WC CWF Health District Board Minutes - 05/12/2017WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES
May 12, 2017
Wichita Falls -Wichita County Public Health District
1700 Third Street - Parker Conference Room
Wichita Falls, Texas
BOARD MEMBERS PRESENT:
Julie Gibson, D.V.M., Chair
David Carlston, Ph.D., Vice -Chair
Keith Williamson, M.D.
Kaye Knauff, DNP, RN, FNP-BC
Larry Rains, D.D.S
BOARD MEMBERS EXCUSED ABSENCE:
Robin Moreno, MHA-HSA, ACHE, Secretary
Scott Plowman
OTHERS PRESENT:
Lou Kreidler, R.N., B.S.N.
Arthur J. Szczerba, M.D.
Woodrow W. Gossom, Jr.
Mark Beauchamp
Eric West
Veterinarian -City
Citizen At -Large -County
Physician -City
Registered Nurse -City
Dentist -County
Citizen At -Large -City
Restaurant Association -City
Director of Health
Associate Health Authority
Wichita County Judge
County Commissioner
City Council Liaison
I. CALL TO ORDER
Dr. Julie Gibson 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. Julie Gibson called for the review and approval of minutes from the meeting held on Friday January 13,
2017. Dr. David Carlston introduced a motion to approve the minutes as presented and Dr. Keith Williamson
seconded the motion. The motion passed unanimously.
At this time it was noted the excused absence of Robin Moreno and Scott Plowman.
III. MEMBER RE -APPOINTMENT
David Carlston, Ph.D. re -appointment in the County appointed Citizen At -Large was conducted by Wichita
County Judge Woodrow Gossom, Jr.
IV. ARBOVIRUS UPDATE
Lou Kreidler stated that an Arbovirus is vector borne diseases (mosquitoes) that extend over three of the
Health Department programs. Al Gonzales the Public Health Preparedness Coordinator, Susan Morris the
Environmental Health Administrator and Kelsey Tatum Epidemiologist are representatives from each of three
programs to present today.
Al Gonzales the Public Health Emergency Preparedness Coordinator began the presentation with Zika:
Preparedness and Response the significant focus of Public Health Emergency Preparedness. The Response
phases are broken out into three basic phases. Wichita Falls is still in the mosquito season Phase 2.
Phase 1 PREPARATION - Vector present or possible in the state
• Communication
• Surveillance
• Vector Mitigation
• Pregnant Women Outreach
• Blood Safety
• Lab coordination
Phase 2 RESPONSE - Mosquito Season (mosquito activity)
• Communication
• Surveillance
• Vector Control
• Pregnant Women Outreach
• Blood Safety
• Lab coordination
Phase 3 RESPONSE - Confirmed local or regional transmission by mosquitoes
• Communication
• Surveillance
• Vector Control
• Pregnant Women Outreach
• Response to Zika positive patient
• Blood Safety
• Lab coordination
RESPONSE OBJECTIVES
➢Prevent transmission of the Zika virus
➢Conduct education and outreach activities for the general public and healthcare community
➢Provide information to partners, stakeholders and the public regarding the Zika virus
➢Coordinate the Community Response to include public health, healthcare and emergency management
The Health District has prepared for travel acquired and locally acquired Zika cases.
PREPAREDNESS ACTIONS
✓Coordinate with Local, Regional and State partners
✓Control Mosquitoes
✓Collect the required specimens for labs
✓Provide public information
✓Provide guidance and information to healthcare partners
✓More detailed areas
The Health District and Partners work together as a supportive team on a step by step process to cross all the
functions. A chart was incorporated with a breakdown of functions within the Health District to deal with Zika or
any other Arbovirus.
ZIKA RESPONSE ACTION TABLE for
Limited Local Confirmed Transmission -single, locally acquired case, or cases clustered in a single household.
SURVEILLANCE (Nursing)
Intensify surveillance for human cases in a 150- and radius or other boundary as deemed appropriate) around home or other likely sites of exposure.
Consider conducting household and door-to-door surveillance for clinically compatible cases.
Encourage healthcare providers to immediately report results for any positive orequivocal cases.
Deploy targeted surveillance and monitoring programs for pregnant women in the country.
VECTOR CONTROL Environmental
Conduct intensified larval and adult mosquito control in a 150-yard radius (or other boundary) around case -patient home including residential habitat
reduction and outdoors acespraying.
Provide mosquito control education to public.
Continue focused community interventions to disrupt breeding rounds.
Leverage partnerships with local governments and non -profits for support.
LABORATORY TESTING Lab
Activate sure in testing and engage clinical laboratories, providing guidance on specimen collection, transport and reporting of results.
Provide guidance to healthcare providers.
Providespecimen collection and shipping uidance.
Collect appropriate specimens from impacted area.
Ship collected specimens.
COMMUNICATION PHEP
Prepare press release/media statement.
Monitor local news stories and social media postings and make adjustments to communications as needed.
Assist with targeted communication, surveillance and monitoring programs for pregnant women in the county jurisdiction.
Assist with guidance to healthcare providers.
Deploy targeted communication for pregnant women in the county.
& La
Notify local blood collection agencies for awareness.
Provide guidance to blood collection agencies as apl
WOMEN OUTREACH (Nursing & WIC)l
Aed monitoring oroarams for oreanant women in the
As part of preparedness Al Gonzales and Kelsey Tatum attended a Zika Boot Camp at South Padre in
Cameron County one of the first that had a locally acquired case. Cameron County shared both the good and
bad lessons learned the area has many unique problems and issues related to the border. The different
seminars and workshops provided additional information and tools. Immediately upon return work began to
update the basic plan of the Health District to include the functions of logistics, vector control, epidemiology
and command.
Susan Morris the Environmental Health Administrator presented an overview of the Vector Control program
➢ Continue to fight the threat of West Nile Virus. West Nile is here and needs to be kept in the forefront not
just Zika. West Nile mosquitoes fly high in the air feeds off birds and the Zika mosquitoes are in the grass
when disturbed bites ankles. There is the threat of travel related Zika for the local mosquitoes to pick up
through the people so the fight needs to continue.
➢ Works with Texas Tech and the Texas Department of State Health Services on mosquito pesticide
resistance. The Health District was contacted and scheduled to receive what are called little black jars with
tongue depressors. Once received the jars will be filled with water for the mosquitoes to lay their eggs on
the tongue depressors then sent back for the mosquitoes to be raised and tested for pesticide resistance
within the local area. It is not believed the local area will have a problem with pesticide resistance since one
pesticide is not used long term.
➢ Set BG sentinel traps during the daytime hours and the Gravid and CDC light traps at night. BG traps are
designed for the Aedes aegypti and Aedes albopictus to test for Chikungunya and Dengue that are set in
the morning for pick up 24 hours later. Gravid traps are designed for Culex species that carries the West
Nile virus are set at night and picked up the next morning. The traps are labeled as mosquito traps please
leave alone but problems remain with thief of the traps and are vandalized for the batteries but last year it
was successful with placement around the treatment plants and fire stations. Monday starts the placement
of the BG sentinel traps at the water treatment facilities and the Gravid traps at the wastewater treatment
facilities. The traps are strategically located in the four corners of the City then more are put in other
locations.
➢ Acquired additional equipment and a new chemical to help fight the battle. Changed out the chemical to a
more expensive water based chemical for the year to hopefully help with the Aedes and Culex types
mosquitoes.
➢ Requested a fulltime person in place of several seasonal employees to have better control of the program.
Mosquito control used to be a six month season it has become more full time due to awareness that
mosquitoes carry diseases and a change in weather the perfect conditions for a continuing mosquito
season. Full time personnel dedicated to mosquito control year round rather than part time seasonal
personnel would be beneficial by keeping equipment in working order to create a more efficient less costly
program.
K
Stay abreast of everything happening around the world, nation and state as it applies to vector borne
issues. Now just not the mosquito but a new tick disease in the northeast that has been moving down that
can be deadly. The Powassan virus called POW just has to attach to you not like Lyme disease where the
tick has to be attached to you for over 24 hours.
Lou Kreidler asked Susan Morris to explain the difference between the Aedes and Culex mosquitoes on how
the both are treated and what a difference it makes to the Vector Control program with the onset of Zika.
Susan Morris explained the Culex mosquito carries the West Nile virus. The Culex likes to fly high to feed on
birds at night with a preference of dusk and dawn the vector control trucks go out at those times with the spray
aimed high. The spray is in 20 micron droplets the micron has to touch the mosquito in flight to kill the
mosquito. Once the micron hits the ground it has a very low residual not a high enough residual to kill the
beneficial insects, bees and butterflies. The spray is not a preventive measure the chemical is the most
expensive and least effective method of control.
The Aedes aegypti and Aedes albopictus are mosquitoes capable of transmitting Zika, Chikungunya, and
Dengue. The Aedes are active daytime biters resting in the grass during the day that also like to go inside and
rest on walls. The trucks chemical spray in the air dissipates once it hits the grass. The one thermal fogger on
hand uses a chemical that leaves a residual not only killing the mosquitoes but the beneficial insects, bees and
butterflies. Personnel need to be careful with the chemical it is very intensive it is to be applied around
buildings and houses which most are private properties so the application is not done at residents but referrals
are made to hire a pesticide applicator.
Kelsey Tatum the Epidemiologist with the Infectious Disease Control program continued with the presentation.
TRANSMISSION OF ARBOVIRUSES
Zika as previously mentioned is transmitted through the Aedes species mosquitoes but there are other
pathways of transmission such as sexual transmission, mother to fetus and blood transmission. Humans are
the only known host of the Zika virus.
West Nile Virus is the Culex species mosquitoes. Birds are the primary host; other mammals such as humans
and horses are dead end hosts. A person can be infected but the Culex mosquitoes cannot bite an infected
person and acquire the virus which keeps down the spread.
Dengue is spread through the Aedes species mosquitoes. It is here locally so it is a possibility the only known
reservoir host aside from humans would be monkeys just the primates. Some uncertainty exists about what
other animal species Dengue could possibly exist in.
REPORTING PROCESS
National Electronic Disease Surveillance System (NEDSS)
The majority of Lab reports for reportable conditions in Wichita Falls are through NEDSS an electronic lab
reporting system supported throughout Texas it often is the initial notification of a report of disease. Anyone
plugged into the system can report and update on a daily basis. Reports are also received from the Texas
DSHS Lab in Austin, the hospitals and physician offices.
Old School... Telephone
The telephone is the most frequent way to hear about potential Zika cases before it is confirmed due to the
Health District facilitates the actual testing of the Zika virus for Wichita County that is sent to the State Lab in
Austin. Zika is done differently because the testing is done through the State there are commercial testing
available that might be reported through NEDSS but the test has already been done and come back positive.
INVESTIGATION
A report of a suspect or confirmed disease begins the investigation process. The medical provider is contacted
for the demographics and medical records pertaining to the individual's illness. Next is the interview with the
individual to get the basic information relevant to the case of disease that includes international/domestic
travel, employment, household, outdoors, blood donations/transfusions, and sexual history in Zika cases due
to the sexual transmission risk. Whether confirmed or not the Epidemiologist and Environmental team perform
an environmental risk assessment of the home. Education is provided on potential mosquito breeding sights,
self-protection, mosquito reduction materials, larvicide, bug spray, and safer sex material with Zika.
CASE STUDY: DENGUE /N WICHITA?!
Notification through NEDSS late January 2017 in Wichita County was a report of positive Dengue IgM in an
approximately 50 year old female immediately Lou Kreidler and Susan Morris were notified. Contact was
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made with the provider for additional information the specimen had been collected a week or two prior. The
provider said the patient had recently been to Bali where dengue was present which was a relief clearly the
patient got sick in Bali brought dengue back and we did not have dengue in Wichita Falls. However upon
actual contact with the patient the trip to Bali was months prior, typically the incubation period is around two
weeks so the trip to Bali was outside of the exposure period. The question remained did she get sick in
Texas?!
DENGUE IN THE U.S.
➢ Almost all cases of dengue are acquired abroad.
➢ Occasionally there are small pockets of local transmission but usually not persistent.
• 2010 Florida Keys - 67 cases
• 2013 Martin County Florida - 29 cases
• 2013 South Texas -Mexico border - 51 cases
➢ A locally acquired case would be a very big deal!
The investigation continued the patient's first labs done at the beginning of January immediately following her
onset were negative. The first positive lab was mid -January and repeatedly positive every two weeks
afterward. Further interviews with the patient revealed some domestic travel in Texas down to Weatherford in
Parker County next to Tarrant County. Naturally DSHS was extremely interested in the case and
recommended a collection of additional specimens to send to the DSHS Lab in Austin and CDC that was
facilitated through the Health District provider. During the wait as previously discussed a Health District
investigative team visited the patient's home to do an environmental risk assessment. At this time it was
believed the patient was past the bi-rhythmic period no longer at risk of being bitten by a mosquito and the
mosquito could transmit to other people. However concern was that maybe she had been bitten by a
mosquito and the mosquito laid eggs that were waiting to hatch. Further investigation was conducted,
clarification of travels and potential exposures. The patient's specimen sent to the CDC for further testing
came back negative for; Zika, DEN 1, Den 2. Texas DSHS said the patient most likely had an "unspecified
flavivirus" that is not reportable. It was quite a mystery because she had the text book Dengue but the case
closed no Dengue the patient was bitten by a bat which was quite interesting.
Lou Kreidler mentioned the outbreak of Yellow Fever in Africa and Brazil that the mosquito is here it is
troubling due to a shortage of the vaccine and Yellow Fever has been controlled by vaccine. It is spreading
and the manufacturers cannot keep up it is concerning along with the other things out there on the radar.
Dr. Williamson said it showed up in Brazil immigration from Somali and those areas.
Dr. Gibson asked about the number of local cases of West Nile virus.
Susan Morris answered that there had not been any local cases this year. Dallas and Tarrant County have
positive mosquito pools already. Locally last year only had positive mosquito pools, no human cases it has
been kept at a low count because of the active Vector Control program. The programs budget has not
changed over all the years but it is going to have to change soon with everything that is happening.
Kelsey Tatum replied that some go under the radar occasionally ITT Lab reports are for West Nile Virus that is
reportable but not an acute condition.
Mark Beauchamp asked if there have been any microcephaly cases related to Zika in the United States.
Lou Kreidler advised all the microcephaly cases that have been reported have been those travel related.
Kelsey was asked to provide an update on the press release sent out on the two local cases of mumps it could
be an ongoing issue for a while.
Kelsey Tatum announced mumps are officially in Wichita Falls maybe a little longer then known with 4
confirmed cases, 1 probable and a handful of suspect cases currently being tested. Currently all the suspect
cases are adults the youngest suspect 26 years old and laboratory confirmed 28 years old. Providers are
urged to use PCR testing an ideal test for mumps it can actually detect the virus and the serology IgM test is
often false negative. From a mumps exposure to a development of symptoms it typically is 16-18 days but can
be from 12-25 days which is one of the reasons it can be such a problem not even known sick the most
contagious is 2 days prior up to 5 days after. It definitely can be tricky to keep on top of the cases to make sure
the individuals stay home and educate employers especially in sensitive occupations. Extra steps are taken
1.1
for those that may have been exposed to be aware to seek treatment if necessary.
Dr. Julie Gibson questioned had they actually not been vaccinated.
KelseyTatum responded that actually the majority of the confirmed cases had been vaccinated.
Dr. Szczerba acknowledged that is the main issue with the disease up to 20% on average different numbers
are reported by different communities have different percentages but up to 20% all vaccinated people lose the
immunity protectant or may develop mumps if this is the real number for the last few years this is a relatively
low number. Realize that many families relatively many refuse to vaccinate their children for the local area
there are very few cases but 20% of vaccinated people may have a chance to get the disease if they are
exposed.
Lou Kreidler added there had been 2 outbreaks in Texas maybe 3, relatively close in Johnson County and
Dallas County both had up over 100 individuals. It is highly contagious a droplet infection with a long
incubation period because most contagious prior to the onset of symptoms individuals are going to work about
their daily activities now known sick and spreading the germs.
Mark Beauchamp asked do the vaccinations you get as a child last a lifetime.
Dr. Szczerba replied that up to 90% may keep the immunity for a lifetime even disease which not always is
symptomatic or having disease one time would leave immunity forever.
Dr. Williamson stated the one dose MMR initially is about 78% effective thus by the time an adult probably
about 50-60% those that got it as a child are again able to get the disease. Some thought is clinical disease up
to 30% of the cases have no symptoms it is what keeps adults immunization up to date because the adult
catch the virus unaware.
Dr. Julie Gibson asked for any recommendations for a business owner with most of the employees under 30
years old.
Kelsey Tatum stated CDC said with the two doses of MMR assumed immunity but actually an average of 88%
chance immune that about 12% never seroconvert never develop the antibodies. As usual wash your hands,
cover your cough, environment cleaning any standard household detergents will kill the virus it is very easy to
kill. If an employee is sick especially with a swollen face absolutely send them home.
V. NEXT MEETING DATE
Friday July 14, 2017 was noted as the next meeting date.
VI. ADJOURN
Dr. Julie Gibson adjourned the meeting at 12:50 pm.
1-) 6- '-5
Print Name
Julie Gibson, D.V.M.. Chair, David Carlston. Ph.D., Vice -Chair. or Robin Moreno, MHA-HSA, ACHE, Secretary
Wichita Falls -Wichita County Public Health Board
City -County Board
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