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In this issue:
Archive
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VDH Launches Virginia Health Beat Kelly Vance Lobanov -- Editor The Virginia Department of Health is pleased to announce the premiere of its first Web-based newsletter, Virginia Health Beat. "Communication is key in our mission to protect the public's health," said State Health Commissioner, Robert B. Stroube, M.D., M.P.H. The quarterly publication provides Virginians insight into the various programs VDH offers and a better understanding about their impact on the community.
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VDH Finalizes SARS Emergency Response Plan The Virginia Department of Health has finalized development of an emergency response plan for severe acute respiratory syndrome (SARS). The plan details overall procedures for the public health response in the event of a SARS outbreak in Virginia. "The response from local health departments and clinicians in Virginia in reporting and isolating potential SARS cases has been outstanding and has proven effective," said State Health Commissioner Robert B. Stroube, M.D., M.P.H. "This written plan goes beyond what we have so far experienced and provides us with well thought out steps to take in the event of a more serious public health situation." A $22 million federal grant received last year from the U.S. Centers for Disease Control and Prevention has provided for the hiring of more than 100 public health officials to assist with emergency preparedness and response. They include thirty-five epidemiologists located throughout the state to assist with disease investigations, such as SARS. "The federal grant dollars we received last year to bolster our public health infrastructure for response to bioterrorism also has improved our ability to respond to natural outbreaks of disease," Dr. Stroube said. In April 2003, the State Health Department announced that SARS had been added as a reportable disease in Virginia as part of its ongoing efforts to identify suspect cases and limit spread of the disease. Physicians and clinicians are required to provide information to VDH about any reportable disease. For a copy of the SARS Response Plan, log onto the Virginia Department of Health's Web site at www.vdh.state.va.us/epi/newhome.asp.
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Richmond MMRS Holds Mock Emergency Drill The Richmond Metropolitan Medical Response System (MMRS) recognizes the need for emergency preparedness in the event of a mass medical emergency impacting the Richmond-area, and a group of professionals convened recently to address that need. MMRS, a consortium of professionals from all over the metropolitan region brought together to address and coordinate regional medical system preparedness, held an all-day, simulated emergency drill on June 11, 2003 at the Richmond Convention Center. The drill encompassed a staged infectious disease outbreak concurrent with an international terrorist attack aimed at a cluster of fictitious communities in Central Virginia. The drill tested the region's emergency response capabilities in various areas including planning, command and control, and operations. Nearly two hundred individuals from various federal, state, and local agencies, as well as volunteer and community service organizations, and private businesses, all served various functions throughout the drill. The simulated emergency included several examples of incidents which might occur in a real-life crisis including terrorist shootings at a local hospital, a train derailment with mass casualties, the release of a toxic contaminant in the water supply, the assassination of a retired Virginia Senator who candidly professed anti-terrorist political views, and continuous breaking news media updates. The drill events also allowed the group to practice mobilizing and caring for patients as well as activating the Strategic National Stockpile of medicines. "MMRS has held a series of summits over the past three months which have helped to better prepare this group to respond in a medical crisis. The summits and drill exercise have enabled us to more efficiently address vital response issues and make improvements in our existing plans," said MMRS Steering Committee Chairman William R. Nelson, M.D., M.P.H. Previous sessions also provided participants with a fuller understanding of how Hospitals, Public Health, Emergency Medical Services, Government Agencies, Fire, Law Enforcement, Public Affairs, and Emergency Management systems all work together in a mass medical event. "An activity such as this is bound to uncover some areas that require strengthening and improvement. However, this exercise was hugely successful in that it fostered good communication among the various agencies that would closely interact in a real medical crisis," said Dr. Nelson. "It challenged our views of what a mass medical emergency response should entail and allowed participants to 'act out' a scenario and subsequently take steps to revamp existing response plans." MMRS will provide future opportunities for multi-agency, multi-jurisdictional interaction, and continue to offer activities that illustrate how the entire regional system works during a mass medical response situation.
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| In
the News
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Exotic Pets May Pose Health Risks: Salmonella Infection Linked to Reptiles
Salmonellosis is a bacterial disease that can be spread from reptiles (including turtles, lizards, snakes and tortoises). According to the U.S. Centers for Disease Control and Prevention, an estimated 70,000 people get salmonellosis from contact with reptiles in the United States each year. A person who has been infected with Salmonella may experience mild or severe diarrhea, fever and occasional vomiting. Blood stream infections can be life threatening, especially in the very young, the elderly or in persons with weakened immune systems. Some people are more likely than others to get salmonellosis. Infants, children under age five, organ transplant patients, people with HIV/AIDS, and people receiving treatment for cancer are at greater risk for serious complications, or in rare occasions, death, from salmonellosis. Animals can have the same symptoms as people, but infected reptiles usually do not show any symptoms at all. Nearly 100 percent of reptiles carry the Salmonella bacteria. It is shed in the feces of the animal. People become infected if they do not wash their hands properly after touching the feces or after touching a surface that has been contaminated by the feces, like surfaces touched by the animal in its space or around the house if allowed to roam free. Case studies involving infants who became ill from salmonellosis from reptiles suggest that the children had no direct contact with the animals. Instead, they became infected via another family member who handled the reptile or from using eating utensils or bottles that were washed in the same sink as the reptile or its cage. The Virginia Department of Health suggests at a minimum that reptiles not be kept in households and daycare centers with children under the age of five. "Children that small are not old enough to understand the consequences of putting their fingers or toys in their mouths," explained Dr. Suzanne Jenkins, Assistant State Epidemiologist. "Children of any age who do not understand the importance of washing their hands should not have access to reptiles. Keeping reptiles as pets in homes where there are small children is an unnecessary and avoidable risk." For more information on salmonellosis, go to http://www.vdh.state.va.us/epi/salmf.htm. To learn more about reptiles and Salmonella go to http://www.cdc.gov/healthypets/animals/reptiles.htm.
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Bad bug Vibrio vulnificus: The Raw Deal
Vibrios are bacteria that can cause gastrointestinal illness in people who eat raw or undercooked molluscan shellfish, regardless of age or health history. Some people with certain health conditions (liver disease, excessive alcohol intake, diabetes, AIDS or HIV infection, stomach disorders, inflammatory bowel disease, cancer, abnormal iron metabolism, steroid dependency or any illness or medical treatment which results in a weakened immune system) can suffer serious illness or even death from a kind of Vibrio bacteria called Vibrio vulnificus.
In addition to frequent monitoring of water and shellfish quality, technological advances in the commercial shellfish industry offer the connoisseur alternatives to an otherwise raw deal. Three post-harvest treatment methods: individual quick freezing (IQF), low heat pasteurization, and high pressure processing allow people to enjoy raw shellfish safely. Since 1989, an increasing number of commercial processing facilities that sell oysters on the half shell destroy Vibrio bacteria using the IQF method (cryogenically or quick blast freezing). Low heat pasteurization has been an option since 1995. This process involved partially cooking in-shell oysters in hot water and then quickly chilling them in cold water. High-pressure processing is the newest post-harvest treatment technology. In-shell oysters are subjected to hydrostatic -high pressure up to 45,000 psi (pounds per square inch). The process automatically separates oysters from their shells. The oysters are placed in a special pressure chamber that can generate high levels of hydrostatic pressure. Each of these methods is effective in reducing Vibrio vulnificus bacteria to undetectable levels. All treated oysters and clams come with labels indicating post harvest treatment. Consumers should note that Vibrio bacteria do not change the appearance, taste, or odor of oysters or clams. Eating raw oysters or clams with hot sauce or while drinking alcohol does not destroy the bacteria. If you do not bring home treated oysters and clams, the only solution for destroying the bacteria and eliminating the risk of infection is to thoroughly cook them. The Virginia Department of Health warns that people at "high risk" should never eat raw shellfish. For more information about Vibrio vulnificus and raw shellfish log on to http://www.vdh.state.va.us/epi/oystersvibrio.pdf
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Tetanus on the Rise in Young Americans A recent review of tetanus by the U.S. Centers for Disease Control and Prevention (CDC) reported 130 cases of tetanus in the U.S. between 1998 and 2000, up slightly from the previous three years. The report also found a continuation of a trend, seen during the past decade, of more people under the age of 40, and even 20, getting infected. Although these numbers may seem small, each case of tetanus is tragic because the disease is easily preventable with vaccine. Tetanus is a serious, sometimes fatal disease caused by bacteria spores that enter the body through cuts in the skin. Spores can enter through even a tiny pinprick or scratch, but thrive in deep puncture wounds or cuts. Tetanus may follow surgery, burns, deep puncture wounds, crush wounds, ear infections, tooth infections, splinters, animal bites, abortion, pregnancy, injection drug use, body piercing, and tattooing.
Once inside the body, tetanus produces a toxin. As the toxin spreads, it causes painful muscle spasms in the neck, arm, and stomach that are often strong enough to break bones. Even with good medical care, recovery is slow and may take up to several months. The disease was fatal in 18 percent of the most recent cases. A vaccine to prevent tetanus was first produced in 1924. Today the vaccine is often combined with diphtheria and pertussis vaccine when given to children and combined with diphtheria when administered to adults. Due to waning antitoxin titers, tetanus immunizations given during childhood do not produce lifelong immunity. Most individuals have antitoxin levels below optimal levels 10 years after the last dose of tetanus toxoid containing vaccine. As a result, additional doses of vaccine are required every 10 years to maintain protective antitoxin titers. Many Americans, however, haven't received a booster vaccination in the last 10 years. The CDC estimates that over half of Americans over age 20 are not properly vaccinated against tetanus and are vulnerable to the potentially deadly illness. Tetanus vaccine is available at your local health department so protect yourself from this potentially deadly disease today by getting immunized. |
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| Your
Community
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Refugee and Immigrant Health Program Commemorates World Refugee Day Close your eyes. Think of your home, with all of its comforts, such as running water, adequate heating and air conditioning, and a fully stocked refrigerator. Now consider your neighborhood, with those well-manicured lawns, safe cul-de-sacs, and the joyous sound of children playing. Imagine how you would feel if this tranquility were suddenly disrupted by the sound of heavy artillery, armored vehicles and bombs detonating. Fear, panic, confusion and dread may only be a few of the emotions you would initially feel as you clutch your family and flee for your life. Open your eyes. You have just allowed yourself to momentarily suffer a few of the emotions that a person who is a refugee experiences in his/her daily fight for survival. Unlike you and me, refugees are people who do not have the luxury of removing the threat to their very existence by merely closing and reopening their eyes. Often, refugees must seek out new homes away from their homelands to begin a safe new life. A refugee is a person who is forced to flee his/her country of origin because of civil conflicts, persecution, human rights violations and the absence of civil liberties. Between 1980 and 2002, the United States accepted for resettlement over 1.8 million of the world's refugee population. Of this total number of refugees who arrived to the U.S., 10,488 chose Virginia as their new home. The Virginia Department of Health Refugee and Immigrant Health Program (RIHP) plays an important role in facilitating refugee resettlement. Through the provision of initial health assessments to all new refugees entering the Commonwealth of Virginia, RIHP not only protects the public's health, but also eliminates health related barriers to successful resettlement of Virginia's refugees. The program's mission is to protect the public's health by empowering health districts to provide thorough initial heal assessments to all new refugees entering the Commonwealth of Virginia. Identification and treatment of tuberculosis is one of the program's main focuses, but the health assessment form also addresses numerous other health related concerns. For example, a thorough completion of the health assessment can identify the referrals needed for treatment of chronic illnesses such as diabetes, hypertension, and post-traumatic stress syndrome. Being in quality health promotes a person's positive self-image and serves to increase his/her self-efficacy in adjusting to his/her new life. In facilitating the removal of health barriers, RIHP aids refugees to prepare to enter the work force and achieve economic self-sufficiency as quickly as possible. On June 20, as a part of its commemoration of World Refugee Day, RIHP launched a new Web site, http://www.vdh.state.va.us/epi/rihp/. Health and cultural education materials are now readily available to VDH employees, medical practitioners and the general public. One of the highlights of the Web site is the "Ethnicity of the Month." Each month, a new ethnicity will be featured, accompanied by a brief overview of the culture and social practices. An increased understanding of others increases our ability to embrace and assist people in need. Through education, the program attempts to promote public awareness of the positive contributions that refugees make to our communities through the addition of diversity and culture. Let us not forget, the history of the United States reflects in great measure the history of its refugee and immigrant populations.
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Alexandria City Public Schools and Local Health Department Team Up for Bike Smart Hammond!
Both students had nothing but good things to say about Bike Smart Hammond!, an innovative physical education curriculum recently launched at F.C. Hammond Middle School in Alexandria, Virginia. Alexandria City Public Schools teamed up with the Alexandria Health Department's Cardiovascular Health Project in a departure from the traditional P.E. class emphasis of team sports to a lifetime skill-activity. In three short weeks, students went from learning the basics of bicycling to becoming safe cyclists. Acronyms like "W.I.T.C.H." (Water, Identification, Tire pump, Change/Cell phone, Helmet) and "A.B.C." (Air, Brakes, Chain) help kids remember important bike safety tips. Bike Smart hammond! kicked off in May with the goal of teaching 300 sixth and seventh graders. Plans are underway to expand teacher training over the summer and develop a mentor program for next school year. The program started with a $5,000 grant from the Alexandria Health Department's Cardiovascular Health Project, which enabled the school system to purchase 33 bikes. Another $500 grant from Virginia Department of Health's Center for Injury and Violence Prevention bought helmets. Bike Walk Virginia and VDH conducted trainings for teachers and various community organizations provided other materials and encouragement. The community responded favorably and now, students hear stories from life long bicycling advocates, including women who have bicycled across Europe. Perhaps the most surprising part is that Spokes, Etc., the bicycle shop where the bikes were purchased, offered to extend a discount to teachers and over twenty took advantage of the offer. They now give extra encouragement to students. One P.E. teacher reports that response from kids has been so positive that they plan to start an after school bike club next year.
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Healthy Lifestyles Campaign Outshines Expectations The Lord Fairfax Health District held a one-mile walk on May 17, 2003 at the Greenway in Luray, Virginia. The event was held to kick off the "Healthy Lifestyles Campaign" and to help adults in our region achieve the Healthy People 2010 goal of increasing healthy behaviors through planned community activities. The goal of the campaign was to encourage adults to increase their physical activity by walking three times a week. The event was made possible with the Preventive Health and Health Services Grant. Nurses, clerks and registered dieticians throughout the district were available during the event to discuss the importance of exercise and proper nutrition. The event was planned during the local Page County Mayfest event. The Town of Luray Parks and Recreation Department was a strategic partner, and offered the use the Greenway to create an exercise site. The Greenway is available to the public on a daily basis and provides a scenic peaceful walk by the Hawksbill Creek. In preparation for the event, public health staff visited area physician offices, physical therapy departments and exercise/fitness facilities and discussed the planned event and encouraged them to refer their clients to participate in this preventive health project. State, county, and federal agencies hung posters advertising the event. Area businesses advertised the event to their employees and patrons. One area business, EMCO Enterprises started a daily walk for its employees and donated a beautiful front door with sidelights for the door prize. Each participant received a pedometer. Other prizes included: safety lights, a Walkman, recreation sets, volleyball sets, badminton sets portable radios, frisbees, and certificates of $150 to the fitness center of choice. The health department staff and the community worked hard to pull this event together, and in spite of a rainy day the event was a great success. Two hundred bags of assorted items promoting exercise were given away, and over 100 pledges to walk were made. Positive comments are still coming in from the community on the program.
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Sisters Together: Move More, Eat Better Campaign Promotes Women's Support Network
In addition, the women have the option to participate in a monthly alternate physical activity to expose them to new ways of moving more. These activities have included low-impact aerobics, bowling and salsa dancing. The nutrition portion of the program is just getting started. Every other month, the women will have the opportunity to participate in brown bag luncheons on topics such as appropriate serving sizes, meal planning and lower fat alternatives. The program is based on studies of women who say they are more likely to become physically active if they have a steady, reliable partner or group. Women reported beginning an exercise program in the past, but then fizzling out due to lack of support. However, being in a group provides the accountability and encouragement for these women to stay motivated. In fact, Wanda Story and Sabrina Reynolds, who were joined together based on their preference to walk at a particular time and location, have become great friends. They hosted a cosmetics party together and now they are going on a vacation to New Orleans together! Sisters Together of Alexandria is modeled after a national project of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Institutes of Health (NIH) through the Weight-control Information Network (WIN). Their website is www.niddk.nih.gov/health/nutrit/sisters/sisters.htm. Due to the high percentage of African American women who are overweight, the original program targeted African American women 18 to 35 years old. However, in Alexandria, strong interest came from all races and ages so the program is inclusive of all women.
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Smoke-Free Dining in Virginia Beach
This publication is currently placed in city libraries, recreation centers, YMCAs, the city Farmer's Market, and the Visitor's Center and Oceanfront informational kiosks. The brochure was so well received that some locations have already requested more brochures after only one month! The brochure is constantly being updated as new restaurants open or as restaurants choose to become smoke-free. With second-hand smoke being responsible for over 50,000 deaths annually, Virginia Beach is trying to emphasize the importance of smoke-free environments. The project is always willing to provide educational materials to any restaurant on the benefits of eliminating smoke from its establishment.
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| VDH
Heroes
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Beverly
McGary Selected as Public Health
Also recognized for their many contributions to public health nursing were Regional Public Health Nurse of the Year recipients Frances Shroeder (Eastern Region), Pat Johnson (Southwest Region), and Betty Redmond (Northern Region). The Virginia Department of Health salutes all the winners and applauds their diligent and faithful efforts to serve the community.
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There
is an old adage about only eating raw shellfish (oysters, clams,
and crabs) harvested during months containing the letter "R." This
may be outdated advice due to better refrigeration, transportation,
and other technological advances, but shellfish lovers should still
be cautious on their next visit to the raw bar. Three Virginians
have already been ill and one has died this year from consuming
raw shellfish containing 
Vibrio
bacteria can be found naturally in coastal waters, including
waters approved for oyster and clam harvesting, and are not a result
from pollution. The bacteria thrive in warm, salty environments
which is why the risk for is higher during warmer months. To reduce
the public's risk for infection, 
Fatima
had never been on a bike in her life and was thrilled just to learn
to balance with her feet on the pedals. Alejandro thought he knew
everything about biking but was surprised when he couldn't define
"W.I.T.C.H." or tell what "A.B.C." meant. 
"This
is just what I was looking for," said one enthusiastic participant
of a new walking program for women in Alexandria, Virginia. She
was referring to the 
In
an effort to promote smoke-free environments and overall healthier
living, the 
The
Virginia Department of Health, in collaboration with the Virginia
State Nursing Council, has chosen Beverly McGary as its Public Health
Nurse of the Year for 2003. On May 15, 2003 , Ms. McGary was an
honoree at a ceremony recognizing her achievements in public health
nursing and for her efforts to create effective partnerships for
change in the community. As a public health nurse with the