County of Marin Health and Human Services

Public Health Newsletter

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Public Health Newsletter - Oct/Nov 2019
Marin County Public Health Newsletter Volume 7 - Issue 10 - October/November 2019
In this Issue: EVALI | PSPS | Shelters | AIDS | 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.

Vaping-Associated Death in Marin

This month, a 45-year-old previously healthy Marin County woman died from complications related to the use of e-cigarettes, becoming the state's fourth confirmed case of EVALI (E-cigarette or Vaping Associated Lung Injury).  There have been forty-seven deaths and 2,290 EVALI cases nationwide since July 2019, reported to the Centers for Disease Control and Prevention (CDC).  This is a reminder for clinicians to ask regarding vaping history in patients with compatible symptoms, and to help guide patients away from these harmful products.   Marin County Public Health issued this advisory last month, reminding clinicians to report suspect cases and recommending all residents refrain from vaping.  The CDC issued interim recommendations caring for patients with suspected or known lung injury. 

Power Shut-Offs

Last month, Marin County experienced an unprecedented county-wide prolonged planned power shutoff.  While all of us were inconvenienced, as healthcare providers, you witnessed many of the health consequences associated with this event.  Our 911 ambulance call data helps tell the story of the stress this presented, especially to our older residents.  During the five-day outage:
  • Emergency department visits for fall-related injuries at Marin Health Medical Center tripled.
  • EMS responses to skilled nursing facilities and residential care facilities in the county more than doubled.
  • The number of EMS responses for residents over age 80 doubled.
Planning for the next shut-off will take these lessons into account.  Read more about the health impacts of the outage on vulnerable Marin County residents in this Marin Voice op-ed.  For more information on preparing your family, neighbors and patients for an extended power outage, go here.

Severe Weather Emergency Shelter 

As winter comes, Marin County is resuming the Severe Weather Emergency Shelter (SWES) plan as an appendix to the County's Extreme Temperature Emergency Annex.  This service is a seasonal, temporary shelter, opened during extreme weather to augment the existing 190 permanent emergency shelter beds in Marin.  Homeward Bound of Marin will operate the SWES at the Marin Health and Wellness Campus in San Rafael.  The determination will be made by 3PM on the day prior to opening the shelter, based on forecast conditions.  Our goal is to end homelessness and recognize that it is unacceptable that so many of our neighbors are unsheltered any night of the year. 

World AIDS Day 

December 1 is World AIDS Day.  More than 700,000 lives have been lost to AIDS in the U.S. since the condition was recognized in the early 1980's.  In 2012, the Federal Drug Administration approved the use of Pre-Exposure Prophylaxis (PrEP) for HIV.  By taking one pill a day, individuals can protect themselves from HIV.  Undetectable equals untransmissible.  Still, between 15-20 new cases of HIV are diagnosed in Marin annually.  We can do better.  Marin has a strong network of service providers, committed to HIV prevention and treatment.  For more information about HIV prevention in Marin, go here.
 

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotThis month's newsletter covers two climate-related threats to health - power shut-offs due to fire risk and extreme weather shelters.  These offer a glimpse into the societal disruption and health impacts of climate change.  They also offer lessons in how we can become more resilient.  As stewards of health for Marin, we can use our voice to highlight the everyday impact of changes to our environment on community well-being.  I'm grateful for your support as we recognize climate change as a public health crisis. 
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 - September 2019
Marin County Public Health Newsletter Volume 7 - Issue 9 - September 2019
In this Issue: Flu | Bullying | Measles | Rabies | Stop the Bleed | 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

Last year, Marin County was highly impacted by influenza.  This month, there have already been two reported deaths in the Bay Area.  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 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.

Standing Up Against Bullying

Bullying has potentially life-long effects on mental health and well-being.  The Marin County Office of Education and many local schools are working with Sandy Hook Promise to support safe school environments.  Last week, schools across the county participated in Sandy Hook Promise's "Start with Hello" campaign.  Students and school staff are increasing awareness about the risks of social isolation, which includes bullying, violence or depression.  Marin schools are supporting health by encouraging students to lead a culture of inclusion and connectedness.

Measles 

In 2000, the World Health Organization (WHO) declared that the United States had eliminated measles.  Recent outbreaks have shown this was sadly premature.  Because many providers have not seen active measles, the Centers for Disease Control and Prevention (CDC) has created two videos  that describe the clinical features of measles, including diagnosis, treatment and infection control measures.  This year, there have been 5 measles outbreaks in California, 4 of which were linked to international travel.  Providers should make sure patients have measles protection before international travel.

World Rabies Day

World Rabies Day is September 28th.  Rabies circulates in Marin County wildlife, and one in ten local bats tested are rabid.  Clinicians can help by making sure that anyone exposed to domestic or wild animal bites is evaluated for post-exposure prophylaxis (PEP).  Marin County Public Health created a poster to help remind clinicians about how to administer PEP.  The poster can be downloaded here.

Public Health Program Spotlight:  Stop the Bleed 

The Marin County Emergency Medical Services (EMS) Agency's partnership with Marin County schools was recently highlighted in the Marin IJ.  This month, EMS distributed more than 600 "Stop the Bleed" kits to high schools across the county.  EMS is responsible for the planning, implementation and evaluation of prehospital services.  It works with stakeholders to maintain a high quality, coordinated system of emergency medical care for All in Marin.  EMS also works in partnership with local hospitals, fire departments and the Marin Medical Reserve Corps on community preparedness activities, including Sidewalk CPR.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotThis month offered another unwelcome example of the risks of vaping, with more reports of e-cigarette-related deaths.  I hope I captured our concerns as a medical community in this op-ed last week.  Clinicians can refer interested community members to a public forum on vaping, co-sponsored by Marin Public Health, on October 7.  As always, please send recommendations for future topics, and thank you for all you do.
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 - August 2019
Marin County Public Health Newsletter Volume 7 - Issue 8 - August 2019
In this Issue: Public Charge | Overdose Awareness | Vaping | STD | 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.

Public Charge                 

On August 14, 2019, the U.S. Department of Homeland Security (DHS) published the Inadmissibility on Public Charge Grounds final rule.  This rule is a major revision of the legal test for determining eligibility for residency among legal immigrants.  Marin County has already seen a chilling effect on Medi-Cal enrollment due to fears of deportation and/or immigration restrictions.  This rule, which goes into effect October 15th, is expected to further reduce health care access for Marin's Latinx community.  Limiting access to preventative and primary care services is costly and threatens the health and well-being of our neighbors and our community. 

 Marin Recognizes Overdose Awareness Day

The Marin County Board of Supervisors passed a resolution recognizing August 31st as International Overdose Awareness Day.  Our elected leaders have prioritized this issue since the launch of RxSafe Marin, our community-wide opioid safety coalition, in 2014.  On August 20th, Board members received a report outlining progress, including a 48% reduction countywide in opioid prescribing over four years.  Trauma-informed prevention efforts, including screening; access to addiction treatment; and client-centered pain management are cornerstones to reducing substance use disorders and opioid-related deaths in our community.

Unexplained Vaping-Associated Pulmonary Illness   

The California Department of Public Health (CDPH) has reported more than 20 cases in the past two months of severe acute pulmonary disease among previously healthy adults associated with vaping cannabis or cannabidiol (CBD) oils.  As of August 27, 2019, the Centers for Disease Control and Prevention (CDC) is investigating 25 possible cases nationwide, including 1 death.  Marin County Public Health advises clinicians to remain alert and to report potential cases (by phone 415-473-4163 or email MarinCD@marincounty.org).  This outbreak provides an opportunity to counsel patients about the known health risks associated with e-cigarette use and vaping.  It also highlights the importance of local efforts to curb the rise in youth vaping.
                                                                              

Public Health Program Spotlight:  STD Prevention and Control

Sexually transmitted infections (STIs) in all groups, and particularly among men who have sex with men (MSM), continues to increase in Marin.  Marin County's Sexually Transmitted Diseases (STD) Prevention and Control program works to educate the community and provide resources to health care providers.  As students return to school, consider using pre-participation physical examinations as an opportunity to complete risk-base STD screening among Marin teens and young adults.  This population accounts for more than 1/2 of new STD infections in Marin County.

  Message from the Deputy Public Health Officer

This month, we issued a public health advisory regarding a case of meningococcal meningitis.  We have confirmed that it was serogroup B disease.  Following Centers for Disease Control and Prevention (CDC) recommendations, most colleges and universities require meningococcal conjugate (MenACWY) vaccination prior to admission.  But most schools do not require MenB vaccinations.  As Marin students prepare to return to colleges and universities across the country, it is a great time to counsel patients on the benefits of MenB vaccination.   Have a safe holiday weekend.

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, July 2019
Marin County Public Health Newsletter Volume 7 - Issue 7 - July 2019
In this Issue: Flaccid Myelitis | PPD | Ebola | Foster Homes | Rabies | 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.

Acute Flaccid Myelitis 

Acute flaccid myelitis (AFM) is a rare but serious syndrome that causes muscle weakness or paralysis, mostly in children.  Three national outbreaks have occurred since 2014.  Most patients developed AFM in late summer or early fall.  AFM typically presents with limb weakness one week after a viral infection.  The Centers for Disease Control and Prevention (CDC) believes viruses, including enteroviruses, play a role in AFM.  Marin County health care providers should contact Marin County Communicable Disease Prevention and Control (CDPC) if they suspect AFM at 415-473-4163.  CDPC will coordinate specimen collection and laboratory testing.  The AFM Physician Consult and Support Portal provides clinicians with access to 24/7 neurologist consultation. 

PPD Shortage 

Due to an expected shortage of APLISOL, the Centers for Disease Control and Prevention (CDC) is recommending that providers:
 - Substitute IGRA blood tests for TSTs. 
 - Substitute TUBERSOL for APLISOL for skin testing.
 
Please notify Marin County Tuberculosis Control Program if you have any difficulty screening for LTBI (by phone at 415-473-4163 or email MarinTB@marincounty.org).  LTBI screening and treatment is a key component of "Getting to Zero" TB cases in California and nationwide.  For more information, visit the Marin County Tuberculosis Control Program's website.

Ebola

After an outbreak-related case of Ebola was reported in Uganda, the Director-General of the World Health Organization (WHO) declared the current Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern.   As of July 28, 2019, there have been 2,687 confirmed and probable EVD cases and 1,803 deaths connected to this outbreak.  While the threat of disease spread to California remains very low, the California Department of Public Health (CDPH) is closely monitoring the outbreak.  Health care providers should ask all persons who present with suspected infectious diseases about any travel, domestic or international.

Foster Our Future

Each year, approximately 80 children in Marin County need temporary (foster) homes, but 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.  The next orientation is scheduled for Thursday, August 22, from 7:00 to 8:30 pm at the Marin Health and Wellness Campus (3240 Kerner Blvd., San Rafael, CA  94901).  Visit the Foster Our Future Marin website or call 415-473-2200 for more information.

Public Health Program Spotlight:  Rabies Control Program

The Rabies Control Program is one of Marin County's mandated communicable disease prevention and control programs.  Annually, 10-12% of captured bats in Marin County test positive for rabies.  Most human rabies cases in the United States have been caused by bat bites that were unrecognized or undetected due to bats' extremely fine teeth.  Human rabies can be prevented by providing rabies pre-exposure prophylaxis (if indicated), prompt local treatment of bite wounds, and/or appropriate rabies post-exposure prophylaxis.  Marin County Public Health works closely with Marin Humane, WildCare and other community partners to prevent human rabies.  Visit the Marin Rabies Information Page to access a Bite Report and the rabies Post-Exposure Prophylaxis Algorithm.

Message from the Deputy Public Health Officer

Last month, we informed readers about the risk of extended power outages (3 - 5 days) due to the launch of PG&E's Public Safety Power Shutoffs (PSPS) program.  Wildfire season is now here.  In addition to preparing your family, neighbors, and patients for extended power outages, it is time to organize your wildfire preparedness efforts.  Visit FireSafe Marin and make sure you are Ready to Go.  We also encourage health care providers to join the Marin Medical Reserve Corps today.  The time and energy you invest in preparedness will increase our community's overall resilience.  Thank you!

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 - June 2019
Marin County Public Health Newsletter Volume 7 - Issue 6 - June 2019
In this Issue: Power Outages | Measles | Fair | Pharmacists | Epidemiology | 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.

Public Safety Power Outages

To prevent forest fires associated with power lines, PG&E will continue to conduct Public Safety Power Shutoff (PSPS) in our region when risk is elevated.  While many of us are inconvenienced by these outages, which may last for days, power shut-offs may be life-threatening for others.  Many of our residents depend on electrically powered technologies to live safely at home.  State and local agencies are planning new supports for vulnerable residents in evacuations and extended power outage scenarios.  As health care providers, you can help ensure your family, staff and patients are prepared by sharing these preparedness resources

Preparing for Measles in Marin

As of June 21st, there have been 53 confirmed measles cases in California this year.  Marin County has seen no cases yet in 2019, but remains vulnerable due to pockets of low vaccination rates.  Healthcare providers should remain vigilant in testing for and reporting measles.  The California Department of Public Health (CDPH) testing guide, Should I Test for Measles, recommends considering measles in patients of any age who have a fever >101 F, plus at least one of the three "Cs" (cough, coryza or conjunctivitis) or a descending rash that starts on the face.   CDPH has also released updated Measles Immunization Recommendations

A Healthy County Fair

County fairs are not known for healthy food and drink.  The Marin County Fair is an exception.  Thanks to Play Fair, an initiative supported by all three hospitals and the County, healthcare providers can recommend the fair to their patients, knowing they'll have a happy and healthy experience.  Reflecting local values, the fair is smoke-free, all vendors offer at least one healthy option, alcohol use is controlled, and there are healthy activities for all ages.  Join the over 100,000 anticipated fair-goers July 3-7 to see why ours was named "the healthiest in the West" by the Western Fairs Association.

Training for Pharmacists in Opioid Crisis Response

As trusted members of the healthcare system, pharmacists play a vital role in opioid epidemic response.  New state laws and emerging trends offer pharmacists new opportunities and responsibilities.  The California State Board of Pharmacy, Marin County Health and Human Services, and RxSafe Marin are hosting a free Continuing Education forum for pharmacists on July 20th, "Prescription Drug Abuse and Diversion: What a Pharmacist Needs to Know."   Attendees will be awarded 7 hours of CE credit for attending the full session, including the one-hour training to meet the requirements for interested pharmacists to furnish naloxone. 

Public Health Program Spotlight:  Community Epidemiology

The Marin County Community Epidemiology Program monitors the vital signs of our community.  The team, located at Marin County Wellness Campus in San Rafael, collects, analyzes, and translates health data to guide public health strategy in Marin.  The program informs evidence-based programming, collaborates with community organizations on their data needs, shares data publicly through interactive dashboards, and conducts disease investigations to protect the community.   Metrics and outcomes of select Public Health initiatives are at Marin Livestories:  Translating Data into Action.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotRecent announce- ments of Immigration and Customs Enforcement raids and proposed mass deportations are unsettling to many clients we serve and can discourage access to medical care among immigrants.  As stewards of health, this is an opportunity to remind ourselves of the World Health Organization constitution which states, "the highest attainable standard of health is a fundamental right of every human being."  At the Marin County Department of Health and Human Services, all are welcome regardless of immigration status.  Interested providers can join us in this simple message and share the resources available at the Canal Alliance Know Your Rights website.
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 - May 2019
Marin County Public Health Newsletter Volume 7 - Issue 5 - May 2019
In this Issue: Housing | Hep C | Narcan | Healthy Stores | Message from the Deputy Public Health Officer
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A monthly message to physicians and other health care providers from Marin's Public Health Officer.

Housing and Health in Marin 

The Marin County Whole Person Care pilot program is demonstrating the health benefits of housing the chronically homeless.  As of May 2019, 130 previously homeless people in Marin have been housed under this grant-funded program.  There has been a corresponding and significant decrease in emergency department visits and days in the hospital among those newly housed.  For more information and more complete results from the pilot, visit the Whole Person Care website.

May is Hepatitis C Awareness Month 

An estimated 2.4 million people are living with hepatitis C in the U.S., but most are unaware.  Hepatitis C is a leading cause of liver cancer and liver transplants.  The CDC recommends all people born between 1945 and 1965 get tested.  Treatment options have improved dramatically in the last decade.  The role of the pharmacist in screening and management is growing.  This free CME/CPE activity, Pharmacy Essentials for HCV Screening and Management, provides a comprehensive overview of HCV care.

Medical Reserve Corps Distributing Narcan

 Opioid overdose remains a leading cause of accidental death in Marin.  The Marin Medical Reserve Corps (MMRC) has mobilized to respond to this crisis.  A team of MMRC volunteers has been certified to offer training to community groups in the use of intranasal Narcan and provide free kits to those who may be able to offer bystander assistance in an opioid overdose.  To learn more or to schedule a training for your organization, email rxsafemarin@gmail.com.  

Public Health Program Spotlight:  Healthy Stores for a Healthy Community

The retail environment strongly shapes our choices regarding health.  In Marin, a team of youth volunteers and community partners are assessing 182 retail stores to determine the potential impact on youth health behaviors.  Led by HHS Community Health and Prevention - Tobacco Control Program, the Healthy Stores for a Healthy Community program assesses marketing practices for tobacco, alcohol, and food and beverage items.  The goal of the campaign is to improve the health of all residents and decrease health inequities through influence on the retail environment.

Message from the Deputy Public Health Officer

 What seems to have been the longest, wettest winter has ended!  Marin County families are now headed out to our beaches and pools.  Please consider posting this infographic to educate patients on strategies to prevent unintentional drownings.  Drowning continues to be a leading cause of injury and death for young children, ages 1 - 4.  Stay safe and have a fun summer! 
Lisa Santora, MD, MPH
Deputy Public Health Officer
Marin County
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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 - 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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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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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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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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Matthew Willis MD, MPH
Marin County Public Health Officer
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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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Matthew Willis MD, MPH
Marin County Public Health Officer
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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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Matthew Willis MD, MPH
Marin County Public Health Officer
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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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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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Matthew Willis MD, MPH
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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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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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Matthew Willis MD, MPH
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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