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WC CWF Health District Board Minutes - 04/27/2012WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES April 27, 2012 Wichita Falls- Wichita County Public Health District 1700 Third Street - Parker Conference Room Wichita Falls, Texas MEMBERS PRESENT: Richard Sutton, M.D., Chair Lauren Jansen, R.N., M.S.N., Ph.D., Vice -Chair David Carlston, Ph.D. Tracy Hill, D.D.S. Scott Plowman MEMBERS ABSENCE EXCUSED: Robin Moreno, M.T., Secretary Clay Clark, D.V.M. Not Present Amy K. Fagan, M.P.A. Not Present Not Present Dorothy Roberts -Burns Ray Gonzalez Board Members Director of Health Assistant Director of Health Health Authority Assistant City Manager Council Liaison County Commissioner I. CALL TO ORDER & INTRODUCTIONS Chair Dr. Sutton called the Board of Health meeting to order at 12:00 pm after a quorum of members was attained. II. APPROVAL OF FEBRUARY MEETING MINUTES AND ABSENCES Dr. Sutton called for the review and approval of minutes from the last meeting held on February 24, 2011. Dr. Carlston introduced a motion to approve the minutes as presented and Scott Plowman seconded the motion. Motion passed unanimously. At this time it was noted the excused absence of Dr. Clark and Robin Moreno. III. EPIDEMIOLOGY UPDATE Leslie Gresham, Epidemiology Charge Nurse discussed the history and characteristics of the ongoing shigella seen in the community. Shigellosis is a gastrointestinal illness with an acute onset of diarrhea often marked by mucus and blood in the stool, fever, abdominal pain, cramping, headaches, nausea, and vomiting, self limiting from 3 -10 days. The infections can be severe with hospitalization, and usually occur in 10 -15% of the very young and very old. The Etiologic agent is a Shigella species; there are four different species, with group D seen in the community. Annually, in the United States 14,000 cases are reported. Wichita County rates have been low for the past years; 2009 had no cases, 2010 had 1 case, 2011 had 3 cases. The incubation period is 1 -7 days, typically symptoms are seen within 3 days. The period of communicability usually lasts 1 -4 weeks after onset of symptoms, but can be shortened by use of antimicrobials. Modes of transmission are person -to- person (fecal -oral route from poor /non washed hands), sexual contact, fecal contaminated objects (did not wash hands), contaminated food (person with illness did not wash hands preparing food), contaminated /inadequately treated drinking water, and ingestion of contaminated /untreated recreational water. Treatment can be fluid /electrolyte replacement and antibiotic therapy. Mild infections can recover quickly without antibiotics and the more severe appropriate antibiotics can shorten the duration of illness (a significant increase in antibiotic resistance has been noted). The Health District initiates a case investigation once notified of a reported case of shigella in the community. The first step is to contact the patient or parent to identify possible sources within the last 7 days prior to the onset of symptoms. Collection of information includes household members and /or close contacts with similar illness, attendance of school or daycare, employment, extra curricular activities such as sports, hobbies, groups, clubs, a 7 -day food history including meals eaten in the home and those in restaurants, public gatherings where there maybe a commonality, drinking water source, any exposure to recreational water, and travel. There were 68 cases reported in Wichita County for a period of 29 weeks that started on October 2, 2011 to present, with an additional 3 cases outside the county but seen in Wichita County for treatment. Researched case distribution categories follow: ❖ Age from 5 months to 64 years saw dramatic increase in ages from 1 -10 years, contributed to lack of hand washing. ❖ Gender male /female almost even 50/50 split. ❖ Race was 52% White followed by 34% Hispanic. ❖ Zip Code even split. ❖ School with most cases was IC Evans in Burkburnett. In an effort to help control spread of the disease, the Health District initiated the following steps: ❖ Increased surveillance in schools and with community partners. ❖ Notified medical providers and day cares of increased cases. ❖ Environmental Health Division provided hand washing education to student population. ❖ Wichita Falls water testing done to ensure the safety of the drinking water; results were negative. The Health District will continue to: ❖ Remain active with the two electronic surveillance programs; ESSENCE (Electronic Surveillance System for the Early Notification of Community based Epidemics) and RODS (Real -Time Outbreak Detective System). The data can indicate increase of patients seen with GI illness with ability to track the numbers. ❖ Work closely with our community partners, stakeholders, and providers for notification of increases seen and do testing in attempt to identify the cause. ❖ Provide education to most vulnerable populations, daycares, schools in the fall. 2 Norovirus was segregated to the base, the Health District was not specifically involved due to not seen in the community. The Etiologic Agent is Calicvirus with an incubation period from 12 -48 hours, but it can remain communicable from 1 -3 weeks. Transmission is close personal contact; it can be aerosolized by vomit, spread through fecal -oral route, contaminated food /water, or contaminated surfaces. Gastrointestinal Illness (GI) acute onset is diarrhea, nausea, vomiting, abdominal pain, fever, and /or headache, self limiting from 1 -3 days. It is extremely contagious, has a large viral load that can be excreted (minimum .18 particles to cause illness), and shedding can last weeks. The only treatment is supportive therapy oral or IV rehydration. On Sunday March 11, 2012, Sheppard Air Force Base (SAFB) Public Health received a call from student health that reported 39 initial cases of GI illness. Initial testing was done with lab confirmation. SAFB had a total of 206 cases between March 11 and March 21, 2012, per day 30 -40 cases that tapered down to 15 a day. Those affected included permanent party, airmen, non - commissioned officers, students, military training leaders, and beneficiaries; most cases occurred in training squadrons 365, 362, 364. The SAFB Public Health recommended: ❖ Hand hygiene. ❖ Quartered anyone ill for 3 days past resolution symptoms. ❖ Establishment of 6 sick bays (contained exposure did not go to student health to start IVs, medications, not allowed to mess hall food). ❖ Disinfection of the affected areas 4 times daily. All are good procedures but the source may never be discovered. IV. IMMUNIZATION UPDATE Teressa Stephenson, Preventive Health Services Supervisor, covered the immunization service history and changes as of January 1, 2012. Prior to January 1, 2012, the Health District received all pediatric vaccines from Federal and State Funds through the Vaccines for Children Program. Texas participated in the Federal Vaccines for Children (VFC) Program since its inception in 1994, and is known as Texas Vaccines for Children Program (TVFC). The Program was initiated by the passage of the Omnibus Budget Reconciliation Act of 1993. Legislation guaranteed that vaccines would be available at no cost to providers in order to immunize children who meet the eligibility requirements. VFC Provider Guidelines: ❖ Health Districts and Private Providers can receive free vaccine to administer to eligible clients 18 yrs of age and younger. ❖ Providers cannot charge for the vaccine, but can charge an administrative fee not to exceed $14.85 per dose. Federal VFC Eligibility Guidelines: ❖ Children that receive Medicaid. ❖ Children enrolled in the Children's Health Insurance Program (CHIP). ❖ Uninsured: A child who has no health insurance coverage. ❖ Underinsured: A child who has private health insurance, but coverage does not include vaccines, covers selected vaccines or caps vaccine coverage at a certain amount. ❖ American Indian or Alaskan Native. 3 Historically, Texas immunization rates were low and the State had extra funding with a less stringent definition of eligibility for the TVFC Program. The TVFC eligibility guidelines allowed Health Districts and Private Providers to provide vaccines to Medicaid and CHIP participants, American Indian or Alaskan Native, Uninsured, and Underinsured. Underinsured was defined as those with health insurance coverage that did not pay for vaccines or the family was unable to meet their co- pay /deductible The Health District, in addition, could vaccinate anyone that did not meet the outlined criteria, but chose to use a Public Health Clinic. TVFC eligibility is based on self declaration. . Major changes as of January 1, 2012, are attributed to the reduction of federal funds for vaccine purchases and vaccine price increases. Texas is now to follow the Federal VFC eligibility guidelines. The federal definition of underinsured is: a child with private health insurance that the coverage does not include vaccines, covers selected vaccines (TVFC eligible for non covered vaccines only) or caps vaccine coverage at a certain amount (TVFC eligible once coverage amount reached). The community no longer has the option to walk -in and be vaccinated with TVFC vaccine. The Health District now has to refer those insured and some underinsured clients to their primary care physician for immunizations. Privately purchased vaccine can be provided if the client chooses to pay for them up front and can then choose to submit a claim to their insurance company for reimbursement. The TVFC pricing for the Health District is based on family size and monthly income, priced at $3.50, $7 or $14 per child regardless of the number of shots received that day; no child is denied for the inability to pay that is eligible for the TVFC program. TVFC provides all required and Advisory Committee on Immunization Practices (ACIP) recommended vaccines. Private vaccine fees at the Health District effective May 7, 2012 on insurance covered vaccines (typical vaccines given to school aged children) are set by the City Manager and are available for review. The Adult Safety Net (ASN) Program started in August 2007, when DSHS received extra funding to provide free adult vaccines to Public Health Clinics and Federally Qualified Health Clinics (FQHC) for clients that met the following eligibility criteria. ❖ Uninsured: No health insurance. ❖ Underinsured: Health insurance does not cover vaccines, can not afford co- pay /deductible, cap on wellness benefits or vaccine coverage (same definition as used for TVFC). The ASN Program Eligibility Requirements changed as of January 1, 2012. ❖ Previous Eligibility Requirements: Uninsured and Underinsured. New Eligibility Requirements: Uninsured only. Medicaid and Medicare are considered insurance coverage, not eligible for the ASN vaccines. In addition numerous ASN Vaccines have been dropped. ❖ Previous covered ASN Vaccines; Tdap, Td, MMR, Hep A, Hep B, Twinrix (HepA/Hep B), Varicella, HPV, MCV, Zoster (Shingles). ❖ Current covered ASN Vaccines; Tdap, Td, MMR, Hep B. ASN Vaccine Pricing for the Health District is $15 per shot. The Health District will continue seeking ways to enhance vaccine services and educational efforts to the community and private providers regarding the importance of vaccination in order to keep the incidence of vaccine preventable diseases from increasing. 4 V. NEXT MEETING The scheduled date of June 22, 2012 was in conflict with member's previous engagements; an alternative date will be e- mailed to members for agreement. VI. ADJOURN Dr. Sutton requested a motion to adjourn. The motion was made by Dr. Jansen and seconded by Scott Plowman the motion carried and the meeting was adjourned at 12:35 pm. RECEIVED IN CITY CLERK' OFFICE DATE: --( - � Z 3Y- I IVI E: � Kichard Sutton, M.D., Chair, Lauren Jansen, M.S.N., Ph.D., Vice - Chair, or Robin Moreno,M.T., Secretary Public Health Board