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WC CWF Health District Board Minutes - 04/26/2013Y WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES April 26, 2013 Wichita Falls- Wichita County Public Health District 1700 Third Street - Parker Conference Room RECEIVED !N Wichita Falls, Texas CITY CLERK'S OFFICE DATE: V-2 �T113 BY: _A/.%� TIME:1 :.' MEMBERS PRESENT: David Carlston, Ph.D., Chair Tracy Hill, D.D.S. Michael Lamar, M.D. Jane Leach, Ph.D. MEMBERS ABSENCE EXCUSED: Clay Clark, D.V.M. Kirk Harlow, Ph.D., Secretary Scott Plowman, Vice -Chair Lou Kreidler, R.N., B.S.N. Amy K. Fagan, M.P.A. Glen Minter, M.D. Not Present Not Present Ray Gonzalez Board Members i Director of Health Assistant Director of Health Associate Health Authority Assistant City Manager Council Liaison County Commissioner I. CALL TO ORDER Dr. David Carlston called the Health Board meeting to order at 12:00 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES Dr. Carlston stated the minutes are to be reviewed at the next meeting for approval. At this time it was noted the excused absence of Dr. Clay Clark, Dr. Kirk Harlow, and Scott Plowman. 111. EPIDEMIOLOGY OVERVIEW Leslie Gresham, Epidemiology Charge Nurse explained the Epidemiology program does the investigation, containment and help with prophylactics for contacts of illness. Texas legislature every year sets a list of what they consider public health illness or threats for the state and providers are required by law to report. Trends seen in Wichita County will be discussed today. The Health District has an STD clinic that sees clients 5 times a week and visits are made to the county jails. In the month of March an increase of gonorrhea cases was seen. Gonorrhea is the cause of bacteria that infects any mucus membranes through the mouth, eyes, but usually reproductive system. It is a common found infectious disease that is the second most reported disease in the United States. Each year 820,000 people are newly infected. In 2011 only 321,000 were reported to CDC based on their estimates the majority of these infections are among the 15 to 24 years. Gonorrhea is not reported directly to the Health District so the following is our calculations. In 2012 had seen 52 cases with 31 contacts treated of those 34 males and 18 females. In 2013 to date seen 20 cases, in March had 9 cases of those 6 males and 3 females. Lou Kreidler stated that in one month the Health District saw a 50% increase in the number of cases that got the District's attention. Leslie Gresham created a spreadsheet of the patient demographics, sexual preference to check for any commonalities. The Disease Intervention Specialist of Dallas County was contacted and the information forwarded to them to check for commonalities and /or trend setter. Dr. Lamar asked if the common sexual partners are both treated at the Health District. Leslie Gresham responded they are required to come in for treatment on site. Dr. Leach added that other places in the United States give the medicine to the partner to take home to the partner it is standard care in the big cities, does the Health District do that. Lou Kreidler replied it has never been done at the Health District. Dr. Lamar commented there has always been an argument that you are not supposed to treat people you have not seen. Data out now states that success rates are better in future prevention when you go ahead and treat the partner that the public health benefit is so great. Clinical Features and Complications ❖ Most clients are asymptomatic (approximately 80% of the population) ❖ Signs and Symptoms • Dysuria • Discharge • Pain ❖ Complications • Pelvic Inflammatory Disease (PID) • Infertility Treatment ❖ CDC recommends use of dual (two drug) therapy ❖ Increased antimicrobial resistance is of great concern and the successful treatment of gonorrhea has become more difficult ❖ All partners within 90 days should be treated as a potential contact Campylobacter Etiology ❖ Gram negative bacterium ❖ 21 species within the Genus • Most human illness (80 %) is caused by Campylobacter jejuni ❖ Occurs most frequently in the summer months An increase seen before the summer months has caused alertness. Thirty known pathogens can cause GI illness the CDC estimates about 48 million individuals in the United States will become ill which is about 1 in 6 individuals. Campylobacter is estimated the leading cause of foodborne illness in both children and adults in the United States that accounts for 1.3 million annually. As few as 500 ingested bacterium can lead to illness with an onset of 2 to 5 days after exposure. A gastrointestinal illness can 1 include diarrhea, nausea /vomiting, abdominal pain, fever, headache, and malaise. It is self - limiting usually from 2 to 10 days after illness onset will recover without treatment. Complications can include Bacteremia, miscarriage, neonatal sepsis, reactive arthritis, Guillain -Barre syndrome, and hemolytic uremic syndrome (HUS). The 2012 incidence of culture confirmed cases were 14 of 3 out of 100,000 for Wichita County a 19 case count a 14% increase compared to a steady baseline since 2006. The highest rate of infection occurs in children younger than 4 years. An estimated 8,500 hospitalizations annually with approximately 76 deaths in the United States per year can be attributed to Campylobacteriosis. Every year the FDA puts out a food safety progress report that showed in 2012 an increase in Campy with no statistical change with I Coli and Salmonella. The report noted for every Campy case reported there are 30 cases they go undiagnosed. Transmission ❖ Reservoirs • GI tracts domestic and wild birds • Farm animals • Pets are most common (dogs, cats, hamsters) ❖ Vehicles • Improperly prepared /cooked poultry (cross contamination through preparation) • Untreated waters • Unpasteurized milk Treatment ❖ Rehydration is the key element ❖ Antibiotics are usually not necessary but may shorten the duration of illness and excretion of organisms up to 3 weeks Prevention ❖ Proper hand hygiene after handling raw poultry ❖ Proper washing/decontamination of cutting boards and kitchen utensils ❖ Avoid cross contamination of produce with raw poultry ❖ Cook poultry thoroughly (165 degrees) ❖ Do not consume unpasteurized milk/juice ❖ Use of chlorinated water supply for consumption ❖ Proper hand hygiene after contact with feces of dogs and cats Health District Campy/obacter Case Trends ❖ 2011 total of 5 cases ❖ 2012 total of 28 cases; 13 males and 15 females. ❖ 2013 to date total of 15 cases; 8 males and 7 females Dr. Lamar questioned whether it was better sampling, better testing, or actual increase of cases. Leslie Gresham replied considering the difference of numbers since 2011 believes an increase because CDC has seen a 14% increase. Also attributed to the fact that providers receptiveness to the Health District notifications have done more tests. Dr. Lamar asked if the increase was driven from home or restaurant contamination. Leslie Gresham indicated in general there was no epi link and at the time was dealing with shigella there was not a big comparison with campy that the majority of the campy occurred after October not been 12 months. 3 Health District Campylobacter Age Trends ❖ 2012 the 1 to 5 years commonly the biggest population ❖ 2013 to date the over 50 years (none of the 1 to 5 years as previous year) An investigation was done that did not lead to a link. Although foodborne do not believe a restaurant issue at this point mainly because the number of cases are spread out even with an increased number in the last month. Health District Campylobacter County Trends ❖ 2012 majority in Wichita Falls ❖ 2013 to date mainly in Wichita Falls few in Burkburnett and Iowa Park Lou Kreidler stated for most people in the surrounding counties Wichita Falls is their medical home. Interesting with campy have not found any link no common food source, restaurant, anything has been puzzling. Foodborne Outbreaks Investigation Steps 1. Detecting a possible outbreak 2. Deriving and finding cases 3. Generating hypotheses • Hypotheses generated interviews 4. Testing the hypotheses • Analytic studies • Laboratory testing of samples 5. Finding the point of contamination and source of the food 6. Controlling an outbreaks • Recall product(s) • Remove source of contamination • Revise production process 7. Deciding an outbreak is over It can remain a mystery if cases cease without finding an association between food and illness. What is H7N9 ❖ Subtype of influenza A virus that is sometimes found in the GI tracts of birds ❖ Normally does not infect humans ❖ Although rate, at the end of March 2013 China reported human and bird infections with a new strain of H7N9 Transmission ❖ Close contact with infected birds (living and dead) ❖ Environments contaminated with droppings or mucus of infected birds ❖ At this time there has not been any evidence suggesting ongoing spread of this virus from person -to- person The transmission is important due to the ability of any influenza virus to mutate rapidly. Clinical Features ❖ Severe respiratory illness • High Fever • Cough • Difficulty Breathing • Malaise 4 Complications ❖ Several cases have progressed to very serious illness. • Pneumonia • Acute Respiratory Distress Syndrome (ARDS) • Septic Shock • Multi -organ Failure • Death Prevention ❖ Currently no vaccine to protect against the virus and no rapid testing to distinguish H7N9 from other flu viruses ❖ CDC advises travelers to China to take precautions to avoid contact with birds and wash hands thoroughly ❖ Travelers need to monitor their health during and after their trip for signs and symptoms up to 10 days after return Treatment ❖ At this time H7N9 virus is susceptible to antiviral drugs used to treat seasonal flu (Tamif/u, Relenza) ❖ Influenza viruses are always changing and some changes can result in drug resistance Where We Stand ❖ As of April 25th 109 lab confirmed cases of human infection was identified with one each in Taiwan and Taipei with both links back to China ❖ Reported 22 deaths ❖ Contacts being monitored ❖ No evidence of sustained human - to-human transmission Risk to the United States ❖ No cases of human or bird infection with H7N9 detected in the United States ❖ At this time, the risk to people in the United States is low, no restriction imposed on trade or travel ❖ CDC issued a Health Alert for Public Health Officials and Clinicians with guidance for isolating, testing, and treating basically for those with influenza symptoms that traveled through China III. NEXT MEETING DATE June 28, 2013 V. ADJOURN Dr. Carlston requested a motion to adjourn. The motion was made by Dr. Michael Lamar and seconded by Dr. Jane Leach the motion carried and the meeting was adjourned at 12:40 pm. �Z� a1�' Print Name Chair of the WFWC Public Health Board Title 5