Holiday Wish List, by Frances Smith

It's that time of year when gifts are exchanged, and we make the effort to find or do something specials for those who are important in our lives. It's also the time of year when we take note of those around us who are less fortunate than we are, and we contribute either directly or through helping agencies and service clubs.

Here at the Health Department we have a wish list for the New Year, and I would like to highlight a couple of items. One, we are looking for a volunteer to help in the Healthy Start program to do outreach to first time parents, a couple of hours a week. This includes making phone calls to the new parents who have been referred to the program. The second item on our wish list is a vehicle in good condition for the parent editors to use to make home visits. The value of the vehicle should be tax deductible to the donor, as the vehicle will be used for transportation and not resale.

So if you have extra time, or one too many cars in your driveway, then give us a call. Kathy, our Healthy Start Supervisor would love to hear from you (756-2020, ext. 670). Share this information with others who may be able to help. The Healthy Start program is a worthy cause--helping new parents learn how to give their baby the best start in life.

Vaccine Recall, by Frances Smith

You may have already heard about a nation-wide vaccine recall by the drug company, Merck. There are 2 vaccine products that are of concern--PedvaxHib and COMVAX, and only in certain production lots of these two specific vaccines. Both of these vaccines are given to children age 2 months to 5 years to protect against meningitis, pneumonia, and throat infections. This recall is just a precaution, because Merck found bacteria (Bacillus Cereus) on the equipment that produces the vaccine, but so far, none in the vaccine itself.

We haven't used these vaccine products at the Health Department here, but other doctors' offices may have. The good news is that so far there have been no reports of anyone having any ill effects. If there were to be any problems, it would be within one week of receiving the vaccine, and the most likely problem would be a swollen, red area around the injection site. A disseminated infection could include nausea, vomiting, and diarrhea. If either problem occurs, the health provider should be contacted. The other good news is that the kids who got the recalled vaccine don't have to be re-vaccinated, because the vaccine was determined to be potent.

The bad news is that this recall will probably result in a shortage and rationing of Hib vaccine for awhile. (Hib is short for Haemophilus influenzae Type b). Rationing has happened in the past with vaccines for pneumococcal disease, chickenpox and also influenza. Vaccines are one of the best health care bargains in the world today. For a relatively low cost, we are protected against serious illness that can cause disability or death. By vaccinating children against childhood diseases, we also protect society as a whole.

HIV in Coos County, by Frances Smith

December 1st was World AIDS Day. This was a day to pause and remember what this disease has done to populations all over the world, and the effect that it can still have on individuals and society. Coos County Public Health started an AIDS education/prevention program 20 years ago when federal funding became available. At the beginning of the AIDS epidemic, some people were very afraid to be in the same room with someone with the disease--afraid that just breathing the same air could be infectious. Since those early days, education about transmission, prevention and the development of effective treatment have greatly reduced the fear of AIDS. A cure is still elusive.

The federal AIDS prevention funds have been reduced over the years and are distributed to counties according to a formula based, in part, on the number of AIDS cases and also the number of persons who test positive for HIV in our county. Coos County Public Health received $10,838 this year (via the state) for HIV prevention, based on our numbers. Our county has had about 25-30 persons with HIV disease participating in the HIV/AIDS case management program each year. In 2006, there was only one positive test (i.e. infected person) out of the 397 tests done through the publicly funded test sites in our county. In the previous two years, there was none. In addition to providing tests at the Health Department, we contract with the Harm Reduction Center of Southern Oregon (based in Roseburg) to do outreach testing in our county. The HRC does testing at the South Coast Hospice Bereavement Center, and other locations, such as ADAPT, Belloni Ranch, and Shutter Creek Correctional Institute. Results at the outreach site are available in about 30 minutes.

Consider: Are positive tests rare here because very few here are infected? Or are the persons who might be infected not getting a test? Any suggestions on how to reach those who are at risk?

A Resource Guide for Diabetes, by Frances Smith 11/29/07

November was Diabetes Awareness Month. To put it simply, diabetes occurs when the person's pancreas doesn't make enough insulin (type 1) or the insulin isn't working the way it should (type 2). Without insulin, the sugar from digested food that is carried in the blood can't move into the cells (where it is needed for energy). So the person gets tired, and thirsty, may have blurred vision, urinate often, and may lose weight. The person who has type 2 diabetes may have the same symptoms as type 1--except that most likely, he or she is overweight, and being overweight helped to trigger the type 2 diabetes. When diabetes is uncontrolled, too much sugar in the blood damages the blood vessels, which can be especially bad for the eyes and the kidneys. Good control of blood sugar through diet, medication, and exercise can help the person with diabetes maintain good health, protect the eyes and kidneys, and prevent other complications, such as amputations.

We have lots of diabetes here--7% compared to the state rate of 6%. And we are seeing more cases of type 2 in children, which used to be unheard of. The burden of diabetes is significant--for those who have the disease, and for those who don't, but who share the costs of diabetes through public and private health insurance.

Coos County Public Health was fortunate to have federal funding to administer a community diabetes education program for 7 years. (The funding ran out last year.) During those years we helped to develop a community diabetes coalition, which still meets monthly as the Chronic Disease Coalition. We also taught classes (Meals Made Easy and Stanford's Chronic Disease Self Management Program) , provided foot care kits, educated through movie slides and other media about symptoms and the importance of testing, and developed a local resource guide.

This year the Health Department applied for and received a grant from the Elizabeth Furse Diabetes Program of the American Diabetes Association to revise and reprint our local diabetes guide. The Chronic Disease Coalition helped to update the information. Copies are available through North Bend Medical Center's Health Resource Center, the Health Department, Southern Coos Hospital, and the South Coast Diabetes Association support groups. The guide is especially helpful for someone who is newly diagnosed. We are fortunate to have local resources such as certified diabetes educators, classes, and support groups in our community.

Consider: Are health insurance payments adequate for nutrition counseling for diabetes? What can we do as a community to help prevent obesity, so that we can help prevent Type 2 diabetes?

MRSA in Our Community, by Frances Smith, 11/21/07

It's been in the news, and we're getting lots of calls at the Health Department. MRSA, most commonly seen as boils, stands for Methicilin-Resistant Staphylococcus Aureus. It has infected people here in community settings--the jail, at the college, and in at least one of the schools. During a recent home visit, a mother told our nurse that she and her baby had it. MRSA is not one of the 50+ diseases that is reportable in Oregon, so we really don't know how widespread it is in Coos County. The doctors and labs don't have to report it to the Health Department. And we are not required to "investigate" and figure out where it came from. (But really, staph can be found just about anywhere because about 30% of us carry the germs without knowing it or getting ill.)

What we have been doing is giving out advice about prevention--mostly about washing hands and cleaning surfaces with a bleach/water mixture or a commercial product that kills staph germs. We also strongly recommend to not share used towels and gym clothes, and we advise those who participate in contact sports to cover their skin if it is broken or abraded. The environmental health staff are cautioning those who rent vacation homes to be sure to clean the hot tubs between the tourist renters. It was interesting to hear in a recent teleconference that the San Diego County prison was able to reduce MRSA among the inmates by improving hygiene. They doubled the clothing allowance, increasing underwear changes from 2 to 4 per week and allowed 2 changes of jumpsuits instead of one. (That extra laundry cost an additional $3 million per year.)

We can be thankful this Thanksgiving for antibiotics and clean laundry. This "community acquired" staph infection may be resistant to methicillin, but there are other antibiotics that treat it successfully, if draining the sores doesn't take care of it. There is no need to panic, but we should be prudent. Let's keep washing our hands thoroughly so that we can be healthier as we start into this holiday season. If you want to know more about MRSA, type in this website from the American Academy of Pediatrics: www.aap.org/new/mrsa.htm. Or type in www.cdc.gov and go to diseases and conditions and select MRSA.

Consider: Should public health officials in Oregon make MRSA a reportable disease, as it is in many other states?

Lung Cancer and Taxing Cigarettes, by Frances Smith, 11/14/07

November is National Lung Cancer Awareness Month. Coos County has the unwelcome distinction of having the highest rate of lung cancer in the state for over 5 years. Eighty to ninety percent of lung cancer is caused by smoking tobacco. Twenty to thirty years ago, Coos County had the highest rates of smoking in the state, so it's not surprising that today we have the highest rates of lung cancer. Coos County continues to have a high rate of smoking in adults (27% compared to the state rate of less than 20%), so we can expect to continue to see high levels of lung cancer for years to come. On Thursday, November 15, which is this year's Great American Smoke out Challenge, those who are motivated to stop smoking may try to quit for a day. Practice over time can eventually create success. One of the best motivators for quitting is raising the price of cigarettes, and the most effective way to do that is through a higher tax. Passing the tax increase in Measure 50 would have kept an estimated 29,000 to 32,000 kids from starting this addiction (and saved hundreds of millions of dollars in health care costs over time--costs that the public is paying through Medicaid and Medicare). It's incongruent that in this country we are very concerned about the health effects of some products, such as lead paint on children's toys, but we continue to allow the sale of a product with over 40 known carcinogens. If this country's leaders won't stop the sale of this carcinogenic product, then can we make it unaffordable for many and at the same time, use the proceeds for a good cause? That concept didn't fly in Oregon. The majority of Coos County's voters in this last election must think that a higher tobacco tax is not a good way to fund children's health insurance--maybe because of concerns about changing the constitution, or poor people having to bear the brunt of this tax...

Consider: Is there another option to pay for health insurance for kids that people will support?

A Lot of Shots, by Frances Smith 11-07-07

Imagine that pandemic flu arrives in Coos County, and people are starting to get sick. But with luck, we will get a portion of the national stockpile of vaccine routed through our local public health department. How can we get the vaccine distributed so that as many as possible get vaccinated, and in a hurry? And who is on the priority list if there is not enough to go around? What are the essential services and who are the key people to protect? Locally, the priority is still under discussion with our health system partners, although we do expect to follow federal and state guidance when the time comes.

As for giving shots, our public health nurses know from experience that we can set up a public clinic (e.g., at the North Bend Community Center) in 30 minutes and vaccinate about 200 people per hour. It will be more of a challenge since we have lost 4 nurse positions this year due to funding cuts. So 1600 people could be vaccinated in one 8 hour shift at one site. Obviously, we are going to need some help to quickly distribute vaccine county-wide.

This past Thursday, (November 1st) in Bandon, the Southern Coos Health District showed that they are a capable partner in providing a "mass prophylaxis"clinic for the public. With the contribution of vaccine from public health (valued at $7,000) for this exercise, the Southern coos Hospital nurses gave shots for 5 hours in a drive through clinic, at the same time that Coos County Public Health staffed a clinic in the Bandon Library. We got to practice communication and coordination between our two sites during this exercise, and a lot of people in Bandon got free shots.

Consider: How could you or your organization help in the community's response when pandemic influenza arrives?