Loading...
HomeMy WebLinkAbout051503 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, May 15, 2003 Board Members: Dan Titterness, Member - County Commissioner District # 1 Glen Huntingford, Member - County Commissioner District #2 Wend! H. Wrinkle, Vice Chairman - County Commissioner District #3 Geoffrey Masci, Chairman - Port Townsend City Council fill Buhler, Member - HosPital CommiSJioner District #2 Sheila Westerman, Member - Citizen at L1",e (City) Roberta Frissel/, Member - Citizen at L1",e (County) Staff Members: Jean Baldwin, Health & Human Services Director L1rry Fay, Environmental Health Director Julia Danskin, Nursing Services Director Thomas L1cke, MD, Health Officer Ex-officio David Sullivan, PUD #1 Chairman Masci called the meeting to order at 2:30 p.m. All Board and Staff members were present with the exception of Member Westerman. There was a quorum. APPROVAL OF AGENDA Member Buhler moved to approve the Agenda as presented. Commissioner Huntingford seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES The following corrections were noted in the Minutes of April 17, 2003: Page 2, Informational Items: . Under the Jefferson County Washington State WIC Report, Sentence 2 should read: "Julia Danskin reported that this federally-funded Women, Infant and Children (WIC) program is subsidized 34% by Jefferson County." The following sentence should also be added: "The estimated cost to provide the WIC program at JCHHS is $90,562, of which approximately $55,293 comes from Washington State and Federal funds, and an estimated $35,269 from Jefferson County funds." Page 4, Board Sponsors for Environmental Health Regulation Development: . Paragraph 5, the sentence should be corrected to reflect (HB1376) rather than (SB1376). . Paragraph 6, the Water Policy or Comprehensive Drinking Water Ordinance workgroup should include Wendi Wrinkle in addition to Member Buhler and David Sullivan. Commissioner Huntingford moved to approve the minutes of April 17, 2003 as corrected. Member Frissell seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT - None HEALTH BOARD MINUTES - May 15,2003 Page: 2 OLD BUSINESS AND INFORMATIONAL ITEMS Letter to Public Works Board Trust Fund ADDlication for Beckett Point Community On site Sewa!!:e Svstem: Last month, the Board authorized Staff to prepare a letter of support, which was included in the agenda packet. Member Buhler moved to approve the letter as presented. Commissioner Huntingford seconded the motion, which carried by a unanimous vote. NEW BUSINESS Communicable Disease UDdate - Severe Acute ResDiratorv Svndrome (SARS): Dr. Locke reminded that the Board had previously received the notice and fact sheets sent to providers in the County. Some of this information - such as the case fatality rate - is already out of date. Among the probable cases of SARS, the fatality rate for people with the corona virus infection is now about 15% as opposed to 4-5%. People over the age of 65 have a much higher fatality rate - possibly reaching 50%. There continues to be a lot of press coverage on SARS, despite there being little evidence that it has hit the U.S. Of the 60 or so probable U.S. cases, only six people have actually tested positive for the infection. It continues to be out of control in China and Taiwan. It is encouraging that Vietnam and Singapore have brought it under control using isolation and contact precautions. SARS might be the fIrst opportunity to exercise new rules dealing with isolation and quarantine. Communicable Disease UDdate: SmallDox Vaccination: Dr. Locke noted that the Board materials included a press release from the Association of State and Territorial Health Officials (ASTHO) that essentially states that they do not support Stages II and III of the national smallpox vaccination program. He believes the statement from Washington State Public Health OffIcers Society would be even clearer, that there is no evidence to suggest the vaccinations should continue and that such an effort would be hugely expensive. Although Federal agencies are on record as having gone into Stage II efforts, it appears they are reconsidering this action and might continue with an extended Stage I. The Board of Health felt an expression in support of either of these organizations' positions was not essential at this time. Communicable Disease UDdate: West Nile Virus ResDonse: Member Frissell mentioned a recent letter to the editor of The Leader from a County resident reporting a lack of response from the Health Department regarding a dead crow. She fears that even the perception of an unconcerned response might make people less inclined to report. Jean Baldwin explained some of the challenges in educating citizens as to the limits of the County's surveillance capabilities. She reviewed the recommended procedure for handling crows until they can be picked up by the County and said she had also spoken with clerical Staff about the screening protocols. Dr. Locke added that Jefferson County is allotted 40 tests throughout the entire mosquito season and has already tested six crows. He reminded that the County is not testing mosquitoes for West Nile. Veterinarians are monitoring unvaccinated horses with symptoms, which was how West Nile was introduced. In addition to the Board's request last month that the Department produce a press release on West Nile, there was interest in including the Health Department protocols and a statement that garden centers have HEALTH BOARD MINUTES - May 15, 2003 Page: 3 larvicide products available for home ponds. It was suggested that in light of the recent letter to editor, The Leader might be more likely to print the Department's letter response and an article. Public Health Fundinl!: - Action Alert: Dr. Locke noted that the referendum that would have allowed a public vote on a dedicated source of public health funding died in the legislature. Since the $49M that had been a stable funding source never made it into the House budget the current focus is to have complete funding for the second year of the biennium. There was support for modifying the last paragraph of the draft letter in the agenda packet as follows: in the third sentence, replacing "its minimum share of funding" with "the state's share of funding" and in the fifth sentence, replacing "Without this funding" with "Without adequate funding." Mav 13. 2003 Health of Jefferson County Forum - Next SteDs: The Board commended Staff and Chairman Masci for their excellent efforts in putting together the workshop, noting that the information was valuable and the groups well organized. Jean Baldwin recognized the valued participation of school boards, UGN, hospital commissioners, and the OlyCap Board. She then led a discussion of a strategy for moving into the next phase, noting there was interest in the following work groups continuing: health care access; vulnerable populations - young children, 18-34, and seniors; socio-economic issues and impact on health; substance abuse, and mental health. Each work group would include one staff person and two community facilitators (Chairman Masci, David Sullivan, and Members Frissell and Buhler). The facilitators would help the Department define what the workgroup would be measuring long term. A workshop summary and priorities would be provided to the Board in its next Board packet. Jean Baldwin noted that on May 15, the State Department of Health and Clague and Associates would be coming to get feedback on how local health jurisdictions do assessment. They might want to contact Board members. There was discussion of other opportunities for groups to hear a presentation ofthis data: presentation to the physicians, the religious community, mental health and substance abuse boards, and the hospital board. It was suggested that a written summary ofBRFSS/Other Data as well as what was done in the forum might be more useful thana lengthy presentation. Jean Baldwin recognized that CD-ROMS with the data would replace future printing of the books, which cost $8 each. There was Board agreement that the Data Steering Committee and new facilitators should meet before the groups start convening so that facilitators can present in a common format. It was suggested that the format used in the afternoon of the workshop be duplicated, but receiving discussion questions in advance and suggesting certain portions of the book with which the group should become familiar. Chairman Masci suggested that the work groups might be tasked to issue a press release after three to six months. Jean Baldwin agreed to send some information out soon to bring this all together. National Nurses Week Focus on Public Health Nursinl!:: Marty Johnson, School Health Nurse for Chimacum, Brinnon and Quilcene as well as Children with Special Healthcare Needs, talked about National Nurses Week, which is celebrated May 6_12th. She provided background on the life of the founder of Nursing, Florence Nightingale and provided a brief review of the history of Public Health. She then offered the results of her survey of the professional background ofthe County's public health nurses, which accrued to 429 years of collective nursing and nursing-related work experience. Referring to a 1946 discussion guide titled "Is Your Health The Nation's Business?," she described how public health protection has become a basic government responsibility. She reviewed the core functions of Public Health and displayed a chart of the impact of vaccines in the 20th Century. She showed newspaper clippings about smallpox collected by health nurses from 1936-46. The U.S. Department of Health and HEALTH BOARD MINUTES - May 15, 2003 Page: 4 Human Services predicts the critical shortage offull-time nurses to reach 150,000 by 2005 and 800,000 by 2020. She then compared contemporary public health nursing practice with some ofthe qualities being sought in nurses in 1914. She reviewed the various County Health programs and discussed a sampling of client contact counts from 2002, representing home, office and school encounters in community-based programs coordinated and staffed by public health nurses. A pie chart was used to illustrate revenue sources for community health programs and the challenges of funding for Public Health for 2003. She provided background about and reviewed goals of public health nurse home visits. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS - - None AGENDA PLANNING/ADJOURN The meeting adjourned at 3:42 p.m. The next meeting will be held on Thursday, June 19 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH ~. ~ ffrey Masci, Chairman (Excused Absence) (}t:;U6(.tl~" ;rh Buhler, Member an (Excused Absence) Sheila Westerman, Member I~-?~~ Roberta Frissell, Member April 17, 2003 Public Works Board 210 11 th Avenue Southwest, Suite G-2 Port Office Box 48319 Olympia, Wa 98504-8319 RE: Public Works Trust Fund Application for Becket Point Community Onsite Sewage System Dear Public Works Board Members: The Jefferson County Board of Health strongly supports this application. The installation of a community system more than 200' from the Discovery Bay will reduce the impact to the bay from the Becket Point onsite sewage systems. Discovery Bay is a rich shellfish production area and has maintained high water quality standards under increasing pressure from development and changing uses. The Board of Health is aware of the sensitivity of this area due to its physical proximity to the marine waters and excessively coarse soil conditions. Both the Jefferson County Discovery Bay Watershed Plan and the Washington State Shoreline Survey of Discovery Bay highlight this area as high risk for degrading water quality. The members of the community have shown a high degree of commitment to this project through community meetings, preparation of feasibility reports and cooperation with the local health jurisdiction in correcting or minimizing impacts from these onsite sewage systems. Their efforts are admirable. We will continue to provide educational opportunities to the community in effectively managing their household practices for the effective long-term operation of this community onsite sewage system. We appreciate your careful consideration of the proposal and strongly urge your support of this project to remove at least 79 individnal wastewater discharges that are in such close proximity to Discovery Bay. Sinc~ __ GeoffMasci ~ Jeffers. on ~~ard of Health L~_ .......tl> Dr. Thomas Loc e Jefferson County Health Officer - &?- COMMUNI1Y HEALTH 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 NATURAL RESOURCES 360/385-9444 DEVELOPMENTAL DISABILITIES 360/385-9400 SUBSTANCE ABUSE & PREVENTION 360/385-9400 (ASTHO) ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS IMMEDIATE RELEASE MAY I, 2003 CONTACT: Paula A. Steib, 202-371-9090 psteib@astho.orq THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS (ASTHO) ASKS FOR MORE CLARITY ON NATIONAL SMALLPOX VACCINATION PROGRAM (Washington, D.C.) - May 1,2003 - States must be prepared to address all public health threats and emergencies, including smallpox, according to ASTIIO President Mary C. Selecky, Secretary of the Washington State Department of Health. Speaking today to the Institute of Medicine's (lOM) Committee reviewing the nation's smallpox vaccination program, Selecky stressed that to assure continued progress in this area of preparedness, federal, state, and local health officials must have: . A national consensus on who should be asked to consider voluntary vaccination at this time, and why. . A clear articulation of the best currently available intelligence information regarding the potential risk of smallpox to the nation. . A clear statement of all currently known benefits and risks of smallpox vaccination. . A clear statement outlining all liability and compensation protections that now exist under federal legislation. . Sufficient resources for public health preparedness against all possible threats and emergencies, including smallpox. "Smallpox preparedness isn't just about numbers of people vaccinated, "said Selecky. "There are other very important elements. Planning, training, exercising, and revising the plan, are all key to smallpox preparedness. " Selecky told the committee that the experiences of the national smallpox vaccination program to date must be critically reviewed as expansion efforts are being considered. She outlined four questions that minimally must be addressed: . Who agreed to be vaccinated and why? . Who declined and why? . What was the adverse event experience? . What are the risks and benefits of vaccination in light of the current level ofthreat? In an April survey conducted by ASlliO, jurisdictions were asked about the current status of their vaccination program, their ability to vaccinate their entire population within 10 days should there be a confirmed smallpox case, and influences on their ability to vaccinate those targeted for pre-event vaccination. Thirty-four jurisdictions (33 states and New York City) responded. When asked if they could effectively vaccinate the entire population within 10 days, half answered "yes." The survey indicated that the ability to vaccinate ajurisdiction's entire population is not perceived to be related to the number of individuals vaccinated pre-event. Several jurisdictions with fewer than 500 vaccinated individuals responded "yes," while several with over 1,000 vaccinated either responded "no" or did not reply. States indicated that impediments to implementing the vaccine program have included liability and compensation issues, the unanticipated cardiac adverse events associated with vaccination, the perception of a reduced t1rreat level, and other issues such as severe acute respiratory syndrome (SARS). Selecky told the Committee today, "Building preparedness for all potential hazards is very important. Smallpox vaccination is just one element of public health preparedness." According to the Centers for Disease Control and Prevention, approximately 33,500 public health and healthcare workers have been vaccinated as part ofthe national program. By mid-April 2003, four of the 62 jurisdictions receiving preparedness grants had each vaccinated more than 1,500 individuals. Fewer than 1,000 individuals were vaccinated in each of 52 jurisdictions and 20 jurisdictions have vaccinated fewer than 100. The Association of State and Territorial Health Officials is the national nonprofit organization representing the state and territorial public health agencies of the United States, the U.S. Territories, and the District of Columbia. ASTRa's members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy, and to assuring excellence in state-based public health practice. ### Position Statement on Smallpox Vaccination Washington Public Health Officers Society March 24, 2003 The guiding principle in planning for a possible smallpox attack is to balance the benefits of preparedness with the risks associated with the vaccine. Smallpox vaccine is effective at preventing smallpox, both before and within a few days following exposure. It also has the highest rate of serious side effects including death of any immunization currently in use. In addition to risk to vaccinees, inadvertent spread can occur to household members and close contacts. Data concerning the risk of contact vaccinia is from the late 1960's and considerable uncertainty exists as to the applicability ofthis research to populations in which mv I AIDS, organ transplantation, cancer chemotherapy, and immune suppression are prevalent. Planning smallpox response addresses pre-event (preparations prior to any reported suspected or confirmed case of smallpox) and post-event (after a smallpox attack has occurred). Pre-event vaccination plans have been divided into three stages. Stage 1 consists of identifying volunteers for smallpox emergency response teams who will provide emergency assessment and care to initial suspected and confirmed smallpox cases. Stage 2 consists of vaccinating healthcare workers and emergency response personnel, such as law enforcement, fire and emergency medical personnel. Stage 3 consists of vaccinating the general public. Only Stage 1 has been recommended by ACIP and is being implemented. This minimizes the number of vaccinated personnel at risk for side effects while developing the capacity to rapidly provide care, investigate cases and provide focused (ring) vaccination and more widespread vaccination in response to an outbreak. The state and local health officers of Washington agree that planning and coordinating a robust post-event response to a smallpox outbreak is the key to effective emergency preparedness and that vaccinating smallpox emergency response team members is an important part of that preparation. We do not, however, see a compelling medical justification for expanding vaccination beyond Stage 1 as a pre-event preparation strategy. Rather than expand to Stage 2 pre-event vaccination, we believe that efforts should focus on planning for rapid post-event deployment of vaccine in response to an outbreak. Based on our steadily accumulating knowledge about this vaccine, a focus oflirnited resources on planning and training for post- event mass vaccination offers a far greater benefit to the public and minimizes the significant risks associated with the very large scale vaccination envisioned in Stage 2 ofthe National Smallpox Vaccination Plan. As health officers for Washington State, we have supported and implemented a very cautious and limited Stage I vaccination program. While Stage I vaccination efforts should be ongoing (as new health care workers join existing smallpox emergency response teams), we believe that medical justification for Stage 2 vaccination is lacking and accordingly do not support such efforts. Time and resources to prepare for the formidable challenge of a bioterrorist attack are limited. Within these limited resources priorities must be made. It is our professional judgment that post-event smallpox vaccination preparedness and all hazards emergency response system development are much higher priorities than Stage 2 smallpox vaccination. We urge federal officials to reexamine their priorities with respect to pre-event smallpox vaccination and remove Stages 2 and 3 from the national response plan. Report Faults Federal Officials for Problems in Smallpox Program April 30, 2003 By ROBERT PEAR WASHINGTON, April 29 - Congressional investigators said today that federal health officials were responsible for many of the problems that have crippled the nation's smallpox immunization program. President Bush and other administration officials had said they hoped that 500,000 health care workers would be vaccinated against smallpox within a month after the program began on Jan. 24. The actual number, 33,444 as of April 18, is only 7 percent of the goal. The investigators, from the General Accounting Office, said the administration was considering a huge reduction in the number of people to be vaccinated, in the belief that a smaller number, perhaps as few as 50,000, might be enough to respond to a smallpox attack. The accounting office examined difficulties in carrying out the vaccination program at the request of Senator Susan Collins, Republican of Maine, who is chairwoman of the Committee on Governmental Affairs. In a report to Congress, the investigators said they found that the federal Centers for Disease Control and Prevention was reconsidering the goal of vaccinating 500,000 health care workers. The Bush administration told the investigators that "there is no longer a deadline for the first stage, and that as few as 50,000 vaccinated health workers nationwide would provide sufficient capacity to respond to a smallpox attack, n the report said. But, the report said, the Centers for Disease Control has not set a new nationwide goal, has not said how it arrived at the lower figure and has not asked states to revise their plans for immunizing health care workers. The accounting office said the federal government should work with state and local health officials to revise their goals and to assess their capacity for responding to a smallpox outbreak. Dr. Julie L. Gerberding, director of the Centers for Disease Control, agreed. Up to 10 million civilian health care and emergency workers are supposed to be vaccinated in a second phase of the smallpox program, which begins next month in some states. In the past month, the number of people receiving the vaccine averaged 2,000 a week. Federal officials said they hoped the number would rise because Congress recently authorized compensation for people injured by the vaccine. William A. Pierce, a spokesman for the Department of Health and Human Services, said the program was well run. But the accounting office said federal health officials shared responsibility for the problems, for these reasons: · The government underestimated the cost of administering the vaccine. It initially put the cost at $13 a person. State and local officials found that the actual cost is $75 to $265 a person. · The administration rushed into the program and tried to expand it too rapidly. It distributed contradictory information about who should get the vaccine and who should not. Education and training materials were confusing. · The government refused to distribute needles that were potentially safer than those used to give the vaccine. Nurses and other health care workers were therefore apprehensive about the risk of needle-stick injuries that would expose them to live virus in the vaccine. "Progress has been slow," the report said. "Hundreds of hospitals have opted not to participate in the smallpox vaccination program at this time, contending that the risks outweigh the benefits." When Mr. Bush announced the vaccination campaign on Dec. 13, he said, "There's no evidence that smallpox imminently threatens this country." Figures compiled by the federal government show that about half of all the people vaccinated to date are in eight states: California, Florida, Minnesota, Missouri, Nebraska, Ohio, Tennessee and Texas. The Institute of Medicine, an arm of the National Academy of Sciences, said last month that the government should re-evaluate the costs, risks and goals of the vaccination program, to determine if some states had already inoculated enough health care workers to cope with a bioterror attack. Copyright 2003 The New York Times Company