County of Marin Health and Human Services

Public Health Newsletter

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Smoking carries a hefty price tag for all Californians - from the addiction and diseases it causes, to the premature deaths of far too many smokers - it affects our communities and families in many costly and profound ways.  A county-by-county report of the costs of smoking in California was recently completed and released on October 15, 2014 by University of California San Francisco researchers. It is the third in a series of reports on California smoking-attributable costs funded by the Tobacco-Related Disease Research Program and the Tobacco Control Program of the CA Department of Health Services.  Every ten years, the Cost of Smoking in California report analyzes the economic burden of smoking, illustrating the costs associated with smoking-related illnesses and premature death. The newly released study found the overall cost of smoking for California was $18.1 billion. The full report on cost of smoking in California can be reviewed at http://www.trdrp.org/files/cost-smoking-ca-final-report.pdf

Each Marin resident, including nonsmokers, shells out $551 for the cost of smoking, according to this county–by county report of the costs of smoking in California. The total annual cost of smoking to residents of Marin is $138,354,000. This report did not conduct a Marin County specific smoking prevalence survey but the last Marin specific survey conducted by the California Tobacco Control Program showed that 7.3% of adults in our county still smoke. This report shows that we still have a lot of work to do to reduce smoking. 

Although we have made great progress in reducing the number of smokers in Marin and in reducing the secondhand smoke concerns, there remains much to be completed as we strive for a tobacco-free community. The county’s Tobacco Related Disease Control Program is currently working with all local jurisdictions to update their Smoke-Free Ordinances to include: (1) multi-unit housing smoking restrictions; (2) e-cigarette restrictions and; (3) restricting the sale of tobacco in pharmacies. The county also provides cessation services to residents who wish to stop smoking and is actively working with behavioral health providers in an attempt to reach the population of residents with the highest smoking rates.

The Smoke-Free Marin Coalition recently launched a 10-year campaign to improve the health of Marin residents by educating consumers and retailers on how marketing practices influence consumption of unhealthy products and assist in making the retail environment a healthier place for Marin residents. The Healthy Stores for a Healthy Community Campaign is a statewide and local collaboration between tobacco use prevention, nutrition and alcohol prevention partners.

Marin should be proud of our successes in addressing tobacco use and secondhand smoke dangers, but the fight is ongoing and the Smoke-Free Marin Coalition will continue its efforts to free Marin County residents of the tragic and expensive impacts of tobacco and e-cigarette use. Please contact Bob Curry, Marin County Tobacco Related Disease Control Program at rcurry@marincounty.org with any tobacco concerns or questions.  

There is no Ebola in Marin County. (Outbreak Map)

Marin is prepared to respond to a communicable disease outbreak, including Ebola.  Marin County Health and Human Services (HHS) is working with local hospitals and the California Department of Public Health (CDPH) to ensure that clinicians and hospitals countywide are educated and prepared.

It is unlikely that a case of Ebola virus will occur in Marin. However if a suspect case should occur, there are systems in place to ensure a quick response from the department and the medical community, and to maintain public safety.

Airports in the US that handle travel to and from West Africa and other countries that may be transit points, will now be checking temperatures of any passengers who have been in the affected countries. Fever is the initial symptom of Ebola, so anyone with a fever will be placed in isolation and if they have traveled with family or friends, these people will be placed in quarantine.

Should there be a suspect case in Marin County, Public Health and our health care partners are prepared to quickly, safely and effectively intervene. We work collaboratively with emergency medical services, the hospitals, clinics and private providers to practice our response plans to assure the safety and health of our community.

As we enter the flu season, we would like to remind healthcare personnel that while Ebola at this time remains a theoretic risk locally, influenza is not.  Obtaining your influenza vaccination is one simple measure you can take now to protect yourself and our community from serious illness.

Links & Resources

Centers for Disease Control and Prevention (CDC)

Hotline: While there are currently no confirmed or suspect cases of Ebola in California, California Department of Public Health has set up a hotline at 855-421-5921 to answer questions from those concerned about the possibility of Ebola in California.  

For Providers

Marin County Public Health Advisories: https://www.marinhhs.org/content/public-health-updates 

Public Health Advisory: Evaluating Patients for Possible Ebola Virus Disease: Recommendations for Healthcare Personnel and Health Officials - 10/3/14 - Advisory

Ebola Virus Disease Health Advisory - 8/8/14 - Advisory

CDC Information for Health Care Workers
CDPH Ebola resources (including signage)

Signage requesting patients report travel history: English | Other languages

Algorithm for Assessment of Potential EVD in Outpatient Clinical Setting (PDF)

Influenza transmission in health care settings presents risk to both health care workers (HCW’s) and their patients, many of whom are vulnerable to severe influenza disease. Influenza vaccination of HCW's protects against influenza infection, illness, and mortality. Marin County health care facilities, in agreement with Health Officer orders, have joined other Bay Area health facilities in adopting policies requiring HCW’s to be vaccinated or to wear a mask in patient care areas.  Read more.

 

 

Marin healthcare providers see the impact of excessive calorie consumption every day, across the age spectrum. Diabetes and obesity are model conditions for partnership between public health and clinical medicine because most cases are both preventable and curable. Health practitioners in Marin County are working to limit the harmful consumption of sugar-sweetened beverages (soda sweetened with sugar, corn syrup, or other caloric sweeteners including sweetened juices, sports and energy drinks).

According to the CDC, consumption of sugar-sweetened beverages is a major driver of the obesity epidemic. Over the past decade, per capita intake of calories from sugar-sweetened beverages has increased by nearly 30% nationally, partly due to marketing strategies targeted to children and adolescents.

This summer, Marin County Public Health, supported by a resolution from the county Board of Supervisors, will again be promoting the “Soda Free Summer.” The Soda Free Summer includes measures to educate residents on how to read labels for the amount of sugar in beverages and how to make healthier drinks with water, fresh fruit and herbs. “Rethink Your Drink” events will be held through the summer at a variety of community-based organizations and summer programs for youth.

Health care providers play a vital role in reinforcing healthy eating and active living messages in each encounter. Combined with upstream interventions like the Soda Free Summer, we can begin to reverse the growing burden of obesity as a more integrated health system.

The California Department of Public Health has confirmed 58 measles cases in California residents so far in 2014, up from 4 cases at this time last year. Six Marin residents were exposed to measles on a domestic flight in March; all were vaccinated and none have become ill. Marin County is particularly vulnerable because of high rates Personal Belief Exemptions from childhood vaccinations including Measles/Mumps/Rubella (MMR). Health providers should remain vigilant for signs of measles and continue to promote vaccination.

Measles should be considered especially for those born after 1957 who may be unimmunized or under-immunized (less than 2 doses of measles containing vaccines). Measles spreads through infected droplets that are passed in the air when an infected person coughs or sneezes. The virus can remain viable in air spaces for up to 90 minutes.

Identification

Measles is an acute, highly communicable viral disease with prodromal fever, conjunctivitis, coryza, cough, and small spots with white or bluish-white centers on an erythematous base on the buccal mucosa (Koplik spots). A characteristic red blotchy rash appears on the third to seventh day; the rash begins on the face, then becomes generalized, lasts 4-7 days, and sometimes ends in brawny desquamation. Leukopenia is common. The disease is more severe in infants and adults than in children.   Complications may result from viral replication or bacterial superinfection, and include otitis.

Marin County EMS Agency has achieved the 2014 Mission: Lifeline® EMS Silver Level Recognition Award. This award is based upon the achievements in care delivered in 2013.

ST elevation myocardial infarction (STEMI) is among the most critical emergencies that Emergency Medical Services routinely respond to.  Timely and well coordinated response between all aspects of the response system is critical for survival. As an EMS agency that delivers education in ST elevation myocardial infarction (STEMI) identification, access to 12 lead ECG and develops protocols derived from STEMI Guidelines, our medics are driving improvements in the care and outcomes of STEMI patients.

Collaboration among pre-hospital and hospital providers is the essence of Mission: Lifeline. The American Heart Association recognizes the vital importance Emergency Medical System providers provide to the overall success of Mission: Lifeline STEMI Systems of Care. The correct tools and training allow EMS providers to rapidly identify the STEMI, promptly notify the destination Center and trigger an early response from the awaiting hospital personnel.

The criteria to achieve the Mission: Lifeline EMS Silver award is based on meeting the achievement measures for at least one and up to three calendar quarters with no single measure scoring below 75%. The individual measures are as follows:

  • Percentage of patients with non-traumatic chest pain > 35 years of age, treated and transported by EMS who receives a pre-hospital 12 Lead ECG.
  • Percentage of STEMI patients transported to a STEMI Receiving Center, with pre-hospital First Medical Contact (FMC) to Device (PCI) < 90 Minutes.
  • Percentage of STEMI patients transported to a STEMI Referring Center with arrival (to Referring Center) to Fibrinolytic Therapy administration in <30 Minutes.

For more information and for a listing of all Mission: Lifeline EMS Award Recipients, please visit : www.heart.org/mlemsawards

Marin County has seen a consistent elevation in pertussis incidence during the past year. Since April 1, 2013, 224 pertussis cases have been reported to Marin County Public Health. This is compared to five cases in 2012.

The vast majority of cases are among school-aged children and most are associated with school-based clusters. Providers can help limit further spread of disease by following these simple steps. These are especially important in limiting transmission in schools.

  • If pertussis is suspected, test, treat and isolate cases for 5 full days of antimicrobial therapy or until testing is able to rule out pertussis.
  • Post-exposure antimicrobial prophylaxis is recommended for symptomatic and asymptomatic close contacts.
  • Symptomatic close contacts are to be excluded from school or work until a minimum of 5 days of effective antibiotic treatment.
  • After 21 days of cough, antimicrobial therapy is no longer indicated for treatment of pertussis, regardless of whether treatment was offered earlier in the course of disease.

Ensure that all children and adults are up to date with recommended pertussis vaccine.

For more information on pertussis diagnosis, treatment and infection control, please visit: http://www.cdph.ca.gov/HealthInfo/discond/Documents/CDPH_Pertussis%20qui...

For information on pertussis laboratory testing: see http://www.cdph.ca.gov/programs/immunize/Documents/PertussisLaboratoryTe...

Report pertussis cases to Marin County Communicable Disease Prevention and Control by fax (415) 473-6002 or phone (415) 473-7805 within 24 hours.

Marin City is making amazing strides towards health and wellness for its residents.  The State of California has taken notice and Marin City will receive a visit from the California State Office of Health Equity on February 7th.  The Office of Healthy Equity was formed at the state level to provide a key leadership role in reducing health and mental health disparities to vulnerable communities.  The State is interested in the overall effort to revitalize Marin City, spearheaded by Marin City Community Services District (MCCSD) in collaboration with many partners.

As health professionals, we know that most of what contributes to health happens in our neighborhoods and communities.  I applaud the local leaders and policy makers such as the MCCSD Board, General Manager Johnathan Logan, Domenica Giovannini, and Terrie Green for their commitment to health.

Some of the exciting developments include:

  • The MCCSD Board passed a Wellness Policy setting a nutritional standard for food and drink and designated all service district facilities to be Smoke-Free. The policy’s implementation starts on February 1, 2014.
  • The fully funded $5M George “Rocky” Graham Park is scheduled to be completed in the spring of 2015. The innovative park design was chosen by the community and will feature community art, an amphitheater, and a mixed use synthetic field.   
  • Marin City CX3 (Communities of Excellence) Project is a state initiative focused on assessing food accessibility and quality in Marin City and implementing changes based on community priorities.
  • Marin City Fitness Center & Boxing Gym is open to the public and houses work-out equipment, a full-sized boxing gym, and a multi-purpose space. MCCSD is currently developing programming and a membership schedule that includes a sliding fee scale.
  • MCCSD was awarded the contract to redevelop The Marin City (Betty Times) Ball Field by the Sausalito/Marin City School District. Phase one (starting this summer) will include installation of a turf field designed for use by multiple sports and will be available for use by the entire county/surrounding areas through rental agreements.  
  • MCCSD has launched a Capital Campaign to redevelop the current Manzanita Recreation Center and other agency facilities. This will update and expand facilities, allowing for increased programming and mixed use.

To learn more or to get involved with any these projects, please contact the Marin City Community Services District at 415-332-1441 or marincitycsd@gmail.com

Influenza activity remains widespread in Marin County and regionally.

As of January 22, 2014, there have been 29 flu-related deaths reported in persons under aged 65 year in the ten-county Bay Area region, including two in Marin. Many of the deaths have occurred in persons who did not receive this year's flu vaccine.

Laboratory testing of specimens has shown an overwhelming predominance of the H1N1 virus over H3N2, both of which are components of this year's seasonal vaccine.

Since its emergence in 2009, the current strain of H1N1 has been shown to cause more severe disease in those with obesity, chronic cardiovascular or pulmonary disease, any immune deficiency, pregnant women, and in some cases, otherwise healthy young adults.

All isolates so far appear to be sensitive to oseltamivir and zanamivir. For those in whom treatment is indicated, treatment should be started as early as possible in advance of laboratory confirmation. Currently, supplies of antivirals and flu vaccine are adequate in Marin County.

There have been no bed shortages in Marin hospitals.

The Marin County Department of Health and Human Services continues to recommend persons over six months of age should be considered for receiving the flu vaccine. The healthy adolescent through middle aged population should also be vaccinated, and this group may need special motivation from providers to be immunized.

For regular updates on Marin County influenza activity visit www.marinflu.org

For additional information

http://www.cdc.gov/flu/professionals/antivirals/index.htm

http://www.cdph.ca.gov/healthinfo/discond/Pages/Influenza%28Flu%29.aspx

Remember, it's not too late to vaccinate!

Marin County has comparatively high numbers of parents who refuse required childhood vaccinations. This fall, Marin County Public Health and the Office of Education conducted a survey of kindergarten parents to better understand the beliefs of those who refuse vaccinations. A new law requiring a discussion with a medical provider prior to obtaining a vaccine exemption goes into effect January 1, 2014. The results of this survey can stimulate community dialog and inform providers as they help families navigate choices. 

pharmacy sign

Tobacco Sales Status Among Marin Retail Pharmacies 

As of November 2 2, 2013

Preferred Retail Pharmacies that do NOT sell tobacco products

City

Name of Pharmacy

Address

Larkspur Ross Valley Pharmacy 2 Bon Air Rd
Mill Valley Pharmaca 230 E Blithedale Ave
Safeway 1 Camino Alto
Novato Costco 300 Vintage Way
Phamaca 7514 Redwood Blvd
Target 200 Vintage Way
San Anselmo Jack's Drug Store 121 Tunstead Ave
San Rafael Golden Gate Pharmacy 1525 E Francisco Blvd
Marin Medical Pharmacy 750 Las Gallinas Ave
Pt. Reyes Station West Marin Pharmacy 11 Fourth Street

 

Retail Pharmacies that DO sell tobacco products

City

Name of Pharmacy

Address

Greenbrae CVS 330 Bon Air Shopping Ctr
Larkspur Lucky 570 Magnolia Ave
Mill Valley CVS 759 E Blithedale Ave
Rite Aid 701 E Blithedale Ave
Safeway 110 Strawberry Village
Walgreens 227 Shoreline Hwy
Novato CVS 2035 Novato Blvd
CVS 1707 Grant Ave
Rite Aid 910 Diablo Ave
Safeway 5720 Nave Dr
San Anselmo CVS 880 Sir Francis Drake Blvd
Walgreens 820 Sir Francisco Drake Blvd
San Rafael CVS 909 Grand St
CVS 442 Las Gallinas Ave
Rite Aid 471 Third Street
Rite Aid 1500 Northgate Mall
Safeway 950 Las Gallinas Ave
Walgreens 155 Northgate One
Walgreens 830 Third Street

Published in September 2013, "Help Your Patients Quit Tobacco: An Implementation Guide for Community Health Centers" is a new, free guide to integrating tobacco cessation support in a health care setting. Some of the topics covered in the guide include:

  • The "5 A's - Ask, Advise, Assess, Assist and Arrange (follow-up)," the gold standard evidence-based protocol for tobacco cessation interventions.
  • Pharmacotherapy options for smoking cessation including dosage recommendations.
  • Billing codes for the Affordable Care Act (ACA) and Medicare reimbursement for on-site cessation counseling.
  • Realistic discussions of implementation challenges.
  • Suggestions for how to chart tobacco screening and subsequent cessation interactions with patients.

For Marin-based information on cessation classes or in-person tobacco cessation education staff trainings, please contact Beth Lillard at Bay Area Community Resources see blillard@bacr.org, 415.755.2334. To find out more about BACR's tobacco work, go to www.bacr.org/tobacco.

In 2010, the American Heart Association (AHA) celebrated the 50th anniversary of modern-era CPR. The AHA urged medical personnel to train as many people as they could to perform this life-saving skill. The Marin County Emergency Medical Services Agency (EMS) set a goal to train Marin County residents and visitors to perform compression-only, or "Hands-Only," CPR.

A decision was made to hold annual events on the first Saturday in June, celebrating National CPR and AED Week. In 2010, the EMS Agency and its volunteers trained 726 people in four hours, surpassing all expectations. Since then, the numbers have climbed and this year the Agency trained 2,129 participants in "Hands Only" CPR. The venues, which include shopping malls, festivals, bike paths, grocery stores, and even the Larkspur Ferry, are extremely supportive of our efforts to create an army of trained bystanders who are ready to step in when needed. Instruction is free and only takes five minutes to learn. Map of Hands-Only CPR Training Locations

"Hands-Only" CPR is CPR without breaths. This newer method of CPR has been shown to be as effective as conventional CPR in the first few minutes of an out-of-hospital cardiac arrest. About 80% of cardiac arrests occur in private residential settings, and it has been demonstrated that CPR can triple a victim's chance of survival.

Find more information on Hands-Only CPR at www.MarinEMS.org

Elder abuse, neglect and exploitation occurs in every community, including Marin County. Financial abuse is the diversion or theft of funds belonging to the elderly. This includes funds that are used to pay for basic needs such as housing, food and medical care. It is estimated that only about one in five of these crimes is ever discovered. 

The Financial Abuse Specialist Team (FAST) is a multidisciplinary team of public agency representatives and private professionals from the financial services industry. FAST was formed in 2005 to provide expert forensic assistance in the investigation of complex cases of suspected elder financial abuse. FAST also works to raise public awareness and provide community education through professional training programs. To find out more, watch the short video above highlighting the work of FAST team members.  Anyone interested in becoming a FAST volunteer should contact Tara Clark, HHS Volunteer Coordinator at tclark@marincounty.org for more information. 

Elder Financial Abuse and Exploitation Warning Signs

Source: National Administration on Aging and Marin County Aging and Adult Services

Erratic or unusual banking transactions, or changes in banking patterns:

  • Frequent large withdrawals, including daily maximum currency withdrawals from an ATM;
  • Sudden non-sufficient fund activity;
  • Uncharacteristic nonpayment for services, which may indicate a loss of funds or access to funds;
  • Debit transactions that are inconsistent for the elder;
  • Uncharacteristic attempts to wire large sums of money;
  • Closing of CDs or accounts without regard to penalties.

Interactions with customers or caregivers:

  • A caregiver or other individual shows excessive interest in the elder's finances or assets, does not allow the elder to speak for himself, or is reluctant to leave the elder's side during conversations;
  • The elder shows an unusual degree of fear or submissiveness toward a caregiver, or expresses a fear of eviction or nursing home placement if money is not given to a caretaker;
  • The financial institution is unable to speak directly with the elder, despite repeated attempts to contact him or her;
  • A new caretaker, relative, or friend suddenly begins conducting financial transactions on behalf of the elder without proper documentation;
  • The customer moves away from existing relationships and toward new associations with other "friends" or strangers;
  • The elderly individual's financial management changes suddenly, such as through a change of power of attorney to a different family member or a new individual;
  • The elderly customer lacks knowledge about his or her financial status, or shows a sudden reluctance to discuss financial matters. 

Although influenza season officially begins in late September, influenza activity usually peaks in December or January.  Influenza seasons range in severity from mild to severe.  Given the variation in timing and severity of influenza activity each season, frequent assessment of influenza data at a countywide level is needed to understand the extent to which influenza may be impacting Marin residents.  Knowledge of local influenza patterns can also guide clinical decision-making in testing and treatment. The Marin Influenza Surveillance Update is prepared and distributed weekly during influenza season to share influenza activity data with clinicians, other healthcare professionals, and the community. 

The report is a team effort consisting of the following partners:

  • Medical centers in Marin, including Kaiser San Rafael Medical Center, Marin General Hospital and Novato Community Hospital/Terra Linda Urgent Care, provide de-identified clinical and laboratory data.
  • County of Marin Department of Health and Human Services staff analyze the data and prepare the report.
  • State and national public health agencies publish weekly reports that are referenced for context.

The Marin section of the report summarizes laboratory testing and visits to local emergency departments for influenza-like illness.  Additional measures are presented for the state and national levels including mortality and graphic spread across the United States. 

The first edition of this year’s Influenza Surveillance Update will be distributed in mid-October.  The report will be sent to clinicians by email and can also be accessed at www.MarinFlu.org.  

Prescription drug misuse is the nation's fastest growing health problem and a serious concern in Marin County.1 In Marin, more people die from misusing prescription drugs than from motor vehicle accidents.2 Prescription drug misuse is defined as the non-medical use of physician prescribed medication. The most commonly misused prescriptions include opiates, benzodiazepines, and amphetamine-related stimulants.

Prescription drugs are becoming a new gateway drug. Of the 3 million people who began using illicit drugs in 2010, over 25% began by misusing prescription drugs.3 Among young people, prescription drugs are the most commonly abused drug following marijuana.4 Marin County 11th graders misuse prescription pain killers, sedatives, and barbiturates as much as their California peers. The rate of stimulant misuse among Marin County 11th graders however, is 25% greater than the state average.5 Prescription drug misuse is a complex public health problem, contributing to intentional and unintentional drug poisonings, fatal overdoses, and community violence.

The Marin County Department of Health and Human Services (HHS) is convening a group of key stakeholders to gain a clearer understanding of the issue and to create a comprehensive plan for reducing prescription drug misuse in our community.

Additionally, HHS and Boston University are offering a CME conference in San Rafael to support safe and effective management of pain on January 18, 2014, location pending. www.scopeofpain.com.

For more information please contact Kristen Law

  1. Whitehouse.gov (2011), "Epidemic: Responding to America's Prescription Drug Abuse Crisis," accessed 09/19/2013.
  2. National Highway Traffic Safety Administration, Fatality Analysis Reporting System. California Department of Public Health, EpiCenter Injury Surveillance Query
  3. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, accessed 09/23/2013.
  4. Office of National Drug Control Policy, "Prescription Drug Abuse," accessed 09/16/2013.
  5. California Healthy Kids Survey, 2009-2011

Nearly one in three children, and nearly one in two adults in Marin are overweight or obese. Marin County healthcare providers see the impact of obesity every day, across the age spectrum. Obesity is a model condition for partnership between public health and clinical medicine because it is preventable and curable, and it is an epidemic. As one important step in combating obesity, health practitioners in Marin County are working to limit the harmful consumption of sugar sweetened beverages (soda sweetened with sugar, corn syrup, or other caloric sweeteners including sweetened juices, sports and energy drinks).

According to the CDC, consumption of sugar-sweetened beverages  is a major driver of the obesity epidemic. Over the past decade, per capita intake of calories from sugar-sweetened beverages has increased by nearly 30% nationally, partly due to marketing strategies targeted to children and adolescents.

This summer, Marin County Department of Health and Human Services (HHS), supported by a resolution from the county Board of Supervisors, will be partnering with LIFT-Levantate and the Marin City Community Services District to promote the “Soda Free Summer.” The Soda Free Summer includes measures to educate residents on how to read labels for the amount of sugar in beverages and how to make healthier drinks with water, fresh fruit and herbs. “Rethink Your Drink” events will be held through the summer at a variety of community based organizations and summer programs for youth. In addition, HHS will be working with community leaders in the Canal and Marin City through the Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention project, to examine retail marketing, product availability and pricing to help reduce access to sugar-sweetened beverages.

Health care providers play a vital role in reinforcing healthy eating and active living messages in each encounter. Combined with upstream interventions like the Soda Free Summer we can begin to reverse the growing burden of obesity, as a more integrated Health System. 

HIV will remain an epidemic until those infected are diagnosed and treated. The CDC estimates as many 1 in 5 individuals with HIV are unaware they are infected. Screening for HIV infection is now recommended for all adolescents and adults.

In the last several years, Marin has averaged 20 new HIV diagnoses per year. Approximately half of these individuals were diagnosed with AIDS within a year, suggesting long-standing infection at the time of HIV diagnosis. This indicates missed opportunities to diagnose and treat HIV early, to improve survival and limit further transmission within the community.

Routine HIV screening has gotten much easier to perform in the recent past. Most encounters provide an opportunity for "opt-out" testing. Patients don't need a separate consent form-- they only need to be informed of the test and given the option to decline. Testing is minimally invasive when added to routine blood work or performed at the point of care.

In order to eliminate any barriers to screening all adolescents and adults, Marin County provides free rapid HIV testing. The HIV Rapid Response line at 415-457-2002 is available to any county resident or provider. Primary care and linkage to supportive services for people living with HIV are also available.

The importance of early HIV identification, linkage to medical care, and adherence to medication in order to limit the "community viral load" is an important means of primary prevention against HIV. The HIV treatment cascade illustrates the consequences of undiagnosed and untreated disease as a driver of ongoing epidemic spread.

As of January 1, 2013, there were 562 people living with HIV in Marin. The majority are male, over 40, and 1 in 5 is over 60 years of age. Our most recent HIV surveillance report can be viewed here.

On May 7, 2013 the Marin Country Public Health Officer issued a Public Health Update regarding two cases of pertussis at Marin Catholic High School. Since that time 13 additional cases have been reported, including additional cases from Marin Catholic High School and other schools through our community. All known cases are recovering with outpatient treatment. Information has been sent to parents, contact investigations are ongoing and individuals identified as contacts have been notified and offered prophylaxis.

Providers may receive questions from families about medical evaluation, treatment, and chemoprophylaxis for pertussis. Pertussis does occur sporadically in Marin, and some natural variation in baseline activity is expected. However, pertussis incidence in Marin in the past 2 months is above normal levels, and signals active transmission within our community. This is an opportunity to reinforce the importance of vaccination—in countries with the highest vaccination rates, sporadic pertussis incidence is less than 1 case per 100,000 people per year.

Depending on the characteristics of any school- based clusters, the Public Health Officer may issue orders to exclude unvaccinated students from attending school for their protection. If such action is taken a Public Health Update will be sent to providers.  

For your convenience the California Department of Public Health Quicksheets for Pertussis Investigation and Laboratory Testing are attached to this document and also may be found at http://www.cdph.ca.gov/HealthInfo/discond/Documents/CDPHPertussisQuicksheet.pdf

Please report new pertussis cases to the Public Health Department Communicable Disease Unit at the following phone numbers, (415) 473-3038 or (415) 473-7805 Monday through Friday between 8:30 a.m. and 5:00 p.m. or fax a Confidential Morbidity Report to (415) 473-6002.

Marin Municipal Water District (MMWD) community water supplies have been fluoridated since 1973. Recently, regional anti-fluoridation advocates have mobilized to remove fluoride from community waters. Marin County Health and Human Services recognizes fluoridation as an evidence-based, safe and effective means to support oral health. Providers may get questions from patients about this issue. For the Public Health Officer letter of support for community water fluoridation as a public health “standard of care,” see below.  For American Academy of Pediatrics patient information click here.

June 27, 2013

Mr. Larry Russell
Board President
Marin Municipal Water District
220 Nellen Avenue
Corte Madera, CA  94925

Dear Mr. Russell,

As the Public Health Officer for the County of Marin, I support community water fluoridation.  As an advocate for the well being and highest attainable standard of health for every person in Marin, I recognize the importance of disease prevention.  Water fluoridation helps prevent dental disease and gives everyone, especially children who may have limited access to care, a chance to thrive without pain and poor self-esteem from diseased teeth.

Every U.S. Surgeon General for the past 50 years has endorsed fluoridation of community water as a safe and effective means to prevent tooth decay. This year, Surgeon General Regina Benjamin endorsed community water fluoridation as "one of the most effective choices communities can make to prevent health problems while actually improving the oral health of their citizens."  Dr. Benjamin wrote. "In fact, each generation born since the implementation of water fluoridation has enjoyed better dental health than the generation that preceded it." 

Public health protections that are built into the environment, equally available to everyone, are more effective than those that require behavior change from each individual. Community water fluoridation is akin to advances in road safety, food safety, basic sanitation and the monitoring of water and air quality as public health interventions that offer built-in protections for all citizens. 

Leading scientific and medical organizations have examined the evidence regarding community water fluoridation and have come out in support, including the American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, American Nurses Association, Centers for Disease Control and Prevention, and the World Health Organization. The Marin County Department of Health and Human Services, the Marin Medical Society, the Marin Oral Health Advisory Committee, and the Marin Dental Society join this list of informed supporters of community water fluoridation.

Thank you for your attention to this important issue for our community, and please do not hesitate to contact me if I can provide any additional support.

Sincerely,

Matthew Willis, MD MPH
Public Health Officer
County of Marin
Department of Health and Human Services
899 Northgate Dr, Suite 104
San Rafael, CA, 94903
415-473-4163 T
415-473-2326 F
mwillis@marincounty.org

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