County of Marin Health and Human Services

Public Health Newsletter

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Public Health Newsletter - April 2019
Marin County Public Health Newsletter Volume 7 - Issue 4 - April 2019
In this Issue: Measles | Aspirin | STI | WIC | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Measles in California 

In 2019, two outbreaks linked to patients with international travel have been reported in California, and over 700 cases have been reported nationally.   This week, Marin County parents received this letter, outlining the public health measure of excluding unvaccinated children from school if there is a case on campus.  The California Department of Public Health has issued updated measles clinical guidance.  For more information on measles in Marin County, click here.

An Aspirin (Apple) a Day ... 

Last month, the American College of Cardiology / American Heart Association released a national guideline on aspirin use in the primary prevention of Atherosclerotic Cardiovascular Disease (ASCVD).  Based upon cardiovascular risk, adults as young as 40 years old may benefit from daily aspirin.   On the other hand, it is no longer recommended to start or continue aspirin for primary prevention.  Aspirin is still recommended at any age for clinical ASCVD.  As guidelines change, healthy eating and active living remain the mainstay for cardiovascular and diabetes prevention.

STI Treatment Is Prevention            

During the past six years, Marin County has seen a significant rise in sexually transmitted infections (STIs) in all groups, and particularly among men who have sex with men (MSM).  As part of April's STD Awareness campaign, the California Department of Public Health is encouraging providers to test for chlamydia and gonorrhea in MSM.  The most common symptom of an STI is no symptoms at all.  Therefore, risk-based STD screening is critical to reduce STI prevalence in our community.  The Centers for Disease Control and Prevention offers free self-study modules and CME credit.

Local Opioid Crisis Response           

Marin's response to the opioid epidemic was highlighted at the RxDrug Abuse and Heroin Summit in Atlanta last week.  The presentation, entitled "Think Local, Act Local," featured RxSafe Marin and Safe Med LA as examples of community-wide action through local opioid safety coalitions.  The President and First Lady attended the conference, signifying federal interest in a response that's informed by successful models.  The RxSafe Marin dashboard tracks our progress against established goals county-wide.

Public Health Program Spotlight:  Women, Infants, & Children (WIC) 

WIC offers healthy foods and support for nutrition, health and breastfeeding for families at critical periods of growth and development.  WIC provides:
  • Nutrition experts who specialize in nutrition for mothers and their children.
  • Support and information about breastfeeding, including access to breastfeeding experts.
  • Help in accessing health care and other social and economic supports.
  • Special checks to buy healthy foods, such as fruits, vegetables, whole grains, milk, eggs, bread, cereal and more.
We count on health care providers to refer to the WIC Program.  For more information, please call 415-473-4029 or email: marincountywic@marincounty.org

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotIt's hard to believe that measles is back after being nearly eliminated in 2000. To date this year, there are more than 700 cases nationally, including some in several Bay Area counties.  Marin County has been spared so far in the latest outbreak, but we are vulnerable.  Although childhood vaccination rates are 94 percent overall, in some schools less than half of students are fully vaccinated.  Marin hosts visitors from all over the world, our residents are frequent travelers, and measles is more common abroad.  Your vigilance in promoting vaccination and identifying and reporting potential cases is vital to protecting our community.
Warm Regards,
Matt Willis
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Copyright (c) 2019
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter - March 2019
Marin County Public Health Newsletter Volume 7 - Issue 3 - March 2019
In this Issue: Flu | Ebola | Immigrant Health | Flavored Tobacco | Food Pharmacy | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Second Wave in Seasonal Flu

Local influenza surveillance has revealed an unusual late-season increase in incidence.  This is being attributed to increased H3N2 influenza virus transmission, added to H1N1 activity that was dominant earlier.  H3N2 influenza is associated with more severe illness in older adults.  Timely antiviral treatment for at-risk individuals remains important.  Visit the Marin Flu website for the most up-to-date information about current influenza activity in Marin.

Ebola Update

The ongoing outbreak of Ebola in the Democratic Republic of Congo serves as a reminder to review your infection control processes.  CDC recommendations for healthcare facilities have been recently updated.   Direct any questions to Marin County HHS Communicable Disease Prevention and Control unit at 415-474-4163.

Immigrant Health Services in Marin

Recent debate around immigration policies have left many Marin immigrants concerned about being recipients of public supports for which they are legally eligible.  Marin HHS is tracking enrollment in MediCal (health insurance), CalFresh (food stamps), and WIC (perinatal nutrition support).  This publicly available dashboard shows local enrollment rates declining and can help guide local response.
                                                                                              

Flavored Tobacco Ban

On March 26, San Anselmo became the latest Marin city to take action against the harms of vaping and flavored tobacco, joining Corte Madera, Larkspur and Sausalito.  This follows the lead of the County Board of Supervisors' 2018 vote to prohibit the sale of all flavored vaping and tobacco products in unincorporated areas of Marin.  This response is being mirrored in Sacramento, where Senate Bill 38, a state-wide flavored tobacco ban, is moving forward with wide support from the medical and public health community.

Public Health Program Spotlight:  Food Pharmacy

Many low-income Marin residents are food insecure and experience higher rates of preventable cardiovascular disease.  The Marin City Health and Wellness Center food pharmacy program offers low-income patients the fresh taste and nutritional benefits of produce direct from local farms.  Clinic patients who screen positive for food insecurity are given a prescription for free produce at the weekly Rollin' Root mobile market, provided by the Agriculture Institute of Marin and supported by Marin HHS.  Other sites that offer affordable local produce through Rollin' Root are available here.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotThis month, Marin was named the healthiest county in California in the annual Robert Wood Johnson Foundation County Health Rankings for the ninth time in ten years.  High performance in the category of clinical care was noted. 
We are fortunate to have a clinical community that prioritizes high quality care.  Our goal is to help raise your awareness and guide response to emerging threats to health for all communities, so that Marin can be even healthier.
In gratitude,
Matt Willis
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Copyright (c) 2019
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
County of Marin Logo

Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter - February 2019
Marin County Public Health Newsletter Volume 7 - Issue 2 - February 2019
In this Issue: Measles | Celebrating Diversity | Shelter | Pertussis | Child Health | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Measles

Measles continues to circulate in much of the world.  Airport travel can pose a risk for exposure to measles.  While recent measles outbreaks in other states have sparked concern, Californians are not at significant risk for measles unless they travel to Clark County.  While providers should consider measles in patients with fever and a descending rash, measles is unlikely in the absence of contact with a confirmed case of measles or a history of travel or exposure to travelers.  The California Department of Public Health (CDPH) has issued new guidance for measles testing.

All for One & Fun for All! 

This year, the Marin County Fair was recognized nationally by the Western Fairs Association (WFA) for celebrating the diverse cultures of our county.  The Global Stage showcased community performers' artistic interpretations and expressions of the "All for One & Fun for All!" theme.  The fair also hosted an International Festival of Short Film and Video, culinary contests, including a Recetas Latinas Contest for Latino foods, and an Out at the Fair day for Marin County's LGBTQ+ community.

Severe Weather Emergency Shelter Plan Update 

Marin Health & Human Services (HHS) is the primary funder of 165 of Marin's 190 year-round emergency shelter beds.  After a decade, the Rotating Emergency Shelter Team (REST), which provided 60 additional winter emergency shelter beds, ended in April 2018.  This season, HHS developed a Severe Weather Emergency Shelter (SWES) plan to open emergency shelter beds when cold-weather conditions increase the risk of hypothermia-related morbidity and mortality for residents who are unsheltered.   This winter season, we have activated the SWES plan four times and provided seven nights of shelter at the Health & Wellness Campus.   Watch this video to see what we are doing about Homelessness.   Visit this website to read what we are doing about Homelessness.

Pertussis Update

Since 2018, there has been an outbreak of pertussis (aka whooping cough) in Marin County.  Outbreaks commonly occur every 3 to 5 years.  Compared to 44 cases of pertussis in 2017, Marin County had 249 reported cases in 2018.  As of January 2019, there were 18 confirmed cases of pertussis in Marin County.  Visit Marin HHS' Communicable Disease Prevention and Control's Pertussis Update for more information.

Public Health Program Spotlight:  Child Health & Disability Prevention Program

The Child Health & Disability Prevention (CHDP) program is a preventive program that delivers periodic health assessments and services to low-income children and youth in California.  In 2016, the CHDP adopted the American Academy of Pediatrics' (AAP) Bright Futures recommendations for pediatric preventive healthcare.  CHDP providers are now required to provide developmental screenings at 9 month, 18 month, and 24 or 30 month well-child exams.  Health promotion and anticipatory guidance, disease prevention, and early detection of disease contribute to a lifetime of positive health outcomes.

Message from the Deputy Public Health Officer

Last year, HHS released our new Strategic Plan to Achieve Health & Wellness Equity.  In partnership with the community, HHS will be amplifying its work, addressing key conditions that help drive, maintain, or worsen racial inequities.  One indication of success on this front will be decreased exposure to trauma and increased resilience.  By incorporating trauma-informed approaches to care, health care providers can more effectively care for patients and improve health.  The first step of trauma-informed practice is recognizing how common trauma is and asking, "What happened to you?" rather than "What's wrong with you?" (which is not necessarily natural for professionals who start documentation with the "chief complaint").  Learn more about Trauma-Informed Care by visiting the Trauma-Informed Care Implementation Resource Center.
Warm Regards,
Lisa Santora, MD, MPH
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Copyright (c) 2019
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter - January 2019
Marin County Public Health Newsletter Volume 7 - Issue 1 - January 2019
In this Issue: Flu | Training | Resistance | Whole-Child Model | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Flu Update 

Influenza rates continue to rise in Marin County and the virus is actively circulating in our community.  Preliminary results of local surveillance suggest this year's rates are lower than those of the prior two years.  This may be attributable to higher vaccination rates, the match between vaccine and circulating strains, or other factors.  Those who remain unvaccinated are at elevated risk for disease and for more severe and longer duration of symptoms.  Marin's flu season typically lasts through March and clinicians should continue promoting and providing vaccination. 

Training our "First" First Responders

Survival rates after large scale emergencies depend largely on how laypeople --- family members, bystanders, and neighbors --- tend to the injured prior to the arrival of professional first responders.  The Marin Medical Reserve Corps' (MMRC) First Aid for Disaster Response (FADR) program provides hands-on training for non-clinicians to treat life-threatening injuries.  The program was recently honored by the U.S. Department of Health and Human Services for training 600 Marin County residents.  To reach more residents, more clinicians are needed in the FADR training force.  For more information about joining the MMRC, visit www.marinmrc.org.

Limiting Local Antimicrobial Resistance 

Rates of antibiotic-resistant C. difficile and other bacteria are rising in Marin and regionally, making judicious antibiotic prescribing an increasingly high priority.  The Journal of the American Medical Association: Internal Medicine found healthcare professionals in outpatient settings often unnecessarily prescribe antibiotics for the common cold and bronchitis, with urgent care prescribers doing so in nearly half of cases of upper respiratory illness.  California was the first state to adopt antimicrobial stewardship legislation, and the statewide stewardship program has valuable resources for clinicians.
 


Public Health Program Spotlight:  Whole Child Model

As of January 1, 2019, changes came to California Children's Services (CCS) and the 700 medically complex children it serves in Marin.  Marin CCS and 21 other counties adopted the Whole Child Model program, which means the Medi-Cal managed care plan, Partnership Health Plan (PHC), in Marin, is taking over care coordination as well as authorizing and paying for services.  PHC is coordinating care for the whole child, including specialty care, well child care, and behavioral health needs; in addition, PHC will support overcoming barriers to access to care, such as transportation needs.   Marin CCS continues to accept new referrals.  CCS services for occupational and physical therapies at the Marindale MTU also continue.   CCS children in Marin continue with the same CCS benefits and get more comprehensive care through the CCS Whole Child Model program.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotIn order to strengthen communication between your office and mine, and to keep you aware of public health initiatives that may impact your patients, we're adding a feature to this newsletter for 2019.  Each month, a Marin HHS Public Health Program that touches our clinical partners will be briefly highlighted.  This issue features a program serving our children with complex medical needs.  Thank you for all you do to make Marin County healthy, and please suggest topics for future editions.

Warm Regards,
Matt Willis, MD, MPH
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Copyright (c) 2019
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter - December 2018
Marin County Public Health Newsletter Volume 6 - Issue 11 - December 2018
In this Issue: Synthetic Cannabinoid | Public Charge | Shigella | Syphilis | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Synthetic Cannabinoid 

While no cases have yet been reported in Marin County or California, the Centers for Disease Control and Prevention (CDC) is reporting that more than 300 people have presented this year to healthcare facilities with serious bleeding disorders due to synthetic cannabinoid use, including 8 fatalities.  The vitamin K antagonist, brodifacoum, has been found in these synthetic drugs.  Vitamin K1 continues to be the recommended therapy.

Public Charge

The United States Department of Homeland Security (DHS) has issued a proposed rule that would significantly revise the legal test for determining when legal immigrants are likely to become "public charges" and therefore ineligible for residency in our country.  On December 2nd, the Marin IJ published an Op-Ed by Drs. Mitesh Popat (CEO, Marin Community Clinics) and Matt Willis (Health Officer), which describes the detrimental effects this law, as currently written, would have on the health and well-being of our community.  One major effect, which we are beginning to see in Marin County, is a chilling effect on Medi-Cal enrollment.  This could translate into declining revenue and ultimately decreased staffing and service capacity of our county's community health centers.

Shigella

In Marin County, an increasing number of Shigella isolates are being found to carry antibiotic resistance.  The CDC is reporting a national trend of ciprofloxacin and azithromycin-resistant Shigella strains.   Clinicians should be aware of potential treatment failure in Shigella infections treated with ciprofloxacin or azithromycin.  If treatment failure is suspected, clinicians should contact the HHS Communicable Disease Prevention and Control (CDPC) unit (415-473-4163) to coordinate antimicrobial susceptibility testing at the Public Health Laboratory. 
 

Congenital Syphilis

According to the California Department of Public Health, the number of infants born with congenital syphilis has increased alarmingly over the last five years, growing from 33 cases in 2012 to 283 cases in 2017.  This increase is both tragic and unnecessary as congenital syphilis is completely preventable.   Clinicians are urged to test every woman for syphilis once in her first trimester prenatal labs.  Women who are at risk should be tested again in the beginning of the third trimester.  For further information regarding diagnosis, testing and treatment, clinicians can consult the CDC's Syphilis Pocket Guide.   

Message from the Deputy Public Health Officer

I am thankful for the opportunity to live, work and play in Marin County.  Unfortunately, everyone in Marin doesn't experience the same quality of life.  As the recent "Race Counts" report highlights, Marin is the most racially inequitable county in California.  Marin Health and Human Services (HHS) has just released All in Marin, the HHS Strategic Plan to Achieve Health and Wellness Equity.  We are committed to working together with our healthcare partners to reduce racial and ethnic disparities in health outcomes.  Thank you for all you do each and every day to keep All in Marin healthy.
With gratitude,
Lisa Santora
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter - November 2018
Marin County Public Health Newsletter Volume 6 - Issue 10 - November 2018
In this Issue: Tobacco | Wildfire | IMPACT | TB | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Marin Passes Flavored Tobacco Ban 

With support from the Marin medical community, on November 6, the County Board of Supervisors unanimously passed an ordinance preventing the sale of flavored tobacco and e-cigarettes in unincorporated areas.  Marin is helping lead a growing number of communities taking action to reverse the alarming trend of vaping and flavored tobacco use.  On November 29, California lawmakers announced a plan to introduce a bill that would ban the sale of flavored tobacco state-wide. 

Wildfire Smoke Response 

Between the 8th and 20th of November, Marin County experienced an unprecedented interval of poor air quality due to wildfire smoke.  The frequency, duration, and severity of wildfire events is increasing significantly, and each  offers an opportunity to refine our response.   Marin County Public Health issued public health advisories and worked closely with schools, healthcare systems, and emergency response.  For any future events, see this landing page for Public Health wildfire response information.

IMPACT                               

Clinicians are aware that a small number of individuals utilize a large fraction of healthcare and social services, often due to complex medical and psychiatric disease and unmet social needs.  Marin County is launching a two-year pilot program to help thirty of the most vulnerable mental health clients survive safely in the community.  The goals of the Integrated Multi-Service Partnership Assertive Community Treatment (IMPACT) program include reduction in hospitalizations, ED visits, and arrests.  Visit the  website to learn more.                                                                                 

New Guidelines for Latent Tuberculosis Treatment

Although rates of TB disease in Marin have steadily declined, this trend has slowed since 2000.  Most cases of active TB in Marin arise in persons with untreated latent infection, representing missed opportunities to diagnose and treat disease before it can spread.  The California Department of Public Health has updated guidance for latent TB infection screening and treatment.  Visit Marin County Tuberculosis Control webpage for additional resources.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotThe recent wildfire smoke response offered a glimpse into the profound social disruption that large-scale environmental damage brings.  While we respond to urgent needs during such events, it is critical that we recognize the root causes and shift our attention upstream toward prevention.  The clinician voice is vital in signaling the tangible impacts of climate change on the health of our community.
With gratitude,
Matt Willis
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Boulevard
San Rafael, CA 94901
Public Health Newsletter - October 2018
Marin County Public Health Newsletter Volume 6 - Issue 9 - October 2018
In this Issue: Vaping | Myelitis |  Lead | Norovirus | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Flavored Tobacco and Vaping

E-cigarette use among youth is increasing in Marin, threatening years of progress in tobacco control.  The number of Marin County 11th-graders who reported vaping regularly rose from 11 percent in 2016 to 28 percent in 2018.  The use of flavored tobacco, such as menthol cigarettes and flavored cigars, is also increasing among youth and these products are aggressively marketed in African-American communities.   On October 30, the Marin County Board of Supervisors unanimously supported the Public Health Department's request to consider a local ban on the sale of flavored tobacco products.  The vote will be held November 6.

Acute Flaccid Myelitis 

Since early October, there has been a growing number of cases of acute flaccid myelitis (AFM) across the United States.  No cases have yet been reported for Marin County.  AFM is a rare neurological condition that primarily occurs in children, characterized by sudden onset of weakness in one or more limbs and abnormalities of the spinal cord gray matter on magnetic resonance imaging (MRI).  Some cases are testing positive for enteroviruses A71 and D68.  Clinicians should contact Marin County Communicable Disease Prevention and Control (CDPC) if they suspect AFM at 415-473-4163.  CDPC will coordinate specimen collection (CSF, serum, stool, and NP/OP) and laboratory testing.

Child Lead Poisoning Prevention

October celebrates National Lead Poisoning Prevention Week.  Vigilant screening for lead exposure enables early treatment and can identify environmental sources.  Lead poisoning is a highly preventable environmental disease in young children.  Marin County Public Health recommends that all children be assessed for potential lead exposure, especially recent immigrants.  In addition, the California Department of Public Health  mandates blood lead screening at 12 months and 24 months for all children in public programs such as Medi-Cal, CHDP, and the Women Infants and Children (WIC) Program.  Please direct any questions to the Childhood Lead Poisoning Prevention Coordinator, Laurel Johnson, RN, at 415-743-4294. 

Norovirus Is Coming

Every fall, Marin County experiences a surge in gastrointestinal illness, primarily focused in schools and congregate living settings.  Norovirus, the most common form of seasonal gastroenteritis, is highly contagious and is transmitted by direct contact with an infected person; consuming contaminated food or water; and hand-to-mouth contact.  Symptoms often only last for one day, but cases are infectious for 48 hours after symptoms resolve.  To learn more about norovirus, and for instructions on reporting outbreaks, visit the Marin County Communicable Disease Prevention and Control (CDPC) webpage

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotWith all the progress that's been made in tobacco control, it's easy to forget that tobacco remains the leading cause of preventable death in the United States.  Every day, more than 1,000 Americans die from tobacco-related disease --- more than the sum of most public health priorities, including gun violence, suicide, HIV and opioids combined.  For decades, it has taken policy and legislation to protect our communities from tobacco-related harm.  This newsletter highlights one way our elected officials are responding, thanks in part to your voice as clinicians who see the consequences of nicotine addition every day.  Clinicians or others who would like to voice their support can email to BOS@marincounty.org
With gratitude,
Matt Willis
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter - September 2018
Marin County Public Health Newsletter Volume 6 - Issue 8 - September 2018
In this Issue: CURES | Rabies | Flu | Suicide | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Mandatory CURES Use Begins Next Week

In order to promote better-informed prescribing practices, starting October 2, physicians must consult CURES (Controlled Substance Utilization Review and Evaluation System) prior to prescribing DEA Schedule II, III, or IV medications, with some exceptions.  The California Board of Medicine is responsible for regulation and enforcement of the new law for physicians and has developed this useful guideThis short video describes the clinical utility of CURES.

Rabies

World Rabies Day is held annually on September 28th, the anniversary of the death of Louis Pasteur, who developed the first rabies vaccine.  Rabies is nearly always fatal and is endemic in Marin wildlife.  Approximately ten percent of bats tested in Marin carry rabies.   Animal bites are reportable events to Marin Public Health.  Visit the Marin Rabies Information Page to access a Bite Report and review the rabies Post-Exposure Prophylaxis Algorithm.

Flu Update

Last year, Marin County was highly impacted by influenza.  Vaccination remains our best line of defense for health care providers and patients alike.  On November 1st, the Mandatory Influenza Vaccination of All Health Care Workers order goes into effect.  Marin County's Immunization Program is also offering free flu clinics throughout the county.  Visit www.marinflu.org for the most up-to-date information about current influenza activity in Marin.

Suicide Prevention

Marin County's suicide rates are higher than those of most California counties.  Nationally, suicide rates have been increasing annually since 1999.  In Marin, preventable suicides occur across the age spectrum, and two-thirds of the victims are male.  Most have no mental health diagnosis, highlighting the need for community-wide supports.  Marin County Office of Education, Health and Human Services, and others partnered to develop a response protocol for school settings, as part of a wider suicide prevention plan that will be completed in March.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotThis month's newsletter reflects the wide range of health challenges we face as a community and the steps we can take to promote longevity in Marin.  CURES can help address the leading cause of accidental death in Marin, overdose involving prescription opioids.  Flu and rabies mortality is preventable through controlling exposures, vaccination, and post-exposure care.  By screening for suicide risk, clinicians can be a life-saving support and connect patients to services.  As always, your feedback and suggestions for future topics is always welcome.

With gratitude,
Matt Willis, MD, MPH
Public Health Officer
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter - July / August 2018
Marin County Public Health Newsletter Volume 6 - Issue 7 - July / August 2018
In this Issue: Wildfire | Climate Change | Cyclosporiasis | Overdoses | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Wildfire Advisory

California is experiencing unprecedented wildfires this summer, affecting large parts of the state.  As local families travel to areas affected by the fires, Marin County Public Health recommends: 
  • Avoiding areas with poor air quality due to wildfire smoke, especially if traveling with people in sensitive groups, including people with cardiovascular and/or lung disease, infants and children, older adults, persons with obesity or diabetes, and expectant mothers; and
  • If travel to an affected area is unavoidable or essential, then monitor air quality frequently and follow EPA guidelines to reduce smoke exposure and reduce health consequences.

Climate Change Health Impacts:  Extreme Heat 

Heat waves are increasing in frequency and severity, resulting in a higher rate of all-cause and cardiovascular mortality.  The most common diagnoses in heat-related hospital admissions include the following preventable conditions:  heat stroke and sunstroke, fluid and electrolyte disorders, and acute kidney failure.  The risk of hospitalization is greatest in adults older than 85 (primarily due to volume depletion and heat exhaustion).  Households need to prepare for heat and learn symptoms and what to do in case of heat-related illness.  

Increase in Cyclosporiasis Cases in the Bay Area

Since May 2018, there has been an increase in the reported number of domestically-acquired cyclosporiasis cases in the San Francisco Bay Area.  Notably, the first case was diagnosed in a Marin County resident.  Health care providers are encouraged to consider cyclosporiasis in patients presenting with compatible symptoms, such as persistent diarrhea, and to request specific testing for Cyclospora.

Reaching Out to Opioid Overdose Survivors

The H&HS Community Epidemiology Program is piloting a project where individuals who experience non-fatal opioid overdoses served by the Marin County Emergency Medical Services (EMS) system are identified and connected to care.  We are partnering with Bright Heart Health, who provides professional outreach and referrals to treatment and recovery services, such as a naloxone or buprenorphine prescription and a warm hand-off to a treatment program.  This effort is a multisectoral collaboration, including Public Health, Behavioral Health and Recovery Services and community providers.

Message from the Deputy Public Health Officer

On my first day at work in Marin County, I "participated" in a full-scale exercise at the Emergency Operations Center (EOC).  Basically, I watched -- I had never been in an EOC environment.  I mistakenly thought that I wouldn't be responding to an emergency anytime in the near future.  A couple of days later, I deployed to Lake County with the Marin Medical Reserve Corps (MMRC).  In 2017, I deployed to the EOC to coordinate shelter operations at the Marin Center during the North Bay fires.  As I write today, the MMRC stands ready again to deploy to Lake County to provide medical services.  Our ability to serve our communities depends on our own preparedness.  I encourage you to visit FireSafe Marin and review your evacuation plans with your family, friends, and neighbors.  Also, consider joining the new MMRC Surge Team.  The only requirements to join are (1) being an actively licensed health care provider; (2) maintaining an active practice; and (3) registering online with the "Marin County Medical Reserve Corps" at https://www.healthcarevolunteers.ca.gov.
With gratitude,
Lisa
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901

Marin County Public Health Newsletter Volume 6 - Issue 6 - June 2018
In this Issue: Zika | CURES | Hep A | Flavored Tobacco | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Don't Bring Zika Home

After two years of active Zika surveillance, there have been more than 600 travel-associated Zika infections in California.  With summer here, many Marin County residents are travelling to Zika-endemic areas.  The most frequented countries of Zika exposure include Mexico, Nicaragua, and Guatemala.  Encourage your patients to stay informed and protected by visiting the Marin HHS Zika website.

Mandatory CURES Use 

When prescribing controlled substances, many Marin County clinicians consult California's Controlled Substance Utilization Review and Evaluation System (CURES) to guide clinical decisions.  Starting October 2, 2018, all prescribers will be required to check a patient's prescription history in CURES before prescribing Schedule II-IV substances, with some exceptions.  This three-minute video is aimed at clinicians seeking to learn more about CURES and its utility in daily practice.

Hepatitis A Outbreak

California has experienced one of the largest hepatitis A outbreaks since the development of the hepatitis A vaccine, with 704 cases statewide, including 461 hospitalizations and 21 deaths since November 2016.  Incidence has been high among homeless people.  To protect those at highest risk, Marin HHS has partnered with St. Vincent de Paul homeless services in five hepatitis A vaccination clinics over the past year.   Incidence in Marin County has not increased.  Clinicians are reminded to offer hepatitis A vaccine to those at risk and report cases to Marin County Public Health.   

Flavored Tobacco Ban

Tobacco use remains a leading cause of preventable death in the U.S. and in Marin.  Tobacco control policies limit tobacco-related harm, while facing predictable resistance from the tobacco industry.  On June 5, San Franciscans voted to prohibit the sale of menthol cigarettes, flavored cigars, and flavored nicotine-containing vaping products.  Vaping rates among youth have risen dramatically with a corresponding increase in nicotine addiction.  This effort was supported by the San Francisco Marin Medical Society and the American Heart Association.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotClinicians are well aware of the relationship between childhood experiences and life-long health.  Adverse or traumatic events predict risk for chronic disease, mental illness and substance use across the life course.  The medical community responded swiftly against immigration policies that separate families, including the AMA, the National Academies of Sciences, and local physician groups.  More than ever, clinicians are called upon to apply science, compassion and courage in our advocacy for our patients and the community we serve.
Warm Regards,
Matt Willis
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Copyright © 2018
Matthew Willis MD, MPH
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
 
Public Health Newsletter, May 2018
Marin County Public Health Newsletter Volume 6 - Issue 5 - May 2018
In this Issue: Vaping | Pertussis | Syphilis | Foster Care | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Vaping and Marijuana

The annual National Institute of Health's Monitoring the Future Study, which tracks drug use among high schoolers, shows nearly 1 in 3 seniors reported vaping in the past year.   Of these, 11% vaped marijuana oil or hash.  Marijuana initiation in adolescence is known to be associated with poor social and educational outcomes, and evidence is accumulating of an association with early onset psychosis and suicidality.  Health care providers play an important role in screening adolescents and counseling families regarding substance use.

Pertussis Outbreak 

The surge of pertussis (whooping cough) in Marin County continues.   The pertussis vaccine remains the best defense, along with screening, treatment and prophylaxis for high risk contacts.   To protect new mothers and their young babies, pregnant women should receive Tdap vaccine during each pregnancy between their 27th and 36th week.  In this outbreak setting, providers can discuss the risks and benefits of an accelerated vaccination schedule for newborns (e.g., if born to a family with known exposure to pertussis.)  Visit the Marin HHS' Communicable Disease Prevention and Control unit's Pertussis Update for more information.

Syphilis Strikes Back

Since 2014, syphilis rates have increased across the county, state and nation.   Men in general, and gay and bisexual men specifically, continue to face the highest levels of syphilis.   In recent years, syphilis has also risen among women.  One of the most disturbing trends is increasing rates of congenital syphilis.   Since 2013, the number of babies in California born with congenital syphilis has more than quadrupled --- to 278 last year.  The Centers for Disease Control and Prevention (CDC) developed the Guide to Taking a Sexual History, for providers.  Screen your patients for STDs today!

Foster Our Future

Our community needs exceptional people who can provide loving, temporary homes to children in foster care.  While each year, approximately 80 children in Marin County need temporary (foster) homes, we only have 35 approved homes.  Individuals with medical experience, those who can welcome siblings together, and those who are Spanish-speaking are especially needed.   Attend an orientation with a social worker and an experienced foster parent to learn more.  Visit www.FosterOutFutureMarin.org or call 415-473-2200 for more information.

Message from the Deputy Public Health Officer

Grey May is ending, school is almost out, and summertime is coming.  Drowning remains a leading cause of injury death for young children, ages 1 to 4.  As providers, we can encourage parents to prevent drownings by taking precautions.  On June 9th, from 10 am to 2pm, Marin Couty's Emergency Medical Services is offering free training countywise on Hands-Only CPR and Stop the Bleed.  CPR performed by bystanders has been shown to save lives and improve outcomes in drowning victims.  Stay safe and have a fun summer!
Warm Regards,
Lisa Santora
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter - April 2018
Marin County Public Health Newsletter Volume 6 - Issue 4 - April 2018
In this Issue: Pertussis | Drug Take-Back Day | TB | Data | Hepatitis A | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Pertussis 

Pertussis (whooping cough) is on the rise in Marin County and in California.  In Marin, 104 cases have already been reported this year, compared to a total of 74 cases in 2016 and 2017 combined.   Whooping cough incidence has a natural cycle with peaks every three to five years.  The pertussis vaccine remains the best defense, along with appropriate screening, treatment and prophylaxis for high-risk contacts.  Visit the Marin HHS Communicable Disease Prevention and Control's Pertussis Update for more information.

Take-Back Day

Unused and unwanted medications can become a source for misuse, abuse and harm if not disposed of promptly and safely.  April 28 is the U.S. Drug Enforcement Administration (DEA) National Prescription Drug Take-Back Day.  The Marin County Department of Health and Human Services (HHS) and other agencies are encouraging residents to rid their homes of potentially dangerous expired, unused and unwanted prescription drugs and dispose of them at locations throughout the county.  These locations are available year-round.

Latent Tuberculosis in Marin 

Although it is preventable and curable, in a typical year up to 20 Marin County residents will develop tuberculosis (TB) disease.  The vast majority of these cases were carrying the infection in its latent state for years but did not receive treatment that would have prevented disease.  In order to support efforts to find and treat latent TB infection and TB disease, Marin HHS' TB Control Program has created a new webpage for health care providers with resources and tools to screen, diagnose, treat and report TB.  A suspected case of active TB disease must be reported within one working day to Marin County TB Control by telephone at 415-473-4163, or by completing a confidential online report.

Living Data 

Marin Health and Human Services' Community epidemiology Program gathers, analyses, and interprets data on the heath and well-being of Marin County residents.  The data are used for planning and evaluating programs and prioritizing resources.  We have compiled a dashboard of continuously updated data stories or collections of data.  You can explore these "Live Stories" online.

Hepatitis A 

A large hepatitis A outbreak is on-going in California.  The majority of patients in this outbreak report experiencing homelessness and/or using illicit drugs in settings of limited sanitation.  The best way to prevent hepatitis A infection is to get vaccinated.  Data show that hepatitis vaccination coverage is low in Marin County.  The hepatitis A vaccine it recommended  for anyone wishing to obtain immunity.

Message from the Deputy Public Health Officer

April is Sexual Assault Awareness month.  This year's theme is "Embrace Your Voice," building upon the voices emerging from the #MeToo and Time's Up movements.  While studies have shown that most women want to be asked about their experiences with sexual violence, few health care providers screen any patients, male or female, for such trauma.  The SAVE method is a simple protocol to start - Screen all of your patients for sexual violence.  Ask direct questions in a non-judgmental way.  Validate your patient's response and Evaluate, educate and make referrals.  The National Sexual Violence Resource Center has prepared a guide for health care providers.
                                       Warm Regards,
                                       Lisa Santora
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter, March 2018
Marin County Public Health Newsletter Volume 6 - Issue 3 - March 2018
In this Issue: Pain | Lyme | Gun | Rankings | Older | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Healthy Pain Management

Marin County has seen significant reductions in opioid prescribing due to evidence-based concerns about addiction and to opioids' lack of efficacy for many pain conditions.  Providers and patients alike are seeking healthier alternatives.  This will be the focus of the "Healthy Pain Management" Forum, hosted by RxSafe Marin and Marin HHS, April 12, from 11-1, at the Marin County Office of Education.  Pain experts from Marin General Hospital and Kaiser will describe emerging non-opioid pain modalities and local resources.   Clinicians can post this flyer for colleagues and patients.

Ticks and Lyme Disease Prevalence

Marin County clinicians regularly field questions and concerns regarding Lyme disease.  The following figures may help inform these conversations.  During 2013-2017, the regional Napa-Solano-Yolo-Marin Public Health Lab tested 2,950 ticks, 47 (1.7%) of which carried Borrelia burgdorferi, the organism that causes Lyme disease.  One human case acquired in Marin was confirmed in 2016 and none were confirmed in 2017.  Marin County Public Health accepts ticks from clinicians and members of the public for testing.  Instructions for packaging and drop-off of ticks as well as tips for preventing bites can be found here.

Marin Physicians and Gun Violence

Marin physicians in the San Francisco Marin Medical Society featured prominently in recent demonstrations against gun violence.  Framed as a public health crisis, society members joined other physicians to call for major reforms in gun control policies, including removing barriers to studying gun violence.  The voice of these Marin physicians echoes that of major physician organizations, including the American Medical Association and the California Medical Association.  Clinicians who want to join the movement against gun violence can connect to colleagues in the San Francisco Marin Medical Society.

County Health Rankings

Marin has been ranked the healthiest county in the state again by the Robert Wood Johnson County Health Rankings for the eighth time in nine years.  The rankings select multiple indicators of health and well-being, including life expectancy, to compare counties across the state.   This year's results are consistent with prior years', with high overall performance and notable exceptions in excessive substance use and  health disparities between affluent and low-income communities.

Year of the Older Adult

Marin County's Aging Action Initiative's Spring Convening is scheduled for Tuesday, April 3, from 9am to 4pm.  Topics will include reframing aging, falls, and aging equity.  This is a free event, for public sector agencies, non-profit organizations and health sector providers.  You can register for this event here.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotMarin County was again ranked the healthiest county in the state in the annual County Health Rankings.  What lessons can we offer other jurisdictions seeking to improve community health?  Our ranking is partly attributable to known associations between wealth and health.  By addressing health disparities in Marin County, ensuring universal access to health care, and advancing social policies that address inequities, we can better serve as an even stronger model of health for the nation.
Warm Regards,
Matt Willis
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Officer Newsletter, February 2018
Marin County Public Health Newsletter Volume 6 - Issue 2 - February 2018
In this Issue: Fentanyl | Vaccinate Cat | Zika | Salmonella | Food Now | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Fentanyl Overdoses

Last week in San Francisco, three men were found dead of suspected fentanyl poisoning.  Fentanyl has been increasingly present in street-purchased drugs in the Bay Area, and can lead to clusters of overdoses over a short period of time.  Alert physicians can offer early notice by reporting fentanyl overdoses directly to the Health Officer at 415-473-4163.  Fentanyl overdoses also may require multiple doses of naloxone, the opioid reversal agent.  We recommend you prescribe naloxone to patients at risk for overdose.  Patients can call (888) 818-1115, 24/7, to access substance use recovery services in Marin County.

Vaccinate Your Cat!

February is National Cat Health Month.  Marin Health & Human Services is partnering with the Marin Humane Society to urge residents to vaccinate their cats for rabies.  Rabies in domestic dogs and cats can serve as a bridge for transmission from wildlife to humans.  California law requires that domestic dogs be licensed and vaccinated against rabies.  In Marin County, a local ordinance also requires that domestic cats be vaccinated.   However, many pet owners are not aware or are non-compliant with vaccinating their cats. Visit our Rabies Information page for more information.

  Don't Bring Zika Home

After two years of active Zika surveillance, there have been more than 600 travel-associated Zika infections in California.  With spring approaching, more Marin County residents will be traveling to Zika-endemic areas.   The most frequented countries of Zika exposure include Mexico, Nicaragua and Guatemala.  Encourage your patients to stay informed and protected by visiting the Marin County HHS Zika website

Backyard Poultry Flocks and Salmonella

Marin County residents are becoming modern farmers and adding chicken coops to their yards.  The Centers for Disease Control and Prevention (CDC) has reported a major increase in illnesses associated with backyard poultry flocks, especially in California.  For families with backyard flocks, the CDC recommends (1) Thoroughly wash hands with soap and water after touching birds or the areas where they reside, (2) Do not let live poultry into your house, and (3) Supervise children while handling birds and assist with hand-washing.  Salmonella cases should be reported to Marin County Public Health.

Food Now Marin

One in five Marin County residents suffers from food insecurity.  Clinicians can help solve this problem by using the following screening:  "Please let me know if either of these statements is true for your family:  (1) Within the last 12 months, we worried whether our food would run out before we got money to buy more; (2) Within the last 12 months, the food we bought just did not last and we did not have money to get more."  For patients with a positive response to either question, you can offer the new Food Now Marin, a free, bilingual mobile application that helps people find low-cost food sites near them..

Message from the Deputy Public Health Officer

Effective public health practice requires constant vigilance at all levels of our community.  While the health department has many tools to protect the health of our community  and ensure public safety, the best tool is always prevention.  Health care providers in Marin can practice harm reduction by prescribing naloxone.  Pet owners can keep their pets' vaccinations up-to-date.  Travelers can stay informed and prevent mosquito bites.  And, we can all wash our hands more often.  But, one of the most critical forms of prevention is addressing the social determinants of health.  Regardless of the disease or condition, health outcomes are worse when people are poor, hungry and have unstable housing.  Food Now Marin is a great example of our community working together to address one of the key social determinants of health by ending hunger in Marin.
Stay healthy,
Lisa Santora, MD, MPH
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Officer Newsletter - January 2018
Marin County Public Health Newsletter Volume 6 - Issue 1 - January 2018
In this Issue: Flu | Naloxone | MMRC | Cannabis | Integration | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Flu Surge:  Stemming the Tide 

Emergency Departments (ED) in Marin County and across the state are continuing to experience surges related to respiratory illness.  As of January 27th, 470 out of 2,217 tests performed in all three Marin hospitals were positive for influenza, with one reported death under age 65.  Clinicians can help protect ED resources for patients who require emergency response by managing lower risk illness on an outpatient basis.  The vast majority of patients evaluated for flu-like illness in EDs are sent home.  Refer to these guidelines to triage flu-like symptoms and visit www.marinflu.org for local resources and information on latest flu activity in Marin.

Opioid Overdose Reversals in the Community

Opioid overdose remains the leading cause of accidental death in Marin County.  The RxSafe Marin coalition and the Department of Health & Human Services (Marin HHS) are promoting naloxone (Narcan) availability at the community level.   We began training first responders last year.  Police officers in Novato, Fairfax and Mill Valley have revived victims of opioid overdose.  Marin Emergency Medical Services (911) data show increases in bystander administration of naloxone prior to ambulance arrival.  Clinicians should consider prescribing naloxone for patients prescribed opioids, particularly with opioid doses above 90 mg morphine equivalents per day.

Marin Medical Reserve Corps (MMRC) Answers the Call

The North Bay fires deeply impacted our families, friends, and colleagues.  A regional medical surge required the deployment of health care volunteers across the region.  The Marin Medical Reserve Corps (MMRC) and other medical volunteers stepped forward to provide medical care at the Marin Center shelter.  Our response to future emergencies depends on a roster of active, licensed and credentialed health care providers.   The MMRC is recruiting Marin County doctors, nurses, behavioral health professionals, social workers, EMTs and clerical/administrative people.  Join our team and be part of our next response.   Learn more and register here.

Let's Talk Cannabis 

On January 1, 2018, California's new recreational marijuana laws went into effect.  The California Department of Public Health (CDPH) has launched a health information and education campaign about what's legal in California and potential health impacts of cannabis use.  On CDPH's website, you can find information about legal, safe and responsible use, and health information for youth, pregnant and breast-feeding women, parents and mentors.


Public Health Clinic Integration

For decades, Marin HHS offered clinical services in communicable diseases and dental care for low income and uninsured clients.  Expanded access through the Affordable Care Act (ACA) has created opportunities for this care to be fully integrated into Marin's primary care community health centers.  Our community health centers provide comprehensive primary and specialty care, dental and behavioral health care plus support services to meet the needs of our most vulnerable residents.  Following the unanimous vote of the Marin County Board of Supervisors, in January, HHS will be completing the closure of the HHS medical clinics and the transfer of care to Marin Community Clinics.  Visit our clinics integration website for more information.

Message from the Public Health Officer

Matthew Willis Marin County PHO Headshot2017 was a remarkable year in public health in Marin County.  The response of the Marin County medical community to the North Bay wild fires was inspiring and reassuring.  Our health care providers accommodated surges of patients displaced by the fires into our hospitals and clinics, and staffed shelters for evacuees.  This event also highlighted the value of preparedness and planning for future events, which is work for 2018. In 2017, we also moved closer to an integrated care system for Marin's most vulnerable residents, with HHS transferring safety net clinical services to Marin Community Clinics.  This newsletter is resuming its monthly schedule and your suggestions for topics is always welcome. 
Warm Regards,
Matt Willis
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Copyright (c) 2018
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901

Influenza activity has increased significantly in California and in Marin County over the last few weeks, and influenza A (H3N2) is currently predominating this season. In general, H3N2 is associated with more deaths and hospitalizations in persons 65 years and older and in children under 2 years old. Marin County Emergency Departments (EDs) are managing a high volume of influenza patients. Most patients evaluated for influenza-like illness (ILI)1 in EDs are sent home. Clinicians can help protect ED resources for patients who require emergency response by managing lower risk ILI on an outpatient basis. While vaccine effectiveness this season is lower than most years, the recommendations for immunization with seasonal influenza vaccine remain the same. Even when vaccine effectiveness is limited, immunization prevents illnesses and hospitalizations, decreases severity of disease, and offers protection against other strains of influenza that are circulating.  

 

Additional Resources Marin County Public Health – www.marinflu.org

CDPH – www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Influenza.aspx

CDC – www.cdc.gov/flu

PUBLIC HEALTH ADVISORY: Facts About Mask Protection October 13, 2017 Northern California Fires Affecting Marin Air Quality: The fires in Northern California are impacting air quality across the region. The best way to protect yourself from health effects of wildfire smoke is to limit your exposure. Will a face mask protect me from wild fire smoke? The following do not protect your lungs from wildfire smoke: - Bandanas or towels (wet or dry) or tissue held over the mouth and nose: this may relieve dryness but won’t protect your lungs from wildfire smoke - One-strap paper dust mask or a surgical mask that hooks around your ears: these don’t protect against the fine particles in smoke For those who cannot avoid prolonged activities outdoors “Particulate respirator” masks (respirator masks) labeled N95 or N100 may provide some protection: they filter out fine particles but not hazardous gases - The respirator masks do not seal well on people with facial hair or beards -Individuals with respiratory conditions should consult their doctor before using a mask— masks may limit air flow and make it more difficult to breathe. - Respirator masks should not be used on young children: they don’t seal well enough to provide protection What can I do to protect myself? Limiting exposure to wildfire smoke by remaining indoors is the primary goal. Depending on your situation, a combination of the strategies below may work best and give you the most protection from wildfire smoke. Keep indoor air as clean as possible. Keep windows and doors closed. Use a high-efficiency particulate air (HEPA) filter to reduce indoor air pollution. Avoid smoking tobacco, using wood-burning stoves or fireplaces, burning candles, incenses or vacuuming. Minimize the amount of time spent outdoors as much as possible. Avoid vigorous outdoor activities. Drink plenty of water Listen to your body and contact your healthcare provider or call 911 if you experience difficulty breathing, chest pain, severe fatigue, dizziness, or worsening of asthma or chronic respiratory illness PG. 2 OF 2 For those who wish to use an N-95 mask, these may be available at hardware stores or from online retailers As always, if you or someone you know is experiencing an emergency, call 9-1-1. Follow @MarinHHS or MarinHHS.org for updates For up to date information about fires in California go to: http://www.calfire.ca.gov/ For up to date information about air quality in the Bay Area go to: http://www.baaqmd.gov/

 

AVISO DE SALUD PÚBLICA: Datos sobre la protección con máscara October 13, 2017 Incendios en el norte de California afectan la calidad del aire en Marin: Los incendios en el norte de California están afectando la calidad del aire en toda la región. La mejor manera de protegerse contra los efectos adversos para de la salud del humo de los incendios descontrolados es limitar su exposición. ¿Me protegerá una máscara facial contra el humo de los incendios? * Los siguientes no protegen sus pulmones del humo de los incendios: - Los pañuelos o toallas (húmedos o secos) o pañuelos desechables colocados sobre la boca y la nariz: estos podrían aliviar la sequedad pero no protegerán sus pulmones del humo de los incendios. - Una máscara antipolvo de papel de una sola cinta o una máscara quirúrgica con cintas que se pasan por atrás de las orejas: éstas no protegen contra las partículas finas en el humo * Para aquellos que no puedan evitar actividades prolongadas al aire libre las máscaras "respiradoras para partículas" (máscaras respiratorias) etiquetadas como N95 o N100 pueden brindar cierta protección: filtran las partículas finas pero no los gases peligrosos - Las máscaras respiratorias no sellan bien en personas con vello facial o barba - Las personas con afecciones respiratorias deben consultar a su médico antes de usar una máscara - las máscaras pueden limitar el flujo de aire y dificultar la respiración. - Las máscaras respiratorias no deben usarse en niños pequeños: no sellan lo suficientemente bien como para ofrecer protección ¿Qué puedo hacer para protegerme? Limitar la exposición al humo de incendios descontrolados permaneciendo en el interior es el objetivo principal. Dependiendo de su situación, una combinación de las siguientes estrategias puede funcionar mejor y darle la mejor protección contra el humo de los incendios. * Mantener el aire interior lo más limpio posible. Mantener cerradas las ventanas y las puertas. * Usar un filtro de aire de partículas de alta eficiencia (HEPA) para reducir la contaminación del aire en el interior. * Evitar fumar tabaco, usar chimeneas o estufas que queman leña, prender velas o incienso, o utilizar aspiradora. PÁG. 2 DE 2 * Minimizar la cantidad de tiempo que pasa al aire libre tanto como sea posible. Evitar actividades vigorosas al aire libre. * Beber abundante agua * Escuche a su cuerpo y comuníquese con su profesional de la salud o llame al 911 si tiene dificultad para respirar, dolor en el pecho, fatiga severa, mareos o empeoramiento del asma o enfermedad respiratoria crónica * Para aquellos que deseen usar una máscara N-95, éstas tal vez se puedan conseguir en ferreterías o en tiendas en línea Como siempre, si usted o alguien que usted conoce tiene una emergencia, llame al 9-1-1. Siga a @MarinHHS o MarinHHS.org para las últimas noticias Para obtener información actualizada sobre incendios en California, consulte: http://www.calfire.ca.gov/ Para obtener información actualizada sobre la calidad del aire en el Área de la Bahía, consulte: http://www.baaqmd.gov/

Northern California Fires Affecting Marin Air Quality: Health Tips for Marin Residents The multiple fires currently burning in Napa, Sonoma and other northern counties are affecting our air quality and have created a potential health hazard in Marin County. For General Public: Please be aware that with shifting winds and poor wildfire containment air quality can change drastically in a short period of time. Smoke from wildfires can affect health. The most common symptoms are eye and throat irritation, coughing, and difficulty breathing.

 

Follow these precautions to protect your health and those with health problems, especially heart or respiratory conditions, should take extra caution:  

  • Minimize outdoor activities Stay indoors with windows and doors closed as much as possible
  • Do not run fans that bring smoky outdoor air inside
  • Run your air-conditioner only if it does not bring smoke in from the outdoors
  • Consider leaving the area until smoke conditions improve if you experience symptoms related to smoke exposure

For Outdoor Workers:

  • Limit exertion
  • Take frequent breaks
  • If prolonged outdoor activity is unavoidable, proper masks (for example N95 masks) can protect against harmful exposure

Consult with your employer if you have specific concerns For Schools:

  • Outdoor activities should be limited
  • Windows and doors should be kept shut as much as possible
  • When air quality is unhealthy activities such as athletic events or practices should be cancelled or rescheduled
  • Watch for symptoms and take action as needed
  • Students with asthma should follow their asthma action plans and keep their quick-relief medicine close at hand

When to Seek Medical Attention:

  • Contact your health care provider if you experience the following symptoms that do not improve after moving indoors or into a safe air quality environment
  • Shortness of breath or difficulty breathing
  • Wheezing
  • Chest tightness or pain
  • Palpitations
  • Nausea or unusual fatigue
  • Lightheadedness and/or feeling faint
  • As always, if you or someone you know is experiencing an emergency, call 9-1-1.
  1. Follow @MarinHHS for updates
  2. For up to date information about fires in California go to: http://www.calfire.ca.gov/
  3. For up to date information about air quality in the Bay Area go to: http://ttp://www.baaqmd.gov/

AVISO DE SALUD PÚBLICA
12 de octubre de 2017
Incendios en el norte de California afectan la calidad del aire de Marin: Consejos de salud para los residentes de Marin
Los incendios múltiples que arden actualmente en los condados de Napa, Sonoma y otros del norte están afectando la calidad de nuestro aire y han creado un posible peligro para la salud en el condado de Marin.

Para el público en general:
Por favor tenga en cuenta que debido a los vientos cambiantes y la expansión descontrolada de los incendios, la calidad del aire de puede cambiar drásticamente en un corto período de tiempo.
El humo de los incendios puede afectar la salud. Los síntomas más comunes son irritación de los ojos y la garganta, tos y dificultad para respirar. Siga estas precauciones para proteger su salud, y las personas que tengan problemas de salud, sobretodo afecciones cardíacas o respiratorias, deben extremar precauciones:

  • Minimizar las actividades al aire libre
  • Permanecer en interiores con las ventanas y las puertas cerradas tanto como sea posible
  • No activar ventiladores que introduzcan el aire con humo del exterior
  • Usar su aire acondicionado sólo si no introduce humo del exterior
  • Considerar abandonar el área hasta que las condiciones de humo mejoren si tiene síntomas relacionados con la exposición al humo

Para trabajadores al aire libre:

  • Limitar el esfuerzo
  • Tomar descansos frecuentes
  • Si no se puede evitar la actividad al aire libre, las máscaras apropiadas (por ejemplo las máscaras N95) pueden proteger contra la exposición dañina.
  • Consultar con su empleador si tiene preocupaciones específicas
  • Para escuelas:
  • Se deben imitar las actividades al aire libre
  • Se deben mantener cerradas las ventanas y puertas tanto como sea posible
  • Cuando la calidad del aire es insalubre, las actividades como prácticas o eventos deportivos deben ser canceladas o reprogramadas
  • Estar alerta a los síntomas y tomar las medidas necesarias
  • Los estudiantes con asma deben seguir su plan de acción contra el asma y tener a la mano su medicina de alivio rápido

Cuándo buscar atención médica:
Comuníquese con su profesional de la salud si tiene los siguientes síntomas que no mejoran después de meterse bajo techo o moverse a un ambiente con buena calidad del aire.

  • Falta de aliento o problemas para respirar
  • Respiración ruidosa
  • Dolor o opresión en el pecho
  • Palpitaciones
  • Náusea o fatiga inusual
  • Mareo y/o sensación de desmayo

Como siempre, si usted o alguien que usted conoce tiene una emergencia, llame al 9-1-1.
Siga a @MarinHHS para las últimas noticias
Para obtener información actualizada sobre incendios en California, consulte: http://www.calfire.ca.gov/
Para obtener información actualizada sobre la calidad del aire en el Área de la Bahía, consulte: http://www.baaqmd.gov

PUBLIC HEALTH ADVISORY: October 09, 2017 
Northern California Fires- Smoke Advisory: Current Situation

Air quality in Marin County has been affected by multiple fires in Napa and Sonoma County. While concentrations of smoke vary depending upon location within Marin, all areas have been affected and all residents are being exposed. Smoke from wildfires is expected to continue as the wildfires are not yet contained. There are no fires in Marin County as of this afternoon. Smoke can cause eye and throat irritation, coughing, and difficulty breathing. People who are at greatest risk of experiencing symptoms are: Young children, older adults, pregnant women, or people with respiratory conditions (such as asthma or emphysema) or heart conditions: We are advising these sensitive populations to stay indoors, avoid prolonged activity, and seek medical help if respiratory symptoms worsen. When smoke levels are high, even healthy people may experience symptoms such as coughing, a scratchy throat, irritated sinuses, shortness of breath, headaches, stinging eyes, and a runny nose. All residents should limit outdoor physical activities and stay indoors if at all possible. As a precaution, Health and Human Services has recommended that all outdoor sporting activities for children be cancelled.

https://www.marinhhs.org/sites/default/files/files/public-health-updates/ph_advisory_wildfire_smoke_100917.pdf

For up to date information about fires in California go to: http://www.calfire.ca.gov/

For up to date information about air quality in the Bay Area go to: http://www.baaqmd.gov/

Public Health Newsletter July 2017
Marin County Public Health Newsletter Volume 4 - Issue 6 - July 2017
In this Issue: Hep A | Tdap | Foster Care | Syphilis | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Hepatitis A Outbreak 

Outbreaks of hepatitis A disease are currently ongoing in San Diego County and Santa Cruz County in persons who are homeless and/or using illicit drugs.  Transmission is presumed to occur person-to-person; no commercial product has been identified as being contaminated.  The California Department of Public Health recommends offering HAV vaccine to persons who are homeless or might be using illicit injection or non-injection drugs.

Tdap in Pregnancy 

Last year, there were 1,830 cases of pertussis.  108 cases were hospitalized; 47% of hospitalized patients were infants.  Prevention of severe disease and death among infants has become the top priority in pertussis control.  ACIP, ACOG and AAFP recommend Tdap vaccine during each pregnancy, preferably in the third trimester, between, 27 - 36 weeks gestation, regardless of the mother's Tdap vaccination history.   Please remember to stock and recommend pertussis vaccination to protect our most vulnerable patients.

Foster Community, Foster Hope, Foster Our Future 

Our community needs exceptional people who can provide loving, temporary homes to children in foster care.  Individuals with medical experience, those who can welcome siblings together, and those who are Spanish-speaking are especially needed.  Attend an orientation with a social worker and an experienced foster parent to learn more.  Visit www.FosterOurFutureMarin.org or call 415-473-2200 for more information.

Syphilis 2016:  Return of the Great Masquerader

The California Prevention Training Center (CAPTC) is offering a valuable one-hour online course on syphilis.  Syphilis is a growing public health concern as manifest by the 19% increase in cases nationally from 2014 to 2015.  Many people with syphilis go undiagnosed and untreated for years, putting others at risk.   This course offers an easy and inexpensive opportunity to learn the latest information regarding syphilis epidemiology, screening, diagnosis, and treatment.   You can find out more about this course here.

Message from the Deputy Public Health Officer

The Marin County Board of Supervisors is recognizing National Health Center Week, August 13 - 19.  Coastal Health Alliance, Marin City Health and Wellness Center, Marin Community Clinics and Ritter Center provide high quality, cost effective primary care to tens of thousands of Marin County residents.  Our community health center partners' mission is to provide healthcare to Marin County residents, regardless of ability to pay.  Amidst the ongoing healthcare debate, I am thankful for their ongoing commitment and service to our community.
Warm Regards,
Lisa Santora
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901

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