County of Marin Health and Human Services

Public Health Newsletter

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Public Health Newsletter July 2017
Marin County Public Health Newsletter Volume 4 - Issue 6 - July 2017
In this Issue: Hep A | Tdap | Foster Care | Syphilis | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Hepatitis A Outbreak 

Outbreaks of hepatitis A disease are currently ongoing in San Diego County and Santa Cruz County in persons who are homeless and/or using illicit drugs.  Transmission is presumed to occur person-to-person; no commercial product has been identified as being contaminated.  The California Department of Public Health recommends offering HAV vaccine to persons who are homeless or might be using illicit injection or non-injection drugs.

Tdap in Pregnancy 

Last year, there were 1,830 cases of pertussis.  108 cases were hospitalized; 47% of hospitalized patients were infants.  Prevention of severe disease and death among infants has become the top priority in pertussis control.  ACIP, ACOG and AAFP recommend Tdap vaccine during each pregnancy, preferably in the third trimester, between, 27 - 36 weeks gestation, regardless of the mother's Tdap vaccination history.   Please remember to stock and recommend pertussis vaccination to protect our most vulnerable patients.

Foster Community, Foster Hope, Foster Our Future 

Our community needs exceptional people who can provide loving, temporary homes to children in foster care.  Individuals with medical experience, those who can welcome siblings together, and those who are Spanish-speaking are especially needed.  Attend an orientation with a social worker and an experienced foster parent to learn more.  Visit www.FosterOurFutureMarin.org or call 415-473-2200 for more information.

Syphilis 2016:  Return of the Great Masquerader

The California Prevention Training Center (CAPTC) is offering a valuable one-hour online course on syphilis.  Syphilis is a growing public health concern as manifest by the 19% increase in cases nationally from 2014 to 2015.  Many people with syphilis go undiagnosed and untreated for years, putting others at risk.   This course offers an easy and inexpensive opportunity to learn the latest information regarding syphilis epidemiology, screening, diagnosis, and treatment.   You can find out more about this course here.

Message from the Deputy Public Health Officer

The Marin County Board of Supervisors is recognizing National Health Center Week, August 13 - 19.  Coastal Health Alliance, Marin City Health and Wellness Center, Marin Community Clinics and Ritter Center provide high quality, cost effective primary care to tens of thousands of Marin County residents.  Our community health center partners' mission is to provide healthcare to Marin County residents, regardless of ability to pay.  Amidst the ongoing healthcare debate, I am thankful for their ongoing commitment and service to our community.
Warm Regards,
Lisa Santora
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter June 2017
Marin County Public Health Newsletter Volume 4 - Issue 5 - June 2017
In this Issue: Fair | CPR | Shigella | Fentanyl | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

A Healthy County Fair

County fairs are not known for healthy food and drink.  The Marin County Fair is an exception.  Visit June 30 - July 4 to see why ours was named the healthiest fair by the Western Fairs Association in 2015.  Reflecting local values in health, the fair is smoke-free, all food vendors offer at least one healthy option, alcohol use is controlled, and there are regular healthy activities for all ages.  The Marin team shared their healthy fair model in this Growing Healthy Events Guide.

Staying Alive 

On June 10, over 1,600 people were trained in life-saving skills in Sidewalk CPR and Stop the Bleed at 19 venues throughout Marin County.  Bystander response is a key determinant of survival in life-threatening emergencies, and these annual trainings ensure our Marin residents are better prepared every year.  Congratulations to our EMS staff and EMTs / paramedics, nurses, doctors and Marin Medical Reserve Corps volunteers who stepped up again to save lives.  Clinicians interested in volunteering at future events can contact Karrie Groves at kgroves@marincounty.org.  Patients can be directed to visit heart.org/handsonlycpr to watch the Hands-Only CPR instructional video.

Cipro Resistance - Shigella

Shigella isolates across the U.S. are showing new resistance to quinolones.  The CDC is now recommending clinicians order a stool culture and antimicrobial susceptibility testing when Shigella is suspected; reserve antibiotic therapy for patients for whom it is clinically indicated or when treatment is advised in an outbreak setting.   Marin County Public Health will communicate relevant local incidence and resistance patterns to you, our clinicians.  Quinolone-resistant strains are commonly resistant to other standard agents, including azithromycin, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate and ampicillin.  For more information, visit the CDC's Health Alert Network.

Occupational Fentanyl Exposure

Very high potency opioids, such as fentanyl and carfentanil, may pose a contact hazard to medical personnel and first responders who may handle these compounds.  Recently in California, fentanyl and its analogs have been found in other drugs, including heroin, methamphetamine, cocaine, and counterfeit pills made to look like prescription medications, such as alprazolam (Xanax).  To address this concern, Marin County Public Health issued this communication last week to Emergency Medical Services providers.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotAs health care providers, we are facing uncertainty about the systems in which we provide care.  Pending federal decisions may significantly impact our capacity to care for all residents.  When access is threatened, the value of disease prevention is even more clear.  Regardless of the outcome in Washington, as stewards of health for our community, we will remain engaged and responsive to the needs of all in Marin.  Thank you for your excellent standards of care.
Warm Regards,
Matt Willis
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter May 2017
Marin County Public Health Newsletter Volume 5 - Issue 5 - May 2017
In this Issue: Carfentanil | End of Life Option | Norovirus | Zika | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Elephant Tranquilizer New Threat 

Marin County's Emergency Medical Services Agency (EMS) is monitoring drug overdoses and use of naloxone (Narcan) to prevent deaths.  This month, we received the first report of an overdose from Carfentanil.  Carfentanil is 10,000 times more powerful than morphine and 100 times more potent than fentanyl.  It can cause overdose in accidental exposures to particles through skin or inhaled.  This is a reminder to take a substance use and overdose history and to prescribe naloxone for patients at risk for overdose.

 End of Life Option

On Monday, June 12, 2017, the Health Council of Marin (HCM) will hold its Annual Community Education Forum.  The Council is advisory to the Board of Supervisors and the Marin County Department of Health & Human Services on public health and environmental health issues.   Lonny Shavelson, MD, will be the speaker on this year's topic:  California's End of Life Option Act:  A First Year Bedside Report.    The event will be held in the Library of Marin General Hospital, 250 Bon Air Road, Greenbrae, at 7:00 pm.

Norovirus

This month, the Bay Area experienced a surge in gastro-intestinal illness among students and staff in the school setting, which was most likely caused by the highly contagious Noroviruses. While symptoms may only last for one day, people are highly infectious for 48 hours after symptoms resolve.  The most important steps to prevent the spread of Norovirus in schools are:  1) stay home while sick and for another 48 hours after symptoms go away, 2) wash hands after using the bathroom and before eating, and 3) regularly clean with appropriate disinfectant all contaminated and high-touch surfaces.


Mosquitos and Zika

The California Department of Public Health (CDPH) is urging all Californians, in an effort to prevent Zika and  West Nile Virus infections and eliminate mosquito populations, to remove standing water around their homes and businesses.  There is also updated guidance from the Centers for Disease Control and Prevention (CDC) for Zika testing in pregnant women.  Visit Marin HHS' Zika web page for more information.

Message from the Deputy Public Health Officer

Summer time and pool parties are upon us.  As the weather warms up, so does the risk of drowning.  (Drowning is a leading cause of injury death for children ages 1 to 4.)  As providers, we can encourage parents to prevent unintentional drownings by taking precautions.  One of our friends recently hired a high school student with a lifeguard certificate to supervise their child's birthday pool party.  It was reassuring to have an extra pair of eyes when 15 kids of varying ages and swim abilities were screaming "Marco Polo."  Stay safe and have a fun summer.
Warm Regards,
Lisa Santora
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Blvd.
San Rafael, CA 94901
Public Health Newsletter April 2017
Marin County Public Health Newsletter Volume 5 - Issue 2 - April 2017
In this Issue: Vaccination | Take-Back | Concussion | Rankings | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Record High Vaccination Rates 

Kindergarten immunization rates in Marin County are the highest they have been since 2000.  This school year, 93.2 percent of Marin kindergarten students have received all of the immunizations required for school, increasing nearly 20% from the 2011/12 school year, when local immunization rates were at their lowest point, or 77.9 percent of kindergarten students.  Providers and parents can visit the Shots for School website to see if their child's school is well vaccinated.

Medicine Cabinet Spring Cleaning

Medications kept in our home cabinets can be targets for misuse and abuse.   In a recent survey, 60% of Marin County residents report holding on to unused medicines.  Clinicians should remind patients to safely dispose of medications.  Take Back Day April 29 is an ideal opportunity, when sites throughout Marin County will be taking back medications including controlled substances.
 

Marin Concussion Symposium

There is increasing interest and concern among parents and medical professionals about childhood concussions.  On May 6, the Buck Institute will host a symposium for clinicians to advance local standards in the prevention, diagnosis and management of concussions.  Organized by ConcussionSmart Marin -- a coalition of medical professionals, education leaders, athletic experts and brain injury advocates -- the event will offer free CME's to physicians.  Interested clinicians can registered for this symposium here.

   

County Health Rankings

The Robert Wood Johnson Foundation released its annual rankings of California's 58 counties, and Marin came in at No. 2 this year behind San Mateo County.  Marin had been ranked No. 1 in statewide health for seven consecutive years.  Marin retained the top spot statewide in overall health factors, such as education, employment, family and social support, and community safety.  Marin experienced a spike in accidental drug overdoses from 2012 to 2014, the time period reflected in the latest rankings.  In response, the County helped create a grassroots initiative called RxSafe Marin in 2014 to tackle prescription drug abuse.

 

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotThis week, I had the surreal experience of sitting near Newt Gingrich and Patrick Kennedy while they strongly agreed on something of national importance.   The event was the National RxDrug Abuse and Heroin Summit in Atlanta where we had been invited to share our RxSafe Marin coalition model.  While I was encouraged to see that the opioid crisis is a bipartisan priority and proud to share the progress we've made in Marin, it was clear that the epidemic is worsening nationally.  Now more than ever, we need to demonstrate the effectiveness of robust local response.   Thank you for your partnership and the excellent care you offer every day.
Warm Regards,
Matt Willis
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Boulevard
San Rafael, CA 94901
Public Health Newsletter March 2017
Marin County Public Health Newsletter Volume 5 - Issue 1 - March 2017
In this Issue: Disaster Triage | Antibiotic of Last Resort | Drug Overdose | Pertussis | Message from the Deputy Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Disaster Triage and Treatment - Free CME 

Hosted by the Marin Medical Reserve Corps (MMRC) Foundation

Saturday, April 29, 2017
9:00 am - 12:00 pm
Marin General Hospital, 250 Bon Air Road, Greenbrae, CA
West Wing, 1st Floor Conference Center

This free CME presentation (3.0 AMA PRA Category 1 Credit(tm)) presentation is designed to provide new information to physicians and nurses who will choose to or may be expected to respond to disasters in neighborhoods or designated alternative treatment sites.  This program will provide you with key skills for emergent medical triage in your own office practice or as part of a County disaster event or even a personal emergency.

Keynote Speaker:  Jan Horn, MD

Please register today at https://www.surveymonkey.com/r/MMRC429 

Antibiotic of Last Resort

In 2015, scientists reported the emergence of the plasmid-encoded mcr-1 gene, conferring bacterial resistance to the antibiotic colistin, signaling potential emergence of a pandrug-resistant bacterium.  The mcr-1 gene makes bacteria resistant to the antibiotic, colistin.  Colistin is one of the few "last resort" antibiotics available to treat bacteria that are resistant to many other antibiotics, such as carbapenem-resistant Enterobacteriaceae (CRE).  The Centers for Disease Control and Prevention (CDC) Get Smart program offers resources for Marin County heath care providers, including evidence-based adult and pediatric treatment guidelines, to promote antibiotic stewardship.

95 Drug Overdose Deaths in Marin County Between 2012 and 2014

Patients on high doses of opioids are at increased risk of overdose and diminishing function.  Tapering a patient, weaning them from higher opioid doses, can be an important first step to reducing overdose risk and improving function.  It is also helpful to maintain on-going communication with your patient about your concern for their well-being and your commitment to safe prescribing.  The California Department of Public Health (CDPH) is promoting a variety of tools on the prescriber resource sheet, including a tapering pocket guide, telephone consultation services, and an opioid overdose toolkit.   

Vaccine-Preventable Deaths - Pertussis

In 2016, California reported two pertussis infant deaths.  One of these deaths was in a healthy, full-term Hispanic baby; Hispanic infants are 40% more likely to be reported with pertussis in comparison to non-Hispanic, white infants in California.  These deaths are a devastating reminder that all prenatal care providers should ensure that all pregnant women are immunized with Tdap at the earliest opportunity, between 27-36 weeks gestation of every pregnancy regardless of the mother's Tdap history.  Postpartum Tdap vaccination and cocooning do not provide direct protection to the infant.   

Message from the Deputy Public Health Officer

The American Health Care Act ("AHCA"), the legislation intended to "repeal and replace" the Affordable Care Act ("ACA"), was shelved on Friday, March 24, 2017.  The ACA is working in Marin County and in California.  The uninsured rate in Marin County fell from 12% in 2013 to a historic low of 8% in 2016.  Covered California, the state's health insurance marketplace, provides a competitive health insurance marketplace for approximately 12,000 Marin County residents.  By remaining vigilant, informed and engaged, we can improve the ACA, not dismantle or neglect it. 
Warm Regards,
Lisa Santora
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Copyright (c) 2017
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
(415) 473-4163
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Our mailing address is:
3240 Kerner Boulevard
San Rafael, CA 94901

This communication is for those who have been contacted by the Public Health Department by phone the week of January 9-13, 2017

For contacts of Bacterial Meningitis case:

The purpose of this letter is to inform you that you may have had contact with a person who had meningococcal meningitis. For that reason, we encourage you to contact your health care provider or go to Urgent Care to discuss possible preventive treatment with antibiotics (post-exposure prophylaxis).

Close contact includes:

  • household members
  • persons who frequently eat or sleep in the same house
  • persons who spent 4-6 hours per day together
  • persons who have come in close contact with the saliva or respiratory secretions of an infected person.

Preventive antibiotic treatment is recommended for individuals who are close contacts of someone who had meningococcal disease. Ciprofloxacin 500mg one tablet effectively prevents disease.

Symptoms of meningococcal disease include, but are not limited to:

  • Fever
  • Headache
  • Stiff neck
  • Confusion
  • Rash

If you experience any of these signs or symptoms, contact your health care provider immediately for evaluation. 

 

Flu Is Here! On December 1st, the California Department of Public Health (CDPH) announced the first influenza-associated fatality in a person under the age of 65 for the 2016-2017 flu season.  It is mandatory to report laboratory-confirmed influenza cases who require admission to an intensive care unit (ICU) and/or who die at any location (i.e. home, hospital, ER).  Visit www.marinflu.org for the most up-to-date information about current influenza activity in Marin. 

Public Health Newsletter December 2016
Marin County Public Health Newsletter Volume 4 - Issue 10 - December 2016
In this Issue: Flu | RxSafe Marin | Norovirus | TB | Message from the Public Health Officer
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A message to physicians and other health care providers from Marin County's Public Health Officer.

Flu Is Here 

On December 1st, the California Department of Public Health (CDPH) announced the first influenza-associated fatality in a person under the age of 65 for the 2016-2017 flu season.  It is mandatory to report laboratory-confirmed influenza cases who require admission to an intensive care unit (ICU) and/or who die at any location (i.e. home, hospital, ER).  Visit www.marinflu.org for the most up-to-date information about current influenza activity in Marin. 

RxSafe Marin

On December 9th, David Mineta, former White House Deputy Director of Demand Reduction for the Office of National Drug Control Policy (INDCP), addressed attendees of the annual RxSafe Marin community meeting.  Marin's trend of increased co-prescription of opioids and benzodiazepines with age was highlighted.  About one in three Marin residents over age 65 who are prescribed opioids are also receiving benzodiazepines, increasing the risk of falls, cognitive impairment, and overdose.  The leading cause of accidental death in Marin is prescription opioid overdose, and most opioid-related deaths include other sedatives.  Adhering to Marin County safe opioid prescribing guidelines can decrease harmful polypharmacy.

Wash Your Hands!

Norovirus is now increasing in circulation throughout Marin County.  Remind patients of the importance of hand-washing, especially after using the toilet or changing diapers, and before preparing and handling food.  Also, please encourage patients to stay home from work or school for at least 24 hours (OSHA recommends 48-72 hours) after the symptoms have subsided.  Norovirus outbreaks rapidly grow due to contact with others while still contagious.

Tuberculosis Outbreak 

In September 2016, the County of Marin reached an important threshold -- more than 10 related TB cases over a 2 1/2 year period.  These cases (both US-born and foreign born) have close social and familial ties to each other as well as ties to a congregate community site and/or a local work site.  Review of TB genotype results revealed that they all shared the same rare genotype and thus were likely linked in the same local chain of TB transmission. It is critical for health care providers to think TB when evaluating patients.  Also, Marin County providers should enhance screening and treatment of latent tuberculosis infection.

Message from the Public Health Officer

Matthew Willis Marin County PHO HeadshotOn December 6th, the Board of Supervisors passed a resolution opposing any repeal of the Affordable Care Act (ACA).  The ACA, through Medi-Cal expansion, Covered California, consumer protections, and quality improvement initiatives, has increased access to affordable, high-quality health care for tens of thousands of Marin County residents.  Between 2013 and 2016, the number of Marin residents covered by Medi-Cal nearly doubled from 20,154 to 38,843.  Increased access has been matched by quality improvements in prevention and screening, chronic disease management, patient experience and advanced care planning.  HHS is committed to working with you, our healthcare partners, to protect access to high quality health care to achieve health equity for All in Marin.
Warm Regards,
Matt Willis
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Copyright (c) 2016
Matthew Willis MD, MPH
Marin County Public Health Officer
mwillis@marincounty.org
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Our mailing address is:
3240 Kerner Boulevard
San Rafael, CA 94901

In the summer, pediatric patients visit their doctors for health examinations for school entry and pre-participation physical examinations. These are opportunities to discuss both required and recommended vaccinations (e.g., HPV, meningitis). With the introduction of SB277, parents may be seeking temporary and/or permanent medical exemptions for required vaccinations. Visit our Immunization Program website for forms and guidance on medical exemptions or call (415 473 3078) or email (dhiser@marincounty.org) Danielle Hiser, RN, PHN, Immunization Coordinator, with any questions.

Many college campuses are experiencing mumps outbreaks. Summer is around the corner, and students from colleges and universities will intermingle, increasing risk for mumps transmission.  Contact the Communicable Disease Prevention and Control unit at (415) 473-7805, if you have any questions. 

For the seventh straight year, Marin holds the title of the healthiest County in California, according to the Robert Wood Johnson Foundation. Despite the best overall rating, persistent health and social inequities remain a challenge for Marin health officials.

The annual County Health Rankings were released today, and Marin shines in many measures of health. The rankings consider two main health outcomes: premature death and quality of life, and multiple factors that affect health including behavior, clinical care, the physical environment, and social and economic factors.

For example, Marin ranks highest in life expectancy and lowest rates of adults reporting fair or poor health and teen births. Marin is No. 2 among counties with a high number of adults with a healthy body weight and low rate of unemployment and violent crime.

“Community investments such as reserving land for open space and social norms around healthy eating and staying active have helped Marin maintain our ranking,” said Dr. Grant Colfax, Director of Marin County Department of Health and Human Services (HHS). “However, the rankings also reflect major disparities across Marin and help us know where we need to prioritize our work. For example, we need to focus on increasing equity in health care coverage, access to health food, early childhood education, and job training so everyone has an opportunity to optimize his or her health.”  

Marin ranked poorly – No. 54 out of 57 counties reporting – in income inequality, a measure that focused on the ratio between those with the highest incomes (above 80 percent of the median) and the lowest incomes (below 20 percent of the median). The County also fared poorly in one of the foundation’s new additional measures: racial segregation between whites and non-whites. Marin came in No. 50 among the 56 counties reporting. Racial segregation can translate to disparities in income, educational opportunities and work opportunities – all three of which lead to poor health outcomes.

When it comes to opportunities to live a long and healthy life, a few miles can make an enormous difference in Marin. There is a 15-year gap between life expectancy in Ross (94) and Marin City (79), a disparity that correlates with the per capita income.

Marin HHS is working in communities to help improve life expectancy. The Nutrition Wellness Program works with schools that have high obesity rates, which is known to drive heart disease and other conditions that lead to premature death. In Marin City, for example, Marin HHS supports nutrition education, walk to school programs, school gardens, and marketing to attract health-conscious grocery stores.

“While there are signs of progress, we’re more vulnerable than these rankings suggest,” said Dr. Matt Willis, the County’s Public Health Officer. “There is much more to do to achieve health equity in Marin. We need to continue to bolster programs and policies that address poverty, jobs, housing, and education.”

The County has made steady progress on many fronts with social equity, and the Board of Supervisors has made equity a priority. For instance:

  • It has made a commitment to preserve existing affordable housing, explore ways to acquire more affordable housing and encourage landlords to adhere to voluntary rent guidelines.
  • Marin County Parks is in its third year of a program designed to help more Marin residents, especially the underserved, to visit and enjoy parks and open spaces.
  • The Marin County Fair and Play Fair Marin have partnered for 14 years to build and maintain a healthy and successful fair as well as create a resource guide for ongoing and future success.
  • The Department of Public Works is diligent in its efforts to improve disability access and safety at County-maintained facilities, such as widening a popular pathway in the lower Ross Valley.
  • The County has even launched a TV series to promote education on mental health.

Other community efforts working to alleviate poverty and promote success of Marin residents are Rise Together, Marin Promise, and Marin Strong Start.

County fairs are not known for healthy food and drink. The Marin County Fair is an exception. We received the 2015 Merrill Award by the Western Fairs Association for its Play Fair health initiatives. The fair is a strong reflection of the community health values in Marin. The Play Fair team shared their model in this Growing Healthy Events Guide.

The number of reported outbreaks of acute gastroenteritis due to norovirus in Marin County has increased significantly since October, 2015. While this is consistent with the seasonal nature of norovirus, the California Department of Public Health has announced higher than usual activity state-wide. In Marin, affected facilities have included adult congregate living facilities and childcare centers. The duration of most of the outbreaks is a few days to two weeks, reflecting both the natural history of the illness and the control measures taken by the facilities. Information about norovirus can be found here.

This month there was an outbreak of influenza A at a local skilled nursing facility.  During our investigation, the first influenza-associated fatalities were announced for California, which included an infant, an adult and an elder. These events remind us that influenza can cause serious illness or death across the lifespan.  Visit marinflu.org for links to clinical information and surveillance reports.  The first of our regular seasonal influenza surveillance reports for 2015-2016 will be released in early December.

Since 2009, Marin County has seen an increase in syphilis cases, as is being seen regionally. In 2014, there were 20 cases reported. 19 of these were men, and most were men who have sex with men (MSM). USPSTF recommends that providers screen those at increased risk for syphilis infection, including MSM. The CDC recently updated its Sexually Transmitted Diseases Treatment Guidelines, which are now available as a mobile app.

FREE flu shots! October 17th at Novato High School from 10 a.m. to 2 p.m. Available while supplies last, regardless of insurance, ages 3 years and up. Kaiser patients will have their information updated for them. The school is at 625 Arthur Street, and the clinic is open from 10 a.m. to 2 p.m

Dr. Matthew Willis, the County’s Public Health Officer, says a flu shot is the single best defense against influenza, which can lead to a lot of time missed at school or work. The flu virus can spread one day before symptoms develop and up to a week after someone becomes sick, so protect yourself, your family and friends by getting your flu shot.  

Marin HHS staff and emergency medical personnel will be on hand to administer the vaccine. All County staff members are disaster service workers as well, and they are treating the Novato flu shot clinic as a “point of dispensing” to simulate an emergency need to dispense medicine to, or vaccinate, the whole community. The recent wildfires in Lake County and the 2014 earthquakes in Napa have reminded us all about the need for training and preparedness.

“Leadership plays a great role in responding to any disaster, and Health & Human Services is committed to preparing staff for emergency response,” said HHS Projects Coordinator Kristen Seatavakin. “We are looking forward to using this chance to improve the department’s ability to respond and to recognize where we may need to build larger capacity.”

The flu begins with an abrupt onset of fever, muscle aches, sore throat and cough that often make people sick enough to keep them in bed for several days. Flu can be especially dangerous for young children, seniors, pregnant women and people with chronic illnesses such as heart disease, diabetes and asthma.

The California Department of Public Health (CDPH) recommends basic steps to prevent and stop the spread of influenza and other respiratory illnesses in addition to getting the flu vaccination. These include:

  • Stay home when you are sick to avoid spreading illness to those around you.
  • Do not go to work when ill, particularly if you work with vulnerable populations.
  • Wear a face mask when coming within six feet of a sick person.
  • If you are sick, wear a facemask before going near other people.
  • Restrict visitation with vulnerable populations while you are ill.
  • Cough or sneeze into your elbow or a tissue and properly dispose of used tissues.
  • Wash your hands thoroughly with soap and warm water or use an alcohol-based hand sanitizer to get rid of most germs.
  • Avoid touching your eyes, nose and mouth.
  • Stay healthy with a balanced diet, plenty of water and adequate rest and exercise.

Stay up to date with information regarding this season’s flu activity and additional options for flu vaccination by visiting www.marinflu.org.

 

Marin County is known for high average life expectancy and wide health disparities between communities.  Differences in cardiovascular mortality rates drive the 17 year gap in life expectancy within our county.  In order to focus our understanding of this complex problem and to prioritize programs toward early prevention, a new Health Equity initiative concentrates on 1) childhood healthy weight and 2) access to primary care for all.  The initiative is summarized here.

Any providers in the state Vaccines for Children (VFC) program, and any healthcare workers who would like to learn more about childhood vaccines and vaccine preventable diseases are invited to an Immunization Update Conference. Co-sponsored by the health departments of Marin and Sonoma counties, this event features speakers from the California Department of Public Health Immunization Branch. Join us Friday, June 19, 8:00 -11:30 AM, at the Petaluma Health Center. For more information or to RSVP, please call Danielle, our Marin Immunization Coordinator, at 415-473-3078 or click here.

In 2014, 21 Marin County residents were diagnosed with HIV. In recent years, an increasing proportion of those newly diagnosed are Latinos or African-Americans and individuals under the age of 30. Over the past four years, approximately one in four people diagnosed with HIV in Marin had AIDS upon entry into care. Health care providers should remain aware of HIV trends and screening standards to ensure timely diagnosis and early intervention. Please see the Marin County HIV fact sheet here.

coughing infantThe California Department of Public Health (CDPH) reported approximately 10,000 cases of pertussis throughout California in 2014--the highest number in recent memory. CDPH has stated that pertussis has become endemic in California and high numbers of pertussis cases are expected to persist.

Marin County Public Health recommends:

  1. Vaccinate all susceptible individuals against pertussis according to the ACIP schedule and implement cocooning strategy around infants. The pertussis vaccine can prevent the disease or attenuate the severity of the disease.
  2. Think pertussis. Enquire if other household members are or have been recently sick with a respiratory illness, particularly characterized by paroxysmal coughing and post-tussive emesis.
  3. Test for pertussis. People who have been vaccinated for pertussis often present with mild symptoms. Have a high index of suspicion and a low threshold for testing and evaluating individuals for pertussis.
  4. Treat pertussis cases with a course of appropriate antimicrobial therapy.

Chemoprophylaxis is recommended for high risk close contacts of pertussis cases.

  • Infants
  • Pregnant women in their third trimester
  • Household contacts, particularly if there is an infant or a third trimester pregnant woman in the household.
  • Close contacts of high risk individuals (infants and pregnant women)
  • Individuals who visit a sensitive setting or work in sensitive occupations, e.g., day care or health care

Isolate known or suspected pertussis cases and symptomatic close contacts until three full days of antibiotics have been completed and until the cough is manageable; or until the lab test result is received and is negative for pertussis.

Pertussis is especially severe in infants and very young children and can present as an acute cough illness of any duration. Typically, it starts with cold-like symptoms (coryza, sneezing, occasional cough). Fever is absent or minimal. This stage lasts 1-2 weeks with the cough gradually becoming more severe. Spasms of severe coughing are followed by a sudden deep inspiration, often resulting in a characteristic "whooping" sound especially in infants and very young children. Post-tussive vomiting is common in all ages. Illness may be milder in previously vaccinated people. Classic pertussis is 6-10 weeks in duration, but cough may last longer in some people.

Pertussis is highly contagious. Transmission typically occurs when a susceptible person inhales aerosolized droplets from the respiratory tract of an infected person.

Period of communicability: Persons one year of age and older are considered infectious from the onset of cold-like symptoms until completion of three days of treatment or until 21 days after cough onset if no or partial treatment is given. Infants < 1 year are considered infectious for six weeks without treatment.

While questions regarding acellular vaccine efficacy are being addressed, vaccination remains the only avenue to reducing bacterial burden in the community and still offers individual protection and moderation of disease severity.

The Public Health investigation will consist of attempting to contact the case to ascertain if there are high risk individuals inside or outside of the household who need chemoprophylaxis. High risk household contacts will be referred to their usual source of care for chemoprophylaxis.

For more information about pertussis: http://www.cdph.ca.gov/programs/immunize/Documents/PertussisLaboratoryTe...

http://www.cdph.ca.gov/healthinfo/discond/documents/cdph_pertussis_quick...

To report pertussis cases, please call:

Marin County Communicable Disease Prevention and Control at phone: 415-473-7805 or 415-473-4163, or fax: 415-473-6002 Monday through Friday 8:30 a.m. through 5:00 p.m. On weekends, holidays, and after 5:00 p.m. Monday through Friday, call 415-499-9464 and ask to speak with the Health Officer on call.

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