Why Public Health Matters: Disease Surveillance and Investigation How many of you knew when you were recently sworn in that you were assuming responsibility for managing public health in your county?

Today’s Purpose To discuss governmental public health Public health in general The Kansas system and governance structure Statutes Programs Specifically, Disease Surveillance

What is Public Health? Public Health Focuses on prevention Includes environmental health Administers programs and services to reduce chronic disease Improves health outcomes Engages community partners to monitor and assess the health of the community

The Work of Your Health Department The responsibilities and work of the health department require specific expertise. Local public health departments focus on improving health outcomes by providing services such as immunizations, nutrition assistance for pregnant and nursing mothers and their young children, disease investigation and surveillance, emergency preparedness, home health, and enforcement of public health laws. Some health departments also conduct daycare and school inspections to ensure compliance with state regulations and licensure requirements. Communication: during crisis/emergencies, disease investigations, daycares/schools, health promotion and prevention activities

The Work of Your Health Department Beyond program administration, the department Is the link between the local and state department of health Manages communications (state partners, media, community members) Links people to other resources and health services/providers Ensures compliance with federal and state privacy laws Proactively looks for opportunities to bring additional funding/grants/opportunities to the community Communication: during crisis/emergencies, disease investigations, daycares/schools, health promotion and prevention activities

The Governmental Public Health System 100 local health departments, serving all 105 counties Governed by local Boards of Health In most counties, this is the County Commission Kansas Department of Health and Environment (KDHE): The state health department Kansas Association of Local Health Departments: The statewide membership organization that represents 97 of the 100 local health departments Only 5 LHDs have more than 50 employees 73% have fewer than10 employees 31% have fewer than 5 employees

This Is Public Health The work of public health does not take place in a vacuum. Graphic depicts the interrelationships between the local health department and community partners.

Governance of Public Health: Kansas Statutes A look at the statutes…

Governance 65-201: The county commissioners of the several counties of this state shall act as county boards of health for their respective counties. Each county board thus created shall appoint a person . . . who shall serve in an advisory capacity to the county board of health and as the local health officer 65-204: County health funds; . . . allows the county to levy taxes to establish a county health fund to defray costs of carrying out the health laws, rules, and regulations of the state, salary of the health officer, and other personnel . . .

Environmental 65-159: Abatement of nuisances . . . the county or joint boards of health shall have the power and authority to examine into all nuisances, sources of filth and causes of sickness that in their opinion may be injurious to the health of inhabitants within any county or municipality in this state 19-3703: Sanitary codes, administration of K.S.A. 48-929: regarding county responsibilities for emergency response and management (Local health departments are responsible for Emergency Support Function #8: Public Health and Medical Services) Environmental health Emergency Preparedness: LHDs receive CDC funding to participate in planning and response activities in partnership with KDHE at both the local county level and the regional level

Disease Surveillance and Containment 65-202: Local health officer responsible for communicable disease investigations and control measures (also in 65-119) 65-118: Authority for KDHE to designate reportable diseases 65-301: Control of contagious diseases in cities of the second and third class 65-101: Secretary of KDHE responsible for health supervision; investigation of causes of diseases, sickness, and death; sanitation inspections; prevention of spread of disease, outreach services; rules and regulations 75-5210 Health tests and inoculations (purchase and provision of vaccines; 75-5209 requirement for vaccinations for entry to daycare and public school) Disease surveillance and vaccinations 2012 Finney County Measles Outbreak. During a disease investigation, the health dept is required to contact anyone that has the potential of contracting the disease. This means, anyone around the positive cases during the contagious period has to be contacted by the health department and asked a series of questions. In this series of questions, they look for immune status and a history of where individuals have been and when they were exposed. This also determines if they have to be quarantined. Highlights of data from KDHE regarding reportable disease in 2014, there were 13 cases of confirmed measles, 9 cases of confirmed mumps, and 367 cases of pertussis/whooping cough 5 counties in Kansas are currently actively monitoring individuals who have returned from Ebola outbreak regions in Africa Just last month, a brand new tick-borne virus has been discovered in Bourbon County, and has been dubbed the “Bourbon virus”

Isolation and Quarantine 65-128 & K.A.R. 28-1-6: Isolation and quarantine for specific diseases Also 65-126 & K.A.R. 28-1-5 for broader isolation and quarantine authority 65-119(a): Duties and powers of local health officers; Any county or joint board of health or local health officer having knowledge of any infectious or contagious disease . . . Within their jurisdiction, shall immediately exercise and maintain a supervision over such case or cases . . . Seeing that all cases are properly cared for and that provisions of this act as to isolation, restriction of communication, quarantine, and disinfection are duly enforced Disease surveillance and vaccinations 2012 Finney County Measles Outbreak. During a disease investigation, the health dept is required to contact anyone that has the potential of contracting the disease. This means, anyone around the positive cases during the contagious period has to be contacted by the health department and asked a series of questions. In this series of questions, they look for immune status and a history of where individuals have been and when they were exposed. This also determines if they have to be quarantined. Highlights of data from KDHE regarding reportable disease in 2014, there were 13 cases of confirmed measles, 9 cases of confirmed mumps, and 367 cases of pertussis/whooping cough 5 counties in Kansas are currently actively monitoring individuals who have returned from Ebola outbreak regions in Africa Just last month, a brand new tick-borne virus has been discovered in Bourbon County, and has been dubbed the “Bourbon virus”

Reporting Health care providers and laboratories are required to notify KDHE regarding patients with suspected or confirmed reportable diseases. The list of reportable diseases is defined by Kansas statute (K.S.A. 65-118, 65- 128 and 65-6001 through 65-6007; and by K.A.R. 28-1-2 and 28-1-18). Infectious diseases designated in statute must be reported to the state health department (KDHE) within the statutorily defined time frame. Local health care providers must also notify the local health department of confirmed cases reportable diseases.

Why disease surveillance? Impact is LOCAL Local health departments are responsible for disease surveillance, containment, and risk communication.

Some Broad Disease Categories Foodborne Environmental Hepatitis A E. coli Giardiasis Salmonellosis Lead poisoning Asbestosis Black lung disease Bites Human-to-Human Rabies Spotted fever rickettsiosis West Nile Measles Varicella Pertussis Foodborne = Infectious diseases spread through food or beverages (includes waterborne diseases) Environmental = Diseases directly attributable to environmental factors (rather than infectious or genetic diseases) Bites = A catch-all category of diseases spread by non-human bites, be they mammalian (rabies) or from insects (the various vector-borne diseases like West Nile). Human-to-human = Communicable diseases spread directly between humans (anthroponoses) Some diseases cross these broad boundaries (e.g., Hepatitis A is human-to-human but often spread via improperly handled food), and other disease categories exist (e.g., genetic).

Cumulative Case Reports of Notifiable Diseases: 2014 (Red) Hepatitis A: Liver infection, fecal-oral transmission (either person-to-person or contaminated food/water). Vaccine available.

Cumulative Case Reports of Notifiable Diseases: 2014 (Green) Measles: Virus spread primarily through direct contact and air. High contagious. One of the leading causes of death for children globally. Vaccine available.

Cumulative Case Reports of Notifiable Diseases: 2014 (Blue) Rabies (animal): Zoonotic disease (virus). Almost always leads to death (inflammation of the brain & spinal cord) if it gets past the incubation period. Can be treated post-exposure via vaccine.

Cumulative Case Reports of Notifiable Diseases: 2014 (Orange) Shiga toxin-producing E. coli: A bacterial foodborne disease. Commonly caused by raw/undercooked ground meat products, raw milk, or vegetables with fecal contamination. Roughly 10% of those infected develop a more serious, life threatening disease called haemolytic uraemic syndrome (HUS), which has a case fatality rate of 3-5%. The bacteria is killed by thoroughly cooking food.

Cumulative Case Reports of Notifiable Diseases: 2014 (Yellow) Giardiasis (“beaver fever”): Caused by a protozoan parasite, commonly either by drinking the parasite’s cysts from unfiltered drinking water, swallowing recreational water, or consuming food contaminated by feces from an infected human/animal. Hand washing and boiling/filtering/chemically treating drinking water are ways to prevent infection.

Cumulative Case Reports of Notifiable Diseases: 2014 (Purple) Spotted fever rickettsiosis (“Rocky Mountain spottedfever” is one type): Consists of several tick-borne diseases. Infection severity depends on which version of the disease presents; some infections can be very severe. Doxycycline treatment is the response to infection; prevention requires preventing tick bites.

Cumulative Case Reports of Notifiable Diseases: 2014 (Grey) Varicella (“Chicken pox”): Highly contagious viral disease. The virus remains latent in those infected, and can be reactivated (causing shingles). The disease tends to be mild in children but tends to be more severe in adults. Vaccine available.

Cumulative Case Reports of Notifiable Diseases: 2014 (Black) Salmonellosis: Foodborne disease caused by the bacteria salmonella. Most cases are mild but the disease can be fatal. In the 1990s, salmonella strains emerged which are antimicrobial resistant, and those strains are a serious public health concern. Proper food handling and preparation are the best ways to prevent infection.

Cumulative Case Reports of Notifiable Diseases: 2014 (Pink) Pertussis (“whooping cough”): Highly contagious bacterial disease of the respiratory tract, making it difficult for those infected to breathe. Occurs mainly in infants/young children. Untreated, a person can be contagious for three weeks after the first signs of coughing. Vaccine available.

Cumulative Case Reports of Notifiable Diseases: 2014 (Brown) Other Diseases: Amebiasis, Chikungunya virus, West Nile virus, Brucellosis, Campylobacteriosis, Cryptosporidiosis, Cyclosporiasis, Ehrlichiosis/Anaplasmosis, Haemophilus influenzae, Hemolytic-uremic syndrome, Hepatitis B, Hepatitis C, Legionellosis, Listeriosis, Lyme disease, Malaria, Meningitis, Meningococcal disease, Mumps, Q Fever, Shigellosis, Streptococcus pneumoniae, Toxic-shock syndrome, Transmissable spongioform encephalopathy, Tularemia, and Typhoid fever. In 2014, only Lane County and Edwards County lacked any residents having a reported disease.

What Is Your Role? The Board of Health has specific statutory responsibilities, is responsible for management and oversight of the local health department, has a duty to serve its constituents, including ensuring the health and safety of the community. What do you need to be successful?

Partnering With Your LHD Director In 2013, KALHD partnered with KAC on a project designed to engage county commissioners and provide information to them about the important role they play in management of public health To that end, we hosted a series of regional meetings with commissioners and health department directors and asked for their feedback on what is needed to successfully manage public health Some common themes emerged…

Successful Partnerships What do commissioners want from their health department directors? Frequent, timely, succinct communication in context of community needs and resources; no acronyms; explain the “why” as well as the “what”; updates on current events at the department and service utilization Prioritization of goals/requests Accountability (i.e. help explaining to taxpayers the what and why of how resources are invested) Provide choices and solutions Vision

Successful Partnerships What do health department directors want from their commissioners? Communication Investment, not just funding but also time, involvement, increased knowledge, participation, and support Clear expectations Budget that aligns with expectations Leadership Help with enforcement Vision

Role of Commissioners Embrace your role as the Board of Health. Comply with statutory requirements for public health services. Rely on your health department staff for their expertise. Partner with your health department to make informed decisions to improve the health of your community.

Michelle Ponce KALHD Executive Director michelle. ponce@kalhd. org www Michelle Ponce KALHD Executive Director michelle.ponce@kalhd.org www.kalhd.org 785-271-8391