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HomeMy WebLinkAboutMINUTES - 08171993 - IO.2 TO: BOARD OF SUPERVISORS = - O ' — :2 Contra FROM: INTERNAL OPERATIONS CON2-`11.. TEE, Costa o s County August 9, 1993 DATE: Tq-courier SUBJECT: REPORT ON THE STATUS OF COMMUNICABLE DISEASES IN CONTRA COSTA COUNTY SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1 . ACKNOWLEDGE receipt of the &9010 report from the Health Services Director on the status of various communicable diseases in Contra Costa County, specifically AIDS, tuberculosis and the hantavirus ( "Four Corners Severe Respiratory Disease" ) . 2 . REQUEST the Health Services Director to follow-up with the State Department of Health Services on a recent report regarding the prevalence of AIDS in women in California and the methods by which these women were infected (specifically by heterosexual contact versus direct injection drug use) and share the results of the study with each member of the Board of Supervisors . 3 . REQUEST the Health Services Director to make a further report to our Committee on this subject on November 8, 1993 . BACKGROUND: , Our . Committee has been providing oversight to the subject of communicable diseases (primarily AIDS) for the past several years . Recently, we have added tuberculosis to this status report because of the troubling increase in cases which has been identified in this County. This report continue those quarterly reports . - In this report we have also touched on .the hantavirus which has caused several deaths in the Arizona-New Mexico area. This virus is apparently caused by exposure to wild rodents like mice and their excreta and has recently been identified in California. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARDkMITAPPROVE OTHSUNNE WRIGHT McPEAK H SIGNATURE(S): ACTION OF BOARD ON August__1-7 , 1993 APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE.SHOWN. ATTESTED Contact: PHIL BATCHELCLERK OF THE BOARD OF cc: See Page 2 . SUPERVISORS dD COUNTY ADMINISTRATOR ryBY DEPUTY 2 . 0 _ - 2 In the AIDS area, Mr. Finucane and Dr. Brunner' s report notes that Contra Costa County has not yet seen the change in the cause of cases among women which is being experienced nationally. In the East, it is noted that women are now more likely to contract AIDS from heterosexual contacts than from direct injection drug use, even though most of the heterosexual contacts involve injection drug users . This trend is not reflected in the statistics in this County, which still show that the majority of women who contract AIDS have done so as a result of direct injection drug use. However, since the West Coast tends to follow by a few years the national trends, we can expect that in the future we will see an increase in the incidence of women who contract AIDS through heterosexual contacts . Tuberculosis continues to be a problem in this County, particularly among Asian/Pacific Islanders and in West County. It is believed that we should not see a significant increase in the incidence of tuberculosis in 1993 . While there have been no cases of the .hantavirus in Contra Costa County, two cases have been identified in California. Public health warnings are, however, appropriate for those who may be camping or taking part in other outdoor activities which might bring them in contact with wild rodents, which appear to be the source of the virus . We will continue to provide oversight on the general subject of communicable diseases and will report to the Board of Supervisors again following the next quarterly report on this subject. cc: County Administrator Health Services Director Public Health Director Francie Wise, Director of Communicable Disease Control, HSD -2- Contra Costa County The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR Tom Powers, 1st District Mark Finucane, Director Jeff Smith,2nd District ac•s-•,-c Gayle Bishop,3rd District -- -°_ 20 Allen Street Sunne Wright McPeak,4th District `�` ' Martinez,California 94553-3191 Tom Torlakson,5th District (510)370-5003 o; County Administrator ,,: " o FAX(510)370-5098 Phil Batchelor ��sra couNt t �~ County Administrator August 4, 1993 I To: Internal Operations;,,`ommittee From: Mark Finucane, Health Service irector by Wendel Brunner, M.D. zw�-�"� Assistant Health Services Director for Public Health Subject: Quarterly Report on Communicable Diseases AIDS CURRENT AIDS CASES IN CONTRA COSTA COUNTY As of,the end of July 1993, 1159 cases of AIDS have been reported to the Health Services Department. Of these cases 214 were diagnosed under the new and more inclusive definition of AIDS created by the Centers for Disease Control (CDC) at the beginning of the year. At least 693 people with AIDS have died since the beginning of the epidemic. There were two additional pediatric cases reported since our last report to this Committee. In July of this year, the Centers for Disease Control reported that, in 1991 for the first time at the national level, more women with AIDS were infected through heterosexual contact rather than direct injection drug use. Nevertheless, most of these cases are related to injection drug users who are infected. Fifty-percent of the new female AIDS cases in 1991 were due to heterosexual contact, compared with 44% from injection drug abuse. In Contra Costa County, in 199122% of the new cases of AIDS among women were due to heterosexual contact, while 61% were from intravenous drug abuse. In 1992, 27% of the 26 new cases among women in Contra Costa were contracted through sex with men compared to 54% from tainted drug needles. We have not yet seen in our County what the CDC has observed for the nation. The national figures largely reflect high infection rates among male injection drug users observed in the East Coast. What CDC has seen at the national level we can probably expect to see if new infections continue to occur among injection drug users. If these national trends occur here, we are likely to see a significant increase in pediatric cases. Merrithew Memorial Hospital 8 Clinics Public Health • Mental Health • Substance Abuse Environmental Health Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics A-345 (2/93) Report to the Internal Operations Committee page 2 On Communicable Disease in Contra Costa County HIV/AIDS EMERGING AS.A LEADING CAUSE OF DEATH IN CONTRA COSTA YOUNG ADULTS On June 16, 1993, an article by researchers from the Centers for"Disease Control and Prevention reported HIV infection as the leading cause of death among young adults in many US cities, including Concord, California. Young adults are defined in the article as people of ages 25-44 and the article reported only on cities of at least 100,000 population. Concord, the only city in the county with more than 100,000 population(1990 census data) was mentioned in this report. According to the article, the percent of deaths attributable to H1V/AIDS among Concord men aged 25-44 was 19.2% in 1990. The city of Concord is not alone in the loss of young lives. Numerous young residents of many Contra Costa cities have died of HIV/AIDS since the beginning of the,epidemic. During 1990 and 1991 young men lost their lives to HIV/AIDS in Alamo, Antioch, Brentwood, Byron, Clayton, Hercules, Lafayette, Martinez,Pleasant Hill, Orinda, Oakley,Pinole,Pittsburg,Rodeo, San Ramon, Richmond and San Pablo. Vital statistics data indicate that throughout Contra Costa County in 1990, 233 men aged 25-44 died. HIV/AIDS was responsible for 38 (16.3%) of these deaths. This percentage is identical to the 16.5% found at the national level by CDC's study. Furthermore, our local data for 1991 indicates that 234 deaths among young men in this age group occurred, and 50 (21.7%) were attributable to HIV/AIDS. HIV infection is clearly becoming a leading cause of death among young adults in our county, and it appears that this trend will continue for some time, given the number of people estimated to be infected and the lack of a foreseeable cure for HIV disease. Although the deaths of people in this young age group represent a small percentage of all deaths occurring in the county, they impose a disproportionately high impact on society because of the loss of productive years of life. We estimate that the early deaths of Contra Costa residents from AIDS represents a loss of at least 23,000 potential years of life and close to $500 millon lifelong potential earning lost. HIV/AIDS continues to kill increasing number of Contra Costa residents of all ages as shown in the figure below. Report to the Luernal Operations Committee Page 3 On Communicable Disease in Contra Costa County Deaths Among People with AIDS of All Ages who were Residents of Contra Costa County at the time of their AIDS Diagnosis, by year of death 4 - 130,..,.. 130 120 106::. "......":::::... .. . 100 ...... ..::::::::' ':..'....:...:: ow fi0 40 . ::t......... .. 3. ..20 . ::..:. 1982 83 84 85 86 87 88 89 90 91 92 1993 Report to the Internal Operations Committee Page 4 On Communicable Disease in Contra Costa County HIV-1.PREVALENCE IN MEN wH0 HAVE SEx WITH MEN Voluntary testing data from 1992 has confirmed declining levels of HIV infection among gay and bisexual men presenting at publicly funded testing sites in our county. During 1992 only 5% of gay/bisexual men tested positive for HIV. Additionally, although still representing the majority of cases diagnosed with AIDS in 1992, the percentage of new cases among gay or bisexual men has decreased each year since the first years of the epidemic. The figure below illustrates these trends. These facts are encouraging and support the understanding that HIV infection is preventable given appropriate education and behavior change. Percent of new AIDS cases who are gay/bisexual men & HIV prevalence among gay/bisexual men testing voluntarily 7 4% 70.1% sa.9�iq. . . . . . . . . . . . . . . . . . . . . . . 4.4% .......... ...... 59.89'0 ==-. --- 51.5/0 ,...._...,.................. ............ _M ....... ........ _-. ..... �r ....... ...... --- . ..:. Percent of new cases — - -__ ..... ..... - .'1 - 12. a 10. o [OHIM Prevalence '85-'87 '88 '89 190 191 '92 Report to the Internal Operations Committee Page S On Communicable Disease in Contra Costa Cowuy TUBERCULOSIS In previous reports we have presented to this committee the incidence of tuberculosis in Contra Costa and have outlined our course of action. We present here an update on cases of TB reported so far during 1993 to Public Health. There have been 67 new cases of TB reported during the seven first months of 1993, replicating the incidence and also the distribution of TB cases observed in 1992. The cases are uniformly distributed among women (463%) and men (53.7%), and the race/ethnicity distribution of the cases is as follows: Asian/Pacific Islanders continue to represent the largest group (32.S%), and White, African American and Hispanic cases represented 22.4%, 19.4% and 17.9% of the new cases, respectively. The cases from West County represented half(52.2%)of these new cases continuing to affect disproportionally this area of the county. These preliminary numbers for 1993 and their distribution suggest that during 1993 we should not expect to see a significant increase in the incidence of TB. In order to curtail the spread of tuberculosis in our county we continue our course of action emphasizing directly observed therapy for persons at risk for non-compliance and increased screening for people at high risk for infection. In March 1993, over 200 injection drug users from West County who were not in treatment and who are known to have high rates of HIV infection were tested for TB and referred for follow-up evaluation. Additionally, more than 400 inmates entering the county detention facilities have been tested since May, 1993, in an intensified screening process. HANTAVIRUS Hantavirus is the virus responsible for the "Four Comers Severe Respiratory Disease" (New Mexico, May 1993). No cases of hantavirus have been reported in Contra Costa County, but the State Department of Health Services has reported that two cases, both fatal, have occurred in Mono and Santa Barbara Counties. Neither of the California cases had travelled outside of California in the six weeks before illness. Hantavirus is present in at least these two areas of California, but the State Department of Health Services emphasizes that there is no evidence of more widespread disease activity. Given the rural characteristics of parts of our county and the summer season inviting many residents to camping and to other outdoor activities, we want to take this opportunity to alert the community to take precautions to reduce the risk of exposure from wild rodents and their excreta.