1. Cathy White, Public Health Nurse Consultant
CDPHE Update 2017
Cathy White, Public Health Nurse Consultant

2. Topics for Today
Infectious disease update
Public Health Agencies and youth substance abuse prevention
Medication Take Back Program
Marijuana Research
Care Coordination collaboration with local Public Health

3. Infectious Disease Update: Fever
Defined as a temperature over 101°F orally in CDPHE’s guidance (see link)
No exclusion is necessary, unless the child has symptoms in addition to the fever, such as a rash, sore throat, vomiting, diarrhea, behavior changes, stiff neck, difficulty breathing, etc.**
Small differences in temperature due to different methods (such as a tympanic thermometer) shouldn’t change actions
** childcare-settings

4. Fever Guidance
CDPHE’s Infectious Diseases in Child Care and School Settings,
American Academy of Pediatrics Managing Infectious Disease in Child Care and Schools,
Caring for Our Children National Health and Safety Performance Standards Guidelines for Early Care and Education Programs.
A written policy shall be implemented for staff and children regarding symptoms of illness that require exclusion from the child care facility. Guidance documents listed in (C)(2) [above] should be used.**
**From: Rules and Regulations Governing the Health and Sanitation of Child Care Facilities
Additional guidance regarding infectious disease guidelines is provided CDPHE’s Infectious Diseases in Child Care and School Settings, the American Academy of Pediatrics Managing Infectious Disease in Child Care and Schools, and Caring for Our Children National Health and Safety Performance Standards Guidelines for Early Care and Education Programs. Child care facilities may rely on this guidance.
•A written policy shall be implemented for staff and children regarding symptoms of illness that require exclusion from the child care facility. Guidance documents listed in (C)(2) [above] should be used.’**
•Some variability exists between these guidance documents, but the important issue is to have a policy based on standard guidance (and report outbreaks to your local health dept!)

5. Have a policy based on standard guidance
Fever guidance
Some variability exists between these guidance documents, but the important issue is:
Have a policy based on standard guidance
Report outbreaks to your local health dept!

6. Mumps numbers are up
•CDC reports 5,311 cases for 2016 (Highest since 2010)
•Mumps cases have been higher in CO in 2016 (17) and so far in (14 as of 1/27/17)
•Several states are currently reporting outbreaks
–AR: 2,595 cases (as of 1/24/17)
–WA: 301 cases (as of 1/26/17)

7. Mumps numbers are up
•CDPHE and local health depts are currently investigating an outbreak in Denver Metro
•Make sure kids and adults are vaccinated!

8. Mumps
•Transmission: Direct contact with respiratory droplets or saliva from an infected individual
•Incubation Period: Average: days (Range: 12-25days)
•Infectious Period: Person is infectious 2 days before to 5 days after onset of parotitis

9. •Swelling and tenderness of one more of the salivary glands
Clinical Symptoms
•Swelling and tenderness of one more of the salivary glands
Unilateral or bilateral
•Low-grade fever
•Malaise
•Headache

11. Potential complications
Complications could include:
orchitis,
oophoritis,
encephalitis,
hearing loss,
mastitis,
pancreatitis

12. •Up to date vaccinations (2 doses of MMR)
Prevention
•Up to date vaccinations (2 doses of MMR)
•Exclude sick person from work/school 5 days after onset of parotitis

13. Varicella (Chicken Pox)
•Transmission
Contact with respiratory droplets
Direct contact with nasopharyngeal secretions or vesicular fluids from lesions (prior to crusting)
•Incubation Period: Average: days
(Range: 10-21days)

14. •Infectious Period Varicella
Person is infectious 2 days before onset of rash and until vesicles have formed scabs (approximately 5 days of rash onset)

15. Breakthrough Varicella
When a vaccinated person develops varicella more than 42 days after vaccination
Breakthrough infection is milder
Fewer lesions
More maculopapular rather than vesicular
May not have fever
(sometimes described as bug bites)

17. Up to date vaccinations
Prevention
Up to date vaccinations
Exclude symptomatic person from school until lesions have crusted over
Breakthrough varicella cases may be able to return to normal activities earlier because of fewer lesions

18. •Acute onset of generalized, itchy rash
Clinical Symptoms
•Acute onset of generalized, itchy rash
•Rapid progression from macules to papules to vesicular lesions
•Prodrome includes fever and malaise

19. Medication Take-Back Program
Goal: establishing at least one permanent collection location in every Colorado county.
All locations can accept prescribed controlled substances (e.g. Percocet, Vicodin, Xanax, Ritalin and Adderall) along with other prescribed and over-the-counter medications.

21. Items that can be accepted
Prescription medications, including prescribed controlled substances
Over-the-counter medications.
Liquid medications (small amounts in original, non-leaking containers).
Medicated patches (Used Fentanyl and Duragesic® patches are extremely hazardous. They may be folded in half, sticky-side together, and flushed down the toilet.)
Medication samples. Medicated ointments. Vitamins. Pet medications.
Unused drug injection cartridges, e.g. unused EpiPens® and insulin pens (must be unused with needle still protected inside)
Prescription medications, including prescribed controlled substances (DEA Schedule II– V).
Over-the-counter medications.
Liquid medications (small amounts in original, non-leaking containers).
Medicated patches (Used Fentanyl and Duragesic® patches are extremely hazardous. They may be folded in half, sticky-side together, and flushed down the toilet.)
Medication samples.
Medicated ointments.
Vitamins.
Pet medications.
Unused drug injection cartridges, e.g. unused EpiPens® and insulin pens (must be unused with needle still protected inside)

22. Cannot be accepted Marijuana.
Illicit drugs (e.g. DEA Schedule I drugs like heroin, LSD, etc).
Chemotherapy drugs.
Medical tools and supplies. Bloody or infectious waste. Personal care products.
Thermometers. Empty containers. Needles, syringes, and other sharps.
Medication wastes generated by health care facilities, including nursing homes.

23. Community Health Assessments
What does that mean for you?
Data
Schools should be at the stakeholder table
Public Health Improvement Health Plans follow
All Local Public Health agencies complete a community health assessment every 5 years

24. Completing New Community Health Assessments
Alamosa, Boulder Clear Creek, Conejos, Costilla, Delta, Eagle, Silver Thread District (Mineral & Hinsdale), Jefferson, Lake, Mesa, Montrose, Routt, Moffat, Jackson, Ouray, Rio Grande, Saguache, San Juan Basin, San Miguel, Tri County
Weld

25. Planning to Complete Health Assessment
Cheyenne,
Fremont,
Grand,
NorthEast, (Logan, Morgan, Sedgwick, Washington, Yuma, Phillips),
Summit
Teller

26. Youth Substance Use Prevention
Communities That Care (CTC) is a prevention system, grounded in science that gives communities the tools to address their adolescent health and behavior problems through a focus on empirically identified risk and protective factors.
engaging community stakeholders & establishing a shared community vision,
tools for assessing & Prioritizing levels of risk and protection in communities,
setting specific, measurable, community goals.
guides the coalition to create a strategic community prevention plan
Communities That Care (CTC) is a prevention system, grounded in science that gives communities the tools to address their adolescent health and behavior problems through a focus on empirically identified risk and protective factors.
CTC provides a structure for engaging community stakeholders, a process for establishing a shared community vision, tools for assessing levels of risk and protection in communities, and processes for prioritizing risk and protective factors and setting specific, measurable, community goals.
CTC guides the coalition to create a strategic community prevention plan designed to address the community's profile of risk and protection with tested, effective programs and to implement the chosen programs with fidelity.
CTC instructs the coalition to monitor program implementation and to periodically reevaluate community levels of risk and protection and outcomes, and to make adjustments in prevention programming if indicated by the data.
Implementation of CTC is organized into five stages, each with its own series of "benchmarks" and "milestones" to help guide and monitor implementation progress. CTC is installed in communities through a series of six training events delivered over the course of 6 to 12 months by certified CTC trainers.

27. Youth Substance Use Prevention
Alamosa, Boulder, Broomfield, Chaffee,
Cheyenne, Clear Creek, Costilla, Denver, Eagle,
El Paso, Fremont, Grand, Gunnison, Hinsdale, Mineral,
Jefferson, Lake, Larimer, Las Animas-Huerfano, Mesa,
Routt, Moffat, Jackson, Otero, Ouray, Pueblo, Rio Grande,Saguache,
San Juan Basin, Summit, Teller, Tri County, Weld

28. Medical Marijuana Research Grants
Marijuana use in Adolescents and Young Adults with Inflammatory Bowel Disease
Tolerability and Efficacy of Cannabidiol (CBD) on Tremor in Parkinson's Disease
Treating PTSD with Marijuana
Cannabidiol (CBD) and Pediatric Epilepsy
Medical Marijuana in the Pediatric Brain Tumor Population (palliative care)
Medicinal Cannabinoids as Adjunctive Treatment for pediatric epilepsy
Total of $9,000,000 Funded accrued over time from the application and distribution of Medical marijuana Cards
Do Adolescents and Young Adults with Inflammatory Bowel Disease Benefit from Use of Marijuana?
A Randomized, Double-blind, Placebo-controlled Crossover Study of Tolerability and Efficacy of Cannabidiol (CBD) on Tremor in Parkinson's Disease
Treating PTSD with Marijuana: Clinical and Functional Outcomes
Cannabidiol (CBD) and Pediatric Epilepsy
Medical Marijuana in the Pediatric Brain Tumor Population (palliative care)
Use of Medicinal Cannabinoids as Adjunctive Treatment for Medically Refractory Epilepsy (pediatric epilepsy)
Placebo-controlled, Triple-Blind, Randomized Crossover Pilot Study of the Safety and Efficacy of Four Potencies of Smoked Marijuana in 76 Veterans with Chronic, Treatment- Resistant Post Traumatic Stress Disorder (PTSD)
A Double Blind, Placebo-Controlled Cross Study Comparing the Analgesic Efficacy of Cannabis versus Oxycodone
Colorado Cannabis Cohort: Efficacy, Safety, and Usage Patterns of Medical Marijuana for Sleep

29. Medical Marijuana Research Grant
Safety and Efficacy of Smoked Marijuana in 76 Veterans with Resistant Post Traumatic Stress Disorder (PTSD)
Comparing the Analgesic Efficacy of Cannabis versus Oxycodone
Efficacy, Safety, and Usage Patterns of Medical Marijuana for Sleep

30. Marijuana Public Health Research Grants
Comparative Assessment of Driving Impairment in Occasional Versus Heavy Marijuana Users
Acute Effects of Dabbing on Marijuana Intoxication, Driving Impairment & cognitive functioning
Duration of marijuana concentration in Breast Milk
Older Coloradoans and Marijuana: A Public Health Problem or Policy alternative
The Adverse Effects of Edible Cannabis Products
Analysis of Data from before and after implementation of Recreational marijuana in Colorado
Cardiovascular effects of Marijuana in at risk patients
Total $2, Some over 1-3 years study
Comparative Assessment of Driving Impairment in Occasional Versus Heavy Marijuana Users
Acute Effects of Dabbing on Marijuana Intoxication, Driving Impairment & cognitive functioning
Duration of marijuana concentration in Breast Milk
Older Coloradoans and Marijuana: A Public Health Problem or Policy alternative
The Adverse Effects of Edible Cannabis Products
Analysis of Data from before and after implementation of Recreational marijuana in Colorado
Cardiovascular effects of Marijuana in at risk patients

31. Questions? Cathy White, RN, MSN cathy.white@state.co.us