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HomeMy WebLinkAboutMINUTES - 03281995 - 1.O.1 TO: BOARD OF SUPERVISORS �rZI Conus FROM: INTERNAL OPERATIONS COMMITTEE ; _;. ,�j `' , .�; Costa County DATE: March 20/ 1995 SUBJECT: REPORT ON THE STATUS OF COMMUNICABLE DISEASES IN CONTRA COSTA COUNTY SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1 . ACCEPT the attached report from the Health Services Department on the status of communicable diseases in Contra Costa County. 2 . REQUEST the Health Services Director to make annual reports to the Internal Operations Committee on this subject in the future. 3 . REMOVE this item as a referral to the 1995 Internal Operations Committee and instead refer it to the 1996 Internal Operations Committee. BACKGROUND: For the past several years, the Health Services Department has been making quarterly reports to the Internal Operations Committee on the status of communicable diseases in Contra Costa County, specifically AIDS and Tuberculosis . The last report was made to the Internal Operations Committee on November 28, 1994 and approved by the 'Board of Supervisors on December 13, 1994 with the request that the Health Services Director continue to make quarterly reports to the Internal Operations Committee. Attached is the most recent report, which contains data on AIDS and Tuberculosis . On March 20, 1995, our Committee met with Francie Wise and Nancy Warren from the Health Services Department. Ms . Wise reviewed the attached report with us and pointed out the concern the Department has with the fact that of some 647 individuals who tested positive for HIV, 203 of had previously tested negative, meaning that much CONTINUED ON ATTACHMENT: YES SIGNATURE: -RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE _OTE �M R DeSA LNIE JIM RC SIGNATURE (S): ACTION OF BOARD ON March 28, 1995APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS XI HEREBY CERTIFY THAT THIS IS A TRUE L 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.R ATTESTED MAR 2 '" 19% Contact: PHIL BATCHELOR,CLERK OF THE BOARD OF cc: See Page 2 SUPERVISORS AND COUNTY ADMINISTRATOR BY DEPUTY -2- of the counseling and education being provided to at-risk individuals is either the wrong message or that the individuals simply do not want to hear the information and warnings . Ms . Wise also noted that testing is now being undertaken at the three community college campuses in the County. In regard to tuberculosis, it is gratifying to see that the number of new cases is down in 1994 from 1993, although it is still substantially higher than it was in 1985 . We appreciate this information. The Department may want to continue to file these reports on a periodic basis with the Board of Supervisors for informational purposes . However, we do not believe that a thorough Committee review is necessary more often than annually and are, therefore, recommending that the practice of quarterly reports to the Internal Operations Committee be terminated and that such reports be made only on an annual basis . cc: County Administrator Health Services Director Public Health Director Francie Wise, Director, Communicable Disease Control, HSD Contra Costa County The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR Tom Powers, 1st District Jeff Smith,2nd District Mark Finucane, Director Gayle Bishop,3rd District - - 20 Allen Street Sunne Wright McPeak,4th District ' '` -` Martinez, California 94553-3191 Tom Torlakson,5th District ___ i (510)370-5003 County Administrator . ' .. �o� FAX(510)370-5098 Phil Batchelor County Administrator ' �ourvtt March 20, 1995 To: Contra Costa County Board of Supervisors From: Wendel Brunner, M. D. fore—�" Mark Finucane, Health Services Director Re: Quarterly Report on Communicable Diseases HIV/AIDS Cases As of March 2, 1995, 1,522 cases of AIDS have been reported to the Health Services Department. Of that number, at least 911 (sixty percent) have died. Seven AIDS cases among children have been reported; six of these have died (86%). Of the seven children reported, three were infected through transfusions of blood or blood products and four were born to HIV-infected mothers. Of the 1,515 adult and adolescent cases, four are among the 13-19 year old group. The route of transmission of HIV for all cases is demonstrated below: AIDS Cases - Transmission Categories Cumulative through March 2, 1995 965 Legend Gay/Bisexual men Gay/Bisexual IDU No identified risk/Other ® Blood Products s "• 59 "'" g X IDU "R,"rff �g Parent at risk ® Heterosexual contact 296 79 65 51 Merrithew Memorial Hospital&Clinics Public Health Mental Health • Substance Abuse Environmental Health Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics A-345 (2/93) Quarterly Report to the Internal Operations Committee March 13, 1995 Status of Communicable Disease in Contra Costa County Page 2 Adult and Adolescent AIDS.Cases - Male Cumulative through 3/2/95(1,343) Not Reported/Other 3 Heterosexual Contact 41 Blood/Blood Product 79 Gay/Bi IDU 207 IDU ....N "- .,o:., ,. ..:., r..964 Gay/Bi Men 0 200 400 600 800 1000 Adult and Adolescent AIDS Case - Female To date, 171 AIDS cases Cumulative through 3/2/95 (172 cases) among women and adolescent Other/Not Reported 17 girls have been reported. These AIDS cases are attributed to the risk factors Heterosexual contact 56 demonstrated in the table to the right: Blood/Blood Product 10 t 3 3 IDU �� -.r 89 .. 0 20 40 60 80 100 Quarterly Report to the Internal Operations Committee March 13, 1995 Status of Communicable Disease in Contra Costa County Page 3 AIDS Cases by Race/Ethnicity Cumulative through March 2, 1995 Whits 61.9% [934 Native Am 25 ........... 400 ........... ........................ ......................... Asian/Pacific Islander 1.7% African American 26. Latino 9.9% As the chart above indicates, sixty-two percent of adult/adolescent cases of AIDS are White; 26% African American; 10% Latino and 2% Asian/Pacific Islander. 200 New HIV Infections in the Last Five Years Over the last five years (1990-1994), a total of 39,741 HIV tests were provided to clients of Health Services Department clinics or testing sites. Of those, 647 have tested positive for the first time. Two hundred and three (203) of the 647 had previously tested negative in our clinics. The Contra Costa numbers are discouraging because we know that those who have tested previously are aware of their own risks for HIV and of strategies to decrease that risk. Yet apparently risk reduction information has not led to successful behaviors to protect these individuals. Gay and bisexual men; gay/bisexual injection drug users and injection drug users, more than other groups became infected despite having received risk reduction information, counseling and testing. As demonstrated in the two tables below, people of color are disproportionally affected. Quarterly Report to the Internal Operations Committee March 13, 1995 Status of Communicable Disease in Contra Costa County Page 4 Seroconversions by Risk Category 1990-1994 IDUs-n=3,750 `z � 73 �` ?33'YYif GayBisexualIDUs n=132 11 Gay/Bisexual Men-n=1,7 1 72 i s f 0 10 20 30 40 50 60 70 60 Seroconversions of HIV positive status By Race and Risk Category(1990-94) f IDUs who are People of Color 5.5% White Injection Drug Users 0.6% Gay/Bisexual Men of Color- 1 - ;�:, 6.7% r jj .... ......�; '% .....moi;: White Gay/Bisexual Men •, SWAN 0% 1% 2% 3% 4% 5% 6% 7% These numbers demonstrate that we must continue, if not accelerate prevention strategies to gay and bisexual men and injection drug users, particularly in people of color communities. Quarterly Report to the Internal Operations Committee March 13, 1995 Status of Communicable Disease in Contra Costa County Page 5 Ryan White CARE Act Funding Contra Costa County has received a total of $1,203,007 in Ryan White Comprehensive AIDS Resources Emergency (CARE )Act funding for HIV/AIDS services for the coming fiscal year. This represents an increase of almost $103,000 from fiscal year 94 - 95. As in previous years, CARE funding enables the Health Services Department and community-based organizations to continue delivering basic services to people with HIV and their families throughout the county. Additional funds this year will support the expansion of services to those members in our community who are most impacted by the epidemic. An important element in planning service delivery this year is that the CARE Act is due to expire March 31, 1996. This has impacted services on three levels: the funding cycle is shorter; the funds must be expended by March 31, 1996; and there will be no funding after that date unless Congress reauthorizes and appropriates the CARE Act next year. Services which are instituted today have no guarantee of funds in the future. CARE funds have been a vital resource for our Health Services Department. Without these funds, the County would have to assume a tremendous financial burden to ensure that individuals with HIV/AIDS in this County have access to the services which they require to remain healthy, productive members of the community. The CARE Act is a. major source of funds for case management (resource coordination), food, home health care, housing assistance, mental health counseling and transportation. Currently, the Sub,Committee hearings for re-authorization of the Act have been completed and legislation is being drafted. An amendment to restore this year's rescinded CARE Act funds ($13,000,000) was successfully offered by Nancy Pelosi and adopted by the full Committee on Appropriations. It is anticipated that the legislation will reach the House by late March or early April. The Health Services Department AIDS Program is monitoring the CARE Act progress through the Congress and will keep the Board of Supervisors apprised of changes to the Act. HIV Prevention Activities The Prevention Team of the Health Services Department HIV/AIDS Program provides and coordinates HIV risk reduction information for groups at particular risk for HIV infection in the County. As a part of this work, the Team is currently leading a community planning process under the guidelines of the Centers for Disease Control and Prevention and the California State Office of AIDS. We held community meetings to determine how we would develop the local planning group and chose a selection committee which reviewed nominations and recruited over 25 Planning Group and advisory members who represent the county geographically, ethnically, culturally and professionally. The Planning Group also has representation among community residents who are most at risk for HIV or who are HIV-infected, including former injection drug users, other substance users, and gay/bisexual men. The HIV Prevention Planning Group has studied the epidemiology of HIV/AIDS in Contra Costa County and reviewed a needs assessment which was conducted by the County AIDS Program. During March and April, we will discuss prevention strategies and prioritize both target populations and the interventions needed to reach them. The group will develop final recommendations for HIV prevention in Contra Costa County during the fall of 1995. The AIDS Program and the Prevention Planning Group will then develop a plan for HIV Prevention Services Quarterly Report to the Internal Operations Committee March 13, 1995 Status of Communicable Disease in Contra Costa County Page 6 which will also be submitted to the State Office of AIDS in December 1995. The AIDS Program will receive $50,000 from the State to staff this planning effort. An augmentation in State funding for HIV prevention services has been received; $45,000 for fiscal year 94/95 and another$45,000 for fiscal year 95/96 have been committed. Funds are to be used to target substance users and others at risk with prevention education. In the current fiscal year $25,000 of the funds have been awarded to six contract agencies to purchase HIV education materials and to increase street outreach. The remaining $20,000 will be used by the AIDS Program to develop HIV education materials for a campaign targeting substance users and others at risk throughout the county. TUBERCULOSIS Cases In 1994, 99 persons were reported to have TB in our county. This number compares with 110 cases in 1993. In past years, people with TB were predominantly over 65 years of age. This year, only 21 (21%) were over 65. Four children under ten years old and eight adolescents (ages 11-19)were diagnosed with TB. In the State overall, Asians represent 60% of the TB cases; in our county in 1994, Asians represented 43%; African Americans 26%; Whites 23% and Latinos 7%. Regionally 54% of people with TB lived in West County; 21% in East County and 24% in Central County. The 99 cases translate to a case rate of 11.4 cases per 100,000 persons. The number of cases decreased by 10% since 1993, but increased by 65% since 1985, when we had only 60 cases. TB Newsletter With additional funding we received this year to combat TB infection and disease, the Communicable Disease Program is beginning this month to publish a quarterly TB newsletter addressed to physicians and other health care providers to assure that they are aware of the extent of the TB epidemic here and to assure the prompt and accurate diagnosis as well as effective treatment for patients with active TB. Attached is a copy of the newsletter. New TB Services New State funding also allows public health nurses to visit schools and congregate living sites such as residential substance abuse programs and convalescent hospitals to insure that the most recent diagnostic, treatment and prevention information is broadly disseminated. We have also expanded the number of clients receiving Directly Observed Therapy (DOT) to approximately 45% of the active TB cases. Each of these new activities is taking place in an effort to halt and not repeat the increases in TB cases we (and the entire State) have experienced over the last seven years. The TB Newsletter from Contra Costa County C;e mincLi Idms Volume I Number I March 1995 E t=ceu first 1994 TB Cases In Wls�m=ewtublos newsletterfrom the Contra Costa County Health Services Contra Costa Coun Department,"Germinal Ideas." ty The newsletter is for you—for 1994,99 persons were lived in West County; 21%in East people who treat and take care of reported to have TB in our County and 24%in Central County. people with TB in our county. Weounty. This number compares i The 99 cases in 1994 translate to a plan for the newsletter to be informa- with 110 cases in 1993. In past years, I case rate of 11.4 cases per 100,000 tive by bringing you up-to-date people with TB were predominantly persons. The number of cases de- information on treatment issues; on over 65 years of age. This year, only I creased by 10%since 1993,but new legislative mandates about 21 (21%)were over 65.Four chil- increased by 65% since 1985,when caring for and reporting people with dren under ten years old and eight I we had only 60 cases. TB; and on the local picture of TB in adolescents (ages 11-19)were Our 1994 cases are being further our county. We hope that you will let diagnosed with TB. In the State ( analyzed to determine TB risk factors us know how to make the newsletter overall,Asians represent 60%of the I and drug resistance patterns so that more useful to you and your practice. TB cases; in our county in 1994, I we can better understand our local There is a feedback form inside the Asians represented 43%of cases. ( epidemic and the most effective newsletter. We encourage you to use African Americans represented 26%; approaches to achieving a continued it or call us with your suggestions. Whites 23%and Latinos 7%.Re- reduction in the number of cases. gionally, 54%of people with TB Diagnostic News rI most important aspect patient presenting with these symp- smear and culture. A positive culture uberculosis control toms. The most common chest x-ray confirms the diagnosis. Drug suscep- olves the prompt and I abnormalities suggestive of TB are I tibility testing must be performed accurate diagnosis of patients with upper lobe infiltrates or fibrotic initially on all positive cultures. active TB and their prompt and lesions,with or without cavitation. When cultures are negative or effective treatment. Symptoms (A normal chest x-ray makes the unobtainable(such as in most suggestive of tuberculosis include a diagnosis unlikely,but not impos- children), multidrug empiric therapy productive cough, generally of sible, especially in patients with HIV should be started whenever the greater than three weeks duration, infection.)The diagnosis must be clinical or radiographic findings fevers, night sweats, and unexplained confirmed whenever possible with suggest active TB. weight loss. Health care providers sputum examination.At least three should suspect active TB in any specimens should be sent for AFB I � This newsletter is made possible through funding from the California Department of Health Services Tuberculosis Branch. TB Activities and Services Available Through the Health Services Department rv PATIENT and outpatient ensuring the completion of TB - • Pittsburg Health Center edical care for TB patients is therapy even for some of our most 550 School Street ailable through Merrithew I difficult to manage patients. Al- ( M, T,W,F 2:00 p.m. -4 p.m. Memorial Hospital and Clinics and at I though the majority of DOT patients Chest Clinics located at: I are being followed in the County's I Brentwood Health Center Chest Clinic,the service is available I 118 Oak Street • Merrithew Memorial Hospital I to patients followed by any provider. I Wednesday 3:00 p.m. - 5:00 p.m. 2500 Alhambra Avenue,Martinez I Please call us at 313-6745 if you feel Appointments: 646-4715 I that any of your TB patients may I We use only Mantoux(PPD)tests. benefit from this valuable program. I Tests must be read 48-72 hours after • Richmond Health Center I their administration. Persons over the 39th Bissell Street, 2nd Floor I Medical consultation is available ( age of 35 who have not had a test Appointments: 374-3021 I regarding the management of pa- within the past two years should have tients with all forms of TB infection two tests, one week apart. The fee is • Pittsburg Health Center i or disease. Our Medical Consultant is $10 per test. The fee is waived for 550 School Street Charles M. Crane,MD, MPH.You persons known to be contacts to Appointments: 427-8070 can reach him directly or leave a verified cases of TB.Hours are message at 313-6746. The Francis J. subject to change. Please call 1-800- • Advice Nurse: 1-800-524-2247 Curry National TB Center in San 246-2494 for more information. Francisco offers expert medical Public Health Nursing(PHN) case I consultation regarding the manage- management and contact investiga- ment of medically complicated TB Other Communicable Diseases � In Contra Costa County tion services are provided to all I patients. You may leave a message 1992-1994 patients with active TB.A PHN for them at 1-415-502-4700 and they visits each patient monthly or more will respond within 24 hours. Disease 1992 1993 1994 frequently to promote and ensure I AIDS 249 230 189 adherence to and completion of TB skin testing is available through Ab s.,.:.. _ :: .:. ..:..:. therapy. I our Immunization Clinics at: Campylobacter 275 353 407 � sl> :<>:; 892;;,;;,;;`1;.263,;;�:::..:.>:. Directly Observed Therapy(DOT) Richmond Health Center Coccidioidomycosis 7 12 24 is available to patients with active or Public Health Clinic Services Gipr ,a is 75 a 97 200 suspected active TB and their con- 39th Bissell Streets, Ground Floor Gonorrhea 977 950 727 facts who are referred by their Mondays s an d Wednesdayss Ne6a4s1- providers. Medications are brought 2:00 p.m. -4:00 p.m. Hepatitis B 23 4 17 to the patient,generally twiceILL ... . ............ . weekly,and ingestion is observed Concord Public Health Clinic Pertussis 16 42 62 and documented by outreach h 2355 Stanwellell Circle .......... Rab,es An ma! 2 fl worker or PHN. Transportation, food M,T,W 9:00 a.m. - 11:00 a.m. Rabies-Human 0 0 1 and other incentives are provided to Fridays 2.00 p.m. -4 .m c� ..::..::..:...::..:.......:..:...:..:.:...:::<....:.::::..:..........:.:.:.:.....:...: promote adherence with therapy. 4th Fridays until 6:00 p.m. Salmonella 1 95 1 152 116 ThisP rog highly ram is hi hl successful at ' > � SYp#ills >€_ ::::>:::::;:$3::.::: ::9�?,:::<: rn n ...... Tr t e f r at e x Nwse ............... h American QU: STI: N:,::::::.::.: : :::::::::::::::::::: ..::: .:::::.: ::..: N June 1994 the e ...... In dame pharmacies, pafiens picking up isoniazid hate received rnfor Thoracic Society (ATS), the mafion sheets warning Them agarn5tatmg cheese of dnnkrng red carne Centers for Disease Control and while tpkrng Isontoid is there any evidence of o connection between #hrs PreventionCDC ,and the American ( ) drug.and adverse reactions Academy of Pediatrics(AAP) published revised recommendations NNW ............ el is diosly relatefor TB treatment(Treatment of onizre5od to i7 group of j Tuberculosis and Tuberculosis drugs called monoamine oxidase rnhibitors_ These; drugs often`used to Infection in Adults and Children. treat depression;inhibit the body's praductian of an enxY.T) called American Journal of Respiratory and mpnoamine oxtelase VYlthout this enzyme,the body cannot rnefiabolize Critical Care Medicine, 1994; monoamine,substances found In cheese, red wine,and otherfoods 1 he 149:1359-1374.)For a free copy, result rs ail abnormally high c©t�cenR.6110n of tyramine, q type of rnonoarnrne� he boodstream This overabundance of tyramine causes lease call the Tuberculosis Control p hypertensioniiiifPcitlents with hyperlenslve repctrons rriay experience flush Program at 313-6745. ing, headaches palpitohons, ch,1(s, and elevated heart tate and blood To summarize these recommenda- tions,the initial drug regimen for f lyperfensrve reactions to cheese are rare in patients taking Isoniazid adults and children with active or Howevei,:patients who report having symptoms of hypertension after suspected active TB should generally eafing cheese (or other monoamine rich foods should he advised to be isoniazid(INH), rifampin(RIF), avcsid these foods whrle taking rsornazrd After Therapy rs completed, pyrazinamide (PZA) and ethambutol parents should be ahfe to eat:these foods again without any problems (EMB). The EMB is stopped when and if the organism is found to be Source CDC,:PB.Notes, FIV1;994 fully susceptible to all these agents. The PZA is generally stopped at two I noncompliance,homelessness, I and for adverse drug reactions. For months. All medications can be given I chemical dependency(to alochol or patients with a positive culture, two twice weekly after an initial period of I street drugs),psychiatric conditions, I follow-up sputum specimens should at least two weeks of daily dosing. and mental impairment as well as for be collected monthly until the culture Directly observed therapy (DOT) I all children and adolescents. Our I coverts to negative. Drug susceptibil- should be considered for all TB i DOT program is described elsewhere i ity testing should be repeated if the patients and is highly recommended in the newsletter. TB patients should culture remains positive after three for patients at risk for nonadherence be seen monthly to assess their months of treatment or if there is no to therapy due to prior medical adherence and response to treatment, i clinical improvement. TB Control Program Contra Costa County Health Services Department � 597 Center Avenue,,Suite 200-A Martinez,California 94553 Contra Costa County Health Services Department Public Health Division Mork Finucone,Health Services Director • Wendel Brunner MD,Assistant Director of Health Services-Public Health • Froncie Wise,PHN,MPH,TB Controller New Legislation N 1993, the California Legisla- Only three exceptions to the I address,home phone,date of birth, ture codified new mandates for requirement for an approved treatment gender,ethnicity and marital status. the control of TB in our State. plan are provided: The new law,commonly called I *Locating information: patient's "Gotch"for Assembly Member 1. The patient is being transferred to employer,work address and work Gotch who introduced the legislation, an acute care hospital when the phone number. was amended in 1994. transfer is due to an immediate Accordingly to the new law need for a higher level of care. *Treatment information: date of (Health and Safety Code 3281 onset, symptoms,risk factors, (a)(1)),a health facility, local deten- 2. The patient is being transferred physical findings,chest x-ray tion facility or state correctional from any health facility to a findings,bacteriology results with institution may not release a patient correctional facility. dates,PPD induration and interpre- or inmate who is known or suspected ( tation,medications (names,dosages to have active TB disease until after a 3. The inmate is being transferred and dates initiated), compliance written treatment plan is approved by within a state or local detention history,and any other diagnosis. the local public health department. facility system. Treatment plans submitted to the -Physician identifiers: name, local public health department should Treatment plans may be faxed to the address and phone numbers of be reviewed within 24 hours of their Contra Costa County TB Control current physician and hospital and receipt(Monday-Friday).Neither Program at 313-6465. Plans must name,address and phone number of transfers nor discharges may occur include the following information: ( physician and/or facility to whom until after the treatment plan has been the patient is being transferred. approved. -Patient demographics: name,age, Newsletter Inquiry Form If you would like to submit an article for consideration, give us a change of address, make suggestions about the newsletter, or be added to our mailing list, please use this form. Please print. Name: Phone: ! Occupation/Title: ❑ I would like to submit an article for consideration (Please attach your brief article, typed and double spaced.) ❑ 1 would like to make the following suggestions ❑ I would like to be added to the mailing list or to suggest a colleage for the mailing list ' Name: Agency or Affiliation: Address: City: Zip: Please send this form to: ' Eva Mourad,MPH,Senior Health Education Specialist ' 595 Center Avenue,Suite 310,Martinez 94553 ' Phone: 313-6150 '