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HomeMy WebLinkAboutAgenda - 04-03-2002 - 1 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: April 3, 2002 Action Agenda Item No. 1 SUBJECT: Discussion Items from Board of Health DEPARTMENT: Health PUBLIC HEARING: (Y/N) No ATTACHMENT(S): (under seperate Cover) INFORMATION CONTACT: Healthy Carolinians Report Card Rosemary Summers, ext 2411 Healthy Carolinians Slides Jonathan Klein, 968-1786 Strategic Plan Slides Pet Overpopulation Report TELEPHONE NUMBERS: Space Study Alterations for OCHD Hillsborough 732-8181 December, 2001 updated March, Chapel Hill 968-4501 2002 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To discuss items of mutual interest to both Boards. BACKGROUND: The proposed items for discussion are as follows: • Healthy Carolinians Report Card and Activity Update • Summary of Health Department Strategic Plan Accomplishments • Animal Shelter Replacement/ Pet Overpopulation Report • Future Space Needs for the Department Healthy Carolinians Report Card and Activity Update The Orange County Healthy Carolinians in conjunction with the Board of Health spent a good part of last year developing the first report card on the priorities selected by the community in 1996. Since the publication of the report card, the Council and the Committees have concentrated on developing activity plans that will address concerns raised in the report card. The report card and the brief presentation that will be made by the Chair of Healthy Carolinians Council are attached. Summary of Health Department Strategic Plan Accomplishments During the joint work session last April, the Health Department presented a four year strategic plan to the Commissioners. The attached slides briefly outline accomplishments for year one and highlight the upcoming focus for activities identified in the overall plan. If Commissioners wish to review these slides and forward any questions they may have to the Health Director or the Chair of the Board of Health, Health Board members will respond to those questions 2 specifically at the meeting. This may allow for more time for dialogue than in presentation of the slides. Animal Shelter Replacement/ Pet Overpopulation Report Last fall the Commissioners requested a report on pet overpopulation in the county. The attached report is in response to that request. It shows that significant progress continues to be made through a commitment to the spay-neuter program both by the County and by the Animal Protection Society. As the population in the county continues to grow, the pet population also continues to grow, however with aggressive adoption programs, more pets are being adopted through the Orange County Animal Shelter than ever before. The current Orange County Animal Shelter is located on leased land for which the lease is due to expire in 2006. Through the Orange County Space Study process and a subsequent review. and revision, it is anticipated that a square footage of approximately 19,200 square feet will be required to house a new shelter and co-locate Animal Control staff with the new shelter. The Board of Health is asking Commissioners for direction in the process and timing of the shelter's replacement. Future Space Needs for the Department In conjunction with the current CIP submission in December, the Department conducted a thorough review of the draft Orange County Space Study with its recommendations and a review of current and planned program activities of the department. The attached report details changes that were submitted in December and also provides updated information through March of 2002. This report takes in consideration items identified in the Department's Strategic Plan as well Orange County Healthy Carolinians 1 �i Adult and Youth Health Report Cards Orange County Healthy Carolinians 3/28/2002 } Report Card Development Y _ •Year long process •Joint effort between Healthy Carolinians and Board of Health • Eight sponsors that helped defray the cost • Local newspapers distributed to 40,000 households •Published October 31, 2001 •Celebrations and Concerns 3/28/2002 Adult and Youth Health Report Cards 1 2 Orange County Healthy Carolinians r Adult Health Report Card •Tobacco Use B •Substance Abuse F •Nutrition C •Overweight Adults D • Physical Activity D 3/28/2002 Youth Health Report Card •Youth Tobacco Use B *Youth Obesity D •Adolescent Pregnancy C •Child Abuse and Neglect D t 3/28/'1002 L 11 Adult and Youth Health Report Cards 2 Orange County Healthy Carolinians 3 Actions being taken to address the Report Card *Healthy Carolinians committees have regrouped •New action plans are being developed •A community forum is being planned for the fall •A year end report will be presented that reflects progress over the year I 3/28/2002 Child Abuse Prevention t *The Advocates for Children committee has been revitalized •23 agencies now participating •Focusing only on Child Abuse Prevention •Multiple activities planned for Child Abuse Prevention Month in April - 3/28/2002 Adult and Youth Health Report Cards 3 4 Orange County Healthy Carolinians r Youth Obesity •Healthy Weight Coalition formed by Cooperative Extension •Focusing on overweight in children L * Members from schools, nutrition, and Healthy Carolinians •Developing an action plan 3/28/2002 Adult Health Promotion •Healthy Choices, Community Voices Committee (Formerly Preventive Services) •Developing new action plan to focus on increasing physical activity •Promoting the Winners Circle program in area restaurants •Pursuing the Active for Life Grant •Promoting wellness to businesses in partnership with the Chamber 3/28/2002 Adult and Youth Health Report Cards 4 5 Orange County Healthy Carolinians t Mental Health/Substance Abuse •Collaborating with: — United Way Health Issues Team —Task Force on Mental Health Reform — Freedom House — Horizons/Casaworks — OPC Mental Health — UNC Hospital STEP program 3/28/1002 Opportunities for Improvement •Need for more agencies to participate in solutions •Behavior, policy and environmental changes are needed •Calls attention to the need for local data to track progress 3/28/2002 Adult and Youth Health Report Cards 5 Orange County Healthy Carolinians 6 q Thanks • To agency and community volunteers • To the staff • To the Chapel Hill Herald that worked with staff to design and publish • To you for assisting with funding for the coordinator and for recognizing the importance of Healthy Carolinians 3/28/2002 Adult and Youth Health Report Cards 6 Progress Report Strategic Plan 2001-2005 Orange County Health Department 4 � e M'O O � Jm Nash Caraina lbYlfe NaaYh Communicable Disease 000 • Quarterly newsletters to O 0 physician practices • Grant funds awarded from *<V 0 CDC for TB reduction activities and clinician education • Expanded list of physician practices for rapid fax communication 'A • MMR vaccine and disease prevention/education provided at El Centro and Latino even - yd 1 8 , Communicable Disease • Develop regular surveillance activities • Hepatitis A vaccine 1 1 program for restaurants • Influenza pandemic f ti- planning • Outreach & communicatio strategies for selected populations Childhood Immunization • 46% of children age- appropriately immunized by 24 months(up from 16%) • Coordinated with WIC to consistently obtain immunization records • Less than 6 months of activity yielded BIG results 2 9 Childhood Immunization • Develop internet record sharing capability with private i providers • Continue "cleaning" . the records--aiming for over 60 % in 2002 Sexually Transmitted Infections • Bad news—rise in syphilis - from 3 cases to 24 cases in 2001 I V • But mini-RIOT addressed outbreak .i• � ,;: - ,` •-r. • Began integrated clinics 5 �:- .: days/week in January at both sites • Increased appointment % ,' . '•= - availability by 65% (192 to L -y 316) • Use of provider/nurse •. teams 3 Sexually Transmitted Infections • Increase outreach efforts to communities • Screening and ' treatment in jail �. • Research new software programs for improving clinic management • HIV case management services -51Z Clinical Support Services • Denial rate for Medicaid was less than 16% r • IS reprogrammed w appointments, more\ appointment slots per day starting 1/1/02 is s • HUGE increases in third party billing & payments and workload ti 4 ' 11 Insurance Billings • FY 00-01 — $9,728 billed to insurance companies - 14 companies billed • FY 01-02 (as of 2-22-02) —$21 ,205 billed to insurance companies — 31 companies billed Insurance Payments • FY 00-01: — $2,110 received (21% collection rate) — 6 insurance companies paying • FY 01-02: — $6,102 received (28% collection rate) — 17 insurance companies paying • Per month average received: — FY 00-01 = $ 175 — FY 01-02 = $ 870 5 12 Self-Pay & Insurance • Fees represent client & insurance payments • FY 00-01 BUDGET = $21,500 • FY 00-01 Revenue = $28,078 (178% of budget) • FY 01-02 BUDGET = $21,000 • FY 01-02 Revenue (as of 1131102) = $26,904 —fee revenue average $3,800 / month — Projected FY 01-02 revenue = $45,900 (2180/6 of budget) —38% increase over previous FY Clinical Support Services • Need inventory & pharmacy software • Need improvement in I Medicaid and insurance reconciliation y t • Need improvements in client financial screening and collections 6 13 Medical Interpreter Services • Position classification approved 2119/02 .r r R` • Hired one more bilingual staff member s • Three staff members will be attending immersion training this spring ' • Language voice mail box set up • 23 interpreters on contract Nutrition Therapy & Clinical Health Education Services • Half-time nutritionist to begin 3/5102 • Offered position three times before an acceptance 7 . 14 Cardiovascular Health Positive Lifestyles • Health Promotion Coordinator replaced • Received supplemental funds from state for lay health advisor training ° ° o utilizing the Women's ' Health Passport • Working on establishing "lending resources" Dental Health Clinical Services • In last five years the number of Hispanic clients p increased from 56 to 140 -- Y a 250% increase F • The number of visits increased 247% from 159 to 393 4it �}n � ,A _9 8 15 Dental Health Clinical Services a Revenues are increasing: • In 1997-98 -$208,361 p ` ($32,601 over budget) F : • In 1998-99 -$213,095 T Y ($20,195 over) N' • In 1999-00-$202,403 ($5,403 over budget) a;•. (Vacant hygienist position) " • In 2000-01-$240,472 ($32,872 over budget) • Estimated revenues for 2001-02 is $247,800 ($24,000 over budWj Dental Health Clinical Services • Dental hygienist resigned in January • Problems with , retaining dental "attendings" y • Probably will lose funds from dental school • Participating in planning for mobile dental care for seniors 9 16 Food, Lodging & Inspections • EH Program Specialist hired by internal promotion in.January • Transferred an EH Specialist from on-site program to food & lodging in February • Participated in Heart- Healthy dining survey • Continued ServSafe classes for restaurant workers and managers , Well & On-site Wastewater • New EH Specialist began work on January 7 • ' • Transfer of person to food & lodging leaves vacancy `,. in this program �- • Vacant EHS position advertised in February • Current backlogs are 46Y approximately 2 weeks r 10 17 Environmental Health - misc. • Continues participation in Epi and BT activities • Continued participation in Asthma Coalition activities • Continued participation in lead hazard abatement activities • Continued to provided concentrated activities in community settings for wells and septic systems Environmental Health • Low interest loan/grant program for repairing septic system failures • Begin NFWRF program • "Space -the final frontier" • Rules review and revisions in 2002-03 �7 11 18 Vaccination, I D, ,Registration of Dogs and Cats • Leaming new software program • Software glitch diverted some revenues to towns and away from county Animal Sheltering • Shelter replacement plans • Shelter siting and sizing • Relationship with APS steadily improving _ 12 19 Dog/Cat Population, Control • Barn cat spay/neuter program started • Documents and agreements finalized in January Y • Three interested farmers to date stir ,. Other Accomplishments • Instituting jail health services • Established performance standards for home visiting staff • Lowest staff vacancy rate in five years • Publication with Healthy Carolinians of Orange County Youth and Adult Health Report Cards • Successful response to bioterrorism threat 13 20 Critical Needs • Bioterrorism/emergency response needs...surveillance and communication • Response to continual increases in communicable disease, both STI's and investigation of suspicious complaints • HIPAA Compliance Officer/ Billing & Medicaid Specialist • Staffing for primary care clinical services • Space needs for dental and personal health clinical services and animal shelter Critical Needs • Stabilizing dental health staff....hygiene and dentists • Replacing "lost" funding....Smart Start funding & state funding 14 . . 21 Pet Population in Orange County Report to the Orange County Board of Commissioners Surveys of human and pet populations have shown a relationship between dog and cat ownership and household demographics such as the number of people in a household and whether the home is owned or rented. Using these demographic factors, a co-efficient is applied that estimates the dog and cat populations in a given county or geographical area. For example, an owned household with four people living in it has a probability of ownership of one dog of 0.373, and a probability of ownership of two dogs of 0.130. A rented household's probability of owning one dog is 0.327 if four people live there, and 0.151 if only one person lives there. In 1990,the human population was pegged at 93,000 and while the dog and cat population was estimated at 40,000, or 43%of the former. Assuming the same ratio for 2000,we would estimate that there are 50,000 dogstcats in Orange County. As more of the census data is released,these statistics will be reapplied to the new figures. However, there is evidence that there may be fewer than that. From 1997 to 2000 the numbers of pups, kittens and strays sheltered at the Orange County Animal Shelter declined, with pups showing a dramatic 19.4% decrease. Kittens lagged behind with only an 8% decrease. The $7500 you appropriated for the "Barn Cat"program will also improve that figure overtime. "Strays" sheltered decreased by 10.4% over the four years. The past year's statistics look about the same or slightly reduced for 2001-2002. Meanwhile, Animal Controls'pet/tax registration database showed a significant increase in sterilized dogs/cats(15%) and a significant decrease in unsterilized dogs/cats (12.5%.) The database currently contains almost 37,000 dogs and cats. In 1997 the Animal Protection Society inaugurated a stand alone veterinarian clinic with Bobby Shopler as the on-staff veterinarian. This allowed the Animal Protection Society to offer low cost spay neuter to all. Dr. Shopler has neutered 5900 dogs and cats in these four years, thereby largely contributing to the figures cited above. County and town Animal Control Officers have done their part by encouraging owners of unsterilized pets to spay/neuter their pets at every opportunity. The Animal Protection Society also acquired a small grant to offer spay/neuter subsidies for residents that cannot afford to spay or neuter their pets. The dog/cat sheltered and registered figures show that Orange County has possibly turned the corner on pet overpopulation. To further decrease our dog and cat euthanasia in absolute numbers,the Board of Health will be looking into whether the sterilized/unsterilized pet tax differential should be increased from the current 1:2 to 1:5 ratios. The current fees are $5 for sterilized and $10 for unsterilized. Another strategy _ might include increasing the shelter reclaim fee for fertile animals impounded for being at large. . 22 _ Space Study Alterations Orange County Health Department December 2001 Updated March 2002 Carr Building: Environmental Health Services The projected time schedule for resolving the environmental health services staff space compression is not adequate as addressed in the Space Study. There are currently 12 staff members that share 2,000 square feet. Two staff members were added in this current fiscal year to bring the square footage per person to 142 square feet per person with no factors included for file or equipment storage,reception, or waiting areas. There is inadequate space for staff to perform the work as it currently exists. For example,there is no room for even one drafting table for staff to use to modify or create site plans. The current supervisor of the wastewater program does not have a private office due to the original renovation of the building. A temporary solution that will bridge the gap until the new construction and re-location is accomplished is currently being worked on through the siting of already acquired modular units on the Carr Building site. Expansion and Restructure of Personal Health Clinical Services At the end of the 2000-2001 fiscal year, it came to our attention that pregnant women in the southern part of the county, especially those in the lower income brackets were not able to get an initial prenatal appointment until they were 8 to 12 weeks pregnant. Positive pregnancy outcomes are strongly related to beginning prenatal care in the first trimester. The staff quickly moved to initiate services at SHSC at the end of August 2001. From that time until mid- November, 12 pregnant women were accessing those services that were provided only one-half day per week. In January of 2002,the department integrated clinical services in both locations and changed the way services are delivered to both improve efficiency and to provide additional service opportunities for residents. The department is no longer providing services in a categorical model, i.e.,Wednesday is family planning day or Monday is prenatal day;rather, patients can access all services provided on any day of the week on an appointment basis. In January a new appointment system was instituted that increased the number of appointment slots by 40%. In just three months, all appointment slots are booked at about 85%. The increased activity at both Whiffed and Southern has highlighted the need for additional facility space immediately, especially at the Whiffed location. The strategic plan includes the need to provide primary care services at both sites within the next three years. This will improve service delivery and health outcomes for all of our residents. This will require additional staff, however there will also be increased equipment and facility needs as well, especially in the northern location (Whiffed). Of necessity these will affect the ability of personal health and dental health to share the current space. Whitted Needs/Personal Health: ✓ Additional exam rooms,with associated equipment ✓ Additional interviewing rooms ✓ A positive pressure exam room for infectious diseases ✓ A clinical workstation for physicians and other clinicians ✓ Laboratory enhancements to handle additional standard required tests ✓ Separate blood-drawing room ✓ Enlarged pharmacy with built-in workstation 23 ✓ Immediate need for additional storage space for medical supplies and pharmaceuticals that can be secured. Currently storage is in multiple locations with weak security provisions. ✓ Adequate security and-controls for active and inactive medical record storage to ensure compliance with Health Insurance Portability and Accountability Act requirements. The current plan for renovation is inadequate to meet basic needs of the services that are expected of the department. It is anticipated that we will need approximately 8,000 square feet of personal health clinical space by 2003-2004 in the Whiffed Facility and an additional 2,000 square feet beyond that by 2010. Whiffed Needs: Dental Health Dental Health Services at Whiffed occupies a total of 1,246 square feet. Adequate current needs would increase that space to 1,760 square feet. The growth in demand for services is now anticipated to escalate since the General Assembly has chosen not to increase the reimbursement to private dentists for Medicaid clients. It is now anticipated that five years from now, dental services at each location(Carr Mill and Whiffed)will need to be provided four full days per week. We anticipate that Dental Health will need approximately 2,800 to 3,000 square feet of space at each location to provide services four days per week and accommodate patient flow. The immediate problem is that there is an immediate need for more personal health clinical space as well and the current facility is inadequate for both purposes. Whiffed Needs: Health Promotion and Education Services There are three acute needs for additional space for these services. First,there is a need for a "production"room for educational packets, storyboards, display boards, and for"media"handout storage that is secure. Second there is a critical need for storage of equipment and resources that are used for community events and for educational sessions. Car seats,multiple hardwood and posterboard display boards,bike helmets, portable tables, folding chairs, and awnings are some of the equipment currently being stored in offices and halls. Third there is a critical need for a classroom space for small to mid-size groups to meet for educational purposes. The current small Whiffed Health Department Conference Room will need to be reallocated to office space if more space is not acquired. The ideal would be to have a small group session room available in the clinical area of personal health so that clients do not have to come up to the administrative office level. Southern Human Services Center The impact of the expansion of services to the southern end is largely unknown at this time,but if we follow a similar model,the current projections contained in the.Space Study should be adequate including the re-location of Dental Health from Carr Mill to SHSC. The demand for services has typically grown at a slower pace in the southern end of the county, primarily because of the availability of other service providers. The expansion to primary care services in three years will necessitate more clinical space at the Southern location. The anticipated expansion in the Space Study are adequate but may need to come sooner than the projected 2010. There is a current serious storage problem at the southern location as well as at other health department locations. The re-location of Dental Health Services remains adequate as planned. 24 Carr Mill Mall: Dental Health Services The current capacity of the waiting room at Carr Mill Mall is totally inadequate for the number of patients seen in the clinic. Patients often have to wait in the hall and children are often running up and down the halls because there is no room in the waiting area. These are safety concerns for the department as well as parents. This problem can be remedied with some remodeling of the current space and will not require additional space. This immediate need is addressed in the CIP request that hasbeen forwarded. Animal Shelter The current space plan projections for the new shelter is not adequate to meet the projected need. The current shelter is approximately 10,218 sq. ft. and it is anticipated that the space projections for a new shelter should be around 17,000 square feet. This includes two spaces/runs per dog. You cannot clean a dog run with an animal present in it and allows space for the retention of some evidence animals without interfering with shelter operations. In addition,the relocation of the current animal control staff to the new shelter allows for a modest expansion of one additional animal control officer and one additional office assistant by 2010. Co-locating the animal control officers would increase the space needed an additional 2,200 square feet for a total building of approximately 19,200 square feet. These figures may need to be adjusted slightly as planning for the new shelter advances. Storage Space There is an over-riding need for storage space in all locations except Carr Mill Mall. Storage spaces have traditionally been the first to be sacrificed when new staff has been hired and there is no other place to put them. In addition, as programs have grown and changed,there has been a need to have additional equipment available that is used often but not daily. Overall the department estimates that it could use an additional 1,800 square feet of storage space(none of which is records storage). Inactive medical and dental records storage prior to destruction of those records would consume an additional 400 square feet. ®o�ntY yep/'�o Healthy Carolinians of Orange County a Fact Sheet o ] 3 2002 �"..m What is Healthy Carolinians? Healthy Carolinians (HC)'is a community-based partnership to improve the health of North Carolinians. Healthy Carolinians brings together community members, leaders and organizations to form a task force. Healthy Carolinians is based on the concept that community members are the most qualified to effectively prioritize the health and safety problems in their community and to plan and execute creative solutions to these problems. The overall goal of a Healthy Carolinians Task Force is to improve the health and well being of all community residents. Who are Healthy Carolinians? Healthy Carolinians of Orange County involves a diverse group of people from civic groups, schools, churches, health care organizations, UNC Hospitals, UNC Schools of Nursing, Public Health and Social Work, businesses, local government and.health insurance companies as well as concerned citizens of all ages including youth and seniors. Mission: To provide a plan to guide and assist Orange County(OC) in planning and implementing health care strategies to promote healthy lifestyles, improve health status and prevent premature death and injury for all residents in the county regardless of age, race, income or education. Task Force Structure: Healthy Carolinians of Orange County is composed of a council and three committees. The Council is lead by an executive committee. The Council meets quarterly or more often if required. The executive and working committees meet monthly. Membership: Open to all County residents Healthy Carolinians Projects for 2002 • Participate in the Healthy Carolinians Micro-Grant project to administer$10,000 to five community-based organizations in Orange County to address goals of Healthy Carolinians of Orange County. • Improvement of the health and human services resource and referral network in collaboration with Triangle United Way, Orange County Government and Healthy Carolinians committee members and partners. • Encourage the business community to adopt employee wellness programs and include prevention benefits in their health plans. In cooperation with North Carolina Prevention Partners and the Chapel Hill-Carrboro Chamber of Commerce. • Development of several small activities building towards a community-wide campaign to encourage and enable residents to increase physical activity and improve nutrition. • Development of a community awareness campaign on child abuse prevention including activities for Child Abuse Prevention Month in April. • Annual report and community forum in fall 2002 to report on progress made in addressing the issues raised in the 2001 Adult and Youth Health Report Card. Committees and Areas of Focus: Advocates for Children: • Prevention of child abuse and neglect, preventable accidents and injuries involving children, and child and adolescent obesity and overweight Preventive Services: • Adult health promotion and disease prevention Voices for Healthy Adolescent Choices: • Adolescent pregnancy prevention,'improving adolescent parenting skills, improving access to health care for adolescents. Committee Goals Advocates for Children: Preventable accidents and injuries involvina children • By 2003, to improve child abuse and neglect services for at-risk children, parents and families by increasing public awareness of child abuse and neglect and identifying resources which help resolve family management and conflict issues. • By 2008, to reduce the incidence of child abuse and neglect by parents or other caregivers by 10%. Childhood obesity • By 2003, to assess the incidence of childhood and adolescent obesity and physical activity and plan and implement collaborative intervention strategies. • By 2008, to reduce the incidence of childhood and adolescent obesity by 10% and increase the incidence of childhood and adolescent physical activity by 20%. Preventive Services: • By 2003, to improve lifestyle behaviors by 5% in the areas of tobacco use, physical activity, nutrition/obesity and alcohol use. • By 2003, to reduce at least one barrier to health promotion/disease prevention activities for at least 1 special population. • By 2008, to reduce mortality related to heart disease, stroke, cancer and diabetes by 10%. Voices for Healthy Adolescent Choices: • By 2003, to identify available adolescent pregnancy prevention and parenting programs and services and identify gaps in those programs and services. • By 2008, to reduce the incidence of adolescent pregnancy by 2% in OC. For more Information about how to get involved with Healthy Carolinians Contact: Maria Hitt, Healthy Carolinians Coordinator 2501 Homestead Rd. Chapel Hill, NC 27514 Phone: 968-2022 x 291 email: mhitt0 co.orange.nc.us h History of Healthy Carolinians of Orange County 1995 - County Commissioners charge UNC Hospital, UNC School of Public Health & OCHD to initiate Healthy Carolinians of OC 1996 - Comprehensive community assessment completed; priorities established: • Availability and use of preventive health services • Teen pregnancy • Availability and use of prenatal care • Illegal drug sales • Child abuse and neglect • Substance abuse • Poor parenting skills • Health insurance coverage • Poverty rates among minorities • Sexual assault • AIDS awareness 1997- Committees and objectives established, implementation begins • Needs of Children (now Advocates for Children) • Teen Pregnancy(now Voices for Healthy Adolescent Choices) • Preventive Services 1998- Governor Jim Hunt awarded certification to Healthy Carolinians of OC 1999- Behavioral Risk Factor Surveillance Survey completed, new partnerships established, assessment of data provided from BRFSS, priority areas revisited 2000 - Executive Committee acquires joint funding and approval for a full-time Healthy Carolinians Coordinator position with the OC Health Department. Healthy Carolinians of OC awarded re-certification by the Governor through 2003 2001 - Summary of Accomplishments • Community Action Plans were revised with committee input and then approved by the Office of Healthy Carolinians. • Participated in community events including: ► La Fiesta Del Pueblo ► Octoberfest ► Festifal ► Great American Smoke Out • Applied for and received grants from the Office of Healthy Carolinians for staff support for $10,000 in 2000-2001 and an additional$10,000 in 2001-2002 • Applied for and received the Pink Carolina"Dancers in Motion against Breast Cancer" Awareness and Education Grant • Developed the Adult and Youth Health Report Card for Orange County • The Preventive Services Committee formed a trial partnership with the Triangle United Way Health Issues Team as both have similar missions and goals. Assisted in the allocation of TUW funds in the spring funding cycle • Youth Risk Behavior Survey(YRBS) completed in Orange County and Chapel Hill-Carrboro City Schools Orange County Health Department Visit us on the web at www.co.orange.nc.us/health COMM°UNITY HEALTH SERVICES SECTION. januar�, 1V�arch , ZO02 9 Health Note's .u. _. . . _ .. 3 Community Health Services: School Health Services: Judy Butler,RN-Community Health Services Supervisor (245-2425) Penny Burton,RN-6th Grade Hepatitis B Program Coordinator/School Pam McCall,RN-Communicable Disease Program Coordinator(245-2428) Nurse for Hillsborough Elementary(245-2465) Sue Rankin,RN -Immunization,Pb,&Community Health Nurse(245-2461) Toni Thomas-Feren RN-School Nurse for Chapel Hill High School Lori Jean Woodson,RN-Immunization Tracking Nurse (245-2431) (929-2106,ext.1104) Jerry Pipoly,MPH-HIV Counselor (968-2022) Bobbie Hils- School Health Aide(245-2465) Margie Nichols-Community Health Assistant(245-2427) CDC Creates New Bioterrorism Website Syphilis Rate Rises On January 18,2002, The address for the site is In Orange County the CDC unveiled a www.bt.cdc.gov. The year 2001 brought with it more By early November,the'hot spots' new website that offers 4 For those without than its share of surprises.Orange of the county were identified and both new and updated internet access,the CDC County Health Department found targeted. Area physicians were maintains a telephone among those surprises a rising alerted to increase their vigilance Bioterrorism hotline for information. syphilis rate.Compared with the for signs of syphilis. The Health information. The new site The numbers are: year 2000,the incidence of syphilis Department staff stepped up 1-888-246-26YS(English) increased about seven fold. outreach efforts by distributing addresses the need for 9 ) Orange County reported 3 cases of literature and talking one-on-one up-to-date and accurate & 1-888-246-28ST(Spanish) syphilis for the calendar year 2000 with the people of the targeted These lines are available with a whopping jump to 23 cases areas.They also provided blood information on health threats Monday through Friday in 2001. testing in the Geld and distributed arising from exposure to 8:00 a.m.to 10:00 p.m.,& about 230 condoms. biological,chemical,or Saturday and Sunday During the first quarter of 2001, radiological agents. 10:00 a.m.to 8:00 p.m. we saw several cases of primary, The extra effort revealed 5 more *, secondary,and early-latent cases of syphilis in November & The website is the official - p;. Qranq e� e syphilis.The subsequent December. By mid-December the investigations and medical investigation and outreach push b y federal site for medical, ' . a management brought to light the DIS and Health Department laboratory,and public health c., medic to an j ry brought 9 � a total of 10 cases from us staff this s yphilis outbreak professionals to reference g*_ .QII through May. under control. when providing information to g ken till to an¢ges4v TB In May of 2001 a symptomatic Unfortunately,'under control'does the public and for updates on � C�COn es "' syphilis case was identified.This not mean our county is free of protocols related to health ouhps p W case was particularly challenging syphilis. The Health Department Hl� s rl as the client was reported to be threats. plans to continue it's community a d � * allergic to penicillin,was not outreach and health education Eli QC$ll`.. . readily compliant with the efforts. Continued vigilance by the You can also visit u*br ww4Kco.ornrtgsnc.uAed1h , doxycycline regimen nor the county's medical community is vital andjoJlow the linkt to the CDC wadaltu Health Department's investigative to=yent a resurgence. efforts.Only a few of the named This is one t`1,t�� 9 plgrrde contacts to this case were located, Please watch for signs of PaIE and only one contact was found to syphilis among the clients you you want to fall. e OP, $�a� be infected. Fortunately,with serve. Remember,this disease persistence by the Health can be found in many communities Department and the State's and does not stay within the Orange County Health Dept.offers OCHD Clinic Chancres Disease Intervention Specialists bounds of socio-economic status, FREE CONFIDENTIAL (DIS),this case and the contact race or gender. HIV Counseling&Testing Expanded Clinical Services were successfully treated. (FREE Syphilis test included) Suspicion of syphilis is by law The summer months were fairly required to be reported to the It's not who we are,it's the behaviors in which •g variety of services now routine with just a couple of cases local health department within 24 we engage. available 5 days a week being discovered and treated. hours. It is by teamwork between HIV/STD education&training also available. at each site Then came Fall. the Health Department and our •Ill clinical services are b county's medical providers that we We are located at: y In October of 2001 we were faced will be able to keep syphilis at appointment only with 6 new cases of syphilis. Due bay. Southern Human Whiffed Human to the increased number of cases Services Center Services Center For appointments call: and the history of a non-compliant 2501 Homestead Rd. 300 W.Tryon St. 96 8-2022 in Chapel Hill case with many partners who could Chapel Hill,NC Hillsborough,NC 245-2400 in Mboroagb not be found,Orange County was 968-2022 245-2400 declared a priority by the State. For questions about diagnosis, testing,treatment gpdons,and Prevention For alterhoursrepordngof a follow-up ofsyphilis cases, communicable disease that needs please call we9lre all to be reported belore the next Pam McCall Q 245-2428 or about. business day,call 911&ask that p perch 968-2022,ext.303 the health director be paged. To Contact the Schoola'Nurses Call: a ISchool Immunization Requirements Chapel Hill/ Carrboro Schools vaccine Age Requirements Carrboro Elementary Cindy Zwiacher 968-3652,ext.231 group Ephesus Elementary `Stephanie Wily c 929-8715,ext 22z DTP/ 4 6 years History of S doses with 1 dose on or after 4th birthday. Estes Hills Elementary Edwina Zagami 942-4753,ext.313 Di (A 4-dose series is acceptable if the 4th dose is on or after the 4th birthday)Pods.DT is acceptable only for ° b + 55,rt- t t� , those with a true contraindication to pertussis vaccine. a Frank Porter Graham Elementary Me gas Thmas 42=6491,ext 228 :; atrao-4,..'a^. ,'�.1'`.xE_t Glenwood Momentary Megan Thomas 968-3473,ext.232 DR On or No Pertussis is given after turning age 7. This vaccine is Adult Td after used to complete a DTP vaccine series started before 1" 30"" V ��s, �1� r � 7th age 7,for booster doses every 5-10 years,or as a pri- McDongle Elementary . Robbie Bsowa C :°�9E 9-2435, id 2090 . - ,- .• „ t °��<��� ac s xi : "-a xJs _ birthday mary series for students not immunized before age 7. Scroggs Elementary Cindy Zwiacher 918-2165,ext 279 �tty,; Hib Before History of a fall series(3-4 doses,depending on type of Seawall Elementary k a: etRgck` �; - �96Z43d .. Sth vaccine); `'°- "' ` _ �za rJ3�t.,. birthday usually completed in infancy. No further doses are Cnlbseth Middle School Carol Grigg 929-7161,ext.1130 needed if a child has had a dose®>_15 months of age, or if child is>S years. cDon�lgeIYliddle ool �� � bbf ': = ��3�' SS � 9 '_�W Polio 4-6 years History of 4 doses with 1 dose required on or after 4th Phillips Middle School Edwina Zagami 929-2188,ext 257 birthday. (if the 3rd dose of polio is given on or after the child's Srtti Mid31s�3cho `,�t Ireaa SI`deC� 3 Iola ��,�,,�, xG .,� �,�.� �.� � �v �� � 4th birthday,a 4th dose is not required.) Chapel Hill High School Toni Thomas-Ferea 929-2106,ext.1104 C`^' � Measles 12 History of 2 doses at least 30 days apart,with the Lst t C►si11 H ° e r• h � F, months dose given on or after the 1st birthday. Phoenix Academy Carol Grigg 967-8211,ext.211 &up Mums 12 History of 1 dose of each,given on or after the 1st birth- Ylt�at P ry 9i & months day. (most children receive 2 doses of these because o:LdIl a=�OIIII $Ch001S Rubella &up they are included in the MMR vaccine used for the 2nd g dose of measles.) Cameron Park Momentary Margaret Asa Dow 132-9326,ext.261 Hop B Children History of a completed 3 dose series. C tral EYeme ae;11 be, boss or after Efland-Cheeks Elementary Margaret Asa Dow& S63-5112,ext.271 7/1/94 Renee Barber Immunization Update: LCsad7f8q�yn.ElesaeatarY w Ji}1 23 , 13$.e ?f <x There have been a few changes in the law Hillsborough Elementary Panay Burton 732-6137,ext.283 and the ACID recommendations regazding immunizations. NevK ripe: mealary+ C J+:wr s ` 4 abaci 9696"°axt°° •VarieellaVaccine: Pathways Elementary Leigh McFai 732-9136,ext.1119 As of April 1,2002 all children born on or after April 1,20Qj will be required to receive a dose of L�Staabae�cMddle School Barbara i¢ria ie .320 223 Varicella vaccine on or after their 1 st birthday. A child may be excluded from immunization against C.W.Stanford Middle School Angela Wens 732-6121,W.237 Varicella if the child's parent or physician provides a ' d statement that the child has had Varicella disease&the Qe R giv3 kghg3 Sidi 3 �tiI3 ,.. approximate date of illness. t & M *Rubella Vaccine: County s Immunization Rate Ups -, In the past, women of child-bearing age were advised OCHD rani lYtessa a L ;; to wait a full 3 months before becoming pregnant after According to the NC Immunization rt r= receiving vaccines containing rubella.Now,the Registry(NCIR)audit which was done 0 ae effo fafiric,ces€ 0$e recommendation is for a woman to wait only 28 days after in December of 2001,Orange County , ()eA"011, eiit cB�by the Latino; a' vaccination.Although there has never been a documented has raised its NCIR immunization rate 'C0t6ma�llt Oras�'e COIA 4 incident of birth defect due to the administration of rubella 0 2000 43 0/o ``" vaccine during pregnancy,there is a theoretical risk of harm to from 14%in to in 2001. Thispanlsh�messdge�hAe has=b8 *r a fetus when using this live-virus vaccine.The CDC has further rate reflects the number of children es 1 Spams�,spe� wha'ar : .� studied this risk and determined that the greatest risk of harm to between the ages of 24-38 months who '9I 'ctlmmBntCatP $Englnsis °' a fetus would occur within the first 28 days after vaccination. y m m sa a are listed in the NCIR as up-to-date by ImOZI the 114/3/1 by two"rule(that is 4 doses ssag 18 ar�dm�= ealtll<lss9es, ¢ •Shortages&Rumors of Shortages: of DTaP,3 doses of Polio,&/dose of app0 ' its and of e00ns 4 Adult Td-The shortage continues aloe with the s, , r g g Co Oeln lTln gal staff at'oCHll?`�LSt h restrictions on administration. It is expected to end MMR by age 2). We believe this rate, r 9 sometime this year. + (0 ties-, eye Mtindap, although vastly improved,still does not , t � Prevnas—A shortage of this pneumococcal vaccine immunization , Wednesday,,acnd Fndapthen pass the ratle ofeour actual s ki O oal is toes9age to the dppropriatt'Health recommendations n order to assure that the vaccine will be raise this rate even higher next year by ��r D`ep`artment staff far follow np r ' available to the most vulnerable.(for details on restrictions, R They III tn;n, 1—act the Spaalsh ; please call Sue Rankin,Pam McCall,or Judy Butler) working to put more data into the NCIR -• speahmg Client via:as interpreter Ia ,, MMR&Varicella-Production of these live virus vaccines Thanks to the cgoperation of our local response t0 theu message x- was held up for several weeks causing a delay in shipment.No physicians offices,WIC,and data shortages are anticipated for participants of the NC Universal gleaned from the VALs(Vaccine To access,this.line Call(919)6443350. "` Childhood Vaccine Distribution Program,however many of us Accountability s we are on our await shipments on backorder. way to an even better rate by Fall 2002. 1 0YAIr IY.IY Orange County Health Department Visit us on the web at www.co.orange.nc.us/health COMMUNITY HEALTH SERVICES SECTION October December2001 Health Notes Community Health Services: School Health Services: Judy Butler,RN-Community Health Services Supervisor (245-2425) Penny Burton,RN-6th Grade Hepatitis B Program Coordinator/School Pam McCall,RN-Communicable Disease Program Coordinator(245-2428) Nurse for Hillsborough Elementary(245-2465) Sue Rankin,RN -Immunization,Pb,&Community Health Nurse(245-2461) Toni Feren'RN- School Nurse for Chapel Hill High School Lori jean Woodson,RN-Immunization Tracking Nurse (245-2431) (929-2106,ext.1104) Jerry Pipoly,MPH-HIV Counselor (968-2022) Margie Nichols Community Health Assistant(245-2427) Adolescent Health Services `' i irus U Site Flu & Pneumonia Update • • #a Orange County Health Department offers health oNo� � Flu season is upon us,once againl Unlike last 1stA ibee Cnf7rzteCh year,there are no worries about vaccine services to adolescents.Services include rou- tine physical exams,sports physicals,assessment& Cabfstr £J71 Via , t 1, shortages. Unfortunately,some agencies, R =r (Orange County Health Department included), treatment of minor illness,and immunizations. to gym:„ have been dealing with delayed delivery of Fi�a their vaccine. The CDC recommends that Who qualifies. medical providers and health departments first Anyone aged 12 up to 21 years.* target the people in the community considered to be high-risk'for suffering debilitating effects Cost? or death from influenza infection. Through the Fees are based on household income. {'. month of November,we have received a Most immunizations are free. t limited supply of vaccine to offer to people 65 Tuesdays from 1 ? here dal. years&older,as well as those with health When/Where:00 PM, Ct :, eisa conditions that place them in the'high-risk' rto � dsease' M category. (by appointment only) € eY @ Southern Human Services Center xl­ ' � p° 2501 Homestead Road,Chapel ortl�estr swcto a The good news is,if you are under age 65 and pel Hill w � W9, `tom ' a �C healthy,it is not too late to receive a flu shot. call 968-2022 for appointment most Ae �� psda th . Flu season peaks in December through March, " e so it is still a good time to seek vaccination and Wednesdays from 12:30-3:00 PM, s i roh be protected. Orange County Health Depart- (by appointment only) t; ment began offering flu vaccine to the general @ Whitted Human Services Center population after December 1 st. If you have 300 West Tryon Street,Hillsborough,NC < t patients who want to be immunized against call 245-2400 for appointment t influenza,and you have no vaccine available, Pl ase ?y�p t please refer them to OCHD. Transportation from the schools ', 4.a ih kJ 'Wj, to p is available with parental permission. eAlso,let's not forget about the prevention of Parents should inquire at the school's office. 4fr$ 3x; pneumonia!Pneumococcal vaccine(PPV23)is r " ° t still recommended to everyone over age B5. It *parents of adolescents who are under 18 years of age must sign a consent form(provided b OCHD for their can be given anytime during the year,and is g (P Y aYe 2[it tet .t� `: 10 available at OCHD on a routine basis. A child to be seen in this clinic.Although we encourage par- , a �f one-time vaccination is recommended for ents to accompany their kids to clinic,adolescents maybe individuals under age 65 with chronic illness or seen without a parent as long as the parent signs consent pP for this. immunosu ression.Subsequent doses are not a usually recommended for them until after age :z 65. Let s Coming Soon . . . ."The Women's Passport to Health" — What is the"Women's Passport to Health"? Orange County Health Dept.offers FREE CONFIDENTIAL e • It is a women's health guide which focuses on women HIV Counseling&Testing 40 years of age and older. (FREE Syphilis test included) •Topics include nutrition,physical activity,smoking cessation,domestic It's not who we are,it's the behaviors in which violence,chronic diseases,and basic preventative health screenings& we engage. tests. HIV/STD education&training also available. • The guide encourages women to,collaborate with their medical provider and access We are located at: community resources as needed. In addition,this project seeks to reach out to Hispanic women. Southern Human Whitted Human Orange County Health Department is applying for grant funds to conduct a lay health Services Center Services Center 2501 Homestead Rd. 300 W.Tryon St. advisor training with Hispanic women. If the funds are awarded,the project would Chapel Hill,NC Hillsborough,NC include a forum with local medical providers in order to share with providers the 968-2022 245-2400 information gathered during this training-(i.e.information regarding access to services,communication concerns,and other issues which may be unique to this population of women.) 1 welre You'A be hearing more about the project in the near future,so stay tuned! aft, t Staying vigilant to Prevent Lead Poisoning frOtt The Lead Risk Assessment Question- naire provided"by the state of North Carolina is considered an acceptable • Do you provide .' r Modern day sources of lead include: child something harmful.They may screening tool. However,the state medical f • Lead based paint(found in paint view such substances are a routine strongly encourages medical t chips,household dust,and soil part of health maintenance and not services to _ P ' , providers to not rely only on this t # around building foundations.Risk consider them to be medicines or assessment. The best way to monitor young increases with remodeling projects) remedies at all. for lead exposure is through a simple, children? • Foreign-made vinyl mini-blinds inexpensive blood test. " • Roadside soil(a legacy of leaded Special consideration for those The recommendations are that • Are you the gasoline) among us born inside the USA: every child have a capillary parent of an infant,toddler,or • Lead solder(in cans of imported blood lead analysis at the preschooler? food or in old plumbing.) In the USA,our own environmental sees of 12&24 months to avoid • 'natural'dietary supplements controls have only been implemented missine elevated lead levels. • Are young children a part of your (such as calcium from animal bone) in recent history. Lead-based paint life in any other way? • Alternative&folk medicines and lead-contaminated soil and dust Numerous studies show the following • Cosmetics(kohl&surma) are the#1 source of lead exposure in effects of elevated blood lead levels: You have probably answered"yes"to •Leaded glazes&artist paints the U.S.today. • 10µg/dl—neurological damage, at least one of the above questions. If • Improperly fired pottery/ceramics ' 74%of privately owned,occupied including decreased IQ,impaired units in the United States so,let's take another look at lead poi- •Leaded crystal housing neurobehavioral development, Boning.It maybe worth your while! • Battery manufacturers built before 1980 contain lead-based paint decreases in growth/stature and • Lead smelters hearing acuity,and difficulty Orange County is listed as"low-risk" • Solid waste incinerators • The use of lead based paint maintaining steady posture. containing up to 50%lead was • 20 dl—slowed nerve conduction for lead poisoning in North Carolina. • Sandblasting or demolition of widely used through the 1940's µ� However,let us not mistake painted metal structures . widely Today l lead based amt is available velocity ,r • Burning lead-painted wood&its for industrial based p and marine e 30µg/dl—decreases in Vitamin D low-risk for risk-free,! ashes military, metabolism • Fishing sinkers usage' •40µg/dl—decrease of hemoglobin The CDC points out that"no socio- Ammunition castings • Leaded gasoline was a major source synthesis economic group,geographic area,or . Old playground equipment,old of lead in the air up until the . 50-100µg/dl—symptoms of colic, racial or ethnic population is spared" painted or vinyl toys,old toy sol- • 1970's-1980's frank anemia,nephropathy, elimination of lead in and that"virtually all children are at diers... The comp encephalopathy. We've even detected lead in the gasoline was not required by the Higher levels lead to convulsions risk for lead poisoning." Clean Air Act until December 31 g ' phone cords at the health coma,and death. Although lead has been used by than department! 1995 Our goal is to keep levels below for centuries,industrialization of our With the ever-increasing use of 10µg/dl to prevent as many nation and the world over the past Special consideration for those among us born outside of the USA: imported goods&foods,alternative deficits as possible. So,you can century has caused lead to be widely medicines,etc.,it is hard to account see,even though Orange County dispersed throughout our Many children born in foreign for every possible lead-poisoning is a `low-risk'county for severe environment. Lead enters the body countries have not had the benefit of hazard: That is why it is so lead poisoning,we still need to via ingestion,inhalation,and also pharmaceutical or environmental e important ally screen work to protect the wellbeing and controls like those implemented in the n'child for lead poisoning! development of our county's kids. crosses the placenta to unborn controls Leaded gasoline is still widely fetuses. The pervasiveness of lead in used in some countries. Pollution ofTntateLatsorato�1 ease to rneludd t/re putien't=s==;. the environment coupled with the water and air is common.The use of �>'Pu iie H` tfi iirl,t r 'rr7rrtiise the lab sll�`This' lead in products and manufacturing � ��eftratexeactlliand ; normal,everyday hand-to-mouth , s processes are not monitored or + e d sl �u � a rvicesl activity typical of early childhood -3 ' restricted.There are no agencies o pia e ocy rangy puts all young children at risk of de- which detect and restrict the use of ;a patien �Bfood�%wsS Den + Qmdeiines velo in elevated blood lead levels. lead in common medicines and folk ` ' >, f,ntrats"creentn )tloQdteadleyel £_ P 8 Many children perceived to be remedies or cosmetics. ecrme �ar�e�airc t �.s e lµgdl��do another 4 ep � I; r � , �� r � I7us ' Alarcon,alkohl,azarcon,bali olt Iatel eegi nfflub 4 _ i5 ptga tha4Cpnnnatoty `low-risk'come into contact with o£ eciulen c Il n , 3 ,+ ,, coral, hags ret ,lig�day-loo ah, i c lead level sources of lead without our and rueda are names of folk remedies r �� r"°l �tre trttal tei(ol'ts I(r' g(cl§r su a{h11 ve m :' knowledge known to contain lead and have been °' z _ r ettaguitrt R�appropnat�age) im licated in lead poisoning. These � ' E"Wt s * * x P P g 7o starrusin the state ad �rv,ces'r r remedies come from cultures in Latin 1,0, =blood lead analysis £the 2nd level#s IOµgldl,you have' Orange G uhty Heaifh Dept'S c " '£' nbvetuliitted the vandrty of the initial pro ties)FREk America,Asia,Indo-Pakistan subcon 9 3 337 to obt l ttr blood , tinent China,and some Arab states 1rotarnare11 * screemnglevel fihts't .ilnetl as a lead kit rnCldesn r" «EpvuonmentalfTtivestrgafions rind l,b reqursttrdn far„lx� C°nflrmed Elevated Blood Lead Level)f to familW with c ildrea<6 yrs old = x &; § =ti and you must take the appropriate: who haysa co`nffrmed blood When questioning parents about ga11919-733=7656,to"order mailers actton as outlined i' the NC Lead lead level of>10 dl. alternative medicines or home Screening&Follow-up Manual. P� T7te blood lead"speeitnens nre sent vto-- - - remedies,bear in mind they may not U"S-mail in;special mailer cantai,iers: for Orange County kids,calf OCHD Families must be"residents o_ be forthcomin with the information for an Environmental Investigation! f g ' hese mailers are relatively inexpensive— Orange County,to receive th you are seeking.There may be uncer- Small mailer costs 50 cents Anytime a blood lead level changes to service..;, tainty of the legality of the use of (holds up to 5 miciotainers) Call Tom Konsler(245-2370)or an new category,(e.g.from 10-19µg/dl Sue Rankin(245-2461) to make these substances,strong belief in their Large mailer costs$75 cents to 20-44 pg/dp a`Confirmatory'or effectiveness and benefits or fear of (holds up to 25 microtainers) 'Diagnostic'level must be done to be arrangements. g being found guilty of giving their sure this change is accurate. For more info..check our httpJ/wonder.ede.gov/wonder/prevguid&www.cdo.gov Since 9-11 . . . The events of 9-11-01 and its aftermath other correspondence since 9-11,the One research article published in have affected us all.Orange County Centers for Disease Control(CDC) Emerging Infectious Diseases,Nov./ Health Department is no exception. remain an excellent resource for current Dec.2001,entitled"Modeling Potential information and guidance. The CDC Responses to Smallpox as a Bioterrorist Department has been n i ts involvment with The primary impact the Health bioterrorism website address is www. Weapon"outlines a mathematical suspected bioterrorist events and in bt.cdc.gov. Among the current articles model to describe the spread of anticipatory planning for what the future featured are: smallpox after the deliberate release of may hold. Health Department staff has • Interim Smallpox Response Plan& the virus. For those of you with a public been on-site for several"suspicious Guidelines health interest,this is an interesting substance"calls and has worked closely article on the use of available smallpox with Orange County Emergancy • Chemical Agents vaccine along with quarantine of cases Management Services and local law to control an outbreak after a deliberate g Radiological Emergencies enforcement agencies. Several release. There are also numerous links and suspicious substances from Orange information about other resources.You Effective communicaton is incredibly County have been tested,with the can link to the CDC website and other important to management of the new approval of the Federal Bureau of informative sites through the Orange health issues we are facing.To facilitate Investigation,and all were negative for County Health Department website at communication,WE NEED TO KNOW biological or chemical agents. Our www.co.orange.nc.us/health. HOW TO BEST CONTACT YOUR Health Director,Rosemary Summers,and PRACTICE. Please complete the some of our other staff have been and Recently released is the recommends- information below and transmit it to us continue to be involved with local and tion that persons exposed to anthrax via e-mail,fax,or U.S.mail. If we can't state planning for possible future needs. spores who are completing their 60 reach you quickly,we can't help to Regional planning that includes all area days of prophylactic medication may keep you informed of new information hospitals will also be a focus in the next wish to take additional precautions. that often comes straight to us from the several months. This could involve additional prophylac- CDC or the State. Thanks to those who As most of you know,there has been a lot tic medication and/or receipt of anthrax responded to the recent fax survey to of information disseminated,especially vaccine. Physicians with patients in confirm that our new `fax blast'is involving anthrax,appropriate this situation may obtain more reaching you. We had many who did preventative treatment and testing. You information by contacting the Health and not respond to that survey so this will should have received several a-mails or Human Services(HHS)Press Office at help us update our contact information. faxes from the Health Department as (202)690-6343 or accessing information information came out that we felt needed through the website of the HSS office at to be shared. As stated in most of our www•hhs•gov/news. 46— ........................................................................................... ........ Please Reply with the following contact information: Name of Your Practice/Group: Naffing Hddress: Best Contact Person(s) for your office: E-mail Iddress: Fax Number. Preferred method of contact (check one): E-mail Fax - Please replp to Judy Butler— phone;(919) 245-2425. fax (919) 644-3312 e-mail:butlerO co orange nc us or US. Mail.- c/o Orange County Health Department, 300 West Tryon Street Hillsborough NC, 27278 ....................................................................................... ..... ... . .. .. w4 $ 2V _�, MTV .;C+�ir• � i.�:�j:. ;S}L. •-.:{.ya. I �r F.t,.•k_ s.. or• x SKI T .M a c _sty a w� N �yTw'V.�'lY � "T,.t1.X�9--•�`-�.a4Y-+?!,�-.4Xa a ar••�.^�.'.a x .i,v'F.r.}f _ -'y vy I`r°da.' S ao.3 ts3.P z" -c� "Y,.'3a. "^^G IL .` ti.t AR - -`.G• r � � V h rTr'1 yv('in r>rl ona-shit��n.o matey,tx she forms on sFxkpl�rg drujs d not � 5en enough to to pra#at Americans from salvlogical and che�nli"th�+ ats,ie#die d :3T .. s - and cancer.- Congress and the Admirrtstraticn nu st also make a long-#sirn CbmMitment to stnangthen thft- r fundamenta14 of our public health system: - - more and better pubffc health professionals - JIM a state-of-dwi-art early warning system and cornmunkations network Ali: better-equipped laboratories Aft' = � and tracking of diseuases and monitoring of environmental exposures. 1.49 neglected, Annedca's Punic health system is Vital to or defense agalost biolcglr.W and Merrdcal attacks, as well as on-Ong serious health concerns such as asthma and cancer, and the unforeseen wxxgencles of tomorrow At cans of afford to do toss. I � 1 1 - Tl>rie Trutt f�iir - • 9�, YOUR HEALTH, YOUR COMMUNITY. 4 d 11 Ccii YOUR RIGHT TO KNOW. � a &PPP tt)99' H r r i "4 A GF lvr MI www.heafth'Iramedcarmorg r e�r C�fra�r. , ,�