19 Kids to Miss a Month of School

February 15th, 2012 by Will Humble 2 comments »

A 4th grader in Gilbert was diagnosed with the mumps last week. Had all the staff and faculty in the school been previously vaccinated for the mumps at the school- it really would’ve been no big deal. But, it turns out that 19 kids at the school hadn’t been vaccinated for the mumps (mainly because their parents chose to sign exemptions from our vaccination requirements).

As a result, the 19 previously unvaccinated kids can’t go to class for about a month. Of course- the public health system doesn’t want to exclude the unvaccinated kids from school, but there’s really no other choice at this point- because it’s the only tool left to stop a potential cascade of new cases. Mumps can be pretty serious and spreads easily. It’s a virus that causes swelling in the salivary glands, high fever, loss of appetite and fatigue. There can be a lot of serious complications including meningitis, spontaneous abortions in pregnant women, and sterility in males. It’s spread by sneezing, coughing, contact with mucus membrane secretions, etc. My mom says it almost killed me in 1962.

Our official rules for this kind of situation say: “When a mumps case has been at a school or child care establishment, the administrator of the school or child care establishment, either personally or through a representative shall: a) Consult with the local health agency to determine who shall be excluded and how long each individual shall be excluded from the school or child care establishment, and b) Comply with the local health agency’s recommendations for exclusion.” The 26 day exclusion period ordered by Maricopa County represents a full “incubation period” after exposure- the minimum needed to ensure that mumps won’t spread to additional people in the school.

Dr. Bob England from Maricopa County Public Health said it best in the paper this week; “It matters whether people around you have been vaccinated. It matters at least as much as it matters whether you’ve been vaccinated. No vaccine is perfect. Even people who have been vaccinated can contract diseases if they’re exposed to them. The key is to never be exposed. That’s how we’ve made all those previously common childhood diseases so rare. It’s not that the vaccine is so perfect. It’s that you get enough people vaccinated that when one person comes in with a disease that germ has a hard time finding another person to jump to. It’s called the herd effect.

Overall, 95% of Maricopa County elementary school kids are up to speed on the mumps vaccine, but it’s not evenly distributed. Some schools are at 100%, but one Maricopa County school is only at about 50%! Our team does a detailed annual analysis of immunization rates by school and gives that info to each of the county health departments every year- so they can do some intervention work.

Enjoy AZ’s 100th B-day

February 13th, 2012 by admin No comments »

Please take some time to enjoy Arizona’s 100th birthday celebration this  week.  The Arizona Centennial Commission   held Arizona Best Fest this past Saturday and Sunday.  There’ll also be a host of events going on tomorro (AZ’s actual 100th Birthday) in the Capitol mall area- especially the area between the House and Senate buildings just across the street from us.

Our parking garage was open all weekend (to anybody).  On Tuesday, we’ll put down the arm in our parking garage so we’ll still have a place to park when we come to work.  Some of the streets around us were blocked off for the events.

The celebration continues on Wednesday for ADHS staff – we’ve compiled an excellent presentation of Arizona Health Services through the Century.  A timeline set up in the Igloo will help you learn interesting facts from the Board of Health in 1912 – all the way through the centennial of the lab, which is May 23, 2012.  Leadership is also going to serve you a good old-fashioned meal that would have been right at home in territorial Arizona – chili!  So c’mon over, pardner, and recollect a bit with us as we stroll down memory lane in and around the Capitol.

Arizona Mexico Commission Progress

February 10th, 2012 by admin No comments »

I’m writing this from my hotel room in Rocky Point- after a long day (and night) of the inter Plenary Session.  The 2 day conference started Thursday and goes through tonight.  We meet twice a year- it’s basically an opportunity for us to form partnerships across the border and to develop regional approaches to things like valley fever surveillance, burn patient infrastructure, substance abuse, TB, border first aid, farmworker health, and Sonora’s efforts to provide licensing and quality assurance services for assisted living in Sonora (and how we can partner with them as they set up their program). 

During last summer’s Session we signed a bi-national Declaration to develop regional surveillance for valley fever.  We’ve made a lot of progress in the last 6 months, and tomorrow we’ll be following up on that initiative at Sonora’s public health laboratory, checking out the lab instruments and equipment that we were able buy (with federal funds) and indefinitely post in Hermosillo in their lab. We’ll also be setting up some joint training sessions. There are lots of other examples of what we do through the Commission on health- this is just an example. 

The Arizona Mexico Commission was started by then Arizona Governor Paul Fannin in 1959 to improve partnering between Arizona and Sonora in a wide range of areas.  It’s evolved over the years to become a premiere and unique cross-border nonprofit organization whose mission is to improve the well-being and quality of life for residents of Arizona by promoting a strong, cooperative relationship with Mexico and Latin America through advocacy, trade, networking and information.  The Commission has 14 bi-national committees that act as industry and community advocates in partnership with the Commission Sonora-Arizona (from Sonora, Mexico) to facilitate cross-border trade, business and community networking and bi-national information sharing.  Our link is through the Health Services Committee.

Click here to see some of the public health facilities and an ambulance they use on the beach.

Recovery Through Whole Health RFI

February 9th, 2012 by admin No comments »

We’ll be having a “Request For Information” session regarding our “ Recovery Through Whole Health, the Regional Behavioral Health Authority with Health Homes” project (a.k.a. the upcoming Request for Proposal for behavioral health services in Maricopa County) on March 21 from 1- 5 pm at the Radisson City Center at 3600 N. 2nd Ave. in Phoenix.

We’ll have more details about the event in March through an official notice from ADHS via the State of Arizona e‐procurement system, ProcureAZ and on our Integration Website.   Folks can also register at https://procure.az.gov/bso/ under commodity code 952‐08 to receive the “official” notice of the RFI.

This will be a relatively informal event where we’ll provide some information about the project and our expectations…  and it’ll provide an opportunity for potential bidders, other behavioral health providers and consumers, peers and family members to ask questions about the project.  We don’t expect to be asking for written responses – again, this will be a relatively informal affair.

Neglected Global Tropical Disease Initiative

February 8th, 2012 by admin No comments »

Last week marked an important milestone toward better controlling 10 neglected tropical diseases by 2020. The Bill & Melinda Gates Foundation, the World Bank, 13 pharmaceutical companies, the U.S., U.K. and U.A.E. governments and other global health organizations announced a new, coordinated push to defeat diseases like Dengue, rabies, blinding trachoma, Buruli ulcer, endemic treponematoses (yaws), leprosy (Hansen disease), Chagas disease, sleeping sickness, leishmaniasis, cysticercosis dracunculiasis (guinea-worm disease),echinococcosis, foodborne trematode infections, lymphaticfilariasis, onchocerciasisriverblindness), schistosomiasis (bilharziasis), soiltransmitted helminthiases (intestinal worms).  Believe it or not- 1.4 billion people worldwide affected by the diseases above- most of whom are among the world’s poorest. 

An event at the Royal College of Physicians this week kicked off the new collaboration, which will focus on prevention efforts expanding existing drug donation programs to meet demand through 2020; share expertise and compounds to accelerate research and development of new drugs; and provide more than $785M to support research efforts and strengthen drug distribution and implementation programs. 

You can see an introductory video and the this week’s event in London on the http://www.unitingtocombatntds.org/ website.  The Executive Summary of the initiative is called Accelerating work to overcome the global impact of neglected tropical diseases- A roadmap for implementation.

Public Health Preparedness Milestone

February 7th, 2012 by admin No comments »

Back in 2008 we set the ambitious goal of becoming a “Public Health Ready” state- and we’ve worked hard over the last 3 years or so to accomplish our goal.  We made it last month- and Arizona became one of only a couple of states to have all county health departments recognized by Project Public Health Ready (PPHR). The program is basically a competency-based training and recognition program that assists local health departments to respond to emergencies… by building preparedness capacity and capability through a continuous quality improvement model. 

The process has helped us to expand the scope of emergency planning and the functional role of our county health departments.  Our state public health system is now better equipped to handle a wider range of emergency situations than they were before recognition.  Congrats!

Dispensary Application Timeline Forecast

February 6th, 2012 by admin 7 comments »

As you know from earlier blog posts a judge ruled in a state case that had challenged our dispensary applicant selection criteria.  The judge’s decision basically struck down several of the selection criteria we had been planning to use to for competitive areas of the state (areas where there will be more than 1 applicant per Community Health Analysis Area.

Our teams are busy dotting the Is and crossing the Ts right now on an express rule package that would remove the dispensary selection criteria struck down (AZ residency, child support, previous bankruptcies etc.) and to set new dates to accept dispensary applications.  Our rule changes will focus solely on making adjustments to comply with the judge’s decision and to set a new timeline for accepting dispensary applications.  

Our team is making good progress on the Rule package, and we expect to be finished this month (February).  I’ll keep you posted here, and I’ll let you know when the rule package is filed- including a link to the final set of rules.  We’re still on track to be able to accept dispensary applications in April.  We’d then have  about 45 days to review and award dispensary certificates- so we could potentially award up to 125 dispensary certificates by mid- to late-June. If someone is pretty much ready to go at that point, we could see medical marijuana dispensaries operating in July or August.

AZ Smallpox Outbreak

February 6th, 2012 by admin 3 comments »

Smallpox broke out in southeast Arizona almost exactly 100 years ago last week (co-incident with the Statehood activities).  The first cases were in Tucson and Douglas with a few dozen cases and several deaths… and there were a few additional cases in Nogales and Globe.  Of course, all the cases were among folks that hadn’t been vaccinated.  The public health interventions of the time were much like what we would do today- case contact follow up with targeted vaccinations of folks that had contact with cases. 

For example, Dr. Chenoweth (Santa Cruz County Superintendent of Health) implemented an aggressive targeted vaccination effort following the Nogales case.  From the 1912 records, we know that Dr. Chenoweth immediately began a “house-to-house vaccination campaign, vaccinating every person within a radius of six or seven miles of the case under quarantine, except one person who secreted herself and escaped vaccination, but developed smallpox instead.”  These two cases were the only ones reported from Santa Cruz County. 

As the outbreak progressed in the following months, the State Board of Health weighed in on the public health response that had been undertaken in the various counties.  The 1912 State Board of Health minutes stated that: “In our opinion this (contact and ring vaccination campaigns) is not sufficient, as there is no one to keep check on the patient or guardian to see that vaccination is done.  Our public health law should be amended to read:  In addition to the above stated section, no principal, teacher or superintendent shall permit any person to attend school, unless they have been vaccinated.  A large per cent of the children of Arizona have not been vaccinated and will not as long as they are allowed to attend school without first having been vaccinated. 

So, the February 1912 Smallpox outbreak in SE AZ was that spark that triggered the debate about whether and how to require vaccination as a prerequisite for attending school.  You can check out our pre-school and school resource page to find out more about today’s school vaccination requirements.

EMS Overdrive

February 3rd, 2012 by admin No comments »

This month has been a doozy for our Bureau of Emergency Medical Services and Trauma System team.  This week we finished the 2nd of 2 high-profile and important decisions.  A couple of weeks ago I made a decision to let Yuma City take over part of the ambulance response in that town.  I thought the city folks had given solid evidence why they should be allowed to provide their own service (technically called establishing public necessity).  I also locked in the rates for the Yuma ambulance to the level they are at right now for 3 years. 

I also OK’d a merger of two ambulance companies in the Valley this week.  Rural Metro Ambulance will take over four areas where PMT ambulance used to respond, but they can’t raise rates on customers for at least 3 years.  I also required Rural Metro to keep the electronic health data that PMT is using in those four areas, as well as expand it to other areas it serves.  That electronic data provides an important window into how the system is doing in responding to emergencies, providing important interventions, and getting people quickly to the right kind of treatment.  Timeliness is important in any emergency, but we have been able to document the differences in quickly getting patients into medical care after cardiac arrest and traumatic brain injury. 

Some folks don’t realize just how closely ambulance service is regulated- it’s an important element of patient care and ADHS along with partners across the state have to make sure it’s the best it can be in Arizona.  The state is broken up into Certificate of Necessity areas where companies or cities have a contract to provide the service.  The contracts outline how long a company has to respond to a call, how much they can charge and what happens if they don’t do a good job.  You can learn more about this on our Bureau of Emergency Medical Services and Trauma System website.

Referee a Safe Super Bowl Party

February 2nd, 2012 by admin No comments »

When it comes to the Super Bowl, defense matters. When it comes to planning a Super Bowl XLV party, good defense against foodborne illness matters even more.

Food Safety Playbook

Fans should follow the food safety play book at the Super Bowl parties that they host. Large gatherings can increase the chance of becoming ill, but by following these rules all fans can enjoy the game and their food, safely. 

Illegal use of Hands

Avoid penalties for “illegal use of hands.” Unclean hands are one of the biggest culprits for spreading bacteria, and finger foods at parties are especially vulnerable. Chefs and guests should wash their hands with soap and warm water for 20 seconds before and after handling food. Also, be sure to clean eating surfaces often, and wash serving platters before refilling them with fresh food. 

Off sides

Think of your party fare as two different teams – uncooked versus ready – to – eat foods. Prevent “encroachment” at all costs and keep each team in its own zone. The juices from raw meat can contain harmful bacteria that contaminate other food. Use one cutting board for raw meat and poultry and another one for cutting veggies or foods that will not be cooked. If you use only one cutting board, wash it with hot soapy water after preparing each food item. 

Equipment Violations and Holding

Call a “time out” and use a food thermometer to be sure meat and poultry are safely cooked. Remember that internal temperature, not meat color, indicates doneness. Steaks should be cooked to 145°F, ground beef should be cooked to 160°F, and all poultry should be cooked to 165°F.

 “Holding” may be one of the most likely offenses your referee encounters if your party lasts late into the night. Never hold foods for more than two hours at room temperature. Refrigerate or freeze leftovers promptly to block offensive bacteria from multiplying. The same rules apply for cold foods. If cold food has been sitting out for more than two hours, do not eat it. When in doubt, throw it out of the game and your party. 

False Start

When it comes to foodborne illness, there is not opportunity for an instant replay. To avoid these infractions, make sure you understand the rules completely. 

Special Teams

One of the best resources available before kickoff is USDA’s virtual representative, “Ask Karen,”available at AskKaren.gov. Food safety coaches are available Monday through Friday from 10 a.m. to 4 p.m. ET on the “Ask Karen Chat” and by phone at the USDA’s Meat and Poultry Hotline, 1-888-MPHotline (1-888-674-6854). Recorded messages are available 24 hours a day.

If you would like a printable copy of this, please visit our website.