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WC CWF Health District Board Minutes - 02/26/2016WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES February 26, 2016 Wichita Falls- Wichita County Public Health District 1700 Third Street - Parker Conference Room BOARD MEMBERS PRESENT: Scott Plowman, Chair Julie Gibson, D.V.M., Vice -Chair Diane Stewart, R.N., Secretary Keith Williamson, M.D. David Carlston, Ph.D. Larry Rains, D.D.S BOARD MEMBERS ABSENCE: Robin Moreno, MHA -HSA, ACHE OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Amy Fagan, M.P.A. Woodrow W. Gossom, Jr. Wichita Falls, Texas Restaurant Association -City Veterinarian -City Registered Nurse -City Physician -City Citizen At- Large - County Dentist - County Citizen At- Large -City Director of Health Assistant Director of Health Wichita County Judge I. CALL TO ORDER Scott Plowman called the Health Board meeting to order at 12:00 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES Scott Plowman called for the review and approval of minutes from the meeting held on Friday January 22, 2016. Dr. Williamson introduced a motion to approve the minutes as presented and Dr. Rains seconded the motion. The motion passed unanimously. At this time it was noted the excused absence of Robin Moreno. III. ZIKA VIRUS AND VECTOR CONTROL AI Gonzales the Public Health Emergency Preparedness Coordinator and Susan Morris the Environmental Health Administrator merged the Zika Virus and Vector Control presentation. Al Gonzales commenced the presentation with facts about Zika in Wichita Falls - Wichita County: 1) There are no known Zika disease cases in Wichita Falls or Wichita County at this time. 2) The mosquitoes that can carry Zika virus do live in Wichita County, 3) The Health District has a mosquito surveillance and control program. 4) The Health District is monitoring the situation closely in the area. The Centers for Disease Control (CDC) released: 1) Zika is primarily spread through the bite of an infected mosquito. 2) The best way to prevent Zika is to prevent mosquito bites. 3) Infection with Zika during pregnancy may be linked to birth defects in babies. 4) Pregnant women should delay travel to areas where Zika is spreading. 5) Returning travelers infected with Zika can spread the virus through mosquito bites. Public Health actions are; surveillance, vector control, public education. Everyone can; reduce risk, stay informed, prevention. Susan Morris affirmed that not all mosquitoes are the same, Different mosquitoes spread different viruses and bite at different times of the day. Zika is an Arbovirus (group of viruses that are transmitted by mosquitoes, ticks, or other arthropods) a member of the family Flaviviridae. The mosquitoes have to be infected in order to carry the virus from one person to another it bites an infected person and transmits that to another person, The Zika virus is carried by the Aedes aegypti and Aedes albopictus primary vectors found in our area that also spread the Chikungunya and Dengue viruses. These are early summer mosquitoes active biters all day and night as opposed to the late summer West Nile mosquito that bites at dusk and dawn. Al Gonzales stated local transmissions are found in Central America, Mexico, and Marshall Islands. The United States has yet to see a local transmission related from mosquito to person but has seen a person transmission. The States affected are: Alabama, Alaska, Arkansas, California, DC, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Maryland, Massachusetts, Minnesota, Nebraska, New Jersey, New York, Ohio, Oregon, Pennsylvania, Puerto Rico, Tennessee, Texas, Virginia, Virgin Islands. In the U.S. only travel- associated cases with no reported focal mosquito -borne Zika cases. As of February 24, 2016 the U.S. States had 107 reported travel - associated Zika virus disease cases and no locally acquired mosquito -borne cases. The U.S. Territories had 1 reported travel - associated case and 39 reported locally acquired cases. In addition Susan Morris said it is an important concern. The people that travel to the locally acquired areas can get bitten by an infected mosquito and possibly be caring the virus which causes a need to protect our mosquitoes. One travel advisory is not to get bitten for at least a week after the return to the U.S. in an attempt to not infect the local mosquitoes. Dr. Williamson said he was under the impression Zika came out of West Africa like Chikungunya. Al Gonzales responded it did originally back in the 60's it was named after the Zika River in that area. In the U.S. we have seen imported cases a person gets bitten by an infected mosquito while traveling returns here then a local mosquito bites an infected person that infects the mosquito. Judge Gossom questioned if one of the mosquitoes bite someone here in the U.S. that was infected does that then transmit to that mosquito. Al Gonzales answered yes that the mosquito can bite someone then transmit it to the next person. It is the first time we have heard to protect our mosquitoes which is unusual. Centers for Disease Control and Prevention (CDC) released "Zika virus is spread to people through mosquito bites... most common symptoms... fever, rash joint pain, and conjunctivitis (red eyes) ... illness is usually mild with symptoms lasting from several days to a week... severe disease requiring hospitalization is uncommon." It can cause Guillain -Barre syndrome (GBS) an uncommon sickness of the nervous system in which a person's own immune system damages the nerve cells, causing muscle weakness, and sometimes paralysis that is a big concern. Scott Plowman asked if they are positive of that. Al Gonzales replied that everything seems to be pointing to that but they have started to see other things. Lou Kreidler said it has been found in fetal and placental tissue they know those children are born infected with the Zika virus being in a protected environment the only way would be from the mother. Al Gonzales stated he did not believe of a need to worry as implemented in preparedness be prepared but not scared is one of the things being emphasized to the public, Susan Morris the Environment Health Division continues to work hard on surveillance, vector control and together on public education with the use of social media. Any CDC related advisories would be sent out immediately to health providers and a press release when applicable. The personal preparedness is to stay informed, know what is going on, to reduce the risk. 2 Susan Morris said to practice the 4 D's; Dusk and Dawn, DEFT, Dress, Dump and Drain. Use mosquito repellant properly apply it over your clothes read the label, dress with loose fitting light color clothes long sleeves /pants, and dump any standing water. Wichita County has 40 different mosquito species with only about 5 of the species capable to transmit any type of disease but any mosquito is bad. Lou Kreidler asked Susan to discuss the integrated mosquito pest management mosquito plan how it is done and how this year it will be different from the previous West Nile mosquito plan. Susan Morris explained the West Nile mosquitoes like stagnant water the seasonal vector control workers put out traps that release stinky smelly water to attract and collect live mosquitoes. Now the difference with this mosquito a trap must be used with some type of CO2 attraction the plan is to use dry ice. Problems with these traps are thief about 5 or 6 more traps are needed to place in secure locations. The division does surveillance, traps, public education, source reduction to dump standing water when possible a cheap way for mosquito control. The entire City and unincorporated areas are mapped out to treat the water with larvicide any area that cannot be treated are sprayed the least effective most expensive method as the last resort. The older generation has more of a concern for West Nile whereas the younger generation with Zika. Lou Kreidler continued that the mosquitoes trapped are not identified here but sent to Austin for identification of what species, whether infected and carries any diseases. When the information is received back based upon that we put out a press release. Like clockwork for the last two years the first West Nile has been in August. Scott Plowman asked how often mosquitoes are sent to Austin. Susan Morris replied it is dependent on the weather during the drought few were sent but last year sent almost daily. Also it is based on the mosquito population and whether enough employees to set traps. Austin does call the next day on any positive cases. Lou Kreidler indicated at this time of year additional staff seasonal vector control workers are hired to walk the ditches, do larvicide treatments, set and monitor the traps. Funding from the County provides Vector Control to buy chemicals and put on additional staff. Susan Morris said she regularly recruits through Midwestern that Dr. Vogtsberger recommends excellent candidates some have been hired in full time Sanitarian positions. Lou Kreidler stated the main Zika concerns are the birth defects seen in children. This week the Health Department sent off the very first blood specimen to test for the Zika virus. An individual had been in Brazil came back to find out eleven weeks pregnant had not shown any symptoms not sick but just as a precaution to follow CDC standards. She had not been established with an OB /GYN so it can be information her obstetrician can use as they follow her pregnancy and treatment. People travel all the time so many take cruises. Another concern because it is sexually transmitted and does live in a males sperm is the issue if someone that has traveled to locally acquired areas come back to a partner that is either of child bearing age, pregnant, or considering pregnancy then they need to have serious conversation for protection against the virus for the potentially unborn child. The Zika virus symptoms are mild with 7 to 10 days of fever the major concern /issue are the birth defects and the Guillain-Barre syndrome. Scott Plowman questioned what happens when an average person gets it. Lou Kreidler answered that to an average person it feels like the flu; fever, aches, pain, red eyes. It can cause the Guillain -Barre syndrome a neurological disease sometimes with paralysis that generally starts from the lower extremities up the body that usually self resolves after a period of time. It has been seen in some vaccinated individuals as an unwanted side effect usually self - limiting to resolve itself. People have been hospitalized because the paralysis will go up further to cause respiratory issues. Some 3 g individuals do have lasting neurological deficits after they have had the disease Dr. Rains asked why the Zika virus is just now being presented. Lou Kreidler imagines they had seen it in the numbers that they have but was not attentive until the awareness of increased numbers of microcephaiy in infants in those areas tied to Zika as the same with Guillain -Barre neurological issues then the attention was brought forth. Chikungunya causes longer lasting disease effects from muscle aches, weakness that sometimes can last a life time with close to 20,000 cases reported since January 1, 2016 no one has heard about because it does not have the birth defect issue that Zika does which makes it such a concern. Al Gonzales mentioned another thing on the forefront is the Olympics in Brazil. Dr. Williamson had one concern that he had not heard anyone mention or it may not be known does a single infection with Zika confer permanent immunity. Lou Kreidler responded she did not know the answer and Al Gonzales responded they do not know yet. Dr. Williamson said what he read was that 80% have no symptoms so we are going to have people return here that are not going to seek any form of medical care that carry it. It is a daytime aggressive mosquito we are going to set up autochthonous transmission here if it does not confer permanent immunity we are going to have a long term problem with birth defects that is scary. Lou Kreidler answered they are rapidly working on a vaccine so that will probably come sometime in the near future. Al Gonzales confirmed there are still a lot of unknowns on where it is going like the Ebola with the one nurse in England that recovered had been in the hospital twice now they are finding more and more at what these viruses are doing. It appears the government is going to pass a $1.8 billion bill for Zika most going to surveillance with some overseas to these areas that have issues. The best we can do is vigilance and preservation. Lou Kreidler stated what amazes her about mosquitoes is it takes only a bottle cap of water to breed a mosquito not a large body of water to set up a breeding station. Dr. Gibson said as far as she knew there was no need to worry about the animals she had not heard anything. Lou Kreidler said she had not heard or seen anything and Susan Morris stated it is a person to mosquito to person, they prefer people. IV. NEXT MEETING DATE April 22, 2016 was noted as the next meeting date. V. ADJOURN The meeting adjourned at 12:35 pm. Print Scott Plowman Chair Julie Gibson D. V.M. Vice -Chair, or Diane Stewart R.N. Secretary Wichita Falls - Wichita County Public Health Board City - County Board 0