Investing early to prevent hepatitis A outbreaks among people living homeless

Patty Hayes.jpg

By Patty Hayes, RN, MN Director, Public Health – Seattle & King County

In recent years, urban areas in the US have been grappling with hepatitis A outbreaks affecting people experiencing homelessness. In 2017 in San Diego County, nearly 600 people were infected with hepatitis A, over 400 were hospitalized, and 20 people died as the result of an outbreak centered among people living without permanent shelter. The costs were astounding: San Diego County ultimately spent over $12 million responding to the outbreak, and the emotional toll on people living homeless and those who love and support them was impossible to quantify.

According to the 2019 Point in Time Count, there are over 11,000 people living homeless in King County. Given this large vulnerable population, when Public Health – Seattle & King County identified our first case of hepatitis A in someone living homeless in April 2019, we deployed both a public health response and a preventative strategy. Based on the risk of a large outbreak, I am pleased to announce King County has allocated $375,000 to expand our provision of free hepatitis A vaccinations to people living homeless. This new funding will allow us to intensify and expand hepatitis A vaccination efforts to help reduce the risk for large scale outbreaks.

A free hepatitits A vaccine clinic held at the Salvation Army Jefferson Day Center. Pictured are Gayle Kneeland, a nurse volunteer with the King County Public Health Reserve Corp, and Dr. Robert Johnston, a physician volunteer with the King County Public Health Reserve Corp.

A free hepatitits A vaccine clinic held at the Salvation Army Jefferson Day Center. Pictured are Gayle Kneeland, a nurse volunteer with the King County Public Health Reserve Corp, and Dr. Robert Johnston, a physician volunteer with the King County Public Health Reserve Corp.

The source of this funding is King County’s Loss Control Program. Within the Office of Risk Management Services, the Loss Control Program works with King County agencies to identify areas of potential loss and recommend strategies to reduce exposure to liability. It is dedicated to addressing unanticipated risks where advanced planning and budgeting is not possible.

Our County leadership understands the importance of investing early. In announcing this funding, King County Executive Dow Constantine said: “Providing hepatitis A vaccinations for people experiencing homelessness is an issue of equity, a prudent financial move, and a public health imperative. It’s our duty to protect the most vulnerable among us, and by investing in prevention we may avoid spending millions responding to the major outbreaks we’ve seen in other areas.”

Over the next few months, we will expand our free hepatitis A vaccination clinics for people experiencing homelessness throughout King County. Our goal is to deliver vaccinations to hundreds more people at high risk for infection. Vaccination teams will work in conjunction with community organizations, shelter operators and low-income housing providers as well as utilizing our Healthcare for the Homeless Network’s Mobile Medical Van to offer vaccines to people living in encampments, villages, and on the street.

Vaccination efforts for people without permanent shelter can be time-intensive. Multiple visits to shelters and encampments are required as staff build trust and provide preventive vaccinations to this highly-mobile population. I am grateful that in King County we are dedicating the resources to successfully implement this vital work.

Follow along with the work of Public Health – Seattle & King County on their Public Health Insider blog.

Innovating to Reduce Harm in Las Vegas

The costs of the opioid crisis are a top concern among policymakers in Washington, DC, and continue to dominate headlines daily. The cost in human life, family suffering and finances is sobering. In 2017, the nation lost more than 47,000 Americans to opioids, and in my home state, Nevada Department of Health and Human Services Office of Analytics reports that there were 401 opioid-related overdose deaths. This week, a new study estimated that the federal tax revenue lost to the opioid epidemic totals $26 billion, nationally. Diseases related to drug use have also surged, with Hepatitis C increasing 133 percent between 2004 and 2014, tracking with the growth of opioid injection hospital admissions. Reports of dangerous, dirty needles littering public parks and neighborhoods are common.

A Standardized Approach is Needed to Address Social Determinants of Health

By Dr. Colleen Bridger, MPH, PhD.
Director
San Antonio Metropolitan Health District

America leads the world in medical research and medical care and for all we spend on health care, we should be the healthiest people on earth. Yet on some of the most important indicators, like how long we live, we’re not even in the top 25, behind countries like Bosnia and Jordan. There is growing recognition that health starts – long before illness – in our homes, schools and jobs. In fact, only about 20 percent of a person’s health happens in the doctor’s office – the rest happens out in the world and things like healthy air and water may not be in a person’s control.

Now is the Time to Tell Policymakers that Trauma Matters to Our Health

By Kelly Colopy, MPP, BCHC Chair and Director, Long Beach Health Department Director
and
Amanda Merck, MPH, Senior Research Area Specialist, Salud America!, UT Health San Antonio  

Public health professionals all over the country are leveraging practice and policy strategies to address the issue of trauma, including incorporating a “trauma-informed” point of view into the way they conduct business. In recent years, public health science and practice has become more cognizant of the evidence of, and action needed, to support those who suffer from trauma. This awareness and response is starting to transform the field.

Wrapping Up the Highs and Lows of Urban Public Health in 2018

By Chrissie Juliano, Director, Big Cities Health Coalition

As 2018 winds down, I am celebrating my four year anniversary with the Big Cities Health Coalition, which has been a leader in the urban public health field for 16 years. While our membership, staffing, location, and infrastructure have changed over the years, our mission, vision, and goals remain the same: to protect health of those who live in America’s big cities for present and future generations.

Guarding against viral misinformation this flu season

By Joseph P. Iser, MD, DrPH, MSc
Chief Health Officer
Southern Nevada Health District

As a clinician and a public health professional, I see every day how technology can help providers give patients useful information, better care, and drive better outcomes. As doctors, we use online toolkits to help treat our patients, eReferrals to provide more efficient access to smoking cessation resources, and electronic health records can make everything more accessible for both providers and patients. In my role as the Chief Health Officer of the Southern Nevada Health District, I’ve also come to see what a valuable public health tool technology and social media can be. In our agency, we use Twitter, Facebook, and YouTube throughout the year to educate and motivate our community on public health issues from violence, to STDs, and of course, the flu. We created a new video earlier this year about the importance of the flu vaccine and have a Twitter account dedicated to information about the flu.

World AIDS Day 2018: Progress Continues, Disparities Remain

By Kim Rodgers, Communications Specialist, National Association of County and City Health Officials

World AIDS Day, observed annually on December 1, provides the opportunity to highlight our accomplishments, remember those who have lost their lives to HIV and AIDS, and refocus our efforts on what still needs to be done to end the epidemic. Local health departments are in the forefront of these efforts, working on initiatives to address the prevention and treatment of HIV and AIDS and support work towards a cure.

Child Development-Community Policing: How One Local Health Department Joins Local Police on The Front Line in The War on ACEs

By Stacey Butler, LCSW, Child Development-Community Policing Director
and Gibbie Harris, Director
Mecklenburg County Public Health

Gunshots ring out at a Charlotte, North Carolina apartment complex, and a five-year-old girl is struck in the leg by a stray bullet. Charlotte-Mecklenburg Police (CMPD) arrive on scene.  Recognizing the potential psychological trauma for the child and her family, they call the Child Development-Community Policing (CD-CP) on-call clinician. She responds within minutes, providing acute trauma intervention alongside her officer partner, who is beginning the work of helping the child and her family feel safe again. This officer-clinician team continues to visit the family over the next few days and weeks to assess progress and needs, providing targeted interventions, and helping reestablish a sense of safety both inside and outside their home.

Ten lessons we learned about how to deploy teams into post-hurricane settings

By Mitch Stripling, MPA, Assistant Commissioner, Bureau of Agency Preparedness and Response; Colin Stimmler, MA, Senior Director for Agency Preparedness and Response at the New York City Department of Health and Mental Hygiene

Disasters like Hurricane Michael show how severe the public health impacts from a coastal storm can be.  When disasters like this strike, many local and state health workers are often willing to help in another jurisdiction, but they aren’t quite sure how.  

New Report: Shortage of “Disease Detectives” in Local Health Departments Puts Cities at Risk

By Big Cities Health Coalition and Council of State and Territorial Epidemiologists staff

Epidemiologist, noun
epidemiologist \ˌe-pə-ˌdē-mē-ˈä-lə-jist
An expert scientist who studies, detects and tracks injuries and disease in our communities.

Epidemiologists serve on the front lines of public health, protecting Americans and the global community. When health threats emerge, these “disease detectives” investigate. They identify the causes, factors and patterns associated with illness, determine who is at risk, collect evidence to recommend preventive actions, and rapidly implement control measures. Epidemiologists also respond to major health hazards including emerging threats such as Zika and Ebola, as well as natural disasters such as floods and hurricanes. They also work on chronic issues facing communities including obesity, diabetes, cancer, HIV/AIDS and motor vehicle crashes.

Big Tobacco is marketing vapes to our kids, so our city took them on and won — it’s the FDA’s turn now

By Tomás Aragón, MD, DrPH, Health Officer and Director, Population Health Division, Derek Smith, MSW, MPH, Tobacco Free Project Director, San Francisco Department of Health

This blog originally appeared here in the Hill.

The FDA recently announced that it considers a new surge in teen e-cigarette use to be an epidemic, and will give e-cigarette manufacturers 60 days to prove that they are not marketing to kids. This is a very welcome move for those of us who have been pushing to prevent teen tobacco use. Our city recently took on the makers of e-cigarettes and won. The FDA should take San Francisco's lead and do everything it can to protect kids from Big Tobacco.

Hurricane Harvey: In the Eye of the Storm

By Big Cities Health Coalition Staff

It’s been one year since Hurricane Harvey hit Houston and the surrounding area with record-breaking rain and devastating floods which inflicted injuries, infectious diseases, chemical exposures and mental trauma on residents. Public health officials from the Houston Health Department, a member of the Big Cities Health Coalition, were on the front lines in the lead up to the hurricane and its aftermath. Today, many are reflecting on the events of those four historic days in August 2017 and what lessons were learned, and can still be learned, from the disaster.

Let schools be places for learning—not “JUULing”

By Brian A. King, PhD, MPH, Deputy Director for Research Translation, Office on Smoking and Health, Centers for Disease Control and Prevention

Remember your high school bathroom? If it was anything like mine, the bathroom was a fairly foul-smelling place that you wanted to leave as quickly as possible.

But things are changing. Kids are flocking to school bathrooms across the country faster than the cafeteria on pizza day. School bathrooms have become places where students gather to socialize and use e-cigarettes—in particular, e-cigarettes shaped like USB flash drives that deliver a high level of nicotine.

Minneapolis Health Department Supports a Young Food Entrepreneur

By Dan Huff, Director of Environmental Health, and Gretchen Musicant, Commissioner of Health, Minneapolis Health Department

This blog originally appeared here on The National Association of County & City Health Officials (NACCHO) Essential Elements Blog.

Jaequan Faulkner, 13, started selling hot dogs in front of his Minneapolis home in 2016, calling his establishment “Mr. Faulkner’s Old Fashioned Hot Dogs.” His food stand came back this summer bigger and better than before, and it grew popular with customers in the neighborhood.

Recently, his business came to the attention of local officials when someone complained that he did not have official permits.

To make sure people are safe from food-borne illnesses, all events that serve food to the public in Minneapolis must be permitted, and violators are subject to an immediate shutdown.

Our Top Takeaways from NACCHO Annual 2018

By Big Cities Health Coalition Staff

We just returned to D.C. from the NACCHO Annual Conference, a summer pilgrimage for public health enthusiasts, which took place this year in New Orleans. The theme of this year’s conference was Unleashing the Power of Public Health. Our time in The Big Easy was especially frenetic this year, with lots and lots of sessions that we found fascinating. Below is a collection of our top takeaways from some of the most engaging sessions we participated in. Tell us which moments you thought were most important in the comment box below, or on Twitter at @BigCitiesHealth.

Public Health and Medical Community Pledge to Decrease Gun Violence

By Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County

This blog originally appeared here in the Public Health - Seattle & King County blog Public Health Insider

Firearm-related injury and death, from suicide to accidental injury and homicide – is a major public health problem and a leading cause of premature death in King County and nationally. In 2016, 663 adults and 20 children died from a firearm injury in Washington state, including 144 adults and 7 children from King County.

Firearm-related injuries have very high personal and financial costs to individuals, families and society – and that’s why prevention is essential.  In 2015, the cost of firearm fatalities alone (not counting non-fatal injuries) in King County was almost $200 million from medical costs and lost productivity, and nationally the cost is in the hundreds of billions of dollars each year.


LGBTQ Pride and Public Health

By Ginger Lee, MPH, Bureau Manager, Collective Impact & Operations,
Long Beach Department of Health and Human Services

June is LGBTQ Pride month.  Pride is a time when lesbian, gay, bisexual, transgender, queer and questioning people join together to further strengthen community by celebrating joyously, with parades and other events.  Pride is also a time when the LGBTQ community remembers its history. And for public health professionals, Pride is a time to reflect on what we can do to address social conditions that negatively affect the health of LGBT people, and to strengthen conditions that support health within our LGBTQ communities.