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2010 Grant County Public Health Potpourri

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2010 Grant County Public Health Potpourri

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  1. Grant-Adams County Medical Society Meeting Monday, October 11th, 2010 Alexander L. Brzezny, MD, MPH, FAAFP Health Officer Grant County Health District (GCHD) 2010 Grant County Public Health Potpourri

  2. State of the Public’s Health in Grant County. • Is our resident’s health better than 2 years ago? • H1N1 2009-2010 Pandemic in Numbers. • Who became infected and where? • 2010-2011 Influenza Season. • How to diagnose, what to report, what is new? • Pertussis Resurgence in the United States. • Why now, why here, and how to fight it? TOPICS and objectives

  3. Grant County State of the PUBLIC’s health 2010 http://www.doh.wa.gov/HWS/GHS2007.shtm http://www.doh.wa.gov/PHIP/products/phi/indicator.htm\ http://www.countyhealthrankings.orghttp://www.wspha.org/2010HealthChamps

  4. Notifiable Conditions, Grant County, 2010 Chlamyd. HCV Pertussis Salmonel.

  5. Years of healthy life expected at age 20 (2009) Seattle-KING 55 years KITTITAS 54 years (74 years total) CHELAN -DOUGLAS 51 years (71 years total) GRANT 46 years (66 years total)

  6. Adult physical activity (2007) GRANT 58% SAN JUAN 74% ADAMS 64%

  7. Adults with diabetes (2008) KITTITAS 5% Seattle-KING 6% CHELAN-DOUGLAS 7% GRANT 9% (ADAMS 11%)

  8. Low birth weightrate (per 1,000) (2009) KITTITAS 3/1,000 GRANT 6/1,000 ADAMS 6/1,000

  9. Teen birth rate (per 1,000) Seattle-KING 10/1,000 GRANT 35 /1,000 (ADAMS 57 /1,000)

  10. Teens overweight CHELAN-DOUGLAS 23% GRANT 32% ADAMS 34%

  11. Adult preventive cancer screening - Colorectal KITTITAS 70% GRANT 61%

  12. Adult dental care BENTON FRANKLIN 78% GRANT 59%

  13. Food service safety Counties with 100% GRANT 92%

  14. Reported child immunizations GRANT 68% (ADAMS 71%) SPOKANE 28%

  15. Maternal cigarette smoking ADAMS 2% GRANT 10% SPOKANE 19%

  16. Adults with unmet medical needs GRANT 13% OKANOGAN 19% ADAMS 22%

  17. Teen physical activity ADAMS 54% GRANT 50% Seattle-KING 40% SNOHOMISH 41% YAKIMA 42%

  18. Where does Grant County rank in health factors and outcomes among WA State counties? • A. Top 10% • B. Top 30% • C. Just about in the middle • D. Bottom 30% • E. Bottom 10% QUIZ question #1 (U. of WI)

  19. Grant County Health Factors (#28 /39)

  20. Grant County Health Factors (#28 /39) • Health Behaviors: #30 (obesity, smoking, teen birth rate, Chlamydia rate, drinking); #1 San Juan • Clinical Care: #31 (uninsured, DM2 screening, hospice use, primary care); #1 Sea-King • Social and economic factors: #27 (HS graduation, income inequality, single-parent, children in poverty); #1 Whitman • Physical environment: #7 (pollution, healthy foods access; liquor stores density); #1 Garfield

  21. Grant Morbidity & Mortality (#28 /39)

  22. Grant MORBIDITY and MORTALITY • Mortality: #28 (premature death); #1-#3 Whitman, San Juan, King • Morbidity: #27 (poor physical or mental health days (DAYS /YEAR), low birth weight, poor health (%)); #1-#3 San Juan, Douglas, Kittitas

  23. Where does Grant County rank in health factors and outcomes among WA State counties? • A. Top 10% • B. Top 30% • C. Just about in the middle • D. Bottom 30% • E. Bottom 10% QUIZ question #1

  24. Population growth with socioeconomically challenged in-migration Grant ranks at the bottom 30% for health in WA Several indicators demonstrate a persistent lack of improvement: lower life expectancy, less physical activity, higher rates of DM2, high teen overweight, lower preventative services utilization, low birth weight, and alarming teen pregnancy rate. BAD NEWS (Grant County)

  25. Grant Co. residents enjoy open spaces, low traffic and pollution, proximity to healthy foods and outdoor recreation. CHILD PROFILE utilization is high. Maternal smoking rate is low and overall smoking rate is dropping (cost?). Grant Co. teens are more active than those in most of the state. Access to healthcare services is good. SOME Good news (Grant County)

  26. 2009: • Budget ~$2.2mln (final) • Staff ~27.0+ FTE • 2011 (projected) • Budget ~$1.7+mln (in 1999: $1.86mln) • Staff ~22.0+ FTE (in 1999: 25.6 FTE) • (Grant Co. population in 2000: 74,698) • (Grant Co. population in 2010: ~90,000) PUBLIC HEALTH FUNDING AND STAFFING

  27. Grant public health, 20052011 H1N1 DRAFT DOCUMENT, GCHD, 10/11/2010

  28. Grant County and Washington state 2009-2010 H1n1 PANDEMIC in numbers http://www.doh.wa.gov/notify/other/H1N1SummRpt.pdf

  29. Which County in Washington experienced the second highest severe pan-H1N1 disease rate during 2009-2010 season? Which one the highest? • A. Whatcom County (Bellingham) • B. King County (Bellevue) • C. Grant County (here) • D. Adams County (near here) • E. Pend Oreille County (Newport) QUIZ question #2 (DOH)

  30. 20 2009-2010 Influenza A H1N1 Virus hemagglutinin neuraminidase type of nuclear material strain number year isolated virus type geographic origin virus subtype A/Mexico/4108/2009 (H1N1)

  31. Pandemic H1N1 2009 Pedigree, 1979-2009 2009 Human A/H1N1 (2009-??) Eurasian Swine A/H1N1 (1979-present) ? Human “seasonal” A/H3N2 (1968-present) Avian Influenza viruses “Triple reassortant” Swine A/H1N2 (1998-present) North American Swine A/H1N1 (1918-present) Human “seasonal” A/H1N1 (1977-present)

  32. April 15 – first U.S. case confirmed by CDC (CA) April 26 – U.S. Government declares a “public health emergency” May – CDC provides prototype vaccine virus to manufacturers June 11 – WHO raises pandemic level to 6 June 19 – H1N1 reported in all 50 states October 6 – first H1N1 vaccine doses admin’d April 2010 – first confirmed H1N1 death in Grant Pandemic H1N1 Influenza Virus - Timeline

  33. Extrapolation ’08‘09 season

  34. Washington Laboratory Surveillance, 2009-2010 First Wave Second Wave

  35. Number of severe H1N1 cases (WA) (n=1667) Second Wave Third Wave ? First Wave

  36. Number of severe h1n1 (by WA region)

  37. Number and rate of h1n1 (1st wave)

  38. Number and rate of severe 2009 H1N1 by age group, April–August 2009 (n=188) 8.9

  39. Number and rate of critical H1N1 by age, April–August 2009 (n=63); (2nd wave) 0.9 0.9

  40. Number and rate of severe flu A by age, Sept 2009–April 2010 (n=1479), (2nd wave)

  41. Number and rate of critical influenza A by age, Sept 09–April 10 (n=360); (2nd wave) 8.2

  42. Number and rate of fatal flu A by age group, Sept 09–April 10 (n=81); (2nd wave) 2.3 2.2 1.2 0.2

  43. Number of fatal 2009 H1N1 by county, April–August 2009 (n=17)

  44. Number of fatal influenza A by county, September 2009–April 2010 (n=81)

  45. Rate of severe 2009 H1N1 by WA county, April–August 2009 (n=188)

  46. Rate of severe influenza A by WA county, September 2009–April 2010 (n=1479)

  47. Which County in Washington experienced the second highest severe pan-H1N1 disease rate during 2009-2010 season? • A. Whatcom County (Bellingham) • B. King County (Bellevue) • C. Grant County (here) • D. Adams County (near here)  2nd highest • E. Pend Oreille County (Newport)  highest QUIZ question #2

  48. Two distinct pandemic waves. Grant County: 1 fatality, 31 severe cases. Grant County severe disease rate: 36 /100,000 WA State: at minimum confirmed 1,650 hospitalizations and deaths in WA were due to this novel influenza virus (4,459 CDC estimate). Severe disease rate greater in E. Washington (especially 2nd Wave). Pre-school children: highest hospitalization rate. 5-24 y.o. age group had highest attack rate. Summary of the 2009-2010 h1n1 (I.)

  49. Pregnant 8-11x more likely to be hospitalized and 3-4x more likely to be admitted to an ICU. Fatal and critical cases treated later than those with less severe disease. Most hospitalized and fatal cases had an ACIP-recognized high risk medical condition (asthma, chronic lung disease, and diabetes). Overall, H1N1 less severe than anticipated. Summary of the 2009-2010 h1n1 (II.)

  50. 1.4 influenza deaths per 100,000. • 24.7 severe influenza cases per 100,000. • 5% of severe cases died in the 1st Wave compared to 9% deaths among the severe cases in the 2nd Wave. • GRANT COUNTY HEALTH DISTRICT • Cost: $360,000 (or $4.50 per resident) • 70 volunteers augmenting 28 staff (100 individuals) • 8,920 vaccines given in 8 weeks (11% population) • WSPHA recognized GCHD for “exemplary public service”. Summary of the 2009-2010 h1n1 (III.)