In this issue:

Headlines

• Virginia Department of Health Provides Virginians Public Health Emergency Preparedness Tool
   
• VDH receives national coverage of its statutory rape campaign

In the news

• Give Me a Burger With Everything… But Hold the E. coli !
   
• College Students And Parents Urged To Learn More
  About Meningococcal Disease and Vaccination
   
• Quiet Revolution in Cardiovascular Health Promotion
   
• Blood Pressure Measurement Standardization Course Available to Health Care Professionals
   
• Virginia Beaches Closely Monitored for Health Concerns

Your Community

• Crater Health District Addresses Dinwiddie Residents' Drinking Water Concerns
   
• Russell County Health Department Partners with County Schools for Summer Program
   
• Hampton Health Department’s Women Health Day
   
• Happy Heart Club Promotes Healthy Eating and Physical Fitness to Youth

VDH Accolades

• Mount Rogers Shines in Lighten Up Virginia!
   
• Congratulations to One of VDH’s Own!

Virginia Department of Health Provides Virginians Public Health Emergency Preparedness Tool

Trina Lee

	Click here to order public emergency wallet cards.

The Virginia Department of Health recently created a handy wallet card which contains useful emergency preparedness tips and a fill-in-the-blank area to record personal health information necessary for receiving medical services during an emergency. Virginia is the first state to produce and distribute such a tool.

“The wallet card is being provided to raise the public’s awareness of potential public health emergencies including bioterrorism and provide steps people can take to prepare,” said State Health Commissioner Robert B. Stroube, M.D., M.P.H. “We’ve learned through Hurricane Isabel and other tragic events that the public must take an active role in preparing for emergencies in order to protect their health.”

About the size of a credit card, the compact format is durable and expandable. It folds out to about the size of a regular piece of paper and its contents include:

• Tips for creating a family emergency health plan and template
• Information about mass immunizations/medications and what people should do if directed to a dispensing site
• Chart of a few diseases and exposures potentially associated with terrorism, including general symptoms and treatment information
• Contact information for additional resources

“Virginians should use the information in the card to talk with their families and healthcare providers about different potential risks and create a family emergency health plan,” said Lisa Kaplowitz, M.D., M.S.H.A., Deputy Commissioner for Emergency Preparedness and Response Programs at the Virginia Department of Health.

People are encouraged to fill out the card with their family’s personal health and emergency contact information, including the telephone numbers of nearby hospitals and local/out-of-town contacts as well as medical information, such as blood type, allergies, medical conditions and current medications. All family members should keep the plan accessible and review it often. Resources for more information or for answers to questions are also provided on the card including Web sites and telephone numbers.

Log onto the Emergency Preparedness and Response Programs Web site to order a public health emergency wallet card.

VDH Receives National Coverage of its Statutory Rape Campaign

Rebecca Odor

The Virginia Department of Health Center for Injury and Violence Prevention (CIVP) sponsored a public awareness campaign in Northern Virginia, Richmond, and Roanoke in June and July to help reduce sexual coercion and statutory rape.

The campaign's message, "Isn't she a little young? Sex with a minor, don't go there." appeared on outdoor billboards in Richmond and Roanoke. Also, 255,000 post cards, posters, coasters and napkins carried the message into approximately 150 bars, restaurants and retail establishments in Richmond, Roanoke, Arlington, Falls Church and Alexandria. The effort is a follow-up to a pilot project CIVP conducted in Hampton Roads in July 2003, which showed that 55 percent of men interviewed at the close of the pilot remembered the campaign's message.

A June 14 Virginia Department of Health news release generated a story about the campaign on the front page of the Washington Post. Following that, program managers took calls from Black Entertainment Television, Good Morning America and the Comedy Channel's "Tough Crowd" show. They participated live on National Public Radio's "Talk of the Nation" call-in show, Voice of America and on MSNBC's Abram's Report. Additional interviews were conducted by CBS Evening News with Dan Rather, Ad Weekly, ABC National News and on all Richmond area television stations. The story was carried on the Associated Press wire and appeared in 62 media outlets in approximately 20 other states. A story about the campaign will also appear in the next edition of PR Week and on the internet news source, Salon.com.

The campaign, targeting men age 18 to 29, hoped to change the norms around relationships with minors, making it no longer acceptable for adults to engage in sex with minors. "We encourage adult men to talk to their peers and discourage them from pursuing teenagers. What they are doing is unhealthy and against the law," said Robert Franklin, male outreach coordinator for sexual violence prevention at the Virginia Department of Health.

The response generated from the campaign seems to have started that conversation among men and women. In addition to the above-referenced media reports, the campaign and its issues were discussed on the Rush Limbaugh Show, numerous local morning and afternoon radio talk shows in Richmond, Northern Virginia, Lynchburg and Harrisonburg. Black Entertainment Television ran an internet story and bulletin board that received over 90 discussion posts in seven days.

For more information on sexual coercion, statutory rape and this campaign, visit the Web site at www.varapelaws.org. You may also e-mail Robert Franklin or call the Virginia Department of Health's Center for Injury and Violence Prevention at 1-800-732-8333.

Give Me a Burger With Everything… But Hold the E. coli !

Michelle Stoll

Discussions about how long burgers should be grilled can get as heated as the coals they sizzle above. Opinions and tastes are as varied as the assortment of condiments layered atop the final product. However, unless you like a little E. coli with your burger, you’d better leave it on the grill a little while longer.

So far this year, eight cases of the harmful E.coli strain O157:H7 have been reported in Virginia. Eating undercooked ground beef is the most common cause of illness from this strain of E.coli. Bacteria can get mixed into the meat when it is ground up and the only way to get rid of it and make sure it does not make you sick is to thoroughly cook the meat.

“When we’re talking about ground beef and E.coli illness the best prevention is to cook those burgers well done,” said Diane Woolard, PhD, Director of the Division of Surveillance and Investigation. “Once ground beef has been cooked thoroughly to an internal temperature of at least 160 degrees, it is safe to eat.”

Outdoor grills may not distribute heat evenly and extra precautions should be taken to ensure that hamburgers, especially previously frozen patties, are well done before serving. A basic meat thermometer can tell you for sure if the meat has been cooked long enough.

Other sources of E.coli include consumption of unpasteurized milk and juice, alfalfa sprouts, lettuce, salami, and contact with cattle. Waterborne transmission occurs through swimming in contaminated lakes, pools, or drinking inadequately chlorinated water.

Symptoms for E. coli usually appear two to four days after exposure. The illness often causes severe bloody diarrhea and abdominal cramps. Other symptoms may include vomiting, fever and chills. In a small percentage of cases, the infection can cause the kidneys to stop working. Young children are especially vulnerable. E.coli infection can be spread from person to person for up to three weeks or more, although this usually occurs within families or in daycare situations.

“Most gastrointestinal infections can be transferred from one person to another, and E. coli O157:H7 is no exception,” noted Dr. Woolard. “We cannot emphasize enough the importance of hand washing and good hygiene when someone has diarrhea or other symptoms of a gastrointestinal infection.”

The Virginia Department of Health recommends the following tips for preventing E.coli:

• Never eat rare or undercooked ground beef.
• Cook ground meat to 160 degrees F or higher. The color of the meat may not be a reliable indicator that the meat is well done. Use a meat thermometer to be certain.
• Do not drink unpasteurized milk or cider.
• Always wash any raw fruits or vegetables before eating.
• Always carefully wash your hands before and after preparing foods.
• Always refrigerate meat products. Never leave raw meats at room temperature.
• Wash cutting boards after meats have been on them and before using the same surface to cut fruits and vegetables, or use separate cutting boards for meats and other foods.
• Make sure children wash their hands carefully, especially after using the toilet or handling animals.
• Always wash your hands with soap and warm water after using the toilet or changing diapers.
• People with diarrhea should not use public swimming facilities.
• Clean and disinfect diapering areas, toilets/potty chairs, toys, etc. at least daily and when soiled.

So next time you slap a burger on the bar-b, make it well done and enjoy a safe and healthy summer.

College Students And Parents Urged To Learn More About Meningococcal Disease and Vaccination

Vaccine May Protect Against Dangerous Illness

Laura Ann Nicolai

Certain college students – especially freshmen who live in dormitories – may be at increased risk for meningococcal disease, a potentially fatal bacterial infection. Virginia Department of Health officials recommend that college students and parents learn more about this disease and protect themselves through vaccination.

Caused by the bacteria Neisseria meningitides, meningococcal disease can lead to bacterial meningitis (an infection of the brain and spinal cord coverings) and sepsis (a bloodstream infection). It is primarily transmitted through the exchange of respiratory and throat secretions (i.e., coughing, sneezing, kissing and sharing items such as a drinking glass, utensils or cigarettes). The risk for college students also has been linked to certain social behaviors, such as exposure to passive and active smoking, bar patronage and excessive alcohol consumption.

Nearly 3,000 people are diagnosed with meningococcal disease in the U.S. each year. About 10 percent of these people die, in spite of treatment with antibiotics. Of those who survive, one in five suffer long-term effects that can include brain damage, seizures, hearing loss or limb amputations.

The proportion of cases among adolescents and young adults has increased in recent years, including cases at U.S. colleges and universities. Studies indicate college freshmen living in dormitories are at increased risk for disease and that up to 80 percent of meningococcal cases among college students are vaccine preventable.

"While meningococcal disease is rare, it is a very serious illness with potentially tragic consequences,” said Jim Farrell, Director of the Virginia Department of Health Division of Immunization. “The symptoms can sometimes resemble the flu and the majority of cases can occur in the winter months, making diagnosis difficult.”

Prior to enrollment in any public four-year institution of higher education, Virginia law requires all incoming full-time students to be vaccinated against meningococcal disease or to sign a waiver stating they are aware of the risks, but chose not to be vaccinated. In addition, the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) both urge parents and college students – especially those who live in or plan to live in dormitories – to learn more about meningococcal disease and the potential benefits of vaccination.

The vaccine protects against four of the five most common serogroups of N. meningitidis – A, C, Y, and W-135. The vaccine is approximately 85 to 100 percent effective. Adverse reactions are mild and the vaccine protects for three to five years.

For more information about meningococcal disease or the vaccine, contact your local health department or visit the Virginia Department of Health Division of Immunization Web site.

Quiet Revolution in Cardiovascular Health Promotion

Jody Stones and Charles Ford

Over the past two years, Virginia Department of Health’s (VDH) approach to improving Virginian’s cardiovascular health has undergone a quiet revolution. Specialists in the Cardiovascular Health Project no longer rely solely on health education campaigns and counseling of high-risk individuals. Now they also focus on building partnerships with communities to create local environmental and policy changes that support people in their efforts to be more physically active and eat heart-healthy diets.

“Research showed that education and counseling alone weren’t enough,” said Jody Stones, manager of VDH’s Cardiovascular Health Project. “They are important but limited in their ability to create positive health changes. To reduce cardiovascular health risks, people need easy access to fitness facilities and support in their efforts to eat healthier diets.”

Project staff began to work with local governments, schools, worksites, medical and religious organizations to create opportunities for their constituents to increase their level of physical activity and improve their nutrition.

One example of the project’s efforts is its partnership with the Prospect Empowerment Center. The project provides grant funding to the statewide African-American faith based organization, which reaches some 300 churches and approximately 50,000 people.

The Center helps individual churches make changes that increase the level of physical activity of their members and increase the types of heart-healthy foods served at church functions. Many churches have adopted policies of providing sugar-free deserts and baked entrees instead of fried foods at meeting and gatherings, and serve healthy snacks and juices at youth functions. The Center has helped 20 churches implement physical activity programs for their members, including the construction of 10 walking trails.

“We began to think and act like entrepreneurs,” said Stones. “We looked for ways to remove the barriers our “customers” faced to getting our “products”, which are physical activity and nutritious foods.

The Center also has successfully initiated many environmental and policy changes to provide people with easily accessible avenues to reduce the risk factors for heart disease, including a sedentary lifestyle, poor nutrition, excessive weight, high cholesterol, high blood pressure and smoking.

“After only two years it’s too soon to see definitive data on the level of impact these changes have made,” said Stones. “We are very encouraged with the amount of comprehensive collaboration we’ve seen among the many partners who are simultaneously applying many techniques to the problem of cardiovascular disease. We expect these efforts to grow as community leaders, health professionals and the general public realize that this comprehensive, multifaceted problem needs comprehensive, multifaceted solutions.”

Blood Pressure Measurement Standardization Course Available to Health Care Professionals

Barbara Mueller and Charles Ford

According to the American Heart Association, several studies have demonstrated that “there is good reason to doubt the accuracy of blood pressure readings” taken by many health care professionals.

To address this issue, chronic disease coordinators from the health districts in central and northern Virginia developed the “Blood Pressure Measurement Specialist Certification Course” specifically for health care providers. Since 1998, more than 1,000 physicians, nurse practitioners, physician assistants, nurses, health educators, pharmacists, emergency medical specialists and medical technicians have been certified. In addition, more than 100 of these specialists have been trained to certify others.

“High blood pressure is one of the major modifiable risk factors for chronic diseases such as heart disease, stroke and kidney failure,” said Barbara Mueller, professional education coordinator for the Virginia Department of Health’s Cardiovascular Health Project. “Its diagnosis can have profound implications for longevity and disability as well as insurability and suitability for certain occupations. For these reasons, the diagnosis of high blood pressure must to be based on accurate, representative and reproducible measurements.”

The course provides a curriculum for teaching a standard approach for performing blood pressure measurements that are accurate and reproducible. Four hours of instruction and practical experience, designed to enhance technique, are provided. Trainings are provided for groups of 10 or more at no charge.

The training includes:

• Care, calibration and maintenance of equipment
• Current guidelines for detection and management of high blood pressure
• How to eliminate errors in the measurement procedure
• Use of mercury, aneroid and digital manometers
• How to respond to mercury spills
• Variability of blood pressure
• Recommended technique for measuring blood pressure in adults and children

The class has been adapted to teach people who wish to use these skills to provide blood pressure screening and monitoring in their churches and other community sites. Training requires a minimum of twelve 12 hours of instruction and practice.

In 2004, the Cardiovascular Health Project’s statewide Healthy Pathways Coalition Medical Committee released a toolkit based on the blood pressure measurement course. It includes a 30-minute film and supporting educational materials that health care professionals can use as a self-study course to update their skills in blood pressure measurement and to review current guidelines for the detection and management of hypertension. The film, available in both VHS and DVD formats, can also be used as an adjunct for trainers when teaching the certification course. Toolkits are available free to health care professionals by calling 1-800-Sentara.

For more information about the course or blood pressure measurement, phone Barbara Mueller, Division of Chronic Disease Prevention and Control, at (804) 864-7883.

Virginia Beaches Closely Monitored for Health Concerns

Michelle Monti

Each summer visitors come to Virginia’s public beaches to enjoy the sun, surf and sand. However, contamination of beaches and their waters by bacteria can increase swimmers’ risks of contracting gastrointestinal illness, respiratory, eye, ear and skin infections and other diseases.

In an effort to reduce the risk of swimmers contracting disease or infection, Virginia has implemented a program of beach monitoring at its major public beaches. Virginia’s Beach Monitoring Program monitors public bathing beaches in the state for certain bacteria, called enterococci, which are linked to disease and infections in humans.

“Enterococci are a group of organisms used to determine the extent of fecal contamination of recreational waters,” explained Michele Monti, Beach Environmental Assessment and Coastal Health (BEACH) Program Coordinator. “While they do not cause illness, scientific studies indicate that their presence is closely correlated to the presence of other disease-causing organisms. People swimming or playing in waters with bacteria levels higher than the standard have an increased risk of developing gastrointestinal illness.”

Beach water sampling is conducted from mid-May through September each year, when the volume of recreational beach use is highest. Samples are collected weekly. When the bacteria levels exceed the level of concern, a local advisory is issued, warning people of the health risks associated with swimming in the water. Additional samples are taken until the bacteria returns to safe levels. Once that occurs, the advisory is lifted and swimming may resume normally.

Beach monitoring programs have been in place in Virginia Beach and Norfolk since the 1970’s. With the passage of the BEACH Act, these programs were incorporated into a state level coordinated Beach Monitoring Program that includes weekly monitoring of bathing beaches for bacteria during the summer months, posting of beaches that exceed the State Water Quality Standards, and notification of the public through press releases to local newspapers and notices on the Virginia Department of Health Web page. Localities participating in the beach monitoring program in addition to Norfolk and Virginia Beach include Newport News and Yorktown, Hampton, King George County, Gloucester County, and Accomac and Northampton Counties on the eastern shore of Virginia. The program is coordinated by the Division of Zoonotic and Environmental Epidemiology in the Virginia Department of Health, with weekly monitoring carried out by state employees in the local health departments. The VDH Beach Monitoring Program has the potential to prevent public exposure to waterborne pathogens when they are at levels that pose a greater than normal risk at the locations in Virginia where the greatest number of people may be affected.

“Virginia’s beaches are a recreational and natural asset,” Monti said. “We want visitors to be informed of any health concerns associated with the beach water so they can have a safe and pleasant experience there.”

To find out if there are any existing advisories for one of the beaches listed above, contact the local health department where the beach is located.

Crater Health District Responds to Drinking Water Concerns in Dinwiddie County

Matthew Killoran

Crater Health District staff had to react fast when concerns arose regarding the safety of a community’s drinking water. On June 2, 2004, a local physician informed the Dinwiddie Health Department that her patient had his tap water tested and discovered elevated uranium levels. The patient lived in Chesdin Manor subdivision and his water came from a community well that serves residents of that subdivision and the nearby River Road Farms subdivision in Dinwiddie County.

The Crater Management Team immediately began work on a plan to address the residents’ health concerns. The team consisted of the district’s Planner, Public Health Nurses, Epidemiologist, Environmental Health Manager, and Health Education Supervisor. Team members coordinated their response with Dinwiddie County authorities, the company that owns the wells in question, and the Virginia Department of Health’s Office of Drinking Water.

On June 4, the Crater staff hand-delivered information packets to each of the 115 homes in the affected area. The packets contained a letter from the District Director, Michael Royster, M.D., M.P.H., that explained the health affects of uranium and advised the residents to only consume bottled water until a long-term solution was found. The packets also included information regarding a community meeting that was to be held on June 9 that would enable residents to voice their concerns to local officials. The Crater staff also opened an emergency call center that evening, and over the weekend, to respond to residents’ questions.

“The Crater Health District staff responded in a timely and professional manner to this issue. Many people put in long hours to address residents’ concerns and to assure the health of these communities was protected,” said Dr. Royster.

The Crater staff also formed a community advisory group consisting of residents from the affected subdivisions. This group of citizens was instrumental in forming the district’s plans for follow-up community meetings as well as voluntary health assessments for each of the 115 families in the area.

Additionally, VDH’s Office of Epidemiology will assist the Crater Health district in collecting and analyzing the health data at these assessments. The district will also utilize its internet Web page to update the public on this issue. Residents will be able to go the Crater Health district Web site to obtain information about upcoming meetings, health assessments, and links to other public health resources.

Russell County Health Department Partners with County Schools for Summer Program

Janette L. Trent

The Russell County School System has identified the Russell County Health Department as a key partner for their 21st Century Learning Center Grant. One hundred thirty students at the Honaker Elementary School, along with their parents, will be involved in a five week summer program.

One of the key objectives of the 21st Century Learning Center Grant is to provide access to health/safety and nutrition related programs. Russell County Health Department staff will conduct classes for both students and their parents in the following areas; Water Safety, CPR, Recreation Vehicle Safety, Emergency Preparedness, Character Education, Nutrition, Diabetes Awareness and Fatherhood.

More than 250 students and parents will participate in the program this summer.  Thirty years of research shows the difference family involvement makes in children’s learning. Students will be prepared to resist peer pressure to use drugs, alcohol and tobacco. Parents may participate in computer and library activities as well as being exposed to health/safety and nutrition related programs.

The Russell County School System and the Russell County Health Department continue their partnership to provide school based clinics, school nursing services, immunization clinics and other health related programs.

Hampton Health Department Recognizes Women's Health Day

Irene Ferrainolo

Last May, more than 75 women over the age of 18 lacking public or private insurance received free health services at Hampton Health Department’s Women Health Day. The event addressed unmet need for screening services, promoted use of the Women’s Clinic and the expanded Adult Clinic services, and to reconnected former patients with available health department services.

The event was staffed by the department’s Adult and Women’s Clinics, Community Health Nursing, Immunizations, Maternal and Child Health Nutrition, Office of Health Promotion, a scheduler from Sentara Careplex Women’s Imaging Center, and a student volunteer.

Pap tests, clinical breast examination, mammograms, tetanus update, nutrition counseling, and cholesterol, blood pressure, glucose, and anemia screenings were offered. Women over the age of 50 were enrolled in the Every Woman’s Life breast and cervical cancer screening program. (Mammograms for women ages 40-49, provided by Sentara at a reduced price, were covered, in part, by Susan G. Komen funds.) Of those screened, 26 women required follow up of some kind.

All women received a Tools for Good Health gift bag containing a salad/sandwich keeper, pedometer, sun screen samples; breast self examination reminder card and stickers, a stress ball, fat grams counter and low fat recipes, and grooming gifts from Sentara.

May 10 was National Women’s Check Up Day, part of National Woman’s Health Week which is a project of the U.S. Department of Health and Human Services, Office of Women’s Health.

Prince William Health District Cuts Ribbon on Mobile Clinic

Anne Terrell

The Primary Health Care Clinic for the western Prince William Health District area was officially inaugurated during a ribbon cutting ceremony at the Manassas Baptist Church on Tuesday, June 15.  Many local dignitaries attended the ceremony, including Mayor Ernie Gillum, Mayor of Manassas, Sean Connaughton, Chairman of the Prince William Board of County Supervisors, a representative from Congressman Tom Davis’ office, Del. Michele McQuigg, and Prince William County Supervisor Hilda Barg.

The 1988, 35-foot mobile clinic was donated by the Prince William Health System and has recently been refurbished through donations and grants. The mobile clinic will provide services to uninsured children and their families at area schools, the SouthEastern Regional Vision for Education (SERVE), and the Georgetown South Community Center. The clinic is currently providing preschool physical exams and is expected to be fully operational when school starts in the fall.

Happy Heart Club Promotes Healthy Eating and Physical Fitness to Youth

Jimeequa Williams

Little people sometimes have big health issues, and the Richmond City Health Department (RCHD) is committed to addressing their health needs. Due to the alarming increase in overweight children in the U.S., the RCHD developed the Happy Heart Program as part of a grant-funded initiative designed to reduce obesity risk factors in school-age children by encouraging good nutrition and increasing physical activity. Twice monthly, Sharon Jones, a nursing outreach worker, travels to participating Richmond-area elementary schools to share healthy eating tips and supply the students with good nutrition info. She is accompanied by Wayne Holmes, a Rock Richmond (a health department physical fitness program) Instructor who leads the students in fun physical activities and low impact exercises. The program participants’ weight is regularly monitored and their progress in recorded throughout the school year. The students receive lots of encouragement. Recently, John B. Cary Elementary School fifth graders, Kenya Jones and Arika Goode, were recognized as the students who lost the most weight during the 2003-2004 school-year and both were awarded prizes. Kenya received a new bicycle, which was donated by a local merchant, and because she already had a bike, Arika received a new watch and some fun fitness items to encourage her to stay active.

A number of new physical activity opportunities have developed within Richmond Public Schools thanks to the success of the Happy Heart Club. The Richmond Public Health Department is working on a variety of programs and partnerships to motivate area youth to practice healthy lifestyles by increasing physical activity and developing good nutrition habits.

Mount Rogers Shines in Lighten Up Virginia!

Edith Bobko

“I am very proud of the level of participation and the success of our staff in Lighten Up Virginia” said District Director D. Craig Smith, M.D., M.P.H. “In our day to day mission to promote healthy lifestyles, they set an excellent example for the community in working to improve their own individual health and inspire others to do the same. I congratulate the ‘Rowdy Gang’ on their first place win, and all of the teams for their fine efforts.”

The five Mount Rogers teams are “Rowdy Gang”, “Honey Pots”, “Motion Maniacs”, “Wicked Stepteam”, and “New Image”. Members of the first and third place teams will be recognized at the Opening Ceremonies of 2004 Virginia Commonwealth Games in Roanoke in July.

Congratulations to One of VDH’s Own!

Jimeequa Williams

Chesterfield Health District Director, Dr. William Nelson, was recently honored with the Richmond Academy of Medicine’s (RAM) 2004 Distinguished Service Award. Currently a member of RAM’s Bioterrorism Committee, Dr. Nelson has been credited with fostering heightened and effective communication between the public health, medical, and local government communities. Nominated by Dr. Tom Franck, Dr. Nelson was one of six medical professionals recognized at a reception in May. Dr. Nelson was also acknowledged for his dedicated work and relationship building efforts within the medical community, following the September 11, 2001 terrorist attacks. Dr. Nelson is the first public-health official to receive the award.