County of Marin Health and Human Services

Public Health Newsletter

pho-newsletter-banner.jpg

This communication is for those who have been contacted by the Public Health Department by phone the week of January 9-13, 2017

For contacts of Bacterial Meningitis case:

The purpose of this letter is to inform you that you may have had contact with a person who had meningococcal meningitis. For that reason, we encourage you to contact your health care provider or go to Urgent Care to discuss possible preventive treatment with antibiotics (post-exposure prophylaxis).

Close contact includes:

  • household members
  • persons who frequently eat or sleep in the same house
  • persons who spent 4-6 hours per day together
  • persons who have come in close contact with the saliva or respiratory secretions of an infected person.

Preventive antibiotic treatment is recommended for individuals who are close contacts of someone who had meningococcal disease. Ciprofloxacin 500mg one tablet effectively prevents disease.

Symptoms of meningococcal disease include, but are not limited to:

  • Fever
  • Headache
  • Stiff neck
  • Confusion
  • Rash

If you experience any of these signs or symptoms, contact your health care provider immediately for evaluation. 

 

Flu Is Here! On December 1st, the California Department of Public Health (CDPH) announced the first influenza-associated fatality in a person under the age of 65 for the 2016-2017 flu season.  It is mandatory to report laboratory-confirmed influenza cases who require admission to an intensive care unit (ICU) and/or who die at any location (i.e. home, hospital, ER).  Visit www.marinflu.org for the most up-to-date information about current influenza activity in Marin. 

In the summer, pediatric patients visit their doctors for health examinations for school entry and pre-participation physical examinations. These are opportunities to discuss both required and recommended vaccinations (e.g., HPV, meningitis). With the introduction of SB277, parents may be seeking temporary and/or permanent medical exemptions for required vaccinations. Visit our Immunization Program website for forms and guidance on medical exemptions or call (415 473 3078) or email (dhiser@marincounty.org) Danielle Hiser, RN, PHN, Immunization Coordinator, with any questions.

Many college campuses are experiencing mumps outbreaks. Summer is around the corner, and students from colleges and universities will intermingle, increasing risk for mumps transmission.  Contact the Communicable Disease Prevention and Control unit at (415) 473-7805, if you have any questions. 

For the seventh straight year, Marin holds the title of the healthiest County in California, according to the Robert Wood Johnson Foundation. Despite the best overall rating, persistent health and social inequities remain a challenge for Marin health officials.

The annual County Health Rankings were released today, and Marin shines in many measures of health. The rankings consider two main health outcomes: premature death and quality of life, and multiple factors that affect health including behavior, clinical care, the physical environment, and social and economic factors.

For example, Marin ranks highest in life expectancy and lowest rates of adults reporting fair or poor health and teen births. Marin is No. 2 among counties with a high number of adults with a healthy body weight and low rate of unemployment and violent crime.

“Community investments such as reserving land for open space and social norms around healthy eating and staying active have helped Marin maintain our ranking,” said Dr. Grant Colfax, Director of Marin County Department of Health and Human Services (HHS). “However, the rankings also reflect major disparities across Marin and help us know where we need to prioritize our work. For example, we need to focus on increasing equity in health care coverage, access to health food, early childhood education, and job training so everyone has an opportunity to optimize his or her health.”  

Marin ranked poorly – No. 54 out of 57 counties reporting – in income inequality, a measure that focused on the ratio between those with the highest incomes (above 80 percent of the median) and the lowest incomes (below 20 percent of the median). The County also fared poorly in one of the foundation’s new additional measures: racial segregation between whites and non-whites. Marin came in No. 50 among the 56 counties reporting. Racial segregation can translate to disparities in income, educational opportunities and work opportunities – all three of which lead to poor health outcomes.

When it comes to opportunities to live a long and healthy life, a few miles can make an enormous difference in Marin. There is a 15-year gap between life expectancy in Ross (94) and Marin City (79), a disparity that correlates with the per capita income.

Marin HHS is working in communities to help improve life expectancy. The Nutrition Wellness Program works with schools that have high obesity rates, which is known to drive heart disease and other conditions that lead to premature death. In Marin City, for example, Marin HHS supports nutrition education, walk to school programs, school gardens, and marketing to attract health-conscious grocery stores.

“While there are signs of progress, we’re more vulnerable than these rankings suggest,” said Dr. Matt Willis, the County’s Public Health Officer. “There is much more to do to achieve health equity in Marin. We need to continue to bolster programs and policies that address poverty, jobs, housing, and education.”

The County has made steady progress on many fronts with social equity, and the Board of Supervisors has made equity a priority. For instance:

  • It has made a commitment to preserve existing affordable housing, explore ways to acquire more affordable housing and encourage landlords to adhere to voluntary rent guidelines.
  • Marin County Parks is in its third year of a program designed to help more Marin residents, especially the underserved, to visit and enjoy parks and open spaces.
  • The Marin County Fair and Play Fair Marin have partnered for 14 years to build and maintain a healthy and successful fair as well as create a resource guide for ongoing and future success.
  • The Department of Public Works is diligent in its efforts to improve disability access and safety at County-maintained facilities, such as widening a popular pathway in the lower Ross Valley.
  • The County has even launched a TV series to promote education on mental health.

Other community efforts working to alleviate poverty and promote success of Marin residents are Rise Together, Marin Promise, and Marin Strong Start.

County fairs are not known for healthy food and drink. The Marin County Fair is an exception. We received the 2015 Merrill Award by the Western Fairs Association for its Play Fair health initiatives. The fair is a strong reflection of the community health values in Marin. The Play Fair team shared their model in this Growing Healthy Events Guide.

The number of reported outbreaks of acute gastroenteritis due to norovirus in Marin County has increased significantly since October, 2015. While this is consistent with the seasonal nature of norovirus, the California Department of Public Health has announced higher than usual activity state-wide. In Marin, affected facilities have included adult congregate living facilities and childcare centers. The duration of most of the outbreaks is a few days to two weeks, reflecting both the natural history of the illness and the control measures taken by the facilities. Information about norovirus can be found here.

This month there was an outbreak of influenza A at a local skilled nursing facility.  During our investigation, the first influenza-associated fatalities were announced for California, which included an infant, an adult and an elder. These events remind us that influenza can cause serious illness or death across the lifespan.  Visit marinflu.org for links to clinical information and surveillance reports.  The first of our regular seasonal influenza surveillance reports for 2015-2016 will be released in early December.

Since 2009, Marin County has seen an increase in syphilis cases, as is being seen regionally. In 2014, there were 20 cases reported. 19 of these were men, and most were men who have sex with men (MSM). USPSTF recommends that providers screen those at increased risk for syphilis infection, including MSM. The CDC recently updated its Sexually Transmitted Diseases Treatment Guidelines, which are now available as a mobile app.

FREE flu shots! October 17th at Novato High School from 10 a.m. to 2 p.m. Available while supplies last, regardless of insurance, ages 3 years and up. Kaiser patients will have their information updated for them. The school is at 625 Arthur Street, and the clinic is open from 10 a.m. to 2 p.m

Dr. Matthew Willis, the County’s Public Health Officer, says a flu shot is the single best defense against influenza, which can lead to a lot of time missed at school or work. The flu virus can spread one day before symptoms develop and up to a week after someone becomes sick, so protect yourself, your family and friends by getting your flu shot.  

Marin HHS staff and emergency medical personnel will be on hand to administer the vaccine. All County staff members are disaster service workers as well, and they are treating the Novato flu shot clinic as a “point of dispensing” to simulate an emergency need to dispense medicine to, or vaccinate, the whole community. The recent wildfires in Lake County and the 2014 earthquakes in Napa have reminded us all about the need for training and preparedness.

“Leadership plays a great role in responding to any disaster, and Health & Human Services is committed to preparing staff for emergency response,” said HHS Projects Coordinator Kristen Seatavakin. “We are looking forward to using this chance to improve the department’s ability to respond and to recognize where we may need to build larger capacity.”

The flu begins with an abrupt onset of fever, muscle aches, sore throat and cough that often make people sick enough to keep them in bed for several days. Flu can be especially dangerous for young children, seniors, pregnant women and people with chronic illnesses such as heart disease, diabetes and asthma.

The California Department of Public Health (CDPH) recommends basic steps to prevent and stop the spread of influenza and other respiratory illnesses in addition to getting the flu vaccination. These include:

  • Stay home when you are sick to avoid spreading illness to those around you.
  • Do not go to work when ill, particularly if you work with vulnerable populations.
  • Wear a face mask when coming within six feet of a sick person.
  • If you are sick, wear a facemask before going near other people.
  • Restrict visitation with vulnerable populations while you are ill.
  • Cough or sneeze into your elbow or a tissue and properly dispose of used tissues.
  • Wash your hands thoroughly with soap and warm water or use an alcohol-based hand sanitizer to get rid of most germs.
  • Avoid touching your eyes, nose and mouth.
  • Stay healthy with a balanced diet, plenty of water and adequate rest and exercise.

Stay up to date with information regarding this season’s flu activity and additional options for flu vaccination by visiting www.marinflu.org.

 

Marin County is known for high average life expectancy and wide health disparities between communities.  Differences in cardiovascular mortality rates drive the 17 year gap in life expectancy within our county.  In order to focus our understanding of this complex problem and to prioritize programs toward early prevention, a new Health Equity initiative concentrates on 1) childhood healthy weight and 2) access to primary care for all.  The initiative is summarized here.

Any providers in the state Vaccines for Children (VFC) program, and any healthcare workers who would like to learn more about childhood vaccines and vaccine preventable diseases are invited to an Immunization Update Conference. Co-sponsored by the health departments of Marin and Sonoma counties, this event features speakers from the California Department of Public Health Immunization Branch. Join us Friday, June 19, 8:00 -11:30 AM, at the Petaluma Health Center. For more information or to RSVP, please call Danielle, our Marin Immunization Coordinator, at 415-473-3078 or click here.

In 2014, 21 Marin County residents were diagnosed with HIV. In recent years, an increasing proportion of those newly diagnosed are Latinos or African-Americans and individuals under the age of 30. Over the past four years, approximately one in four people diagnosed with HIV in Marin had AIDS upon entry into care. Health care providers should remain aware of HIV trends and screening standards to ensure timely diagnosis and early intervention. Please see the Marin County HIV fact sheet here.

coughing infantThe California Department of Public Health (CDPH) reported approximately 10,000 cases of pertussis throughout California in 2014—the highest number in recent memory. CDPH has stated that pertussis has become endemic in California and high numbers of pertussis cases are expected to persist.

Marin County Public Health recommends:

  1. Vaccinate all susceptible individuals against pertussis according to the ACIP schedule and implement cocooning strategy around infants.  The pertussis vaccine can prevent the disease or attenuate the severity of the disease.
  2. Think pertussis. Enquire if other household members are or have been recently sick with a respiratory illness, particularly characterized by paroxysmal coughing and post-tussive emesis.   
  3. Test for pertussis. People who have been vaccinated for pertussis often present with mild symptoms. Have a high index of suspicion and a low threshold for testing and evaluating individuals for pertussis.
  4. Treat pertussis cases with a course of appropriate antimicrobial therapy. 

Chemoprophylaxis is recommended for high risk close contacts of pertussis cases.

  • Infants
  • Pregnant women in their third trimester
  • Household contacts, particularly if there is an infant or a third trimester pregnant woman in the household.
  • Close contacts of high risk individuals (infants and pregnant women)
  • Individuals who visit a sensitive setting or work in sensitive occupations, e.g., day care or health care

Isolate known or suspected pertussis cases and symptomatic close contacts until three full days of antibiotics have been completed and until the cough is manageable; or until the lab test result is received and is negative for pertussis.

Pertussis is especially severe in infants and very young children and can present as an acute cough illness of any duration.  Typically, it starts with cold-like symptoms (coryza, sneezing, occasional cough).  Fever is absent or minimal.  This stage lasts 1-2 weeks with the cough gradually becoming more severe. Spasms of severe coughing are followed by a sudden deep inspiration, often resulting in a characteristic “whooping” sound especially in infants and very young children.  Post-tussive vomiting is common in all ages.  Illness may be milder in previously vaccinated people.  Classic pertussis is 6-10 weeks in duration, but cough may last longer in some people.

Pertussis is highly contagious.  Transmission typically occurs when a susceptible person inhales aerosolized droplets from the respiratory tract of an infected person. 

Period of communicability:  Persons one year of age and older are considered infectious from the onset of cold-like symptoms until completion of three days of treatment or until 21 days after cough onset if no or partial treatment is given. Infants < 1 year are considered infectious for six weeks without treatment.

While questions regarding acellular vaccine efficacy are being addressed, vaccination remains the only avenue to reducing bacterial burden in the community and still offers individual protection and moderation of disease severity.

The Public Health investigation will consist of attempting to contact the case to ascertain if there are high risk individuals inside or outside of the household who need chemoprophylaxis.  High risk household contacts will be referred to their usual source of care for chemoprophylaxis.

For more information about pertussis:  http://www.cdph.ca.gov/programs/immunize/Documents/PertussisLaboratoryTe...

http://www.cdph.ca.gov/healthinfo/discond/documents/cdph_pertussis_quick...

To report pertussis cases, please call:

Marin County Communicable Disease Prevention and Control at phone: 415-473-7805 or 415-473-4163, or fax: 415-473-6002 Monday through Friday 8:30 a.m. through 5:00 p.m.  On weekends, holidays, and after 5:00 p.m. Monday through Friday, call 415-499-9464 and ask to speak with the Health Officer on call.

Smoking carries a hefty price tag for all Californians - from the addiction and diseases it causes, to the premature deaths of far too many smokers - it affects our communities and families in many costly and profound ways.  A county-by-county report of the costs of smoking in California was recently completed and released on October 15, 2014 by University of California San Francisco researchers. It is the third in a series of reports on California smoking-attributable costs funded by the Tobacco-Related Disease Research Program and the Tobacco Control Program of the CA Department of Health Services.  Every ten years, the Cost of Smoking in California report analyzes the economic burden of smoking, illustrating the costs associated with smoking-related illnesses and premature death. The newly released study found the overall cost of smoking for California was $18.1 billion. The full report on cost of smoking in California can be reviewed at http://www.trdrp.org/files/cost-smoking-ca-final-report.pdf

Each Marin resident, including nonsmokers, shells out $551 for the cost of smoking, according to this county–by county report of the costs of smoking in California. The total annual cost of smoking to residents of Marin is $138,354,000. This report did not conduct a Marin County specific smoking prevalence survey but the last Marin specific survey conducted by the California Tobacco Control Program showed that 7.3% of adults in our county still smoke. This report shows that we still have a lot of work to do to reduce smoking. 

Although we have made great progress in reducing the number of smokers in Marin and in reducing the secondhand smoke concerns, there remains much to be completed as we strive for a tobacco-free community. The county’s Tobacco Related Disease Control Program is currently working with all local jurisdictions to update their Smoke-Free Ordinances to include: (1) multi-unit housing smoking restrictions; (2) e-cigarette restrictions and; (3) restricting the sale of tobacco in pharmacies. The county also provides cessation services to residents who wish to stop smoking and is actively working with behavioral health providers in an attempt to reach the population of residents with the highest smoking rates.

The Smoke-Free Marin Coalition recently launched a 10-year campaign to improve the health of Marin residents by educating consumers and retailers on how marketing practices influence consumption of unhealthy products and assist in making the retail environment a healthier place for Marin residents. The Healthy Stores for a Healthy Community Campaign is a statewide and local collaboration between tobacco use prevention, nutrition and alcohol prevention partners.

Marin should be proud of our successes in addressing tobacco use and secondhand smoke dangers, but the fight is ongoing and the Smoke-Free Marin Coalition will continue its efforts to free Marin County residents of the tragic and expensive impacts of tobacco and e-cigarette use. Please contact Bob Curry, Marin County Tobacco Related Disease Control Program at rcurry@marincounty.org with any tobacco concerns or questions.  

There is no Ebola in Marin County. (Outbreak Map)

Marin is prepared to respond to a communicable disease outbreak, including Ebola.  Marin County Health and Human Services (HHS) is working with local hospitals and the California Department of Public Health (CDPH) to ensure that clinicians and hospitals countywide are educated and prepared.

It is unlikely that a case of Ebola virus will occur in Marin. However if a suspect case should occur, there are systems in place to ensure a quick response from the department and the medical community, and to maintain public safety.

Airports in the US that handle travel to and from West Africa and other countries that may be transit points, will now be checking temperatures of any passengers who have been in the affected countries. Fever is the initial symptom of Ebola, so anyone with a fever will be placed in isolation and if they have traveled with family or friends, these people will be placed in quarantine.

Should there be a suspect case in Marin County, Public Health and our health care partners are prepared to quickly, safely and effectively intervene. We work collaboratively with emergency medical services, the hospitals, clinics and private providers to practice our response plans to assure the safety and health of our community.

As we enter the flu season, we would like to remind healthcare personnel that while Ebola at this time remains a theoretic risk locally, influenza is not.  Obtaining your influenza vaccination is one simple measure you can take now to protect yourself and our community from serious illness.

Links & Resources

Centers for Disease Control and Prevention (CDC)

Hotline: While there are currently no confirmed or suspect cases of Ebola in California, California Department of Public Health has set up a hotline at 855-421-5921 to answer questions from those concerned about the possibility of Ebola in California.  

For Providers

Marin County Public Health Advisories: https://www.marinhhs.org/content/public-health-updates 

Public Health Advisory: Evaluating Patients for Possible Ebola Virus Disease: Recommendations for Healthcare Personnel and Health Officials - 10/3/14 - Advisory

Ebola Virus Disease Health Advisory - 8/8/14 - Advisory

CDC Information for Health Care Workers
CDPH Ebola resources (including signage)

Signage requesting patients report travel history: English | Other languages

Algorithm for Assessment of Potential EVD in Outpatient Clinical Setting (PDF)

Influenza transmission in health care settings presents risk to both health care workers (HCW’s) and their patients, many of whom are vulnerable to severe influenza disease. Influenza vaccination of HCW's protects against influenza infection, illness, and mortality. Marin County health care facilities, in agreement with Health Officer orders, have joined other Bay Area health facilities in adopting policies requiring HCW’s to be vaccinated or to wear a mask in patient care areas.  Read more.

 

 

Marin healthcare providers see the impact of excessive calorie consumption every day, across the age spectrum. Diabetes and obesity are model conditions for partnership between public health and clinical medicine because most cases are both preventable and curable. Health practitioners in Marin County are working to limit the harmful consumption of sugar-sweetened beverages (soda sweetened with sugar, corn syrup, or other caloric sweeteners including sweetened juices, sports and energy drinks).

According to the CDC, consumption of sugar-sweetened beverages is a major driver of the obesity epidemic. Over the past decade, per capita intake of calories from sugar-sweetened beverages has increased by nearly 30% nationally, partly due to marketing strategies targeted to children and adolescents.

This summer, Marin County Public Health, supported by a resolution from the county Board of Supervisors, will again be promoting the “Soda Free Summer.” The Soda Free Summer includes measures to educate residents on how to read labels for the amount of sugar in beverages and how to make healthier drinks with water, fresh fruit and herbs. “Rethink Your Drink” events will be held through the summer at a variety of community-based organizations and summer programs for youth.

Health care providers play a vital role in reinforcing healthy eating and active living messages in each encounter. Combined with upstream interventions like the Soda Free Summer, we can begin to reverse the growing burden of obesity as a more integrated health system.

The California Department of Public Health has confirmed 58 measles cases in California residents so far in 2014, up from 4 cases at this time last year. Six Marin residents were exposed to measles on a domestic flight in March; all were vaccinated and none have become ill. Marin County is particularly vulnerable because of high rates Personal Belief Exemptions from childhood vaccinations including Measles/Mumps/Rubella (MMR). Health providers should remain vigilant for signs of measles and continue to promote vaccination.

Measles should be considered especially for those born after 1957 who may be unimmunized or under-immunized (less than 2 doses of measles containing vaccines). Measles spreads through infected droplets that are passed in the air when an infected person coughs or sneezes. The virus can remain viable in air spaces for up to 90 minutes.

Identification

Measles is an acute, highly communicable viral disease with prodromal fever, conjunctivitis, coryza, cough, and small spots with white or bluish-white centers on an erythematous base on the buccal mucosa (Koplik spots). A characteristic red blotchy rash appears on the third to seventh day; the rash begins on the face, then becomes generalized, lasts 4-7 days, and sometimes ends in brawny desquamation. Leukopenia is common. The disease is more severe in infants and adults than in children.   Complications may result from viral replication or bacterial superinfection, and include otitis.

Marin County EMS Agency has achieved the 2014 Mission: Lifeline® EMS Silver Level Recognition Award. This award is based upon the achievements in care delivered in 2013.

ST elevation myocardial infarction (STEMI) is among the most critical emergencies that Emergency Medical Services routinely respond to.  Timely and well coordinated response between all aspects of the response system is critical for survival. As an EMS agency that delivers education in ST elevation myocardial infarction (STEMI) identification, access to 12 lead ECG and develops protocols derived from STEMI Guidelines, our medics are driving improvements in the care and outcomes of STEMI patients.

Collaboration among pre-hospital and hospital providers is the essence of Mission: Lifeline. The American Heart Association recognizes the vital importance Emergency Medical System providers provide to the overall success of Mission: Lifeline STEMI Systems of Care. The correct tools and training allow EMS providers to rapidly identify the STEMI, promptly notify the destination Center and trigger an early response from the awaiting hospital personnel.

The criteria to achieve the Mission: Lifeline EMS Silver award is based on meeting the achievement measures for at least one and up to three calendar quarters with no single measure scoring below 75%. The individual measures are as follows:

  • Percentage of patients with non-traumatic chest pain > 35 years of age, treated and transported by EMS who receives a pre-hospital 12 Lead ECG.
  • Percentage of STEMI patients transported to a STEMI Receiving Center, with pre-hospital First Medical Contact (FMC) to Device (PCI) < 90 Minutes.
  • Percentage of STEMI patients transported to a STEMI Referring Center with arrival (to Referring Center) to Fibrinolytic Therapy administration in <30 Minutes.

For more information and for a listing of all Mission: Lifeline EMS Award Recipients, please visit : www.heart.org/mlemsawards

Pages