Clean pump screen or outlet baffle screen; (ii) Install and repair septic tank lids, risers and baffles; (iii) Replace pumps, float switches, and check valves intended to prevent the back flow of effluent into the pump chamber, within Washington State Labor and Industry requirements; or (iv) Make repairs to a septic tank or pump chamber to correct a condition of ground water intrusion or leakage. (v) Excavate for purposes of affixing sweeping 45 degree angle lateral ends and removable end caps on manifolds and lateral lines, for purposes of maintenance, such as flushing, jetting and brushing. (vi) Or other as approved by the health officer. (c) The Operations and Monitoring Specialist shall not: (i) Pump the septic tank and/or pump chamber, EXCEPT in the case where he/she also holds a valid Septic Tank Pumoer's Certificate; (ii) Excavate an OSS's drainfield or any drainfield component, EXCEPT as stated in 8.15.140 (4)(b) above, OR in the case where he/she also holds a valid Installer's Certificate; (iii) Alter devices such as cycle counters or operating hour meters without the prior written approval of the Health Division: (iv) Alter or replace any portion of the subsurface disposal component or pretreatment components, EXCEPT as stated in 8.15.140(b) (v) and EXCEPT in the case where he/she also holds a valid Installer's Certificate and a permit has been obtained for such work; or (v) Replace or alter devices that monitor or regulate the distribution of the effluent. 8.15.150 OPERATION, MAINTENANCE AND MONITORING (6) Operations and Monitoring Agreement and Contracts. (a) The owner of a conventional OSS shall be subject to a permit condition requiring compliance with the inspection schedule specified in Table 1 beginning with the earliest of the following events: (i) The installation of an OSS. (ii) The repair of an OSS. (iii) The alteration of an OSS. (b) Owners of existing conventional systems shall obtain an initial inspection by the Health Division, Licensed Designer or licensed professional engineer and comply with the inspection schedule specified in TABLE 1 beginning with the earliest of the following events: (i) The sale of the property. (ii) The application for a building permit on the site. (¡ii) The use of an OSS as a community OSS. (iv) Identification thatan OSS is in an Area of Special Concern as designated by the JCBOH. (v) Identification that a system has received a WaiverNariance from State or Local Code. (c) Owners of Owners of all onsite sewage systems (conventional, alternative and proprietary systems after meeting manufacturers training requirements) may obtain operations and monitoring inspections from a Certified Monitoring Specialists in lieu of the Health Division, Licensed Designer or licensed professional engineer for the following inspection: (i) Routine O&M (ii) The sale or transfer of a property (iii) The application for a building permit that is not classified as an expansion. CASTLE HiLL CEi'JTER . ò 15 SHERIDAN . PORT TOWNSEND. WA 983ô8 August 29, 2001 To: Jefferson County Physicians and other Health Care Providers (Please circulate.) From: Lisa McKenzie PHN V/\" JCHHS Communicable Disease and Immunization Program Re: Report on Pertussis Outbreak Summer 2001, Chronic Hepatitis Reporting Form, STD Profile Jefferson County 2000 During June and July there were 11 cases of pertussis reported to JCHHS. These cases met the case criteria for reporting by being laboratory confirmed or by meeting the clinical case definition and being epidemiologically linked to a laboratory confirmed case. There were other possible cases that did not have a known exposure to a laboratory confirmed case so did not meet the confirmed case classification for reporting purposes. Of 11 cases 3 were adults and 8 were children. The children ranged from 2-14 years old. The adults were 38 - 45 years old; two of these were parents of children who were cases. Four of 8 children had no previous pertussis immunization, 2 had 1 dose and 2 had unknown immunization histories. Onset of symptoms ranged from 5/4/01 - 7/11/01. Many local Health Care Providers screened and cultured possible cases and treated close contacts of cases. Thank you for your assistance in getting this outbreak under control. We feel fortunate that there was no infant who became ill. It is probable that some low level of pertussis activity remains in the community so we ask for a continued increased level of suspicion for pertussis. Enclosures: The new Chronic Hepatitis 81 Chronic Hepatitis C case report. These reports will allow us to gain information on the magnitude of Hepatitis C and 8 infection in our county. Could you please send reports to me monthly on patients who you have seen each month, unless you have already sent a report for them. The labs do not consistently report on chronic hepatitis and are not required to in the new WAC. I can help with asking about risk factors if requested. Acute cases of Hepatitis B should still be reported within 3 days. Thank you for your much appreciated assistance with this. The STO Profile for Jefferson County 2000. JCHHS staff continues to be available to assist with partner notification if needed. HE)\LTH ENVIRONMENTAL HE~LTH DEVELOPMENTAL DISABILITIES ':Fn ··"lp ~ _'JJ.(';n 'lhn~qc:_qJ.J..J. lFìnnR"i_QL1nn ALCOHOUDRUG ABUSE CENTER lFìnnA"i_QL11"i FAX lFìnl:1A"i-Q4n 1 JEDL'iRTMEf'f; ,. . Sexually Transmitted Disease Profile JEFFERSON COUNTY - 2000 STDiTB Services Summary This report describes the sexually transmitted disease burden in Jefferson County. Primary emphasis is placed on chlamydia and gonorrhea since they are the most fiequently reported STDs in Washington State. The 2000 incidence rates by age and sex for gonorrhea and chlamydia are presented. The report concludes with a presentation of which providers in your county reported STDs. Contents County STD Trends.......... ........................... ........ ........ ................ .... ................ ....... .... ..... ......... ..... ..2 Table I : Washington State Reportable Sexually Transmitted Diseases, 2000...........................2 Chlamydia Figure 1: Chlamydia Incidence Rates, by Age and Gender, 2000 ..............................................3 Figure 2: Chlamydia Cases by Age (13-19) and Gender, 2000 ..................................................4 Table 2: Chlamydia Repeater Infections, 2000 .......................................................5 Table 3: Chlamydia Asymptomatic Infections, 2000 ........................................... ... ..5 Gonorrhea Figure 3: Gonorrhea Incidence Rates, by Age and Gender, 2000................................................6 Conclusion Table 4: Reported Cases of Gonorrhea and Chlamydia by Provider Type, 2000....................... 7 Appendix A: Data Sources, Analyses, and Limitations ..................................................................8 1 Jefferson County STD Disease Trends Table 1: Washington State Reportable Sexually Transmitted Diseases, Jefferson County, 2000 1999 2000 2000 2000 Jefferson Jefferson Jefferson Washington Disease County Cases County Cases County Rate'" State RateÀ (per 100,000) (per 100,000) Chlamydia 35 32 121 224 Gonorrhea I 1 0 - 42 Early Syphilis 0 I * 1.5 Congenital Syphilis 0 0 - 1.3(live births) Late/Late Latent Syphilis , 0 0 - 1.5 PID (Acute)** 4 .., * 8(female) .) Herpes (initial infection) 3 0 - 35 NGU** 3 2 * 38(male) GI/LGV/Chancroid** 0 0 - 0.0 :\IDS cases** 1 2 TOTAL I 46 38 144 327 (excluding AIDS cases) ^ Denominator estimates for the calculation of incidence rates from the population estimates. 1990-2002 PopulatIOn ESllmates and ProjectIOns: Department of Social and Health Services. Washington State Adjusted Population Estimates. April 1999. · Rates cannot be calculated for years with fewer than five cases .. See Appendit A for explanatIOn of disease acronyms. In 2000, Jefferson County experienced a decrease from 1999 in its combined STD morbidity rate. With 38 new cases ofSTDs (excluding AIDS cases 1) in 2000, the incidence rate for all STDs was 144 per 100,000 persons. This is 56% less than the 327 per 100,000 combined STD rate for Washington State. Jefferson County reported no cases of congenital syphilis or GI/LGV/ Chancroid in 2000. 2000 comoared to 1999: · Chlamydia had a 9% decrease in reported cases (32 YS. 35). . Gonorrhea had 100% decrease in reported cases (0 YS. l). · Early syphilis had a 1 oo~~ increase in reported cases (1 vs. 0). · Acute PID had 25% decrease in reported cases (3 Ys. 4). · Initial infection herpes had a100% decrease in reported cases (0 Ys. 3). · NGC had a 33% decrease in reported cases (2 vs. 3). : Complete informatIOn on the HIV/AIDS epidemic in Washington can be found in Washington State HIV/AIDS EpiderruoloQic Profile - 1999, Washington State Department of Health, Office of IDRH, Assessment Unit. 2 Chlamydia Figure 1: Chlamydia Incidence Rates by Age and Gender, Jefferson County. 2000^- 2000 . Female Rate ~- -- ..- .- .-.- ~- --. --~ - ¡ Male Rate 1750 - - .- -- - - -- - '..-. ._._. -- --- - o o 1500 o o o ..- 1250 .... (l) 0.. 2 1000 C1J c:: (l) c..> 750 c: (l) '"0 "g 500 ----------- ---------- --------------------- ------_._--- - - ~- - - - - - --. - - - - - - - '- - - - -- -----.---------- ---------------------- --------_._-- --------------------- 250 -------,,---- ---------------------- o 0-9 10-14 15-19 20-24 25-29 Age (years) 30-34 35-39 40+ Female Rate 0 0 I 1,61 ì I 1,7ì6 I * * I 0 I * Male Rate 0 0 * * 0 . 0 * Female Cases 0 0 12 I 10 I 3 I ! 0 T 1 Male Cases 0 0 2 1 0 I 0 I ^ Denominator estimates for the calculatIOn of incidence rates from the population estimates. 1990-2002 Population Estimates and Projections: Department of Social and Health Services. Washington State Adjusted Population Estimates. Aprz11999. Incidence rates rounded to the nearest whole number. * Rates cannot be calculated for ages with f£:Wer than five cases In, 2000 the female chlamydia incidence rate peaked among the 20-24 year old age group at 1,776 cases per 100,000 after this peak, chlamydia incidence among females progressively declined with increasing age. Only women are routinely screened for chlamydia. Because active case-tinding is preferentially limited to women, the incidence of chlamydia in men may be under-reported by comparison. Caution should be used in interpreting comparisons of chlamydia rates between genders. 3 or- >- 0 0 0 C\J I- C\J I Z Cf) w ::::> Cf) « ~ 0 ü Ü « - 0 z >- ~ 0 « -.J (f) I Ü C') a: ......-... w Q') ,.- I LL C') ,.- LL """"-'" W z w -, W J- ~it.f.~)?;}·~ ~(/.. ..'J IF '..: f~~:r::.~~ ~; ~..~~ ..; : ;0 t¡.'7~ 'f..· .t"'7 "':'''I~ ~:.'"f:.~.~:~"':.~:: 'f,: " ~~~ ,r-~ r :. ~. ,r;. ;.. . j (j) or- co or- f'.. or- Q) - ~ en E Q) CD w I LL or- 0r- e; &I « I Q) I - CÖ lO i ~ or- I i LJ I lO ~ C') C\J or- sesE8 JO .JeqwnN 4 ~ or- Ct) or- o Repeater Infection (Person having more than one infection in a 12-month period prior to being treated. ) Recurrent infection is common and associated with increased risk ofPID and other serious outcomes. Data suggest that young age and incomplete therapy increases the risk for a persistent/recurrent infection. Studies also suggest that women's current male sex partners are not receiving treatment for chlamydia and that women are being re-infècted by resuming sex with preexisting (and infected) sex partners. Careful interviewing and prompt, concurrent treatment of all partners is important. People should be coached to ask health care providers for re- screening if risk behavior occurs. Table 2: Chlamydia Repeater Infections, Jefferson County, 2000. MALE FEMALE TOTAL Reported Cases 5 27 32 Repeaters Identified 1 2 3 % Repeaters 20% 7% 9% Asvmptomatic Infection STD infections often lack signs and symptoms. Additionally, signs of severe complications may not appear until long after infection, reducing the likelihood that the patient will associate complications with the initial time of infection. Screening sexually active adolescents (19 years and younger) for chlamydia should be routine during annual examinations even if symptoms are not present. Screening women and men aged 20-24 is also suggested, particularly those who have new or multiple sex partners and who do not consistently use barrier contraceptives. Careful interviewing and treatment of all partners is important. Table 3: Reported Cases of Chlamydia by Diagnostic Category, Jefferson County, 2000. ¡ I Private Public Total Total i Dia2nosis I Male I Female Male I Female ~laIe I Female Cases AsvmDtomatic ! I 7 ! 7 I 14 14 : S 'ymptomatlc- Uncomplicated ! 1 I 5 3 I 2 4 I .., 11 í Pelvic Inflammatorv Disease I I , I , i 6 6 I , , Other I I I i ! U nknO\.Vl1 ! 1 I I ! I 1 ! i ----I-- ¡ I i TOTAL i 2 15 3 I 12 5 ".., 32 ...1 5 Gonorrhea There were no cases of gonorrhea reported from Jefferson County in 2000. Because most gonorrhea cases are symptomatic and seek medical care, reported cases are considered to be an accurate reflection of true disease incidence in the overall population. Providers in Washington who reported gonorrhea cases in 2000 indicated that 75% of the men were symptomatic for gonorrhea; 50% of the women were symptomatic. Unlike chlamydia there is no widespread screening program for gonorrhea, however, most clinics provide gonorrhea screening at some level and 99% will perfonn gonorrhea testing if the client is symptomatic. National gonorrhea incidence rates have precipitously declined from 1974 to the present. Paralleling national trends, the Washington State gonorrhea incidence has declined 74% from 156.7 per 100,000 in 1988 to 41.5 per 100,000 in 2000. Age distribution in Washington State in 2000 showed age-specific rates peaked at 186 per 100,000 in the 20-24 females and peaked at 157 per 100,000 in the 20-24 year old males. Any targeted intervention for gonorrhea should consider the impact of this disease on different age groups within both genders and direct the prevention message accordingly. 6 Conclusion TabJe 4: Reported Cases ofChJamydia and Gonorrhea by Provider Type, Jefferson County, 2000 I Chlamvdia Gonorrhea Provider Type ~'¡o. of No. of Percent of No. of No. of Percent of Providers Cases Total Cases Providers Cases Total Cases AIcohoVSubstance Abuse Blood BarÙ<!Plasma Center I I Community Health Center Emergency Care (excI. hosp.) Family Planning I 2 .., 6°/ L. /0 Health Pian/HMOs HIV/AIDS I Hospitals 2 4 13% Indian Health J ai V Correction/DetentIOn Job Corps .\1iL'Tant Health .\1ilítarv Neighborhood Health OB;G'lN I 1 1 3~/o Other 5 8 25% Private Phvsicians 2 2 6% Reproductive Health 1 15 4 '70/ I /0 STD Clinics Student Health I TOTAL 13 32 100% 0 0 In Jefferson County, the Reproductive Health providers reported the highest number of chlamydia cases. These providers reported 47% of the total. Other providers reported the second highest number of chlamydia cases (25%). The Healthy People 20 I 0 national objectives for chlamydia incidence are: Females aged 15-24 attending familv planning clinics: 3%. There are 0 Region X Chlamydia Project* Family Planning clinics in Jefferson County. Females aged 15-24 attending STD clinics: 3%. Males aged 15-24 attending STD clinics: 3%. There is I Region X Chlamydia Project* STD/Reproductive Health clinic in Jefferson County. The 2000 positivity rate was: vlale Female .u # ~.'Ö .u .u % IT IT IT Site Tests Pos Pos Tests Pos Pos Jefferson Co FP 5ì :3 5.3 448 10 2.2 The year 2010 Health People national objective ìòr gonorrhea incidence is 19 cases per 100,000. Chlamydia Project Screemng Criteria see page 9. 7 Appendix A: Data Sources. Analyses and Limitations Cases: The number of cases identified and submitted by providers to local health jurisdictions and fOf\varded to the Washington State Department of Health, Office of Infectious Disease and Reproductive Health, STDfTB Services. Population: Denominator population estimates for incidence rates are from 1990-2002 PopulatIon EstImates and Projections: Department of Social and Health Services. Washington State Adjusted Population Estimates, April 1999 Incidence Rates: Incidence rates are calculated as the number of new episodes of a disease (not persons) in a given year divided by the total population (age and sex appropriate) for that year, expressed as a rate per 100,000. Incidence rates allow comparisons between two or more populations by standardizing the denominator and are the most appropriate statistic tó use when investigatIng differences between groups. Rates should not be calculated for incident case totals fewer than five because the rates are unstable. Data Reporting: Gonorrhea, chlamydia. syphilis, Acute PID, NGU and herpes (initial infection) are reportable diseases to the local health jurisdictions and forwarded to the Department of Health. To be reported and included in surveillance data, disease definition must be met. Disease Definitions: · Gonorrhea - isolation of Neisseria gonorrhea from a clinical specimen or observation of gram-negative intracellular diplococci in urethral smears or endocervical smears. · Chlamvdia- isolation of Chlamydia trachomatis from a clinical specimen by culture or non-culture methods that detect chlamydia antigen or genetic material. · SvphiJis - a complex sexual transmitted disease with a highly variable clinical course. See CDC guidelines for surveillance definition. · Herpes Simplex (initial infection only) - diagnostic criteria for reporting can be made through clinical observation of typical lesions and/or laboratory confinnation. · Non-Gonococcal Urethritis (NGU) - presence of at least two of the following features: hIstory of urethral discharge and lor dysuria; presence of purulent or mucopurulent urethral discharge: and/or urethral Gram-stain smear showing 4 or more polymorphonuclear leukocytes (PMNs) per oil immersion field. · Acute Pelvic Inflammatorv Disease (PID) - an acute clinical syndrome unrelated to pregnancy or surgery. A combination of lower abdominal pain; adnexal tenderness; adnexal mass; pain on cervical motion; mucopurulent discharge; and temperature elevation. Patients with a positive test for chlamydia or gonorrhea are reported in those disease categories. · Chancroid - an STD characterized by painful genital ulceration and inflammatory inguInal adenopathy. · Granuloma InQ:uinale (GI) - a slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area. 8 · Lvmphogranuloma Venereum (LGV) - characterized by genital lesions. suppurative rcgJOna! lymphadenopathy, or hemorrhagic proctitis. The diagnosing practItioner is responsible for providing the case information which includes patient demographIcs. source of diagnosis, limited cJinical information including site of infection and treatment, and date of diagnosis. Data Strengths: SexualJy transmJtted disease data may provide more timely information on behav10ral trends in the community than diseases with similar modes of transmission particularly HJV/AIDS. There is a hIgh level of participation in the STD surveillance system by private providers of STD servIces. Data Limitations: CJinically diagnosed cases of SIDs (without laboratory confirmation) may be missed through this surveillance system. Depending upon diagnosing practices, completeness of reporting may vary by source of health care. Data Biases: Biases could exist in the data due to under-reporting, inabiJity of certain populations to access medical services, error in laboratory reporting, or differential reporting or screening by disease and source of care. However, it is assumed that the number of cases that would faU into these categories is small and normally distributed, thus not sÌ!mificantlv -' .... - .I impacting the calculated STD rates. Assumptions: It is assumed that the cases reported from year to year are independent of each other. One violation of this assumption could be if a person who has an SID one year is more likely to have an STD the following year. Also, repeat episodes of the same SID by the same person are not excluded from the numerator count: it is felt that these numbers are not large enough to significantly impact the calculated incidence rates. Finally, we have assumed that all rates follow a chi-square distribution. Female Selective Screening Criteria in Family Planning and Expansion Sites: I. Women 24 and under are to be tested when undergoing a pelvic examination or 2. Women of any age who meet one of the following criteria should be screened at any visit if a pelvic exam is performed: a. Cervicitis or signs and/or symptoms of other STD,* b. PID. c. Exposed to CT. GC or NGC in past 60 days, d. New sex partner during past 60 days, e. Two or more sex partners during the past 60 days, f. Pregnant/Currently planning a pregnancy, g. Seeking an IUD insertion. h. Prior + chlamydia or other STD* within the past 12 months. * SID is defined as Positive for Chlamydia, Gonorrhea, Trichomonas, Syphilis or a Primary case of Herpes or Warts (HPV). 9 Helping People Get the Services They Need Standards for Access to Critical Health Services Standard 1 Information is collected and made available at both the state and local level to describe the local health system, including existing resources for public health protection, health care providers, facilities and support services. Local measures: cD Up-to-dat. information on local crilical health servim il availabl! for use in building partnerships with community groups and ".k.holdm. (~) lHJ staff ilnd contractors have iI mource list of local providers of uitkal health services for use in making client referrals. QJ Th, lilt 01 critical h..llh ""IC" il m.d along with mmment information to determine where detailed documentation of local "p"i~ il ...d.d. State measures: o A lin of critical health services is established and a core set of mnwide access measures esu.blished. Information ;s collected on the core set Dr aeem measures, analyzed and reported to the lHJI and olh!r agenei". @ Infonn.tion il provid.d 10 lHJI and oth!r agenei" about aV3i1abilily of licensed health care providm, faci!itie1 ilnd supponservices. Standard 2 Available information is used to analyze trends which, over time, affect access to critical health services. Local measures: (] 1 O:m tr:l!:bng 2nd r~portir.g system~ inc!L.!d~ key m~J.1Um 01 JC(eU. Periodic surveys jm: conducted regarding the availability of crincal health mvices and barriers to access. (~) Gaps in accm to critical health services are idl'ntilied ming periodic survey data and ot~l'r asmsml'nt inform;Hion. (~) The BOH receives summiíl.rY information regarding accm to critical health servicei at lean annually. State measures: o Consultation il provided to communiti" to It!lp gath!r and analyz' information ,boul banim to "'!\ling critical h..lth services. @ Wriuen procedures arl! maintained and dimminatl'd for how to obtain consultation and lechnical milia'" lor lH1 and oth!r agenci" in gath!ring and a"lyzing infonnation regarding barriers to access. @) Gapl in at"" to critical h..lth mvim at! identifi,d u,ing periodic survey data and other assessment information. o Poriodie Itudi" regarding work lor" needl and th, ,fleet on crilical h"lth ,mim are conducted, incorporated inlo Ih. gap analy,il and dimminated to LHjI and oth!r agenci". Standard 3 Plans to reduce specific gaps in access to critical health services are developed and implemented through collaborative efforts. Local measures: cD Community group' and Itak,holdm. including h"lth care providers, are convened to address 3CCW to critical health services, set goals and rake action, ba~ed on information about local r"our'" and trend,. Thil proe!\l may be I,d by th, lH or it may be part af a separate community process sponsored by multiple pmnm, including the lHJ. @ Coordination of critical h..llh mvi" delivery among health providm i, relleeted in th, local planning prom'" and in the implementation of amn initiatives. (j) Where specific initiatives are selected to improve access, there is analysil of local data and "tablilh,d goal" obleetives and perf;::rmanct i"Jìe<tiüm. State measures: o In[ormation about acceB barriers affecting groups within [he !.tate ii shared with other state agencies tbat pay for or supportcriticalhealthservim. @ State*initiated contramand program evaluations include performance measures that demonstrate coordination of critical heallh ,",vi", delivery among health proViders. @) Protoeo" are dmlop.d for impl.mentation by Itate agenci", lHI and other local providon to maximize enrollm,nt and participation in available insurance coverage. o Where specific initiative~ are selected to improve access, there is analy,il 01 local data ..d "Iablish.d goall. objectiv!! and p,rlonnan" mealur". Standard 4 Quality measures that address the capacity, process for delivery and outcomes of critical health services are established, monitored and reported. Local measures: cD Clinical ,",vim provid,d directly by th, lH or by contract haY! , written quality improvement pi.. including Ipecilie quaiity-bmd p.rlonnan" or outcom, mealurel. Perfonn"" measures are tracked and reported. <i) Staff members are trained in quality improvement methods as evidenced by training documentation. State measures: o Inlonnation about bm pratli", in d.limy of critical health services Îs gathered and disseminated. Summary information regarding d,limy 'yltem chang!! il provided to lH , and other agencies. @ Training on quality improvemenl methodl il available and i, incorporated into grant and program requirements. @) Regulatory program' and clinical ,",vim admini"er!d by DOH have a written quality improvement plan including specific quality-based performance or outcome measures. Menu of Critical Health Services This menu identifies health services and health condition or risks for which appropriate services - screening, education and counseling, or intervention - are needed. General access to health services Ongoing primary care Emergency medical services and care Consultative specialcy care Home care services Long-term care Health risk behaviors Tobacco use Dietary behaviors Physical activity and fitness Injury and violence prevention (bike safety. motor vehicle safety. firearm safety. poison prevention, abuse prevention) Responsible sexual behavior Communicable and infectious diseases Immunizations for vaccine preventable diseases HIV/AIDS Tuberculosis Other communicable diseases Pregnancy and maternal, infant, and child health and development Family planning Prenatal care Women, Infants and Children (WIC) services Well child care Behavioral health and mental health services Substance abuse prevention and treatment Depression Suicide/crisis intervention Other serious mental illness Cancer services Cancer-specific screening (i.e., breast, cervical. colorectal) and surveillance Specific cancer treatment Chronic conditions and disease management Diabetes Asthma Hypertension Cardiovascular disease Respiratory diseases (other chan asthma) Arthritis. osteoporosis, chronic back conditions Renal disease Oral health Dental care services Water fluoridation AUr. 0 6 2001 For additionol information contact the Dept. of Heolth at (360) 236-4085 Standards for Public Health in Woshington Stote ~-~~---_.~.~._-~~------_._~-_. ~~ffe~so!!_~OU_º~ Health and flu_man S~rvices AUGUST 2001 -- - --_._.__._---------~------~_.- NEWS ARTICLES -~------- ~------~._-,._~------~--"~.~,_. Ih:se issues and more aæ brought to you e\ery month as a collection of news stories regarding .leflerson County I ka!th and Human Ser\iCès and its progmm for the public: 1. "County's strategic plan nearing adoption" - P.T. LL\DER. August 8. 2001 ~ "Objection to county booklet" by Kevin Bowen - Opinion Forum. P.T. LEADER. August 9. 2001 3. ""Options" not beliefs are being promoted'" by Patricia Perreault.. and [~ditor"sNote by Patrick Sulli\an. "Celebrate diversity" by Ray Jackson- Opinion Forum. P.T. LEADER. August 15.2001 -/.. "Churches offer help, answers" by Rev. Dan :VlcMillan and "Practice what you preach" by \\ïnky Fuller - Opinion Forum. P.T. LEADER. August 22. 2001 "\ "Flu season to hit soon on Peninsula" - Peninsula Daily 0iews. August 26. 2001 6. "Back-to-school season is vaccine checkup time" and "Vaccine available for college students"- P.T. LEADER. September 5.2001 ~ ~ ~ ; ~ /. ""' '" >, ; " ê " È' ~ C: ~ ~ ? /. = ~ = " " ;; - '" '" c.. 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"ö <2 ~ .~ '-' ~ :~ ::J " ~ ::; ',) '" Cíi '-' ;:; on ::J ~ ::J ::: 1: .2 .... "'" " c.. /, "ö :; 0 " '- ~ '-' ä .... V OJ " 0 OJ 1.) :.2 '- .~ '" '- " ;.. 1.) OJ " v-, OJ) " - '- '- w " ~ OJ V (I"J 0 CD 1.) "ö " E '- OJ) " 2 N ::: :;, v ;; '" 1.) on Objection to county booklet Editor, Leader: Recently we received, at taxpayer expense, a copy of the "Jefferson County Youth Yellow Pages" in which I encoun- tered the following endorsement of ho- mosexuality by the county: "Being gay, lesbian or bisexual is a normal and healthy way to be. It's one more part of who you are - like being tall or short, or black or white, or Asian or Latino. It takes time to know who you are. You might fee! confused, or unsure whether you're gay or straight. It's OK to take your time finding out." The large section included a web link and phone number to a pro-homosexual lifestyle organization. Many intelligent and compassion- ate people believe that being gay, les- bian or bisexual is not "norma!." In fact, many of us believe that homo- sexuality or other inappropriate het- erosexual behavior is a choice - and not in the same category as being black or white or Asian or Latino. We also believe that correctly addressing such deviant behavior involves identifying it as something that is not good. As such -, .- , - '---- '- , .,'j <:: , , - r we would not logically recommend that people seek counseling from those who advocate such behavior. I know my statements will cause some to label me a hater or homopho- bic. I am not. I am merely a person who, along with many other informed and non-hateful persons, disagrees with the advocates of homosexuality and is dis- turbed by the government-funded forc- ing of a non-Christian worldview on our children. Instead of solely advocating the ho- mosexual lifestyles, why didn't the county include a parallel section stating that, if youths are having such tempta- tions, they might want to talk with a pastor or youth director? Why not list Christian websites? The section about homosexuality is not my only concern. There are also sev- eral church groups listed under "Church Activities for Youth," but the list is not inclusive. It does not list the Latter Day Saints, the Unitarians or some New Age fellowships. These are churches that I strongly disagree with, but my question is why does a county-funded publica- tion discriminate among religions? My issue is about fairness. I believe it is time that non-elected government bureaucrats stop propagating their opinions at taxpayer expense and at the cost of performing more basic ser- vices. Furthermore, it is only reason- able to ask that, when they feel compelled to venture into controversy, they present both sides of an issue and stop forcing their views on those of us of differing opinions. KEVIN BOWEN Port Townsend ( , --- A RfiiOun:. Guide for Preta"~ Teens, Young Adults and Families Options, not beliefs are being promoted EJlIcr, L¿aJer [n nb :=trer i)ì Aug, 8, Kevin Bowen oDJec:ed to the mduslOn in the Jefferson Coumy Youth Ydlow Pages of informa- tion thai provided resources for gay,les- 01:,", lnd olsexlIal ¡.auths Mr, Bowen .'tite' :Odt his :"ue :, jDout fairness in f':';;;J[J :() :hc: u,>c: C~! Laxpayers' money· ~;:'..; :~:e ;Jr,:.'senuuon ~)f ?Ositlons on the :r.ane; or' f:ornosexuailtv, Tk Doo,,:et :-'!r Bo\~en mentions is ,Juol¡,hed Dy our countv health depart- é:'~~t ,;: ,er';::~ to Jefferson County .' outn,-\ 'Ign;rìcant ;:¡ercemage of o~r ~èterc,e\èlal taxpayers, ,nciuding many ';' no consIder themselves Chnstian, sup- parr and applaud the department's efforts in r~~ëh¡¡l¡; out :0 sexual nùnority youths, Our ta:dundd publIc health svstem n:iS th= obl:g:HlOn to serve aU ns co~stitu- ~;jh ~nli !o prtJ\lde them wnh the besr JVll;~bJe :JeJ.lth mfOnmatlOn, The "repara- [¡'it" .J[ "conversIOn" therapy described by 'vIr. Bowen has been rejected as un- -~¡;Jt~! lnd potentlail:- hanmful by all md!:Jr f1~;¡lth anG me:1tal health profes- ,¡ur:, Among them Jre the American Ai.;~iOe:T;: or" Ped¡atncs. the .A..merican C_'~;;~êllnJ Associ:.ltlon. the A.mencan PI " :hltit;:c A>socIatlon, the American PS', Ch()¡<)~IC3ì A>socJation and the -------- ~atIonal AssociaÌion of Social Workers. Mr. Bowen demonstrates courageous devotIon to his beliefs, However, the promotion of religIOus perspectives is the responsibility of the churches who espOllse rhem, It is not the task of a pub- licly tìnanced health department. PATRICIA A. PERREAULT president PFLACìíPort Townsend-North Olympic Peninsula I Edllor' s ,Vote. The 2001/2003 Jefferson County Youth Yellow Pages is !abeled as a resource guidefor preteens. {eens, young adults andfamilies./ts in- {rodUCllon Includes "The contents have beer¡ reviewed for accuracy by profes- sionals In {he community and are not ¡mended 10 reflect any particular point of view Parents, guardians, teachers, counselors and spiritual leaders are your /irst source ojhelp when you need understanding, injormation and guid- ance If you SIlII need help and aren' [ sure where to turn, the Youth Yellow Pages offers ideas for where to find people who can listen and advise." It continues "The resources listed are pnmarrly local nonprofit organiza- nons rhat offer support, direct services and community-based programs appro- pnat¿ for preteens, teens. young adults and families, Some prIvate providers únd regional agencies have also been included when local nonprofit options 'Ire lumted, Please note that a listing in r,"Ie Youth .Yellow Pages does not imply support oJ the organization or program," The rabie 01' contents lists rhese cat- è?,JI"¿S :¡Icohol. man/Ilana and other Jmgs, btrth control, childcare, clubs and han?OlllS, conflict resolution, counseling ,wd me¡¡¡al health services, dating vio- ie'lce. disabilities and special needs. do- rnesr:c vIOlence, driving and auto ilcensulIj, eating disorders, education and schools, ¿mergenc-y contraception, emer- genc\' preparedness. employment,family planlll!Jg. financial, medical and other aSSISlanC¿,jìre and saìety,food and cloth- ing, glw safety at home, harassment, hea.rh s¿rVlces. hepatitis, HIVIAlDS, housing, jU\'enile and fami!.'! court ser- "c~s, !úw enjorcement, legal assistance. library ser:ices, mentonng, minorinpos- ,¡, e,"èiUn parenling, peer pressure, preg- nancy, proballon and parole, rape, sexual assault and sexual abuse, recreation, lei- j':lre and sporrs programs,-'runaways, homeless and srreet youths, sexUal orien- !atlon. sexually tral!Smitted diseases, sui- ('Ide pr¿vention and Intervention '.o:mst'iurg, n' and media violence, talk· Ulg [0 vour kids about anything, tattoos and bod," piercing, tobacco, transporta- 11011. rU!onng, volunteering and service It'armng COpl~S oflhe booklet are aVGllable a[ le/ferson COUIlI)' H eairh and H utmln Ser- '-'Ices 615 Sheridan 51. Port Townsend,} Celebrate diversity Editor, Leader: I am both shocked and appalled by the intolerance and bigotry displayed by Kevlß Bowen in the Aug. 8 Leader, You should be ashamed of yourself. You have the audacity to consider gays and other people who live alternative lifestyles as "not nonnal," As the "Heavy Meral Warrior," I have to say that such intolerance abour gays, lesbians and those who are "non-Chris- tian" as far as their beliefs are concerned is not acceptable in this town, which by the way, celebrates diversity, RAY JACKSON Port Townsend .;¡ ,/ T. . . _ ,j I - ,Y(),·-{C Lt' ' \ ;/ '- (5 . (./ ·Y· Churches offer help, answers Editor. Leader 1 though! It was quite amazing. al- though not surpnsing, that Ray Jackson can state In the Aug, 15 Leader that this IS a town that celebrates diversity, and Iß the same sentence tell Mr, Bowen that his beliefs are not acceptable in this ll"...n, \1r. Jackson. aren't you being in- tolerant of Mr. Bowen's intolerance? A town claiming to be !olerant of di- versity must itself be willing to accept all diverse viewpoints. and that includes the views of concerned Christians, I, and many others in this town. agree with Mr, Bowen's concerns regarding the infor- mallon provided in the Youth Yellow Pages, Although I do appreciate the at- temp! at providing helpline numbers to tews In trouble, I was troubled about the repe:lIed reminders in bold lerters and ho \ed borders that the purchase of condoms. bIrth control methods and pregnancy testing could be attained '...:¡hout parental consent and that a '... hole section was devoted to sexual ori- entation. where it was stated: "Being gay. lesbian or bisexual is a nonnal and healthy way to be" (page 39), Many have concerns about these types of messages gIven to teens 1 ha,e and hold to a different set of beliefs, Will you celebrate my diversity as '... ell" When 1 received a copy of the yel- :",'... rJg~s, 1 was also disappoinled that ,ët 0:· 'C' pages. the editors chose to in- clude only a 2-lnch listing of a few chër.:hes tn the area, The directory did nOllßclude the valuable services that our :ücal church youth groups and youth ...orkers can provIde in the support and cou"se! d local teens,¡ called the health ,Ind human services offrce and asked if ,hurches...ere contacted about being ,ncluded Iß the director], or considered ;:npOrlanl in their listing of nonprofit 'rpnlltttlom. The friendly VOice told me Ihal ,he thought the church names ...ere probabll selected randomly out of the church direclory section in the news- paper, and Ihal due 10 separation of church and state, more information about chllTChes and their work with teens could not be included. Bur she did encourage me to keep an eye on' ~:',':\¡ '.\~'l"\te, w'rllch may soon include' ~ \ :', '~', ;-" ., ·".;\d -:fKljllr:\t:': ~:\l'ry leen 10 take ...~'.;\nt:¡~l' oí !he uut":lndll1g "'upr0rl U1;tt;,:an he fOllnd In nl;1flY uf our local .:hun:hes. We cerlalnll don't have all the 10'W ers. bul we can point you 10 the one '" ho does: "Trust in the Lord with all your heart, uan not on your own un- cerstanding, In all your ways acknowl- edge Him and He shaH direct your paths" (Proverbs 3:5-6), The Rev, DAN McMILLAN San Juan Baptìst Church Port Townsend - Practice what you preach Editor, Leader: In his letter to the editor in the Aug. 15 Leader, Ray Jackson said he was shocked and appalled by the "intoler- ance and bigotry" displayed by Kevin Bowen in his letter of Aug. 8. Well, I am shocked and appalled by the uitolerance and bigotry displayed by Mr. Jackson in attacking Mr. Bowen's beliefs. The question raised as to whether the county was promoting "al- ternative lifestyles" was legitimate. It might behoove Mr. Jackson to look up the word "normal." ' Mr. Jackson, in his letter, came per- ilously close to telling Mr. Bowen to get out of town if he couldn't conform to the thinking of those who "celebrate di- versity." In effect, Mr. Jackson not only trashed Mr. Bowen's beliefs, he denied his right to express them. I guess tolerance doesn't mean what it· used to mean anymore. (Well, I knew that.) WINKY FULLER Port Townsend ~- ¿;ZC: -6 ( P'::;r:-iSL1_\ o.,\1L\ :\E\\'S ------ Flu season to hit soon on Peninsula 13 u t official urges L. ~onìe to ctelav getting vaccine By BHDiDA H,,\NRAHA..'i ~f:_\:.\:;,-:.:\ DAiL'¡ .\J¡.:'A'S In an attempt to aVOId d :1u ep:de'm:c dmong the hlgh-:-:sk r:up¡..dulion the state is en1..."Y..l~·· d;.:~:;ig ht:'c...dLb.y pC"Jpk' (u t:2lG1Y ;fl:::l::g d 11u :..;hut \S~_· t'Xprct to ;¡UVt' ~:1V,lg:¡ ::u ';acC::1l~ ~o fT1eet stale i.{:'~;:: :~et'ds.·' ~alcl Cindy' 'C~.. health ¿ducato:' Cor :t1e ,,:,-,:e Depanmem of Hea:,:l 3 ::Y'.r7'¡ur.:Lutlon program. '~,L: 3~:pp:leI'S expec: t,) -¡~:.·;er :ne ';;J.CC¡:ìt:' later ::-:un .. '-::'t:-i G~!,;:; ;;-: ~.he past. "\VthnU;6w:Jn ~tLl!J..~ :;; '~:c- ~:-:1~¡er:dìng ~o health cart:' :~/:":'.îders thut l1u shut~ D(: :Ç:"",::,n to high-risk groups." Plenty of time (.~~;ea~ur; ~aid there....'lIi u,·~,;;L\ '_J; t:me Cor others L;) let :~~ç':r !:Ll shG::~ before nu~~J.~ ~" ¡~lea3u:: :-3did the flu Se(;¡'::iJr1 :he state generally ;1.lns :"'¡"'t't:;, .Ja:-F,¡ary ::lnd .\!,,:'ch, .::,t:":..:.K1n¿ 1n :-eDrLiary :::-:[;1_' .;;;::.UC 'hè \'(jCC¡¡>~' ìS ',';',¡:¡,:cé,"Cl __ oe -:ie!: V': I",'¿ ." ''-.l:1U toe first of October 'We are ';flcouragmg :;:ose ..~ :r:ê hlgh~~lSk categories so ~r< '. nl"" :.,nc;t d.'" ~üon as tfH: ';ac- ,:::>.: <.ir~',\:~s C;'¡eason sale., q Heal thy people can ·.....ait ..:.:-::;1 .at~ ~uvember or De~e:nbe:' ~o get ~.he shot dnd ~:... d\'Uld U1e ::u lnCluded ~n the hlgh- r:,óK ,:ategúI'v include ti-,OSE: .....:::1 didoetes, asthrna or other '~:;6 conditions. heart disease, ~>clney dl~ease. and those ',\'ho ~ire HI''r'~posjt:\'e :::)e!1~i.Jr C;L.zens ùver D~. ;'":µ,·tt::';n '-':::':.re r~sident.s. ;-J;,e~- .vd:: ',\',:) r11l: í-; ;:1 :ht:lr ::)ecor.:i lJr ~i ::·!!nl..~ler und ht:;_:dth ,..;'(' '.\'urkt..'L-; :-;huu]d ubu:..:u!)- :)ld~r gettir.g the shot ear:y. Gleason sald thlS year three "trams of :;:..; will be lnciuded lt1 the vacc:ne, Two A-Strains, :\ew Caledonla and A;;'10scow and Sichuan. a B·Stralfl type lb. The syn;ptoms of the nu include fev¿r, headache, mus- Cd: ache's weakness, sore throat ane: cough, Cieason ..,a:d , Those. w n~) are. a:lç::'glc to 'or,," prote::-, :ound :n é:-:e yolk eggs shc'...~d not reCè;\'t;' the ;::.:.\.:cinaLlO:~. Gleasc¡; 3d.:~ Misconceptions ~..~ieasor. .~aid :nè~o:- are rndnj'" mlsco:1c~ptions daout :r.e tiu, ,:-'.:..:iU(11ng ::--.02 shot .n;·t:cung ::~~~ person ',\/:::-1 the "The vJ.c:..:ine :.::i :-let .~ve. lt cann.ot ca1...;.se an :nfec:ion," ~~:tee:a~~t:~~/~mt~~n~h:~ts é~~~ ;;n):ubi.y 23...lght U 2.:;;,¿..::r :11..:. ',,:'~¡s be¡'ore they ;;ut the .::inuL ~he SdlG.: ~akes ¿8C'..lt two weeks be:·ore th¿ vaCClI1e j)"glns .' Drutec: :::eople clgaln"t th" '.h~ee "t,am~ o(Ou ::~l':UdeQ 1:"'. :hlS }'ear.s \·aCClne. C~ieuso:': :îdlci an:-'cJ'.è '^'aot- ing » UVi~'>.:: the flL: is er.cour- aged :0 get d :1u shot, :n.:é that t:~e stu:¿. is encouragIng :-:ealth}' peupie to '.~'¿~:' untìi ia:ë!" In t!".e ·:ear. '\Ve \\ d:': Lnuse ·AT.,: :l~'~~ at high-risk :(,i be first ::; ~ine to prevent the nu,'J (}ieasor; sUld. "That mea.ns those \\lno are healthy ar:d can afford éO wait ,,!-wuld aUo\\! others :0 protect themselves" ' Cleasor- saiò last vear 15 to 30 perce';: of th~ Cnited States populatlOn oecame infected w::h the ì1u :'-10re :"an 114,UOU nu· reiatl:.d h'..:~p¡ta!lza':.lün3 and more t!wr- :W,UOO t:~¡·re¡ateò deaths UC('''::Ted In Lne \.:n,ted States, ,,¡]v said Wednesday, September 5, 2001 · B 3 Back-to-school season IS vaccme checkup time Vaccinations against such childhood dis- eases as measles. mumps, rubella, diphthe- ria, tetanus, hepatitis B, whoopmg cough and polio are a safe and effective way to prevent serious complications associated with these illnesses, report health professionals. Parents, health care providers, daycare centers and schools can play an active role to ensure that children in Washington are protected against possible complicatlOns from vaccine-pre- ventable diseases, The health department encourages parents and providers to include immunization checks at every office visit. For more information on immunizations, check the state health department website, www,doh,wa.gov/cfh/immunize, talk to your health care provider, or call the local health department at 385-9400, "What did you do on summer vacation?" That's a -:ommon question when kids head back to school. Whether you went to Illinois to visit grandrna, saw a Mariners game at Safeco FIeld or took the trip of a lifetime to China. you may have come back carrying more than Just the memories and souvenirs, reports the Wash!ßgron State Department of Heal¡h, As :nternatlonal !ravel becomes more comrnon. so has the number of vaccine-pre- ventable diseases that are being imported. Many diseases that are rare in the United States still cause devastating illness in other parts of the world, And you don't have to go to those places to be exposed, warns the de- partmenr. Some viruses stay in the air for qUl!e a while, and all it takes to be exposed is to breathe rhe same air as someone who earned the disease back with them from a tnp overseas, So before those summer memones fade away. health officials recornmend that par- ents start the school year off with the com- fort of knowIng their chlldren are fully lrnmumzed, "Kids deserve a healthy start when school opens'-' says Secretary of Health Mary Se!ecky "That's why It's so important to make sure your children are up to date with requued Immunizations before school starts." Immunization rates are relatively high in 'Nashington state, yet about one-quarter of all 2-year-olds are not fully immunized, re- ports the department. The percentage of teens and adults who are not fully protected IS even higher. As parents take theu children shop- ping for school clothes and "back to school" classroom supplies. they should make it part of the rout!ße to see their health care pro- :Ioer to check on what vaccinations the chil- dren need to return to school. advises the departmenr. Severa] immunizatIons are required before children are allowed to attend school. All children in kindergarten and fust grade must receive a second dose of the measles-con- raining vaccine. usually given as the "!\-1MR." \10sr kids get the first dose between 12 and IS months, The Centers for Disease Control and Prevention recommends the second dose be admmistered to children between ages 4 and 6 rather than waiting until they reach the sixth grade. Students in sixth through 12th grade still need the second dose of MMR if they haven't received it. The required hepa- titis B vaccin¿ tTašrbeen e?ctended to include kindergarten through fourth-grade students. ImmunizarlOn exemptions are allowed for medIcal. personal or religious reasons. Vaccine available for college students The C~nters for Disease Control suggests that students entering college who plan to live in dormitones be aware of the availability of meningococcal vaccine. Living In close quar- ters with others makes college students par- ticularly susceptible to mfectious merungitis, It is recommended that students discuss meningococcal disease and the benefits of vaccmation with their health care provider. Currently there :s a nationwide shortage of this vaccine, reports Jane Kurata of Jefferson County Health and Human Ser- VIces, JCHHS can only get the vaccine in vials containing 10 doses that expire in 1 ° days, To make the most efficient use of the available meningococcal vaccine and avoid wasting doses, the health service is taking names, phone numbers and dates of depar- ture for students 'NIShlng to receive the vac- cine, When the department has at least five clIents wanting the vaccine, they will be called to come In to receive the vaccination wlthin the tlme [he vaccine is usable, To learn rnore about the vaccine. residenrs should call their health care provider or JCHHS, 385-9400, -;'- I ) I( -, e t ..._-'-- Mercury levels in Some Fish Pose Health Concerns For Children and Women of Childbearing Age ,\, .1 CO.1SLll SLlte. \'Clshinz,ton is a haven lor se.lfood 10\'ers, Fish is .In excellent, In'v-t.n food and .1 gre.n source of protein, vitamin<;, and mineLlls, £.ning a variety of Ùsh and shellfish contributes to a balanced, h\.'.llthv diet, However. some species of fish contai~ mercury levels th.n present health concerns jar childre:1 ,tnl~ 'yamt'n of childbearing .u:;e, In April. the \V.lshington State Depart- Glent of Health (DOH\ issued a statewide "hsh Consumption ,\LÌvisory," It expands on .1 feder.1l ,ldvisor" b\' thè U.S, Food .md Druz, ,\dmini,tL1tion that warns women of cl1l1dhe.1ring .lgè and children under age 6 not to eat an\' shark. s\yordíish, tildish, or king m.1ckereì. Thè DOH advisory extends th.ll \yarning :0 both fresh-caught and fr,¡zen tuna ste.1ks, It ,1150 recommènds th.n children. Jnd ~.\·:__Jn1en ~':\'ho Jrè or ~~ho nl.1)' become pregnant. limit their eating of c1nned tuna, based on their badyweight. Guidelines .1rè: . '\('omen l1i chikbe,lfing dge should limit the .1I11ount of clnned tuna thev e.n to about one C.in per week (6 ozL ,\ '.\'onun ',..-110 weighs less than 135 pounds should é:.n less :h.1n one can of tuna per week, . Children under cige I) should eat less than one';1.1lf .1 C.Hl of :un.l (3 oz) per week. Specitïc ',wckl;' limits for chil- dren under 6 range from 1 ounce for a child who \veighs .1bout 20 pounds, to 3 ounces for ,1 child who weighs about i)J pounds, Mercury Exposure Mercury contamination is a worldwide problem, .'vlethylmercury is commonly found in m,lnv kinds of fish, especially Lug\.' species th~lt eat smaller fish .1nd .llso those that .lre long-lived. bst \'ear, the N .ttional Resc,lrch Council reported on the toxicological eifects of methylmercury. I In J anuar\', the Centers for Disease Control and Pn~vention (CDC) published data' indi- c.1tÍng that most of the exposure in young children ,md women of childbearing age in the United St.1tes results from eating fish contaminated with methylmercury. Other pmsible sources of mercury exposure include: ~ airborne I11dcury vapors from spills, incinentors. lI1L1 industrial processes: · workpbce contJmin,nion through air \'apors or skin contJct: · folk practices that include the use of rnercurv: · release of mereu[\' from dental work and l11CC11l..',li trcatIl1cnts. ,I!lilllfetl page-! Survey Gives Closer Look at Prevalence of Asthma Increases in a,thnu pre':~¡)encè. seen in n,nion,ll d,tt.l. ¡-¡,\VI: led to growing recogni- tion of tilè sub~tantiJi public health burden of childhood .1"hn1.1. The Department of He.llth began èstinuting the prevalence :',tte of asthm,1 l!l \v~\shington State in 1997, ,\ recent sur':e': of adolcsccl1ts ,l!lowed closer examination of prev.1lence d.1ta. We compared dat.1 on the prevalence rate of .1sthma in ,ldolescents from two sources: the Bc!1.1vior.1l Risk F .lCtor Surveil· bnce System !BRFSS) and the Youth Risk Beh.1vior Survey (YRBS), Throughout the ye,lr, BRFSS interviewers use .1 computer- assisted surve:: to conduct telephone interviews of persons ,lged [8 ,md over, C< "Ii iI/ii ed fiage .l A Monthly Bulletin on Epidemiology & Public Health Practice in Washington State Vol. 6 No.4 In This Issue: Call for Sentinel Physicians Page 2 Monthly Surveillance Data Page 3 Calendar Page :+ WWW Access Tips i Page j Page 2 For More Information: ('1[lLKt the DOH Oifice 'JI :\on·lnkctlous Conditions E?,,!emiolo!(y: Ste\'en :-'l.1cd',n.lld .It ~i,:·nli·42;', ,tcwn ,m.lcdon,¡]d@doh,w.l,")\': ,)r L:1I1.ln S, Benslev .It .'6:-236-4248, Illl '.In, bens]ey@Joh,w.l.¡;o·;: Asthma Survey {from page 1} whu respond ior the child, From prior BRFSS d.lt.l, we know th,n ,1bout 40''l'o oi households h.lve children, :md th,n about 16"{, of those h,l\'e .1 child with asthma, The YRBS is ,1 classroom paper-and-pencil ,urvcv, relies upon self-report, ,md was .1dmiI~istered in :\pril 1999, We examined the 1999 d,lta irom BRf;SS "proxv respondents" for children aged 13-17 ,¡¡hi YRBS ,elf-report dat,l from children in êpdes 9--12, :-'!ost children in these grades ,1re in the .1ge group 13-17 for most of the schoul year. though some high school seniors arc older. The BRFSS .1sks: "Has a doctor ever said th.lt that one of 'four children had asthma?" and "Does this child still have .1sthma?" The YRBS .lsks: "Have you evcr been told by .1 doctor or other health professional that you had asthma?" and "During the past 12 months, have \"em h,ld an asthma attack or taken ,1sthma medication?" These 1999 mn'e\'s incluckd ),608 BRFSS respondents ,me! +,J22 YRBS respondents. Self-Report Gives Higher Prevalence Rates Responses from the two surveys show th,lt self-report results in a higher preva- lence estimate, both ior current asthma and ever had mhma (T.1ble 1), These differ- ences ,1re sLltisticalh' significant and mean- ingiul. The pn:\'alence rate of asthma in ado!cscents irom;e!î-report is J.bout double tt1.1t seen '.vith proxy-report: 1.7 times as hIgh for ever had .1sthnL1, and 2,1 times as high for current asthma. The children in the YRBS SUITe\' are ,;tightly older, and thus have had more time to recei\'e a diagnosis of lsthma. However, this ¡,1Ctor \v(mld not explain the higher prc,.-Jence rate of current asthma. In the YRBS daLl, '.ve found no trend for increased .1sthm.1 prc\'.llence (either current or ever ¡lad) \vith hisher school~Llde, TABLE 1: Comparison of proxy reports and self-reports of asthma in adolescents Ever had asthma Current asthma ~,~~~'cs '",;: i 20':' Proxy-reponed ]/0 (95% CII Self-Report % (95% CI~ 12,3 (9,9- 14,6) 7,1 154-9,2) 20,9 (19,6-22,2) 14,8 (137-15,9) .... ".,. . ~ , -,." ~... ..... ~.'·',-"Þ ,....._,....-...<i>...,.,.,...=-- - -~~-,-_.. Sentinel Physicians Needed for Influenza Surveillance The Washington State Department of Health, in conjunction with the Centers for Disease Control and Prevention, seeks sentinel physicians for influenza surveillance during the 2001-2002 season, Contact Phyllis Shoemaker, 206-361-2830 by August 31. Se'.-erJl rCJsons Il1.lY ::xpbin these differences, including "instrument effects," underreporting by proxies, ,md overreport- ing by adolescents. Instrument effects may arise irom differences in wording between similar questions in the twO surveys. However, the magnitude of the effects is likely to be SI11JIL Underreporting may occur if proxies are unaware of the condition or are "in denial." The BRFSS proxv is usually the parent. although a grandparent or unrelated adult may be the respondent. However, asthma is not ,1 hidden disease. nor .1 dise~lsc with stigma. and it is hard to hide ewn if de- sired. Although J parent or '~.1rcgiver may be in dcni,l!. the research literature gives little evidence of such sit1utlons, O\'erreporting b,' adolescents IS another possible explanation for the higher preva- lence estimates in YRBS. although the reason is unclear, One plausible explanation is ,hat children ,1fe Ekdv :0 be less knowl- ed:;e,lble 1Dout .1 prcci'e medic.l1 diagnosis. , . . " 1 ! . anû ',ome may lIlaccura[ei" Lwei WeIr condition 1S .lsthma. \'{'hile it is true that .1 parent or caregIver may be :11Ore knowl- edgeable than a teenlger, there no reason ior the eifect to be differential: the less k:lOwledg''',lble child would ,eem equally likeh- to underreport .1S to ,y;erreDort. all othe"r t'a\:ti)rS :Jei~g èClUJl. .. But. ,111 other 'f.1Ct·ors 111,.1:: not be equal. .\~thnu :ll:1\' n.l\'e .1 ¡wrceln:d beneficial "status," For example. ,1 t<?en m,lV gain in ;,)Ct.1l ~t<l:11' if :he -:hikL pc'"r" view asthma as .1 svmpathy-inducing disease, It is also plausible chat excused absences {rom school I11.1Y be a desired benefit. These J,lL! confirm th,lt .lsthma in children is .1 substantial public health burden. It is unknown whether the true prevalence rate is closer to proxy report or self· report, but it prob.lblv lies somewhere betwecn the two estimates. Page 3 M nthly S . I 1 D ata by Co U nty 0 urve I a nee J!lne 2001 . - Washington State Department 0f Health .~<o <o'lJ ~ 'lJ~ ~~ ~,<.j ~'lJ ~ ,:\.:S' ~ ,,~ .<, "'- '?- ~ (:J<;:: ,,(:J" <,' ~~ 'lJ~ 'lJ'" ~. ~~ ~,<o ~(:J ~:~ ~, ~'lJ ~~ ,~<o .~<o ~ ~ d> ~ ~ .~ ::..' ,,(:J ~ ~ §' 0: '?-' ~~ ,><0 'lJ\ ~ (:J\ ~ ~" ~:~ ~ 'lJ~ ~'r> (:J~ ~ ë ,,(:J ~~ ~ ~'lJ<:>' ~'lJ<:>' ~(:J" ~'lJ ,,~ 'v'lJ County <V' ~~ C:) ~ '\.)~ ~ ~ ACJrTS \ 0 0 0 , :J 0 0 0 0/0 'J , 0 0 ~ 0 , 0 :] OlD ,.\.~..~~:r_ ., J I , 1 4 0 ~ ~ì/ì ::: ':'~',"r" ! 4 fJ , " u - J 0 , !J , 2:'24 ~ -;;.:. i ~ ~. J ~ :.....1 U '+ ~ J D 0 0 0 0 v 0 0/# ...,(1'.'.J" I :,:1r(: , 0 0 47 8 0 Ji7 ..Ui'..J:':'C:::1 ~ 0 0 0 1 u oj 0 0 '0 0/0 -~;J\V' ::z , " 0 0 ij LU 0 " i..} !41 J u v ) n 6 , 0 0/# =c:j'=]'3S j " u IJ ~ Ferr'/ J 0 J Q D J 0 3 0 j 0/0 :':~3r:K¡~n J ", 0 !J 0 J 0 0 8 1 " 0/# J¿r':¡e:d iJ 0 j " 0 0 C 0 0 0 0 'OlD u :3rant ¡~, , 0 0 0 0 0 0 0 - 1 0 v 2/42 ~af cc~ 0 0 J 0 0 u " ON .: ~ ".1 'f) ." 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J J/iJ r3K:í~3 J I] [I 0 4t.1 d v 'J/'8 'Jr¡(;.r~c',.vr :J/O :Jrrent \¡1cnth ':: 46 ~ 1'1 , 3 " 22 24 986 227 33 38 0/301 'v , v ,;une LOCO .;::0 Q ì2 , 4 3 5 57 1 1 2 962 158 34 67 :0/349 2GCi :0 ,jate 26 208 Q'} 52 -)j 16 43 67 29 68ì8 1459 270 97 7Si2301 "''-' 2000 :0 date ::L 206 31 G 146 ,~ 8 30 189 128 6391 1 1 2 255 69 52/2093 '" ~. J ~:2:::eJ -:r, ''?::;::í~S '¿.:.:::veG JS '); June 30, G:r'e:wl~e ~ ,'~::.n::r:"¿C: ¡ecor:3 ::d¡:r83S 33SCCla::::.J with pesticide exposure '34' \:::':be¡ ::. dev'a:2J :ests :::(j~J ~E:'J(Je,,:':onfl!med reports~ / taul te~ts perfcrmea ¡not [ìiH!lber of chi!:JreI1 tested); number of tests ;Jef r;~ "f;;J::" "3:e ;):~2'.i::S:, ",j; ~Jur',~', '2f restdenc::: fOf chll(jrel1 ~est~(j: # rrV:d(]S fewer than 5 w:.;ts p8r!Qrmed, !1',jmber ,;inltted for ifl'JicatE:S rea:cns ::80: Page 4 'NWW ,~ecess Tips :- :-- í11'.,.;C :ntorr;;Jr:un on ~:::.' me:-"::lfV i,dv;sOf\', :-:fl'; t·) tne Dq:~Jrtment : HeJltt: web )it~:)n '~:'ih Fh'::S rr)f H~J.lth~; " ' ., .V.l~r:t:on :.1t: , , ,-, , ";1:-:\,'",\'. '~~')n. ·;V.l.gO·;' !:Sh Mercury References: '<.ì~:!;:1.il RcsL'J;;:;¡ (:,~,'J.:icì. ;().\-io)¡'.-)(!,Ù.'a/ .. '.'(¡.'. '.[i.!!/)\'i»:erC¡l r\'. ':\·,)h:~g!{-:::1. DC: ~,.lt:onll :',..:.:..Jem~: Press. '::::. -c~·~t('; ;r:¡ Dise.l5è Controi .-1:-:": ~);::':t:nt:on. .'.!fjrÒ¡ddr "!-Jr!{ll,'/:' \XÚt'~,:':- Re/)o,l"!. ..., -::od lnd nJ.ir mercury . "",:::s ::1 ~;!)'Jn~ .:~ddre!1 ~. .1 ·;t:~):11l'!1 IJi ;.~;::idbeJ.¡- .:::,: ,.~:.:. ;.'.\l\Cl.' ':::1; ': :9 -:":-,4', Mercury in Fish (from page 1) Health Effects ['I~.llth probl~ms clUs~d by mercun" ~lr~ m()st s~Y~r~' for th~ deYeloping f~tus a~d for \"oung chiìdren. Preglunt women who C.lt fish cont,lmin.lted with large ,1mounts of methylmercury run the risk that their b,lbies will have central nervous system ,:h.l11gèS th.lt can lffect their blbv's abilitv ',() le:1rn .me! possibly damage to' the hea;t I)r bìood vesscls, In .ldults. methvlmercury can le.ld to problems of the centrll nervous s\"stern .lnd possible ldverse ~Hects on the clrdiovascuhr system, Based on humln and .mimal data. the bternatioIul :\genc:' for Research on Cmcer (lARC) and the Em"ironmental Protection Agency (EPA) have classified methylmercury as .l "possible"' human carcinogen, This me.lns thlt mercury has produced cancer in two mimal species, but :h.lt e\'idence is not .ldequ.lte to say that it causes C.lncer in humans, Reliable .md accurate ways to measure :nêrcur\" in hum.lns require tests of blood. urine. or h,lir samples, and must be per- formed in .1 doctor's office or in a health :linie, \105: tests do not determine the form 'J¡' I11erCUn" exposure. H,Ùr anal:'sis is con· sidered useful for exposures to methylmer- cury, and may yield results for exposures '.,"¡thin the p.lst ye,u, Choosing to e.lt fish 10';v in mercury is m tmportant str.ltegy to protect he.llth. The long,term str.lt~gv for reducing eXDosure to me;cur:: is to lo'~"~r concentra;ion; of ;nethylmercu:'Y in fish b:: limiting mercury ..._-_._-~~~, About Mercury Mercury is a metal that occurs naturally in rocks, solis, water, and air, It may be released into the environment as a result of volcanic activity, Mercury also comes from industrial pollution, especially the burning of coal and other fossil fuels and from burning household or industrial wastes, Mercury compounds settle into sediments of lakes. rivers, 3nd oceans, where bacteria convert the inorganic mercury compound to methyl- mercury, Fish primarily absorb methylmercury from the prey they eat. and also from water passmg over their gills, releases into the atmosphere from burning mercury-containing fud and waste and from other industrial processes, Contami- nants like mercury that .lre released into the atmosphere today ma\' end up on our dinner table tomorro\v. Calendar 8th Annual Joint Conference on Health October 1o, Yakima The conference theme is f felllth Di,,-parities lil </ I\r)/,!c! \Y.ï/h/llt J)rJi'{!el'\": sponsored bv the \'Ç ashington State Public Health .-\sso~ia- tion in cooperation \vith the \X' ashington St.lte Department of Health and the Yakima He,lIth District. For inform.ltion. visit the web site at www.\vsph,l.org ,OJJp3 JJ}lJUalJS ck IJ Jt. 1'¡OPlOÐ'~ el::Je~"J 6£Þ2-B9£86 ~,., GN3SNMOl läOci 1$ Nt;Or.?J3HS Sf9 1N3Wl~t;ld3a S3JIn.:f3S Nt;iWJ1H3 H111;;f3H 'OJ NOS.:f3~.:j3r ~3JI~~O Hlltl3H r¿ SSSþ 3~~Ol S~~OH~ £86 ~r~ra_£xxO~Il~xxxxxXXXXXX%XXXX%%XXXXXXxxxxXXXXXX%XXXX%Xxx ÕUI¡UlJd ~o 'Ideo a¡e:s UO¡õull.jsefV\ CI '<f d aBe¡SCdS n JllllDIIJ GiS l~Sðd ~'C¡iD3 8woeuf!}V V6 '^.auul^JeV'J '1 eJpues $1:0.11I,oUO;] SnOlpajU/ ,OJ ;s;50folwap/d3 aJeJS Hd,'j 'OV'J '145eAeqo) u40r -~~4it~s.!! I ! I ! II!!!!! I ! I! II' !!!! I !! ! I !!! ¡!! I!!! I'! II! !! I!! I !! I! 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