1. 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?

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

3. 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

4. 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

5. 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

6. 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

7. 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.

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

9. 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 . . .

10. 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
: Sanitary codes, administration of
K.S.A : 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

11. Disease Surveillance and Containment
65-202: Local health officer responsible for communicable disease investigations and control measures (also in )
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
Health tests and inoculations (purchase and provision of vaccines; 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”

12. Isolation and Quarantine
& K.A.R : Isolation and quarantine for specific diseases
Also & K.A.R 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”

13. 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 , and through ; and by K.A.R and ).
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.

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

15. 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).

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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?

27. 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…

28. 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

29. 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

30. 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.

31. Michelle Ponce KALHD Executive Director michelle. ponce@kalhd. org www
Michelle Ponce KALHD Executive Director