HomeMy WebLinkAbout2018/01/23 - BOH Packet *NSON COUV.�
Public Health
Always working for a safer healthier Mason County
HEALTHNPUBLIC
MASON COUNTY BOARD OF HEALTH
REGULAR MEETING
Jan 23, 2018
3:00 PM
Commission Chambers
411 North Fifth Street
Shelton, WA 98584
DRAFT AGENDA
1. Welcome and Introductions Chair Kathy McDowell
2. Approval of Agenda—ACTION Board Members
3. Approval of Minutes of Nov, 2017—ACTION Board Members
4. Selection of 2018 BOH Chair -ACTION Board Members
5. Nomination/appointment of Gary Plews - ACTION Board Members
6. Health Officer Report Dr. Diana Yu
7. Community Health Update Lydia Bucheit
8. Administration Updates Dave Windom
9. Environmental Health Updates Alex Paysee
10. Other Business and Board Discussion Board Members
11. Public Comments
12. Adjourn
If special accommodations are needed,please contact Melissa Drewry,427-9670,Ext.589. From the Belfair area,please dial
275-4467,Ext.589;from the Elma area please dial 482-5269,Ext.589.
Mason County Public Health
415 N 6th Street, Bldg 8,Shelton WA 98584,
Shelton: (360)427-9670 ext 400 ❖ Belfair:(360)275-4467 ext 400 ❖ Elma:(360)482-5269 ext 400
FAX (360)427-7787
MASON COUNTY BOARD OF HEALTH PROCEEDINGS
411 North 50 Street,Shelton,WA
November 21,2017
Attendance: Randy Neatherlin,County Commissioner;Kevin Shutty,County Commissioner;Terri Jeffreys.
County Commissioner;Peggy VanBuskirk,Hospital District#2;Vacant,Fire Commissioner;
Absent:Eileen Branscome,Hospital District#1;Kathy McDowell,City of Shelton Commissioner.
1. Peggy Van Buskirk called the meeting to order at 3:00 p.m.
2. Approval of Agenda—Cmmr.Drexler asked to move any action items to the beginning of the meeting
because the Commissioners had another meeting to attend at 4:00.
Cmmr.Drexler/Shutty made a motion and seconded to approve the agenda,after moving items 8,9,and 10
up to follow item 3. Motion carried unanimously.
3. Approval of Minutes September 26,2017- Cmmr.Drexler/Neatherlin moved and seconded to approve
the September 26,2017 minutes as written.Motion carried unanimously.
4. Health Officer Report—Dr.Yu was not present.
5. Administration Report—Dave Windom was not present.Debbie Riley said that she had a wonderful time
at the Washington State Public Health Association Presentation. She said that people seemed interested and
wanted to talk even after the presentation.
6. Environmental Health Report—Debbie discussed the Hammersley Inlet Project meeting at the civic
center held the previous week. She said the Washington State Department of Health spoke about norovirus
and also the dye test at the Shelton Sewage Treatment Plant.
Debbie also spoke about an optical brightener test,and described the process used to test the water.Cmmr.
Drexler questioned where optical brighteners come from to which Debbie explained that it is mostly from
laundry detergent.
7. Community Health Report—Lydia talked about the new nurse,Audrey,noting that she is doing well and
is currently cross training.A posting for the position of Communicable Disease Nurse will be released on
November 27`b.
Discussion was had in regards to the opioid forum and what should change to move forward.Cmmr.
Neatherlin talked about the separation between the providers and community.Cmmr. Shutty mentioned that
he would like to know the rate to which Narcan is being used.Lydia said that is being tracked and would
give the board a report at a later time.
8. Mutual Aid Agreement between Tribes and LHJ—Lydia explained that the parties who sign the
agreement are under no obligation to provide aid to any other signed party to the agreement. She added that
this agreement is state wide and not only regional.Cmmr.Drexler asked what this agreement would be
used for.Lydia said it can be used for anything considered a public health emergency.
Cmmr.Drexler/Shutty motioned and seconded to have the Board of Health sign the resolution,schedule B,
Public Health Jurisdiction Resolution,authorizing execution of the Mutual Aid Agreement for Tribes and
Local Health Jurisdictions in Washington State. Motion carried unanimously.
9. 2018 Meeting Schedule-Cmmr.Drexler/Shutty motioned and seconded to approve the resolution setting
the 2018 Board of Health meeting schedule.Motion carried unanimously.
10. New Board Member-Peggy discussed the applicant and said that though the applicant was not present,
she was interested in having her be a part of the Board.Cmmr.Drexler said that Dave Windom had briefed
BOARD OF HEALTH PROCEEDINGS
November 21,2017-PAGE 2
the Commission on the applicant.Cmmr.Neatherlin and Shutty agreed that she would be a good addition
and were comfortable voting her onto the Board.
Cmmr. Shutty/Neatherlin motioned and seconded to appoint Keri Davidson to the Board of Health.Motion
carried unanimously.
11. Other Business and Board Discussion-Cmmr. Shutty talked about the Tobacco 21 program being
discussed in Olympia.He said he would like to discuss this further,but would rather wait until the entire
board was present in January.
12. Public Comments-None.
13. Adjourn-The meeting adjourned at 3:38 p.m.
ATTEST MASON COUNTY,WASHINGTON
BOARD OF HEALTH
MASON COUNTY,WASHINGTON
Melissa Drewry,Clerk of the Board
Kathy McDowell,Chair
Kevin Shutty,Commissioner
Randy Neatherlin,Commissioner
Terri Drexler,Commissioner
Peggy Van Buskirk,Hospital District#2
Fire Commissioner-Vacant
Eileen Branscome,Hospital District#1
Washington State Influenza Update
Week 52: December 24, 2017-December 30, 2017
Washington State Department of Health, Communicable Disease Epidemiology
Please note all data are preliminary and may change as data are updated
State Summary: Flu activity is increasing
• Twenty nine lab-confirmed influenza deaths have been reported for the 2017-2018 season to date.
• Twenty six influenza-like illness outbreaks in long term care facilities have been reported for the 2017-2018
season to date.
• During week 52, 3.8 percent of visits among Influenza-like illness Network participants were for influenza-like
illness, above the baseline of 1.1 percent.
• During week 52, 27.7 percent of specimens tested by WHO/NREVSS collaborating laboratories in Washington
were positive for influenza.
• Influenza A and influenza B were reported during week 52.
Influenza Laboratory Surveillance Data
Laboratory Data: World Health Organization (WHO) & National Respiratory and Enteric Virus
Surveillance System (NREVSS) Data Reported to CDC
For the 2017-2018 influenza season, CDC has generated separate graphs of data reported to CDC by public
health laboratories (Figure 1) and commercial laboratories (Figure 2). Table 1 combines the data from the
public health and commercial laboratories.
Table 1: WA Influenza Specimens Reported to CDC, Public Health Laboratories and Commercial
Laboratories
A A (2009 A A (Unable A (Subtyping Total % Flu
Week (H1) H1N1) (H3N2) to Supe) not performed) B BYam BVic Tested Positive
49 0 2 6 0 64 15 0 0 897 9.7
50 0 4 13 0 72 19 2 0 732 15.0
51 0 2 11 0 160 44 2 0 906 24.2
52 0 6 13 0 202 49 0 0 976 27.7
Figure 1: Influenza Positive Tests Reported to CDC, WA Public Health Laboratories
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40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38
CDC Week(2017-2018 Season)
®A f 2009 M N1)DA f Unable to Subtype)M g(Subtyping not performed)®BY�m
Figure 2: Influenza Positive Tests Reported to CDC, WA Commercial Laboratories
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.E 200 40
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40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38
CDC Week(2017-2018 Season)
❑Influenza A■Influenza B
Antigenic Characterization
Antigenic characterization has been conducted by CDC on a subset of influenza specimens collected in
Washington state during the 2017-2018 season. Additional antigenic characterization data for the nation is
available in the CDC FluView.
Two influenza A (H3N2) specimens were characterized as A/Hong Kong/4801/2014-like, the influenza A
(H3N2) component of the 2017-2018 vaccine.
One influenza A specimen was characterized as A/MICHIGAN/45/2015-LIKE (H1 Nl)pdm09, the influenza A
(H1 N1) component of the 2017-2018 vaccine.
Three influenza B specimen was characterized as B/Phuket/3073/2013-like, the B Yamagata lineage
component of the 2017-2018 quadrivalent influenza vaccine.
Antiviral Resistance Testing
No testing has yet occurred on specimens collected during the 2017-2018 influenza season.
Outpatient Influenza-like Illness Surveillance
Outpatient Influenza-like Illness Surveillance Network(ILINet) Data
ILI is defined as fever(temp 100°F/37.80C or higher) plus cough and/or sore throat. During week 52, 33
sentinel providers in Washington reported data through the U.S. Outpatient Influenza-like Illness Surveillance
Network Surveillance Network (ILINet). Of 5409 visits reported, 207 (3.8%) were due to ILI, above the baseline
of 1.1%.
Note that for this figure the baseline is determined by calculating the mean percentage of patient visits for ILI
during non-influenza weeks for the previous three seasons and adding two standard deviations. A non-
influenza week is defined as periods of two or more consecutive weeks in which each week accounted for less
than 2% of the season's total number of specimens that tested positive for influenza in public health
laboratories. See hftp://www.cdc.gov/flu/weekly/overview.htm
Figure 3: Percentage of ILI Visits Reported by Sentinel Providers, Washington, 2015-2017
432 0
� 2
0
0
Baseline
1 ---------------- -------------------------------------------------------------
0
40 42 44 46 48 50 52 02 04 06 08 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38
CDC Week of Visit
2016-2017 — 2017-2018
Table 2: Number of ILI Visits Reported by Sentinel Providers by Age Group, Washington
Sentinel Age 0- Age 5- Age 25- Age 50- Over Total Total Percent
Week Providers 4 24 49 64 64 ILI Patients ILI
49 43 3 7 4 2 1 17 4,115 0.4
50 43 8 7 2 3 3 23 4,013 0.6
51 43 10 8 10 6 5 39 3,490 1.1
52 33 52 36 50 32 37 207 5,409 3.8
Influenza Hospitalization Data
Reported Laboratory-Confirmed Influenza Hospitalizations (Spokane County Only)
Spokane Regional Health District requires hospitals to report laboratory-confirmed influenza-associated
hospitalizations. 157 lab-confirmed influenza hospitalizations have been reported since September 2017 (138
influenza A and 19 influenza B). Note that the graph shows hospitalizations per month. For January, few
hospitalizations have thus far been reported.
Figure 4: Spokane Lab-Confirmed Influenza Hospitalizations by Week of Admission and Influenza Type
Influenza Hospitalizations for Spokane County
250 — --
r
0 200 --
e
S2017-1s
a 150 2016-17
.sz
2015-16
I.2 100 , - 2014-15
x - - -2013-14
t 2012-13
.8
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Sep Oct Nov Dec Jan Feb Mar Apr May Jun July
Reported Laboratory-Confirmed Influenza Hospitalizations (Snohomish County Only)
Snohomish Health District requires hospitals in Snohomish County to report laboratory-confirmed influenza-
associated hospitalizations to the health district. See figure below, courtesy of Snohomish Health District.
Figure 5: Snohomish County Influenza Hospitalizations by Season 2013-CDC Week 52
Snohomish County Influenza Hospitalization Surveillance
Through CDC Week 52 (ending 12/30/2017)
so --- -- ----- --- - ---- -- - -- — -
70 - - - - -
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—2013-2014
M - -_ -- -._ _ _ _.
40 _ __ - -__... _.. ___ -_ 2014-2035
—2015-2016
a 30 ____-__ ._ __ _____. -.__- _____ --. -_.._.._ __-___- ___...___ —2016-2017
—2017-201B
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Influenza-like Illness Syndromic Surveillance Data, Western Washington
ESSENCE Syndromic Surveillance Data
Figure 6 shows the proportion of visits at a sample of emergency departments in western Washington for a
chief complaint of influenza-like illness, or discharge diagnosis of influenza, by CDC week. For this purpose, ILI
is defined as "influenza" or fever with cough or fever with sore throat. Syndromic Surveillance ILI data are not
available for eastern Washington facilities. Note data for the most recent week are incomplete.
For more information about Syndromic Surveillance in Washington State, see
http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HeaIthcareProfessionsandFaciIities/Data Repo
rtingandRetrieval/ElectronicHealthRecordsMeaningfulUse/SyndromicSurveillance.
Figure 6: Syndromic Surveillance, Percentage of Hospital Visits for a Chief Complaint of ILI, or
Discharge Diagnosis of Influenza, by CDC Week, Western Washington, 2014-2017
5.5
5.0
4.5
4.0-
3.5-
3.0,
.03.53.0
0
12.5
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1.0
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Week of VIA(CDC Week)
■2013.2014■2014-2015■2015-2016■2016-2017■2017-2018 WemkV■Alert■Severe
Influenza-like Illness Outbreaks in Long Term Care Facilities
Long term care facilities are required to report all suspected and confirmed outbreaks to their local health
jurisdiction per Washington Administrative Code (WAC) 246-101-305. Long-term care facilities are required to
report the following:
• A sudden increase in acute febrile respiratory illness over the normal background rate (e.g., 2 or more
cases of acute respiratory illness occurring within 72 hours of each other) OR
• Any resident who tests positive for influenza
Recommendations for prevention and control of influenza outbreaks in long-term care facilities are available at:
http://www.doh.wa.gov/Portals/l/Documents/51 00/fluoutbrk-LTCF.pdf
Local health jurisdictions in turn report long-term care facility influenza-like illness outbreaks to the Washington
State Department of Health.
Since Week 40 of 2017, 26 influenza-like illness outbreaks in long-term care facilities have been reported to
the Washington State Department of Health.
Seasonal Baselines and Epidemic Thresholds
Figures 8 and 9 are courtesy of Elaine Nsoesie of the University of Washington Institute for Health Metrics and
Evaluation and Al Ozonoff of Harvard Medical School. Methods are based on the work of Robert E Serfling
(1963). hftps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1915276/
Figure 8 shows the percentage of specimens tested for influenza at WHO/NREVSS labs that are positive for
influenza by week. For week 52, the percentage of specimens positive for influenza is above both the seasonal
baseline and the epidemic threshold.
Figure 9 shows the percentage of visits that are for influenza like illness among ILI Net providers. For week 52,
the percentage of visits for ILI is above both the seasonal baseline and the epidemic threshold.
The seasonal baseline is calculated using data from the previous five years, and the epidemic threshold is
1.645 standard deviations above the seasonal baseline. This method is similar to that used by CDC when
calculating pneumonia and influenza mortality, as described in hftp://www.cdc.gov/flu/weekly/overview.htm.
The intention of these models is to provide a data driven approach to determining when influenza has reached
an epidemic level. Under these models, influenza is considered to be epidemic when the percentage of
specimens positive for influenza is at or above the epidemic threshold, and the percentage of visits for ILI is
also at or above the epidemic threshold.
Taken together, these figures show that influenza activity is above the epidemic threshold for week 52.
Feedback on the use of these models is welcomed.
Figure 8: Percentage of Specimens Positive for Influenza, WHO/NREVSS labs
Original data with model In
N
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0- Inter.7017 Dec 2017 Dec 7014 Dec 2015 D.;010 Det 7017
cohni°` ——Epidemic threshold
Seasonal baseline
Figure 9: Percentage of Visits for ILI, Sentinel Providers —Percentage,as
axis
Original data with model Ilt • Week aboveic eshold
v
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Mn
N
d
0
Dec 2012 Dec 2013 Dec 2014 Dec 2015 Dec 20 tb Dec 2017
Calendar rear
Other Causes of Respiratory Infections
During the 2017-2018 season, the following non-influenza respiratory viruses were reported to the National
Respiratory and Enteric Surveillance System (NREVSS).
For more information about NREVSS, see https://www.cdc.gov/surveillance/nrevss/index.html.
Figure 10: Respiratory and Enteric Viruses, Washington, 2017-2018 Season to Date
U)
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E 150
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40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38
CDC Week(2017-2018)
Respiratory Syncytial Virus — Adenovirus ® Rotavirus Human Metapneumovirus — Enterovirus
Human Parainfluenza Virus � Coronavirus� Enteric Adenovirus� Rhinovirus
Respiratory Human
Syncytial Parainfluenza Enteric Human
Week Reporters Virus Virus Adenovirus Coronavirus Rotavirus Adenovirus Metapneumovirus Rhinovirus Enterovirus
49 17 62 23 6 11 2 0 6 81 0
50 15 82 19 18 13 1 0 8 52 0
51 14 145 24 12 19 0 0 11 60 1
52 14 171 23 17 24 1 0 18 62 0
Laboratory Confirmed Influenza-Associated Deaths
Reported Laboratory-Confirmed Influenza Associated Deaths
Note that these counts reflect only deaths officially reported to the Washington State Department of Health.
Note that each influenza season is reported as week 40 through week 39 of the following year. Previously counts of death were
reported from week 30 through week 29.
Twenty nine laboratory-confirmed influenza deaths have been reported since week 40 of 2017, 22 influenza A
and 7 influenza B. Most deaths have occurred in people with underlying health conditions, or in people with no
pre-existing conditions but who were elderly. Zero deaths have occurred in children.
Table 4: Count and rate of reported laboratory-confirmed influenza-associated deaths by age group,
Washington, 2017-2018 season to date
Age Group (in years) Count of Deaths Death Rate (per 100,000_population) _
0-4 0 0.00
5-24 0 0.00
25-49 2 0.09
50-64 7 0.50
65+ 20 2.13
Total 29 0.42
Reported Laboratory-Confirmed Influenza-Associated Deaths, Past Seasons
For reference, lab-confirmed influenza death totals reported to the Department of Health for past seasons are
presented below in Table 5. Note that for the purposes of tables 4 and 5, each influenza season runs from
week 40 of one year to week 39 of the next (roughly October to October).
Past season summaries are available:
http://www.doh.wa.gov/DataandStatisticalReports/DiseasesandChronicConditions/CommunicableDiseaseSury
eillanceData/InfluenzaSurveillanceData
Note that influenza deaths are likely under-reported. The reasons for this under-reporting vary. Influenza may
not be listed as a cause of death, influenza testing may not have occurred in a timely fashion to identify the
virus, or may not have been performed at all, and lab-confirmed influenza deaths may not have been
appropriately reported to public health.
CDC has published information about estimating seasonal influenza-associated deaths:
(http://www.cdc.gov/flu/about/disease/us flu-related_deaths.htm?mobile=nocontent)
Table 5: Count of Reported Laboratory-Confirmed Influenza-Associated Deaths, Past Seasons to Week
52 and Total
Count of Deaths as of Week Count of Deaths Reported for the Entire Season
Season 52 of Season (week 40 to week 39)
2017-2018, to date 29 29
2016-2017 34 278
2015-2016 5 67
2014-2015 21 156
2013-2014 11 80
2012-2013 11 54
2011-2012 1 20
2010-2011 3 36
Table 6: Count of Deaths Reported to WA DOH by County of Residence
Table 6 shows the count of laboratory-confirmed influenza deaths reported to the Washington State
Department of Health by county of residence. Deaths are from week 40 of 2017 through the present. Note that
due to reporting lag, counts may be different at the county level. Only deaths reported by the county as
"investigation complete" are included in the official Washington State Department of Health counts.
Note that due to reporting lag, counts may be different of the county level
Count of Deaths Reported to WA DOH from week 40
County of 2017 to present
Chelan 1
King 2
Kitsap 2
Mason 1
Pierce 5
Snohomish 8
Spokane 7
Thurston 1
Whatcom 2
Additional Resources
International Influenza Data: http://www.who.int/topics/influenza/en/
National Influenza Surveillance Report: http://www.cdc.gov/flu/weekly/
Washington DOH Influenza Information for Public Health and Healthcare Providers:
http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/Im
munization/InfluenzaFlulnformation#recommendation
Washington Local Health Department Influenza Surveillance Reports:
Clark County: https://www.clark.wa.gov/public-health/flu
King County: http://www.kingcounty.gov/healthservices/health/communicable/diseases/Influenza.aspx
Kitsap County: http://www.kitsappublichealth.org/Respiratory.pdf
Pierce County: http://providerresources.tpchd.org/influenza/
Whatcom County: http://www.co.whatcom.wa.us/967/Influenza
Yakima County: http://www.yakimacounty.us/365/RSV-Flu-Stats
1/10/2018
MASON COUNTY SYRINGE EXCHANGE
A DISCUSSION
Diana T. Yu, MD MSPH
Mason County Health Officer
January 23,2018
WHAT IS PROBLEM WE WANT SOLVED?
• Discarded syringes on street
• Treatment resources for persons using drugs
• Opioid overdose
• Blood borne pathogens prevention
• Injection Drug use
1
1/10/2018
HARM REDUCTION
Meets drug users"where they are at"
Spectrum-safer use_- managed use F abstinence
Principles
• Accepts that Ikit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than
simply Ignore or condemn them.
• Understands drug use as a complex,multi-faceted phenomenon that encompasses a continuum of behaviors from severe
abuse to total abstinence,and acluiowtedges that some ways of using drugs are clearly safer than others.
• Establishes quality of Individual and community life and well-being—not necessarily cessation of all drug use—as the
criteria for successful Interventions and pokies.
• UIIs for the non-Judgments,norscoercive praAslon of services and resources to people who use drugs and the
communities In whkh they live In order to assist them In reducing attendant harm.
• Ensures that drug users and those with a history of drug use routinely have a real voke in the creation of programs and
pol-kles designed to serve them.Affirms drugs users themselves as the prima ry agents of reducing the harms of their drug
use,and seeks to
• empower users to share Information and support each other in strategies which meet their actual conditions
of use.Recognizes that the realties of poverty,class,racism,social Isolation,past trauma,sex-based discrimination and
other social Inequalities affect both peoples vutnerabRy to and capacity for effectively dealing with drug-related harm.
•
Does not attempt to minimize or Ignore the real and tragic harm and dangerassociated with Ikit and illicit drug use.
BENEFITS OF SYRINGE EXCHANGE
• Syringe services programs reduce blood borne
pathogen disease.
— Syringe services programs do not increase drug use.
• Syringe services programs are cost effective.
• Syringe services programs are typically the only
location lay people can easily obtain naloxone.
• Syringe services programs provide clients with access
to services such as health care, treatment, and other
essential supports and services
• Rural areas have fewer syringe services programs than
urban areas.
2
1/10/2018
COMMUNITY NEEDS ASSESSMENT
• IDU involvement
• Stakeholders
• Disease rate
• Current SEP use data
• Cost of treatment for Hep C and HIV vs syringe
• Drug related ER data
• Pharmacy sale of syringes
• OD data
• Syringe disposal options—clinics, pharmacies, kiosks,
garbage
• Who are our IDU and what do they need
I
I
G
DATA NEEDED
Q�
• Mason Co rate of H IV, Hep B, Hep C—compare
2015 to 2010
• Syringe exchange use in Grays Harbor, Kitsap and
Thurston — number of syringes, number of users
• Cost of syringe exchange services in other three
j counties
• Number of drug overdose
• Hospital data on Emergency dept visits for drug
related care— bacterial endocarditis, wound care,
overdose
i
I
1/10/2018
STAKEHOLDERS
• Community based organizations
• Law enforcement — City and County
• Fire districts, parks, sanitation
• Health care facilities
• Local businesses
• Drug treatment programs
• Faith based organizations
LAWS AND REGULATIONS
• Drug paraphernalia law
• Syringe prescription law
— ? Blanket prescription by HO
• OTC pharmacy sale restriction
• Explicit syringe exchange laws
4
1/10/2018
SERVICE DELIVERY MODEL
• Community education : safe and proper syringe clean-
up and disposal
• Syringe disposal/drop off sites
• Syringe Exchange
— Fixed location
— Mobile exchange
— Home delivery
• Fire District model
— Secondary or Peer delivery exchange
— Medical Clinic model
— Pharmacy model—vouchers
— Co-location with drug treatment or mental health service
provider
i
HOW TO START
i
• Identify a central location where IDU
— Feel comfortable going to
—Safe
— Co-location with other services/resources
• Begin communication with those that live or
work in area you are considering using for
program
• Data tracking
i
j 5
i
1/10/2018
FUNDING
• Supplies
— Syringes
— Supplies for IDU
— Referral resources
• Disposal
— Solid waste transfer station unit?(like Thurston)
— Picking up syringes from syringe drop off sites
— Storage for supplies and sharps prior to final disposal
• Staff
— Volunteer coordination
— Administration supplies—computer,phone,paper,etc
— Training/Staff development
• Other
— Vehicle/insurance—if mobile exchange
— Rental/insurance if fixed site exchange
— MOU—if using secondary exchangers
GRANTS-NASEN
6
•
H* ah"Services
Manager Report
10,
December-January 2018
Administrative Updates
Join me in welcoming our new division staff!
Audrey O'Connor RN-BSN joined our team as a Public Health Nurse on
November 16, 2017. Audrey specialized in oncology, clinical trials,and on an
ethics review board in her nursing career. Originally from California,Audrey r
has been in Mason County for the past 16 years,and loves the Pacific
Northwest. Audrey enjoy tennis,sailing, kayaking, hiking, and wine
tasting.She is excited about her new position with Mason County Public
Health.
We hired Alison Smallwood into our Community Health Education Specialist position,
and she began employment on December 1, 2017. Alison is a recent Master's of Public
Health graduate.She is from Cincinnati, OH originally,and moved to Washington in May
with her husband Austin who is in the Air Force and stationed at JBLM. During the past
month she has been working with Todd Parker in Housing to develop a profile report on
the housing and homelessness conditions in Mason County. In addition,Alison has been
working with Abe and Christina in the Opioid Response program to create potential
infographics to be disseminated throughout the county. Lastly,she has been
researching and beginning to collect data to update our Mason County Community Health Assessment.
t
Christina Muller-Shinn accepted the part-time Community Health Program Assistant
position,joining our Opiate Drug Overdose Prevention Program team on January 2,
2018. Christina comes to us with over 5 years working in overdose prevention and
response and substance use counseling and developed a volunteer and community
outreach program at a needle exchange program in California. She holds BS& BA
degrees in Ecology studies. She resides in North Mason County and enjoys being active
in the Pacific Northwest.
We said good-bye on December 29, 2017 to our Public Health Nurse,Shannon Severeid who took a position in
Thurston County to serve Lewis County NFP clients as part of the move of Mason County's NFP program to the new
regional HUB located in Thurston County.
Our County and department has been truly blessed to have Elizabeth Custis,our veteran Public Health Nurse of 13
years, Maternal-Health Child Program lead, NFP home visitor and Supervisor, remain in Mason County and not
move on Thurston County with the NFP program. She will be working on developing some new community
programs in Maternal-Child Health with community partners.
Communicable Disease & Notifiable Conditions (3 programs)
September-October,our communicable disease(CD)program nurse received 125 reports requiring data entry into
the State database,and/or investigation and follow-up.The categories were as follows: TB-Latent TB Infection
(LBTI)-5; Hepatitis B-1; Hepatitis C-50;Campylobacteriosis-9; Pertusis-1;Salmonella-2; Giardia-1; Lyme
Disease (suspect) 1; Mumps(suspect)-1; Bacterial Meningitis(suspect)-2; Norovirus 1; Influenza A-related
death-1;for a total of 75. Sexually Transmitted Disease(STD):Chlamydia 41;Gonorrhea 8; Herpes 1;for a total
of 50 and a combined total of CD/STD= 125.
Housing
Community lifeline opened their cold weather shelter November 1. This year,for the safety of adults experiencing
homelessness,funding allows them to stay open continuously rather than being temperature dependent as in the
past. Hypothermia can occur at temperatures at or below 50 degrees when people are wet. They've averaged 28
people per night and have reached the capacity of 35 twice so far. Females have accounted for about 25%of the
nightly residence. It has been reported in the newspapers that the Shelton Police have experienced a 50%
reduction in nightly calls since the shelter opened.
The Veterans House has a service provider and began tenant occupancy in October. Of the three bedrooms,two
have been occupied consistently.
The Veteran Stand Down occurred on November 18. 80 total people received supplies,food and were connected
to services. 17 were counted as homeless this year compared with 21 last year.
Transportation for veterans to American Lake and other places for medical treatment is an identified need. We are
working with Mason Transit Authority and have created a community van program funded by the Lions Club for
veterans. The next step is for the veteran organizations to obtain a volunteer driver pool and identify the weekly
usage to start this service.
The annual Point in Time Homeless Census Count is January 25. This year we are adding a separate youth event
and the veterans organization will also be open for services this day.
For all of Mason County,the table summarizes households that have experienced a housing crisis and contacted
one of two entry points for Coordinated Entry(Shelton—Crossroads Housing and Belfair—North Mason
Resources):
How many people experienced a housing crisis?
Coordinated Entry July-August Sept- Nov-Dec 6 month
October total
People 174 156 74 404
Households 72 69 39 180
Children 76 64 22 162
Male 70 56 35 161
Female 103 98 39 240
Veteran 10 10 6 26
Chronically Homeless 18 11 7 36
Literally Homeless 75 56 1 35 166
Top Reasons for Homelessness
Can't find affordable housing
Fleeing DV/Family Crisis
Job Loss
Mental Health
BHR and Community Youth services continue to serve youth. Northwest Resources SOS program continues to
serve adults with Mental Health and Substance Use Disorder(SUD) challenges. Performance reports are due
January 10, 2018 and more data on the numbers served for the last quarter of 2017 will be available at the next
BOH meeting.
Substance Abuse Treatment and Prevention
The Substance Abuse Prevention Coalition,supported by our substance abuse prevention grant, holds regular
meetings the second Wednesday of each month from 4:00-5:30 pm at the Shelton Library. The coalition is
currently working on topics such as ensuring that we are able to continue our Rx Drug Take Back Boxes and policy
development that reduces sales of alcohol and marijuana to minors.
Ben attended the Annual Substance Abuse Prevention Conference in Yakima in mid-November. He has provided
information to the WA State Prevention Certification Board for re-certification of his Substance Abuse Prevention
Specialist certification,a requirement of the Department of Behavioral Health and Recovery Grant.
The Prevention Education Partners(PEP)Coalition and Mason County Public Health are currently partnering with
The Shelton SADD Club to provide a Promising Practice Media Awareness Education program in the Shelton School
District. A partnership with The Family Education Support Services that provides an Evidence Based Prevention
Parenting education program in Shelton has been contracted for this grant cycle.
The Drug Take Back Boxes are another project of the Shelton Prevention Education Partners Coalition. In 2016,
1,556 pounds of medications were collected. In 2017,over 1,600 pounds were collected.
The Opioid Overdose Program activities over the past two months include:
•Held community workshop on November 30th to educate the community about overdose response protocol as
well as Naloxone. Attendees included;social workers, active using community and concerned citizens
•Held on-site Opioid workshop hosted by Skokomish HOPE/Health Clinic 11/29. Attendees included;tribal police
officers/chief, health clinic employees,teachers and tribal members.
•Dispersed 600 revised Mason County Substance Abuse Resource Guides
•Received two calls on CHPA work cell phone from community members seeking Mason County recovery resources
•Dispersed 64 Naloxone kits into community
Fliers for opioid workshop and new support group ran in Squaxin Island Kla'che'min Newsletter
•Held Opioid Forum in North Mason 11/15 80+pp1 attended
•Connected with Consejo Counseling and Referral Service/Northwest Resources to have representative at
community workshops to connect people to treatment options
Coordinated with Timberland Regional Library to have Opioid workshop in January
•Connected with Squaxin Island Behavioral health office about resources and the possibility of them hosting an
Opioid workshop in 2018
•Coordinated with Mason Transit to have a table at the downtown depot to provide recovery resources as well as
Naloxone kits,starting on January 10th, 2018
•Connected with North Mason Regional Fire Authority to begin receiving overdose reports of those that refuse to
be transported to hospital
•Connected with Sheriff's office to receive reports of suspected overdose as well as Naloxone saves
Maternal-Child Health (MCH)
The Children with Special Health Care Needs(CSHCN) program provides case management and resource support
for families with children who have serious physical, behavioral or emotional conditions that require health and
related services beyond those required by children generally. In 2017,we provided services for 55 families. Many
of these families required assistance with the Medicaid transportation system for medical appointments. By
providing linkage and referrals,families can more easily access the care children need.
Emergency Preparedness
Lydia Buchheit attended the National Healthcare Coalition Preparedness Conference the last week of November in
San Diego, California with the Region 3 Health Care Coalition Executive Committee. Some of the topics of the
courses attended included, Response to Botulism Outbreak, Lessons learned in the 2017 Hurricanes, Local
Coalition Efforts to Maintain readiness for High Consequence Infections Diseases, Developing Innovative Local
Health Emergency Preparedness Infrastructures, and Medical Countermeasures Planning.
From the Director's Desk
January 2018
It's not too late, get your flu shots!
WSALPHO
With the legislative session underway, both WSALPHO and the Washington State Public Health
Association will be working in Olympia putting forward the message of public health. Here in Mason
County we're sticking with "Public Health is Essential" as our slogan.The effort is to keep awareness of
public health in front of the legislature prior to next year's biennial session where a monetary ask will be
made. February 7th is our annual legislative education day in Olympia. BOH Members are welcome to
attend. Contact me for details. Breakfast is provided!
Washington State Health Assessment
The Department of Health has released its draft state health assessment which is open for comment.
The document itself is quite lengthy at over 200 pages.The summary is quite helpful at
https://www.doh.wa.gov/DataandStatisticaIReports/StateHeaIthAssessment . In the assessment, DOH
spends some time discussing how the physical and built environment affects health but I there's not a
great deal of understanding how comprehensive planning and public health can work together to
address the 80%of health which is not clinical health care.This is an opportunity for Mason County to
provide leadership in looking at how our model may work in other jurisdictions.
Mason County Assessment
Mason County Public Health is conducting an assessment internally to add to the statewide effort to
quantify foundational public health.We're currently looking at all the programs and cross cutting
capabilities (accounting, policy work, record keeping)that are foundational to governmental public
health and putting dollar figures to the work we're currently performing.The second half of the
assessment is an evaluation of the foundational programs going forward and asking the questions "if
there was adequate funding, what would that amount be, and how much work could be shared across
jurisdictions to gain efficiency?"This process was beta tested in 2011 with nine other jurisdictions and
then extrapolated that data across the state. We soon realized that extrapolation had limitations so now
this assessment is being conducted in all LHJs.This data should provide us with a model that shows
where money is being spent, where services are being shared for efficiency or need, and what a fully
funded system would look like.
We've received the newest consolidated contract from DOH which will guide many of our activities
going forward for the next two years.The contract contains no major surprises and consolidates some of
the shellfish language in a way that's more clear than in previous amendments. The con-con comes out
every two years and is modified by amendments as funding and statements of work change. We will be
putting together binders for board of health members with a basic set of information on programs,
policies and activities for the March BOH meeting.You will also have the 2017 Annual Report for the
Community Services Department available at that time.
With the loss of our public health nurse, our FTE's stand at 19.9.
State Health Assessment :: Washington State Department of Health Page 1 of 2
Health
N Data and Statistical Reoorts > Stale Health Assessment
Washington State Health Assessment
Executive Summary
To better facilitate strategic thinking about improving
health in Washington,the Department of Health has
drafted a comprehensive assessment of health in our state HealthAssessment
state,working with partners in local and tribal health,
healthcare delivery,and the public health community.We
view this document as a key resource for public health to
function as a Chief Health Strategist—that is,to provide
data and identify key health issues,to convene leaders
across multiple sectors,and to strategize with leaders on
prevention efforts,policy development,and lY�w
communication to promote the health of Washingtonians.
We strived to create an inclusive document,and we hope that the trends and information
this report highlights lead to rich conversations in communities throughout our state.You
can help initiate these conversations by providing feedback by January 23(survey link)
[3_.Please only provide comment once.
If you'd like to get notified when the Assessment is final,sign up hereof_.
View/download entire document(PDF),or use links to specific sections below:
Introduction and Overview
Introduction and Overview(PDF) (Page 1)-This section includes information about
population trends that have implications for the health of Washingtonians,describes
current life expectancy and leading causes of death in Washington State,and discusses
the determinants of health and health disparities.
The following five sections highlight 27 key issues of high importance identified by
stakeholders.
Health Outcomes
Health Outcomes(PDF) (Page 29)-Health outcomes refer to diseases and health issues
that directly affect the length or quality of life.Included here are sections on asthma,
breast cancer,coronary heart disease,diabetes/prediabetes,HIV,infant mortality,mental
health,obesity,oral health,and suicide and safe storage of firearms.
Health Behaviors
Health Behaviors(PDF) (Page 95)-Health behaviors refer to the actions we take that
help us maintain or regain good health,or put us at risk of illness or adverse health
outcomes.Included here are sections on fruit and vegetable intake,physical activity,
tobacco and vapor product use,excessive alcohol use,use of marijuana,and drug
overdose and nonmedical use of pain relievers.
Healthcare Access and Preventive Care
Healthcare Access and Preventive Care(PDF) (Page 139)-Healthcare access involves
aspects such as the availability and location of healthcare providers and behavioral health
providers,health coverage,affordability of services,and preventive care including child
immunizations and prenatal care.
Physical and Built Environment
https://www.doh.wa.gov/DataandStatisticalReports/StateHealthAssessment 1/10/2018
State Health Assessment :: Washington State Department of Health Page 2 of 2
Physical and Built Environment(PDF) (Page 165)-The physical environment is the world
around us.It interacts with the built environment—an area's transportations systems,land
use and community design—in influencing health and well-being.To support health and
well-being in our physical and built environment,highlighted here are fluoridated public
water systems,good outdoor air quality,and safe shellfish harvesting.
Social Determinants
Social Determinants(PDF) (Page 179)-Social and economic conditions are often
referred to as the social determinants of health,and they impact people's access to food,
resources,medical care,and preventive services,affecting health behaviors.Highlighted
here are adverse childhood experiences,domestic violence including sexual violence,
homelessness,and inadequate social support.
Indicator Summary,Statewide Assets and Conclusion
Indicator Summary(PDF) (Page 201)-These final sections of the assessment
summarize the findings of the health issues highlighted and identify eight priority health
issues for Washington State.
The summary is followed by an assessment of the statewide assets and resources we can
leverage to promote health and well-being,including governmental public health;the
healthcare delivery system;statewide partners working in our physical and built
environment;and partners working on the social determinants of health--employment,
income,education,and community resources.
We describe gaps and opportunities identified through the assessment process and set
the stage for working together on building our next State Health Improvement Plan(SHIP).
Appendix
Appendix(PDF) (Page 221)-Health Indicators,Comparison of State and Local Key
Issues,Data Sources and Technical Notes,Acknowledgements.
https://www.doh.wa.gov/DataandStatisticalReports/StateHealthAssessment 1/10/2018
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Foundational Public Health Services
2018 Fact Sheet for the legislature
The Problem
Washington's governmental public health system has a critical and unique
public safety role that is focused on protecting and improving the health of
families and communities. Protecting the public's health is a fundamental
responsibility of the state (RCW 43.70.5121.
After a century of effectively preventing illness and increasing the length and
quality of life in Washington communities, the public health system has become
woefully inadequate and is now unable to meet its basic responsibilities to
protect the health and safety of people in Washington State. A responsive and
viable governmental public health system is essential for healthy and
economically vital communities across Washington.
The Solution
The solution is to rebuild, transform and fund a 21 It century public health system
in Washington by:
FL7; 1. Adopting a limited statewide set of core public health services, called
IvHealth ; Foundational Public Health Services (FPHS)
2. Funding FPHS primarily through state funds and fees that are predictable,
10A HINGT N S T sustainable and responsive to changes in both demand and cost
0ARS OF �aIV
��•�-�•--••�-�••� s 3. Providing local revenue generating options so local communities can
WSALPHO' address local public health priorities, also known as Additional Important
Services (AIS)
4. Delivering FPHS in ways that maximize efficiency and effectiveness and are
standardized, measured, tracked and evaluated
Allene Mares, Special Assistant to the Secretary of Health
Public Health Transformation
Washington State Department of Health
360.236.4023 1 January 2018
Foundational Public Health Services:
O Are a limited set of core public health services-like collecting and sharing
community health data to identify problems and investigating
communicable diseases before they become epidemics
O Must be available in every community in order to protect all people in
Washington
O Are services that only government provides
O Aren't everything public health does
Progress: An Initial Investment
In the 2017-2019 state budget, the legislature appropriated an initial investment
of$12 million one-time funding. While this is not sufficient to fully rebuild and
transform public health for the 215'century, the initial investment is being used to
strengthen communicable disease (CD) activities across the state.
At the local level,$9 million is being invested in each of the 35 Local Heath
Jurisdictions (LHJs) to shore up critical CD control and $1 million is funding three
shared service demonstration projects to test new service delivery models for
increased effectiveness and efficiency. Projects include providing:
O Tuberculosis prevention and control expertise, technical assistance,
coordination and a response team to all LHJs, statewide
O Epidemiology and community health assessment expertise to multiple LHJs in
Eastern Washington
O Expertise and technical assistance to LHJs in making timely information
available to health care providers in their communities
At the state level, $2 million is invested at the Department of Health (DOH) in
implementing strategies to control the spread of CD and other strategies and
include:
O Staffing for microbiology and radiation testing at the state lab
O Information technology staff for system consolidation and modernization
O Health impact review staff at the State Board of Health
O Conducting a statewide FPHS assessment
These investments are being tracked using the State Auditor's Office chart of
accounts called Budget, Accounting and Reporting System (BARS) and DOH
accounting system. Impact of the investments are being measured in the
following areas:
1. Childhood immunization rates-one of the most effective and efficient way
to prevent disease
2. Hepatitis C case reporting and follow-up and partner notification for people
who may have been exposed to sexually transmitted disease-to reduce
long-term and costly impacts of these conditions and prevent the spread of
disease to others
The Work Ahead
The initial one-time investment from the legislature, is not sufficient to address all
of the items in the budget proviso including:
O Fully enhanced CD prevention activities
O Enhanced work in chronic diseases or injury prevention
O Root cause analysis of adverse events in health care facilities
O Comprehensive Hepatitis C follow-up
O Enhanced work on health inequities
Recommendations to the legislature
O Continue the initial investment and build on it to fully fund FPHS
O Provide local revenue generating options so communities can fund
additional local priorities
From the Desk of the
Environmental Health Manager "
December 2017 & January 2018
For Board of Health January 23, 2018
Happy New Year! The calendar year 2017 ended with EH staff finishing up projects, completing
reports and developing their program's work plans for 2018. Highlights of 2017 included:
• In June Maria Machado attended the State Department of Health sponsored
"Environmental Health Training in Emergency Response Operations" workshop at the
Anniston, Alabama Center for Domestic Preparedness.
• Cody Lund was awarded 2 of 3 grants he applied for to perform tasks required for
implementation of the Food and Drug Administration (FDA) Program Standards program
aimed at promoting uniformity of retail food inspections.
• Staff performed 37 Group A public water system sanitary surveys, 66 well site
inspections (47 of those with the driller present), inspected 4 well decommissions and
completed 23 site inspections for new two-party water systems for the drinking water
program.
• The solid waste program responded to 85 new solid waste complaints, completed 245
site visits, closed 74 complaint cases and issued 3 civil infractions (tickets) for solid
waste violations. She also inspected 6 solid waste facilities, renewed 6 solid waste
facility permits and issued 1 new solid waste permit. These numbers are excellent when
one considers the fact that we have not had Department of Ecology funding to operate
a solid waste enforcement program since June 30, 2017 because the Legislature's failure
to adopt a Capital Budget. This source usually funds 75%of our solid waste program.
• Staff conducted 394 inspections at 240 food service establishments and 129 inspections
on 130 temporary food permits. 2,963 food handler cards were issued to Mason County
residents. We received 15 food borne illness complaints and 27 non-illness complaints.
• Staff issued 407 onsite septic system permits, 74 of those were repairs, provided
technical assistance for 33 pre-application conferences and generated 31 loan status
reports. We certified 26 septic system pumpers, 57 installers, and 34 operation and
maintenance specialists to work in Mason County. Sent out a total of 48,041 reminders
for service and educational packets to homeowners. Of the 26,156 septic systems in the
O&M database 87% have record drawings on file and 63% are current on their
service/maintenance.
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• Sixteen routine inspections of 15 permitted pools and 4 permitted spas were conducted.
• Staff followed up on 3 animal bites—2 dogs and 1 cat. We sent 8 bats to the state lab
for rabies testing; none of them were positive for the virus.
• Grant funded water quality work was performed in 3 shellfish protection districts—
Oakland Bay, McLane Cove and Hood Canal #6. Two new shellfish protection districts
were formed because of water quality downgrades. Those areas are North Bay and
Annas Bay. Both present unique issues.
o Allyn is served by the North Bay (County) sewer, so the usual onsite septic
system reviews and Pollution Identification and Correction protocols will not
work. How should the county go about charging a fee for water quality work to
an area where citizens are connected to and paying for sewer service? Public
Works Utilities will need to be an active partner in this work.
o Annas Bay is home to the Skokomish Tribe. They are willing participants to do
work on the reservation properties. We will do our work as laid out in our
policies and procedures for the properties that are not on the reservation.
Some of the preliminary work for Annas Bay is being done under the Hood Canal Regional
Pollution Identification and Control grant we have with the Hood Canal Coordinating Council.
The grant does not have sufficient funding for the implementation of the plan. Although we are
requesting funding through the South Sound Near Term Action workgroup for North Bay,there
is no money to do the preliminary work and write the plan. There may be some funding for
implementation when we get to that point.
During 2018 the Environmental Public Health section of Mason County Community Services will
continue to push for adequate, sustainable funding for water quality and operation &
maintenance work. This funding will allow program staff to do the work in a timely manner that
is beneficial for the county, with the needs of our natural resources and best interests of our
local businesses and citizens identified.
2017 was a year of change for the Environmental Health section. Two long time employees
retired in July. Between them they took over 45 years of Mason County environmental health
experience with them. The current staff are a wonderful group of young professionals with a
great deal of enthusiasm and a willingness to learn. They have endless potential and truly want
to be in Mason County. They are smart and talented, and I am honored to work with them.
We closed out 2017 with a sense of pride and accomplishment. We start 2018 with enthusiasm
and a "can do" attitude for the challenges that lie ahead.
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