WC CWF Health District Board Minutes - 04/22/2016WICHITA FALLS -WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES
April 22, 2016
Wichita Falls -Wichita County Public Health District
1700 Third Street - Parker Conference Room
Wichita Falls, Texas
BOARD MEMBERS PRESENT:
Julie Gibson, D.V.M., Vice -Chair
Diane Stewart, R.N., Secretary
Robin Moreno, MHA -HSA, ACHE
Keith Williamson, M.D.
David Carlston, Ph.D.
Larry Rains, D.D.S
BOARD MEMBER EXCUSED ABSENCE:
Scott Plowman, Chair
OTHERS PRESENT:
Lou Kreidler, R.N., B.S.N.
Amy Fagan, M.P.A.
Stephen Santellana
Jonathan Williams, M.D.
Veterinarian -City
Registered Nurse -City
Citizen At -Large -City
Physician -City
Citizen At -Large -County
Dentist -County
Restaurant Association -City
Director of Health
Assistant Director of Health
Council Liaison
Family Health Center
I. CALL TO ORDER
Diane Stewart called the Health Board meeting to order at 12:05 pm after a quorum of members was
attained.
II. APPROVAL OF MINUTES AND ABSENCES
Diane Stewart called for the review and approval of minutes from the meeting held on Friday February
26, 2016. Dr. Carlston introduced a motion to approve the minutes and Dr. Williamson seconded the
motion. The motion passed unanimously.
At this time it was noted the excused absence of Scott Plowman.
III. INFECTIOUS DISEASE UPDATE
Lou Kreidler told the Board that Nurses had been used in the Epidemiology role due to the lack of funds
but this year grant funds had been received to hire an Epidemiologist. Kelsey Tatum was introduced as
the Epidemiologist recruited from Florida with a Masters of Public Health from the University of Florida
with a concentration in Epidemiology and Bachelor of Science in Biology.
Kelsey Tatum said it had been busy since she began in November with the findings of an increase in
gastrointestinal illness. Gastrointestinal (GI) are infections caused by a variety of pathogens that can
cause diarrhea (sometimes bloody), nausea, vomiting, abdominal pain, cramps, and fever, it is known to
the public as food poisoning. In reality it can be foodborne, waterborne, animal related, person to
person, and spread by fomites (any object that can cause a pathogen you can touch and get sick). The
Gastrointestinal illnesses seen in Wichita County are; Campylobacteriosis, Cryptosporidiosis,
Salmonellosis, Shigellosis.
Campylobacteriosis
o Caused by the bacteria Campylobacter
o Infected through contaminated food or water, direct animal contact
o Incubation is 2 - 5 days
o Symptoms usually last one week or less
o Infectious up to 7 weeks if not treated with antibiotics
Year 2014 saw a low case year with 3 cases or less every month. Year 2015 saw cases spike in March
to slowdown with a rise in July then spiked to 10 in November that continued to maintain a higher case
count than previously seen. The range seen in 2016 has not been what is usually expected currently 7
cases are not fully investigated that could fall between March and April. An investigation could lead to a
lab report from April when the individual actually got sick in February these reports represent when the
people got sick. The case counts represent the cases fully investigated and submitted to the State.
Dr. Carlston asked when the water reuse was taken off line.
Kelsey Tatum answered last year July 2015.
Dr. Carlston commented about the time of the spike.
Dr. Williams also obvious to him asked if the case notifications are coming just from the hospital.
Kelsey Tatum replied the cases primarily come through the hospital ER they supply most cases with a
few from providers that are testing.
Dr. Williams asked if Clinical Pathology, Lab Corp, Quest Laboratories all report to the Health District.
Lou Kreidler said the Labs may not report directly to the Health District but do report to the State so those
do eventually get to the Health District.
Kelsey Tatum continued with Cryptosporidiosis which is not as common as the others but does happen.
o Caused by the parasite Cryptosproidium
o Primary transmission through contaminated or untreated water
o Also person-to-person, via infected animals, and contaminated surfaces or food
o Incubation is 1 — 12 days (7 days average)
o Symptoms usually 1— 2 weeks
o Infectious usually 2 weeks after symptoms resolve
With all illnesses there are the rare cases where the immune compromised get hit harder with infection
but with antibiotics it does help to decrease infection. Not many cases of cryptosporidiosis are seen.
Year 2014 had 5 cases with a slight spike of 8 cases in 2015. Year 2016 has seen 1 case in February
and 2 in March.
Salmonellosis
o Caused by the bacteria Samonella
o Incubation: 12 — 36 hours (ranges 6 — 72 hours)
o Symptoms usually last 4 — 7 days, but potentially weeks
o Communicability: days to weeks
o Transmission through fecally contaminated food or water, or improperly cooked or prepared food
o Also direct contact with infected persons, fomites, animals, or animal environment
Salmonellosis case count was 8 in 2014 and 25 in 2015. January 2016 saw 1 case and 5 in March with
currently 1 case under investigation. The investigated individuals are asked whether other members of
the household are sick. Not all are lab concurrent cases through criteria guidelines sick individuals who
do not have labs can be designated as probable cases so those are reported as well.
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Lou Kreidler added during that time several nurses had been in that position due to a large turnover in
the Nursing staff. Some contributing factors of what has been seen maybe due to an increase of testing
and to hire an individual trained in Epidemiology whom has done better case investigations than in the
past.
Dr. Williamson stated other than just as a percentage of increase the absolute numbers are still very
small it does not take much to swing those percentages when they are that small.
Kelsey Tatum said it can vary it really is year and staff dependent that back two years in 2013 had 60
cases of shigellosis compared to two year after had only 1 case.
Dr. Williams stated his concerns are the record flooding last year that came after the drought plus the big
change in the water system there appears a need to look at the relevance of the changes that were
made.
Lou Kreidler said that a Water Quality Task Force was implemented in which the Health District works in
conjunction with the Water Department, Water Treatment plant, and Sewer Department. The Task Force
meets when increased numbers of cases are seen of any diarrheal illness related to water. On anything
seen historically high the water records are pulled to review the routine water testing of the water
chlorination in the different areas. TCEQ noted the Task Force as one of the strengths of the project
when they visited to look at permitting the DPR project. In addition Kelsey Tatum created a process to
search for commonalities by household, work, day care, and school zip codes. The Water Department
reacts with any occurrence of high concentration in any one area to research for water main breaks and
water tests done in those areas, also any reports at the time of any issues at the Water Plant. It is a very
good system in place that allows an assurance that no issues had been with the water.
Dr. Williamson remarked that everyone was doing better when the reverse osmosis was in use than we
are now.
Dr. Williams stated the water tastes much worse since the water reuse went off line.
Lou Kreidler replied we had been drinking filtered water during that time and we are not now.
Dr. Williams asked are the case counts City or County.
Lou Kreidler said the case counts are only those individuals which reside in Wichita County. Many
individuals from the surrounding counties seek care in Wichita County. When Kelsey receives a report to
discover an individual does not live in Wichita County it is returned to the region for investigation and not
included in the case count.
Shigellosis
o Caused by the bacteria Shigella
o Incubation: 1 — 3 days
o Usually resolves in 5 — 7 days
o Highly infectious; only 10 — 100 organisms needed
o Communicability: 1 — 4 weeks after onset
o Transmission via contaminated food or water, contaminated fomites, and person-to-person
o Spread is common in households and child care facilities
Every year the cases hit differently; 2012 had nearly 60 cases, 2013 had 2 cases, and 2014 had 1 case.
The case count spiked in 2015 from September to October declined then spiked in March 2016 a lot of
the cases in part was due to household spread. The beginning of 2016 had 9 households involved with
only 1 confirmed the 9 households lead to a larger probable report. Currently have 8 confirmed cases, 3
remain to be investigated out of the 5 investigated it is foreseen to have another 8 probable household
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cases based on set of illness in relation to a confirmed case.
The Health District actions on Gastrointestinal Illness are:
• Surveillance - The Public Health Emergency Preparedness (PREP) monitors the surveillance
systems of ESSENCE (Electronic Surveillance System for the Early Notification of Community-based
Epidemics) and RODS (Real-time Outbreak and Disease Surveillance). ESSENCE a web based
program monitors and provides alerts for rapid or unusual outbreaks in the occurrence of infectious
diseases and biological outbreaks. Within the City are 6 pharmacies that report to the RODS
research at the University of Pittsburgh that is watched for indicators of any buying trends in the
community in relation to an outbreak. Kelsey Tatum would be notified to review, investigate, and
notify healthcare providers of the situation.
• Case Investigation - Kelsey Tatum receives lab reports from the hospital, providers, and laboratories
of individuals with a confirmed disease. The individuals are contacted to find out what and where
they ate, drank, the work environment (food, childcare, etc.), in an attempt to locate the case to put
an end to the spread.
• Public Education - Discuss with parents when children are sick about exclusion criteria such as
diarrhea that the children are not to be in school until diarrhea free for 24 hours. Many times the
parents do not tell the day care or school their child is sick.
Everyone can help with the prevention to wash your hands, stay informed become aware of what is
gastrointestinal illness, and seek medical care.
Dr. Williams asked how it is communicated to the medical community.
Lou Kreidler replied the Health District has an Epi response team to work in conjunction with Kelsey. If an
investigation leads to individuals commonalities to a restaurant, school, and/or childcare the
Environmental Health Division is immediately notified to inspect the facility. A memo is broadcast to the
medical community after the investigation of a reportable and a health alert broadcast to physician offices
when cases spike.
Amy Fagan added one instance last year Ebola was broadcast through the Medical Society and Dr.
Strate through the Tactical Information Broadcast Service (TIBS).
Dr. William's concern is that it seems historically -Nhen the water tables come up there are certain level
types of GI organisms now more people collect rain water, there are more water wells and standing
water.
Kelsey Tatum stated the case investigation includes inquiry of the water source and whether it is used in
cooking, drinking, any contact with recreational water, and water source at work.
Lou Kreidler confirmed a spike was seen in GI illness after the flood last year that made it one of the
things to wonder about. A lot of the flood was out in Wranglers Retreat and country areas that did not
feed into here that being known the septic systems got flooded so that was the reason of the Health
District broadcast to the public even reporters to stay out of the flood waters.
Dr. Williams concern is any type of cross over between standing ground water access to overflow of what
is supposed to be potable water. Another concern is water that at one time or another sets in pipes that
may not be used as often basically gallons of water in the pipe work at any given time.
Lou Kreider responded that is a good question that will have to be asked Monday at the Water Quality
Task Force meeting. People have conserved water usage as preached in the drought the number of
water per gallons per day the City uses have gone down. The Water Department does enforce testing of
the water out of the pipes at different sites around town.
Dr. Gibson questioned if any increase in cases with dogs had been seen.
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Lou Kreidler answered absolutely.
Dr. Williams said additional concerns are when the lakes turn over the water has a horrendous taste and
smell. When the numbers spike like it has we need to make sure nothing is missed it is not that he is
trying to make something out of nothing he just does not want to excuse something and end up missing a
possible source.
Lou Kreidler stated that is why we work together and the Water Quality Task Force was put in place to
make sure everything was looked at that something is not going to be missed.
Dr. Williams asked how long are food establishment employees suggested to stay home with their
minimal income they go to work and get a bronze star from the manager.
Lou Kreidler replied an establishment does not want to become known as the one with a food outbreak.
Most have gotten better to send an ill employee home but it still happens like people that send their kids
to school sick. The health inspections are one of the changes of the new Texas Establishment Food
Rules (TEFR) with new regulations in place the staff works hard to help the establishments with
compliance.
Amy Fagan announced the Boards June agenda would be the Community Health Assessment that has
been done for years to identify factors that impact the overall health in the community. New programs
are being designed to target those in the community vulnerable, at risk, and other types of diseases, also
to seek other approaches of health outreach for the children.
IV. NEXT MEETING DATE
June 24, 2016 was noted as the next meeting date.
V. ADJOURN
Diane Stewart requested a motion to adjourn. Dr. Williamson introduced the motion to adjourn
and Dr. Carlson seconded the motion. The meeting adjourned at 12:55 pm.
Signature
If Yeo wmG
Print Name
Scott Plowman Chair Julie Gibson D.V.M. Vice -Chair, or Diane Stewart R.N. Secreta
ry
Wichita Falls -Wichita County Public Health Board
City -County Board