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Home My WebLink About121803 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, December 18, 2003 Board Members: Dan Tittemess, Member - County Commissioner District # 1 Glen Huntingftrd, Vice Chair - County Commissioner District #2 Patrick M. Rodgers - County Commissioner District #3 Gerffrey Masci, Chairman - Port Townsend City Council Jill Buhler, Member - Hospital Commissioner District #2 Sheila Westerman, Member - Citizen at Large (City) Roberta Frisse/!, Member - Citizen at Large (County) Sta(fMembers: Jean Baldwin, Health & Human Services Director Larry Fqy, Environmental Health Director Julia Danskin, Nursing Services Director Thomas Lacke, 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 Buhler. There was a quorum. APPROVAL OF AGENDA Member Frissell moved to approve the agenda as submitted. Commissioner Titterness seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Vice Chairman Huntingford moved to approve the minutes of November 20, 2003 as corrected. In the first and second sentences in the second paragraph on Page 3 "immigration" should be changed to "in migration." Member Frissell seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT - None OLD BUSINESS AND INFORMATIONAL ITEMS Auureciation Awards to Jefferson General Hosuital: Jean Baldwin circulated for signatures awards thanking Jefferson General Hospital, their Clinic Staff, and individual doctors who bought extra vaccine and scheduled extra clinics during this flu season. Washinlrton State Nutrition and Phvsical Activity Plan: Dr. Tom Locke called attention to the kick- off brochure included in the agenda packet, which recognizes the health impacts of inactivity. Currently Jefferson County does not have any associated programs, but there will likely be opportunities within the next year. HEALTH BOARD MINUTES - December 18, 2003 Page: 2 Budl!et Uodate: Financial Manager Veronica Morris-Nakano and County Administrator David Goldsmith were present to brief the Board on the significant budget shortfall affecting the Health and Human Services 2004 budget. Ms. Nakano reviewed that the Board's packet contained revenue and expense budgets for 2004. The first of three factors contributing to this budget problem was that $61,705 in expenses was not seen until after the budget was completed. These expenses related to increases in Information Services (computers, building rent, records management) and Benefits (health insurance). The second factor was that the Department received $36,700 less than expected in revenue. The third factor was how the County's change back to a modified accrual basis of accounting versus a cash basis system created a 13th month in 2003 (13 months of expenses and 12 months of revenue), and accounts for a $100,000 shortfall. Because expenses are increasing faster than revenue, the likelihood of catching up on this shortfall is unlikely. David Goldsmith then used the budget sununary he had distributed to the Board to explain the role of the County as agents of the state, its regional functions, and its municipal corporation responsibilities (parks and recreation and other services, which are not generally mandated). In looking more closely at regional functions, he reviewed the 2002 impacts to the Health and Human Services budget ofthe repeal of the Motor Vehicle Excise Tax and the passage of initiative 701, which put a one percent limitation on property tax. In 2002, the County cut 4% across the whole budget and because oftheir interfund transfers, the Health and Human budget was reduced by just over $100,000 and that amount was held for 2003. Given the current budget conditions, it is unlikely this $100,000 would be restored. Although the Board of County Commissioners has authorized the use of the ending fund balance to bridge the gap in 2004, unless there are program changes, the fund balance of$301,597 in 2003 would be further diminished to $42,314 at the end of2004. He recognized that while priorities are often driven by outside funding, even ifthe Department reduces programs and people, it would still be paying certain costs for the building and infrastructure. In considering where the community prioritized these services in the recent survey, he noted health was number two. The County cannot run any fund as a deficit and as Agents of the State responsibilities increase, the pie that funds everything else is decreasing. The County could cut a municipal function like Parks and Recreation, but parks keep people healthy so there is not currently support to do this. He noted the County had to cut its support ofthe Tri-Area Teen Center and the Brinnon, Tri-Area, and Port Townsend Senior Programs. He said the Board of County Commissioners would be looking at both its broad responsibilities and also programmatically, within the agency. Referring to the 2004 Staffing Schedule, Chairman Masci commented that despite the decrease in revenues, there has been an increase in staffmg since 2001. David Goldsmith explained that the 7.75 budgeted new positions were comprised of 4.25 of fully grant supported position and .5 is a user fee and contractual support for the City of Port Townsend which is for the building official. The remaining 2.5 positions were a corrections officer (required from an ACLU lawsuit), a code enforcement coordinator, a halftime property assessor, and a halftime custodian for the new Sheriffs Department annex. Chairman Masci said that he would expect to see levels of service decrease along with the revenues. When he asked about transfers from other departments, the Commissioners said this was not possible because of statutory limitations. David Sullivan called attention to another pressure, which is whether the need is being met by current expenditures. He asked about the possibility of using banked capacity. Commissioner Titterness HEALTH BOARD MINUTES - December 18, 2003 Page: 3 responded that in his mind this is offlimits. In the survey, citizens had strongly voiced their objection to raising taxes. Referring to David Goldsmith's letter in the agenda packet, Member Westerman asked for clarification of the statement that Community Development and Health and Human Services Departments' budgets have to be fully sustainable. Mr. Goldsmith explained that this meant transfers to the Health Department should be sustainable such as a set percentage of property tax revenue, so that there is a known amount. As it stands, Health and Human Services would likely stay at the current level of public support, plus whatever they generate in fees. He recognized what $100,000 oflocal support accomplishes through our Health Department saying it is possibly one the best-leveraged health departments in the State. Member Westerman expressed concern that in order to balance the budget for one or two years, we might cut programs that we have spent years building and then have to build them up again. Short-term budget solutions can have long-term ramifications. Mr. Goldsmith agreed that as a community we would have to make tough decisions. When the 2003 books are closed, he agreed to report back the actual FTE count. Vice Chairman Huntingford noted that even if the County were to allocate a percentage of property tax for Health and Human Services, other factors would impact that amouut - salaries and benefit increases, or changes in programs or funding at the state or federal level. Across all departments, the County needs to get a handle on its expense growth until revenues catch up. He asked to clarify whether the operating reserves are secure, which Veronica Morris-Nakano confirmed. Jean Baldwin reminded that many costs - rent, information services, wages, benefits and insurance - are ongoing and out of our control. The Department would need to consider cutbacks in its office space and get rid of some computers as well as cutting programs and on-call staff, but there is an issue of matching funds. The Developmental Disabilities and Substance Abuse Boards and their budgets would also need to be reviewed separately. David Sullivan said he sees value in taking a longer-term view. He thinks there would be public support for services of value. David Goldsmith agreed and said there needs to be a dialogue with the community. Member Westerman commented that if the Board realizes that it is necessary to increase revenues instead of cutting anymore services it would benefit from the broader political base of having the Commissioners sitting on the Board. The Commissioners stated that in January the County Commissioners should have an update on five- year revenue projections and would be looking closely at all departments and programs for solutions. Mr. Goldsmith added that there is not a lot of flexibility between funds and reminded that the County's primary revenue source is capped. He suggested the Board look at setting program priorities without dollars and then overlay their budgets. Chairman Masci expressed his frustration that the Board's retreat preceded the budget discussion. HEALTH BOARD MINUTES - December 18,2003 Page: 4 Medical Assistance Administration Strate!!ic Plannin!! Ouestionnaire: Dr. Locke distributed a bar graph comparing State spending in general to State spending on healthcare costs, which reflected a 393% increase over the last ten years. The agenda packet included a questionnaire from the Medical Assistance Administration to solicit the Board of Health's input on how to prioritize spending, work with other agencies and communities and improve health and the workforce. Member Westerman moved to direct Dr. Locke to fill out the survey on the Board's behalf, which could then be brought back to the Board for review/changes in January. Member Frissell seconded the motion, which carried by a unanimous vote. Group B Water Svstems Proiect Report: Susan Porto, Environmental Health Specialist with the Jefferson County Drinking Water Program, gave a presentation on local findings of a voluntary sanitary survey of Group B water supply systems, of which there are about 110 in the Jefferson County. The agenda packet contained the full report from the Washington State Department of Health summarizing data from all participating Counties. The study's obj ectives were to obtain accurate information for systems with greater than five connections, identifY public health risks and needed corrections through site visits, determine status and compliance with routine water quality monitoring requirements, and inform water system operators of needed corrections and required water quality monitoring requirements. There were 37 inspections of the 42 systems with greater than five connections. She showed examples of the top five issues found: I) potential biological/chemical contamination within 100 ft of well (57%); 2) improperly constructed vents and openings in well caps (46%); 3) open storage reservoirs (46%); 4) inadequate water quality monitoring (33%); and 5) lack of source sample tap (26%). Benefits of the program were to provide information to owners about simple alterations that significantly lower risk of contamination, local familiarity with County water systems, existing system conditions were documented, outdated and inaccurate information was corrected, owners were informed of water quality monitoring and provided with a local point of contact to facilitate technical assistance. NEW BUSINESS Influenza Update: Dr. Locke distributed an updated influenza report from the Centers for Disease Control. The agenda packet also contained information the Department sent to providers about influenza activity and anti-viral drugs. Washington State was one of the first 11 states to have widespread activity. As of this week, school absentee rates in the state have dropped slightly, but might go through multiple peaks. The success of getting people to vaccinate early resulted in using up the national supply of 83 million vaccines. A limited supply of vaccine is still available for children and high-risk adults through doctors. As of Yesterday, Jefferson County reported its first influenza-related death -an elderly woman with chronic lung disease. This year's strain might have an unexpected higher virulence and mortality with children. With the shortage in vaccine supply, efforts have shifted to infection control, with respiratory etiquette programs developed for SARS preparation being implemented. Member Frissell noted a concern among the public that this flu vaccine contains mercury. Dr. Locke agreed that thimerosol is used in the adult vaccine as a preservative, but it has an extraordinary safety record. He did note that the influenza vaccine used for young children (6-24 months) is Thimerosol-free. However, he did recognize the general problems of increasing levels of mercury in the environment. HEALTH BOARD MINUTES - December 18, 2003 Page: 5 Draft Policv Concerninl!: Evaluation of Existing On-Site Sewal!:e Svstems and Buildinl! Permits: Linda Atkins reported that the second draft policy document in the agenda packet incorporated the comments and agreements ofthe subcommittee. She asked whether the Board felt it reflected the consensus and the desired direction ofthe Board to bring into the monitoring schedule more systems pursuant to the 2002 code? Member Frissell suggested that Specific Standards #2 - Building Permit Applications contain a notation to clarify the exception that there would not be an inspection requirement for building permits on greater than five acres and greater than 200 feet from shoreline, if the building does not increase plumbing. To address this, there was support for a suggestion by Member Westerman to move the second paragraph ahead of the exceptions. Member Westerman also made the following additional suggestions: to note on the first page who the "third party" is and to include better defmitions of terms such as "non-building building" permits and clarify the difference between "EES" and "basic operational checks." Mr. Fay recognized the need to define the different levels ofEES and suggested better characterizing "non-building building permits" instead of using that term. Member Westerman suggested amending or replacing the reference to WAC 246-272, with a title or description of the WAC. Under inspection results, she asked why any correction of deficiencies would not be done prior to a property sale and said the ordinance might need to be changed to ensure that deficiencies are corrected beforehand? Chairman Masci asked if a property is sold and bought within a year, why there would need to be two EESs? There should be a time frame in which an inspection certificate remains valid. Staff noted that this is covered in the code, but agreed this could be clarified in the policy. There was Board agreement to allow Staff an opportunity to review and consider incorporating comments submitted by Member Westerman before bringing the policy back to the Board. HeaIthv Jefferson Distribution: Jean Baldwin distributed a flyer regarding the three "Making a Difference" groups that would be meeting in January 22 (Families with Children), January 27 (Drug and A1cohollssues), and January 29 (Job Skills and Family- Wage Jobs). The input collected by these groups would first go to the Steering Committee before coming to the Board. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS - None AGENDA PLANNING/ ADJOURN January or February: Briefing on the Draft Ordinance regarding Methamphetamine Manufacturing Site Evaluation and Clean-up, Draft Policy Concerning Evaluation of Existing On-Site Sewage Systems and Building Permits, and Joint Meeting of Board of Health and Hospital Board. February: End-of-the- Y ear Performance Measurement Reports. HEALTH BOARD MINUTES - December 18, 2003 Page: 6 The meeting adjourned at 4:30 p.m. The next meeting will be held on Thursday, January 15, 2004 at 2:30 p.m. at the Jefferson County Health and Human Services Conference Room. JEFFERSON COUNTY BOARD OF HEALTH L (Excused Absence) Jill Buhler, Member SltX~ W P.hJ.!/V ~ Glen untmg ord, V' ~Member (~rs, Member Sheila Westerman, Member . tt', c.':";i 1...,(~f1':'.{..fkY[{ Roberta Frissell, Member ^ c- . WASHINGTON STATE NUTRITION a PHYSICAL ACTIVITY PLAN ~ &~Tih --.--...... , :>;,' DIETARY GUIDELINES FOR AMERICANS . Aim for a healthy weight . Be physically active each day . Let the Pyramid guide your food choices . Choose a variety of grains daily, especially whole grains . Keep food safe to eat . Choose a diet low in saturated fat and cholesterol and moderate in total fat . Choose beverages and food to moderate your intake of sugars . If you drink alcoholic beverages, do so in moderation . Choose and prepare foods with less salt . Choose a variety of fruits and vegetables daily PHYSICAL ACTIVITY GUIDELINES The recommended minimum amount of physical activity for optimal health is at least 30 minutes of moderate activity on five or more days a week. . ';. A STATEWIDE PLAN FO HEALTHY, ACTIVE COM "Obesity and overweight conditions are reac and in Washington State. This plan takes a b health conditions." - '. derlying theme of the Washington State Nutrition sicai Activity Pian is the need to promote nutrition hysical activity simultaneously at several levels - for individuals, for families, within institutions and organizations, in communities, and through public policy. THE VISION The vision for I he llasl1illgtoJ1 State Nutrition & Physical AeUd!y Plan is Ihal Washington residents will enjoy good nutrition. have active Jiws. and Jive in healthy communities. The plan emphasizes building a strong foundation at the institutionaL community, and policy levels so that it will be easier for individuals to choose healthy lifestyles. It establishes nutrition and physical activity objectives to meet the overarching goals, and priority recommendations to achieve the objectives. These recommendations will serve as a guide for groups and institutions across the state as they join the effort to build health-promoting communities. Good nutrition and physical activity are part of the solution to the nearly epidemic public health challenges facing the nation and Washington State. The active support of state and community leaders is critical to creating environments in which individual residents may improve their quality of life by living in healthy, active communities. , . PHYSICAL ACTIVITY OBJECTIVES & PRIORITY RECOMMENDATIONS , y NUTRITION OBJECTIVES & PRIORITY RECOMMEN -- " NUTRITION AND PHYSICAL ACTIVITY ADVISORY GROUP The Nutrition & PhysicaL Activi~ Plan is one outcome of a year of strategic planning by the Nutrition & Physical Activity Advisory Group. The 35-person group includes officials from state and local agencies. and representatives from advocacy organizations from across the state. The group brings together expertise from education. transportation, planning, nutrition, physical activity, agriculture, parks and recreation, economic development, and health care. Bryan Bowden, MS National Park Service Sue Butkus, PhD, RD Washington State University Charlotte Oaybrooke, MS Washington State Department of Heaith Cheza Collier, PhD, MPH, MSW Public Health - Seattle & King County Liz McNett Crowl, BA Northwest Physical Activity Coaiition Barbara Culp, BA Bicycle Aliiance of Washington Shelley Curtis, MPH, RD Chiidren s Alliance Adam Drewnowski, PhD University of Washington Amira El-Bastawissi, MBCHB, PhD Washington State Department of Health Elaine M. Engle, MS Spokane Regional Health District Becky Fitterer Washington State Department of Health Mary Frost Washington State Department of Health Ted Gage, PhD, A1CP Office of Community Development Dorothy Gist WashlngronStareDepartmentMHealth Chris Hawkins. BA Cllmate Solutions Donna B. Johnson, PhD, RD University of Washington Jim Litch, MD, LM WashingtonStareDepartmentMHealth Patricia ManueL MPH, MS, RD Public Health - Seattle & King County Eustacia Mahoney American Cancer Society Julie Mercer Matlick, BA Washington Stare Department of Transportation Jan Norman, RD, CDE Washington Stare Department MHealth Donna Oberg, MPH, RD, CD Public Health - Seattle & King County Debra Ocken, MS, RD Nutrition Consultant Eileen Paul, RD. CD, CDE Group Health Cooperative of Puget Sound Mary Podrabsky, RD Senior Services of SeattJelKing County Wendy Repovich, PhD, FACSM Eastern Washington University Jennifer Sabel, PhD, RD Washington State Department of Health Anne Schwartz, MN. CD Spokane Regional Health District Linda Schwartz, BA, MBA Bicycle Alliance of Washington Caroline McNaughton TitteL MPH, RD University of Washington Pamela Tollefsen, RN, MEd Office of Superintendent of Public Instruction Kyle Unland, MS, RD, CD Washington State Department M Health Juliet VanEenwyk, PhD WashlngtonStareDepartmentMHealth Bob Weathers, EdD Seattle Pacific University Lincoln Weaver, MPA Washington State Department of Health Leslie Zenz, BA Washington Stare Lkpartment M Agriculrur. Coverpl1oto- Tricycle/waIker: www.pedbikeimagesmg/DanBurden ~iW>"_'" D\tii!f .n"iiNI'J ._~ .. ....................Ml n '. "_I!':~_.( 111 g "li!I~. ." Q , g. 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". .. .>\Ilr!lll,~_..,.._.........."'!I'" '~bMliil"~,.__~",~,,~.,,./!IftY ~..~ ,"C_' ,- , . - . '_ _. '- _ ,', _ _ _ '~','> iL, I!flllf._~.iCI_IiJ"~."'~_~ 'fl"~r'*"".I!t~~~.olI~M's*tA'. rUi~. . . . '4..;ef~.,,~~~~P:~Jtst._ ~'........~~. . .. Mlitlllllr,"T..- . - ',_:"-: ':'---'"",-', ti"r'lI"T '~,l 't'J"'l'I".I'fW't"M'it . .0' ""_0""-'" ',,',""',.,_,_'," -, ,'" <:: .->,,- - , 1 .. i~:I(,: l~ 1 tl 'I:I} "'~j 1m ....' i . .\fI1II' r .,'L' .'m . IHI .~ He~iih News Release For immediate release: December 5, 2003 Contacts: Tim Church, Communications Office Donn Moyer, Communications Office (03-193) 360-236-4077 360-236-4076 Supply of flu vaccine in Washington varies between communities High demand a result of the early influenza season OLYMPIA - The early flu season has created an unusually high demand for vaccine in Washington and across the nation. According to the Department of Health, that demand is different from community to community, and the supply of influenza vaccine also varies. Flu vaccine is largely distributed via the private marketplace. "The good news is more people than usual are getting vaccinated against the flu in our state," said State Health Officer Dr. Maxine Hayes. "There is no more vaccine in production nationally, so people who want the flu vaccine should contact their health care provider soon." According to the Centers for Disease Control and Prevention (eDC), nationwide more people received flu vaccine this October than ever before at that time of year, and that appears to be the case in Washington, too. The Department of Health, which provides influenza vaccine for high risk children, ordered 102,000 doses of vaccine for this season. So far, about 92,000 doses have been shipped to local health departments around the state, and the remaining inventory is expected to be shipped within the next couple of weeks. Manufacturers have announced that all supplies have been shipped to end users and other distributors, so the state is not expecting to receive additional stock this season. Influenza is widespread in Washington and is being seen in virtually all areas of the state. While this flu season arrived earlier than usual, there is no way to predict how severe the season might be. Typically, flu season in our state hits full stride in January and continues through March. With a limited supply of vaccine, the Department of Health reminds people that using good health manners is among the best prevention against many diseases, including influenza. Such manners include covering mouth and nose (with a handkerchief or tissue if possible) when --More-- Flu vaccine supply 12/05/03 Page 2 sneezing or coughing; washing hands frequently and thoroughly with soap and water after sneezing or coughing; and staying home from work or school when you're ill. The Department of Health provides flu vaccine for toddlers and at-risk children to local health departments, which distribute it to health care providers. Health care providers and some local health departments also order and purchase flu vaccine for adults and healthy children. The Department of Health flu news Web site (http://www.doh.wa.gov/FluNews/default.htm) has details of influenza in Washington. The CDC flu Web site (http://www.cdc.gov/nip/flu/default.htm)has additional information. ### Visit the Washington Department of Health Web site at htto:l/www.doh.wa.goV for a healthy dose of information. Press Release December 5, 2003 Lisa McKenzie Communicable Disease Program Coordinator Jefferson County Public Health 385-9400 Influenza Season Influenza A activity is widespread in Washington State. Cases have been confirmed in East Jefferson County, school absenteeism is in the 10-25% range. The predominant strain of Influenza A in Washington state is a variant of the H3N2 strains that has been in global circulation since 1977. Nationally, 71% of Influenza A isolates are similar to the AlFujian strain which has undergone a slight antigenic "drift" from the A/Panama strain present in this years influenza vaccine. The current vaccine is expected to be protective for Fujian-type Influenza A. Influenza is a highly contagious illness causing an average of 36,000 deaths and 114,000 hospitalizations per year in the United States; pneumonia is the most common complication in high-risk groups. Influenza, unlike the common cold, has a swift onset of severe symptoms beginning with two to seven days of fever, headache, muscle aches, extreme fatigue, runny nose and sore throat, and a cough that is often severe and may last seven days or more. Public Health Officials Stress the Importance ofInfluenza Vaccinations for: People over 50 years of age. Everyone 6 months and older with chronic diseases of the heart, lungs (including asthma) or kidneys, or diabetes. Anyone whose inunune system is weakened because ofHIV / AIDS or other diseases that effect the inunune system. Children 6 to 18 years of age on long-term aspirin treatments. Residents of nursing homes and other long-term care facilities. Women who will be in the second or third trimester of pregnancy during the flu season. Physicians, nurses, family members, child-care workers or anyone coming in close contact with people at risk of serious influenza. Parents of otherwise healthy children, ages 6 to 23 months, should discuss getting a flu shot for those children with their health care provider. These children are at substantially increased risk for influenza-related hospitalizations. The federal and state funded Vaccines for Children program that subsidizes the cost of children's vaccines at most health care clinics now includes funding for flu vaccine for certain children. Families may want to check with their clinic or physician about this program. Precautions Recommended to Keep from Getting the Flu Include: Clean hands often with soap and water or with an alcohol-based hand cleaner. Avoid touching your eyes, nose or mouth. Avoid close contact with people who are sick, ifpossible. Get vaccinated for flu as recommended for your age and health conditions. Stopping the Spread of Germ If an Individual Is Sick: Cover your nose and mouth with a tissue every time you cough or sneeze. Throw the used tissue in a wastebasket. If you don't have a tissue, sneeze or cough into your sleeve, not into your hands. After coughing, sneezing or blowing your nose, always clean your hands with soap and water or with an alcohol-based hand cleaner. Stay home when you are sick. Do not share eating utensils, drinking glasses, towels or other personal items. For more information about flu visit http: www.doh.wa.gov/FluNews/default.htm For information about upcoming scheduled flu vaccine clinics call the Jefferson County Health and Human Services Information Line at 385-9429 or call your Health Care Provider. Many clinics are obtaining additional vaccine. December 2, 2003 To: Jefferson County Health Care Providers From: Tom Locke, MD, MPH, Jefferson County Health Officer Re: 2003-04 Influenza Season Influenza A activity is widespread in Washington State. Cases have been confirmed in East Jefferson County, school absenteeism is in the 10-25% range, and the Jefferson General ER reports increased cases of pneumonia and respiratory disease hospitalizations. The predominant strain of Influenza A in Washington state is a variant of the H3N2 strains that has been in global circulation since 1977. Nationally, 78% of Influenza A isolates are similar to the A/Fujian strain which has undergone a slight antigenic "drift" from the AfPanama strain present in this years influenza vaccine. The current vaccine is expected to be protective for Fujian-type Influenza A. Successful reduction of the morbidity and mortality associated with influenza outbreaks depends largely on preventive efforts - vaccination and optimal infection control practices. Antiviral therapy plays a relatively minor role in these control strategies but does have some specific beneficial applications. 4 antiviral drugs are licensed that have significant activity against influenza strains: amantadine, rimantadine, zanamivir ("Relenza"), and oseltamivir ("Tamiflu"). Amantadine and rimantadine are older drugs that inhibit viral replication of Influenza A. Zanamivir and oseltamivir are a newer class of neuraminidase inhibitors that interfere with viral penetration of cells by both Influenza A and B. All can be used for influenza treatment, if started within 48 hours of symptom onset, but efficacy studies have been disappointing. On average, antiviral treatment of influenza shortens the duration of illness by only one day. Multiple studies have failed to show significant reductions in influenza-related complications (e.g. bacterial pneumonia) or hospitalizations for any of these drugs. Three of the antiviral drugs are licensed for prevention of influenza infection: amantadine, rimantadine, and oseltamivir. Specific groups recommended for influenza chemoprophylaxsis are: . Persons at High Risk Who Are Vaccinated Mter Influenza Activity Has Begun. Persons at high risk for complications of influenza still can be vaccinated after an outbreak of influenza has begun in a community. However, the development of antibodies in adults after vaccination takes approximately 2 weeks. When influenza vaccine is administered while influenza viruses are circulating, chemoprophylaxis should be considered for persons at high risk of influenza complications during the time from vaccination until inununity has developed. Children aged <9 years who receive influenza vaccine for the first time can require 6 weeks of prophylaxis (i.e., prophylaxis for 4 weeks after the first dose of vaccine and an additional 2 weeks of prophylaxis after the second dose). · Persons Who Provide Care to Those at High Risk. To reduce the spread of virus to persons at high risk during community or institutional outbreaks, chemoprophylaxis during peak influenza activity can be considered for unvaccinated persons who have frequent contact with persons at high risk. Persons with frequent contact include employees of hospitals, clinics, and chronic-care facilities, household members, visiting nurses, and volunteer workers. · Persons Who Have Immune Deficiencies. Chemoprophylaxis can be considered for persons at high risk who are expected to have an inadequate antibody response to influenza vaccine. This category includes persons infected with HIV, chiefly those with advanced HN disease. No published data are available concerning possible efficacy of chemoprophylaxis among persons with HIV infection or interactions with other drugs used to manage HIV infection. Such patients should be monitored closely if chemoprophylaxis is administered. . Residents of Nursing Homes and Institutional Care Facilities During Influeuza A Outbreaks. Using antiviral drugs for treatment and prophylaxis of influenza is a key component of influenza outbreak control in institutions. In addition to antiviral medications, other outbreak-control measures include instituting droplet precautions and establishing cohorts of patients with confirmed or suspected influenza, re-offering influenza vaccinations to unvaccinated staff and patients, restricting staff movement between wards or buildings, and restricting contact between ill staff or visitors and patients. When outbreaks occur in institutions, chemoprophylaxis should be administered to all residents, regardless of whether they received influenza vaccinations during the previous fall, and should continue for a minimum of 2 weeks. If surveillance indicates that new cases continue to occur, chemoprophylaxis should be continued until approximately 1 week after the end of the outbreak. Amantadine/rimantadine have significant CNS and GI side-effects. Neuraminidase inhibitors seem better tolerated but are not well researched for outbreak control. Doses must be individualized for each patient and the potential for drug interactions (especially with HIV infection) must be closely monitored. Summary: East Jefferson County is experiencing the early stages of an Influenza A outbreak. Vaccination of high risk individuals remains beneficial for the duration of the flu season. For maximum benefit, high risk patients receiving influenza vaccination should receive anti- influenza chemoprophylaxis for 2 weeks following vaccination. Antiviral drugs are also useful for other preventive and outbreak control indications. Detailed information on their use can be found at--htto: Ilwww.cdc.qov/mmwr/oreview/mmwrhtml/rr5208a1.htm Memorandum To: Jefferson County Board of Health From: Larry Fay ,} \7 Environmental Health Director ~ ""f Date: December 10,2003 Re: Draft Policy concerning onsite sewage system inspections and building permit application. Attached for your review and consideration is a second draft policy and associated matrix. The matrix has been revised with input from Board members Tittemess and Sullivan. In the way of refresher to the Board, the onsite sewage system regulations adopted by the board in 2000 include provisions for periodic inspection or evaluation of existing onsite sewage systems. The regulation takes a kind of risk-based approach to establish how frequently systems need to be inspected. The frequency varies from every six years for simple systems on large acreage to as frequent as annually for complex systems on sensitive sites. The challenge for the department and the Board was to figure out how to actually implement the inspection schedule. This is easy with new systems. We can simply condition the permit at the time of issuance. With existing systems there is a greater challenge. After long and careful consideration, the Board decided to begin implementing the program gradually by requiring an inspection when a property is transferred, when there has been an application for building permit or when the department and Board have identified an area as an area of special concern. Until now we have only been requiring inspection at the time a property is transferred. We feel we are ready now to move into the next phase, evaluation at the time of a building permit application. There are a couple of complexities with moving into the building permit phase. One is that in many cases we need more information about the system for a building permit application then we do for a sale or transfer. All we really need to know when the property transfers is whether there is indeed a system (We have identified several direct discharges) and whether the system is functional. With a building permit application we frequently need to know fairly accurately the system location, depth, and capacity and to identify a reserve area. The second issue is that the regulation makes no distinction between types of building permits applications. However, building permits are required for a number of building activities that have little or no potential to impact the onsite system. It is confusing for the public and we hear little support for requiring inspections as a condition of these types of permits. (As an informational matter, about 23% of the building permits issued in 2003 were for "non-building" activities or 154 of 682 permits.) The purpose of this policy is to clarify three things: 1) What kinds of activities will trigger the requirement for an evaluation. 2) What kind of evaluation is necessary 3) What happens after the evaluation. 12/11/2003 1" Draft JEFFERSON COUNTY HEALTH AND HUMAN SERVICES ENVIRONMENTAL HEALTH DIVISION POLICY STATEMENT PROGRAM - On-site Sewage Disposal SUBJECT - Evaluation of existing onsite sewage systems Effective this date the following procedure shall be adopted concerning when evaluations of existing onsite sewage systems (EES) will be required and by whom and how they will be conducted. PURPOSE Section 8.15.140 of the Jefferson County Onsite Sewage Code establishes that owners of existing onsite sewage systems shall obtain an initial inspection (EES) when the property that is served by the system is being sold and when an application for a building permit is submitted. The purpose of this policy is to provide clear direction as to when an EES is required, how an EES must be conducted, who can conduct inspections and what results from and inspection. APPLICABILITY This policy applies to individual residential and commercial onsite sewage systems when a property is sold or an application for a building permit has been submitted. This policy is not intended to address EES required under other provisions of the onsite sewage code; community systems, areas of special concern or systems that were permitted with waivers GENERAL POLICY STATEMENT It is the policy of the Jefferson County Board of Health that all residences, businesses or other building where people work, live or congregate in Jefferson County not served by a sewage treatment system must be connected to an approved properly functioning onsite sewage system. It is further the policy of the Board that all systems must be maintained properly in order to reduce the frequency of failure and that all systems will receive periodic third party inspections or EES at the frequency established in the Onsite Sewage Code beginning when a property is sold or when an application for a building permit is submitted. 12/1112003 1" Draft SPECIFIC STANDARDS 1. Time of Sale: An EES conducted at the time of sale is intended to verify that there is an existing functioning system on the property. The inspection must include a visual inspection of the septic tank to confinn the construction material, structural integrity, and liquid capacity, sludge and scum depth as well as general condition with specific reference to inlet and outlet baffles. The general location of the drainfield must be identified and evaluated to verify that there are no direct discharges or surfacing effluent. Time of sale inspections may be conducted by Environmental Health staff, licensed O&M specialist, licensed designers or engineers licensed to practice in Washington. 2. Building Permit Applications: Exceptions- An EES is not required for "non-building" building pennit applications. Examples of "non-building" building permits include but are not limited to building maintenance related activities such as re-roofing and replacing or adding windows, wood or propane stove installation, above ground propane tank installation and interior remodels that do not include new plumbing or additional bedrooms. All other building permit applications will trigger the requirement to have an EES completed as specified in the attached table, appendix 1. 3. Who Can Conduct an EES: Basic operational checks (those inspections with the primary purpose to establish that there exists a functioning onsite sewage system) may be conducted by licensed onsite sewage system designers, engineers licensed to practice in Washington, environmental health staff and licensed O&M specialists. Inspections that are intended to establish the treatment capacity of a system and/or designate a reserve area may be conducted only by licensed designers, engineers or environmental health staff. 12/11/2003 1" Draft 4. Inspection results: Any inspection identifying a failure as defined in WAC 246-272 must be reported to Jefferson County Health and Human Services within 24 hours. Owners of failed onsite sewage systems will be required to initiate steps to correct the failure upon notice from the health department if they have not already started. Any inspection identifying maintenance deficiencies must be recorded in writing in the inspection report and submitted to Jefferson County Health and Human Services and the property owner at the first reasonable opportunity. If the EES is for the purposes of time of sale, it will be the responsibility of the seller and buyer to determine who will correct the deficiency. Deficiencies not corrected by the time of the next regular inspection will be considered a violation. If the EES is for the purposes of a building permit application, it will be the responsibility of the property owner to correct the deficiencies. Deficiencies must be corrected prior to final inspection and sign off of the building permit. EFFECTIVE DATE This policy shall become effective on the date of adoption and remain in effect until amended or repealed by action ofthe Jefferson County Board of Health. Health Officer Date Chairman of the Board of Health Date .... >< '6 c ell Q. 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