ANNUAL COMMUNITY AND ENVIRONMENTAL HEALTH ......Amebiasis B 1 0.23 1 0.23 1 0.23 1 0.23 1 0.23 1...

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ANNUAL COMMUNITY AND ENVIRONMENTAL HEALTH REPORT

AnnualSummaryoftheDivisionofCommunityServicesandEnvironmentalHealthattheToledo-LucasCountyHealthDepartmentfor2015

Toledo-LucasCountyHealthDepartment635NorthErieStreetToledo,Ohio43604Tel419-213-4100Fax419-213-4546www.lucascountyhealth.com

Thispageintentionallyleftblank

PublishedApril,2016

CompiledandPreparedBy:

EricZgodzinski,MPH,RS,CPHDirectorofCommunityandEnvironmentalHealth

DanBaker,MPH,SITCommunityResponsePlanner/MedicalReserveCorpsCoordinator

JerryBingham,RSEnvironmentalHealthSupervisor

DanielleBoyd,MPHPublicHealthAssociate

TerriDalton,MASeniorClerk

KeithDempseyRegionalEbolaCoordinator

SamanthaEitniear,MPH-VPH,CPH,SITBioinformaticsAnalyst

PattiFraker,RD,LDEpidemiologist

JenniferGottschalk,MPH,RS,REHSEnvironmentalHealthSupervisor

AliaKadri,MPHPHABCoordinator/QualityAssurance

ShannonLands,MBAPublicInformationOfficer

LaurenLiebich,MPH,SITEpidemiologist

CherylLocher,MPA,MSDisasterPlanner

GregMoore,MBA,SITRegionalCoordination/BioterrorismCoordinator

JoshuaNiese,RSEnvironmentalHealthSupervisor

BrandonPalinski,MPH-VPH,SITPHABCoordinator/QualityAssurance

BradSherrick,RSEnvironmentalHealthSupervisor

MahjidaSteffinClerkI

ScottStrahlDisasterPlanner

Thisreportisproudlysupportedby:

Dr. David Grossman, MD

HealthCommissioner

TABLE OF CONTENTS

Contents

InfectiousDiseaseIntroduction ________________________________________________________________________ 1

DemographicProfileofLucasCounty__________________________________________________________________ 1

CountsandRatesofReportableDiseases______________________________________________________________ 2

GeographicDistributionofSelectedDiseases_________________________________________________________ 9

Outbreaks________________________________________________________________________________________________10

TimelinessofDiseaseReports_________________________________________________________________________14

EnvironmentalHealthIntroduction___________________________________________________________________16

FoodProtection_________________________________________________________________________________________17

LeadPrevention_________________________________________________________________________________________17

SepticandWater________________________________________________________________________________________20

RecreationalVehicleParks_____________________________________________________________________________24

RodentProgram_________________________________________________________________________________________25

Schools___________________________________________________________________________________________________28

PublicSwimmingPools_________________________________________________________________________________29

BodyArt_________________________________________________________________________________________________31

BathingBeaches ________________________________________________________________________________________32

Smoke-FreeWorkplace_________________________________________________________________________________33

AnimalBites_____________________________________________________________________________________________34

Nuisance_________________________________________________________________________________________________37

ResponseandPreparedness___________________________________________________________________________38

PublicHealthAccreditation____________________________________________________________________________44

QualityImprovement___________________________________________________________________________________46

ContactInformation____________________________________________________________________________________51

INFECTIOUS DISEASE INTRODUCTION

InfectiousDiseaseIntroduction

INFECTIOUS DISEASES

Infectiousdiseases,alsocommonlycalledcommunicablediseases,areillnessescausedbymicroorganisms,(bacteria,viruses,andparasites)andcanbetransmittedfromaninfectedpersonoranimaltoanotherpersonoranimal.Therouteoftransmissionvariesbydiseaseandmayincludedirectcontactwithcontaminatedbodyfluids(e.g.,blood)orrespiratorysecretions,contactwithcontaminatedobjects,inhalationofcontaminatedairborneparticles,ingestionofcontaminatedfoodorwater,orthebiteofananimalorvector(e.g.,insect)carryingthemicroorganism.

KEY FINDINGS

2015sawanincreaseofdiarrhealillnesses:o Campylobacterosisincreasedfrom47in2014to72in2015o Giardiasisincreasedfrom9in2014to17in2015o Cryptosporidiosisincreasedfrom17in2014to19in2015o Salmonellosisincreasedfrom37in2014to43in2015

For2015,therewasadecreaseinthenumberofreportedcasesofHIV/AIDS,with54beingreportedin2014and33beingreportedin2015.Additionally,therewasadecreaseinthenumberofcasesofSyphilis,with59beingreportedin2014and40casesreportedin2015.

LOOKING AHEAD

TheToledo-LucasCountyHealthDepartmentiscontinuallystrivingtodecreasethenumberofinfectiousdiseasesacquiredbyresidentsofourcounty,aswellasthosevisitingourjurisdiction.Increasingcommunityawarenessandeducationarecontinuedgoalsforourupcomingcalendaryear.

DEMOGRAPHIC PROFILE OF LUCAS COUNTY

DemographicProfileofLucasCounty

Table1:LucasCountyPopulationbyGenderandAgeGroup,2010CensusData

Age NumberofFemale Percent NumberofMale PercentUnder5years 14,680 3.3 15,052 3.45to9years 13,984 3.2 14,772 3.310to14years 14,004 3.2 14,625 3.315to19years 16,510 3.7 17,137 3.920to24years 17,029 3.9 16,792 3.825to29years 14,875 3.4 14,536 3.330to34years 13,500 3.1 13,032 2.935to39years 14,112 3.2 13,492 3.140to44years 13,837 3.1 13,209 3.045to49years 16,132 3.7 15,064 3.450to54years 17,088 3.9 16,157 3.755to59years 15,338 3.5 14,411 3.360to64years 12,720 2.9 11,918 2.765to69years 9,020 2.0 7,676 1.770to74years 7,105 1.6 5,622 1.375to79years 6,212 1.4 4,244 1.080to84years 5,761 1.3 3,572 0.885+years 5,942 1.3 2,655 0.6Total 227,849 51.6 213,966 48.4

Table2:LucasCountyPopulationbyRace(aloneorincombinationwithoneormoreotherraces*),2010CensusData

Race Number ofPersons PercentWhite 339,206 76.8BlackorAfricanAmerican 92,260 20.9AmericanIndianandAlaskaNative 4,246 1.0Asian 8,801 2.0NativeHawaiianandOtherPacificIslander 382 0.1SomeOtherRace 11,904 2.7

*Incombinationwithoneormoreoftheotherraceslisted.Thesixnumbersmayaddtomorethanthetotalpopulation,andthesixpercentagesmayaddtomorethan100percentbecauseindividualsmayreportmorethanonerace.

Table3:LucasCountyPopulationbyEthnicity,2010CensusData

Ethnicity NumberofPersons PercentHispanicorLatino(ofanyrace) 26,974 6.1Mexican 22,028 5.0PuertoRican 1,482 0.3Cuban 388 0.1OtherHispanicorLatino** 3,076 0.7NotHispanicorLatino 414,841 93.9Totalpopulation 441,815 100.0Thiscategoryiscomposedofpeoplewhoseoriginsarefromthe DominicanRepublic,Spain,andSpanish‐speakingCentralorSouthAmerican

countries.Italsoincludesgeneraloriginresponsessuchas"Latino"or"Hispanic."

COUNTS AND RATES OF REPORTABLE DISEASES

CountsandRatesofReportableDiseases

OVERVIEW

AccordingtotheOhioAdministrativeCode3701-3-02,casesandsuspectedcasesofselectedinfectiousdiseasesarerequiredtobereportedtotheOhioDepartmentofHealthandlocalpublichealthagencies.ThesereportablediseasesweredeterminedtobeofpublichealthsignificanceinOhio.ManyofthesediseasesmustalsobereportedbystatehealthdepartmentstotheCentersforDiseaseControlandPrevention(CDC)aspartofnationalpublichealthsurveillanceofinfectiousdiseases.

The2015AnnualSummaryincludescasesofreportablediseasethatwerediagnosedamongresidentsofLucasCounty,reportedtopublichealth,andfoundtomeetthepublichealthsurveillancedefinitionofasuspectedorconfirmedcase.Thesedatadonotrepresentallcasesofreportableinfectiousdiseasethatoccurredinthecommunity,asindividualsmaynotseekmedicalcareformildorasymptomaticinfections.Additionally,areportedcaseofdiseasemaynotmeetthesurveillancedefinitionofaconfirmedorsuspectedcase.Surveillancedefinitionsaredesignedtostandardizedatacollectionandreportingacrosspublichealthjurisdictionsandmaydifferslightlyfromclinicaldefinitionsusedinpatientmanagement.Outbreaksormediacoverageofaparticulardiseasecanalsoinfluencetestingandreportingrates.Datainthissummaryareconsideredprovisional.Pleasenotethatdatainthefollowingpagesaregroupedbytypeofdisease.Discrepenciesinnumbersofreportedcasesmayexistfromlocaltostatelevelandnationallevelbasedonanynumberofcriteriatoincludeorexcludecases.Foranyquestions,pleasecontacttheepidemiologystaffatTLCHD.

ThissummaryisintendedtobearesourceforindividualsandpublichealthpartnersconcernedaboutinfectiousdiseasesinLucasCounty.FurtherinformationoncommunicablediseasemaybeobtainedbycontactingtheToledo-LucasCountyHealthDepartment.

REPORTABLE DISEASES

Acomprehensivelistingandguidanceforreportablediseasesandnon-reportablediseasesintheStateofOhiocanbefoundintheInfectiousDiseaseControlManual(IDCM)(http://www.odh.ohio.gov/pdf/idcm/intro1.pdf).ThisdocumentalsoincludesrulescontainedwithintheOhioAdministrativeCode(OAC)thatpertaintoinfectiousdiseasereporting.ServicesprovidedattheOhioDepartmentofHealthLaboratoryandprocessestosubmitspecimenscanbefoundwithinthisdocument.

CHANGES FROM 2014

OnMay1,2015,Rule3701-3-02intheOhioAdministrativeCodechanged.Thechangesinclude:

AdditionofMiddleEastRespiratorySyndrome(MERS)asaClassAdisease

AdditionofChikungunyavirusinfectionunderarboviraldiseases(ClassB)

EnumerationofthefourViralHemorrhagicFeversinClassA(Ebolavirusdisease,Lassafever,Marburghemorrhagicfever,andCrimean-Congohemorrhagicfever)

2015 2014 2013 2012 2011

ReportableCondition Cl

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

ENTERIC

Amebiasis B 1 0.23 1 0.23 1 0.23 1 0.23 1 0.23 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0Campylobacteriosis B 73 16.52 73 16.52 47 10.64 61 13.81 49 11.09 76 17.20 57 12.90 70 15.84 31 7.02 183 41.42Cholera A 0 0.00 0 0.00 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Cryptosporidiosis B 20 4.53 20 4.53 17 3.85 17 3.85 14 3.17 14 3.17 19 4.3 19 4.30 18 4.07 18 4.07Cyclosporiasis B 0 0.00 0 0.00 1 0.23 1 0.23 3 0.68 3 0.68 0 0.0 0 0.0 0 0.0 0 0.0E.coli-NotO157:H7

B 0 0.00 0 0.00 1 0.23 1 0.23 3 0.68 3 0.68 7 1.58 7 1.58 1 0.23 1 0.23

E.coli-O157:H7 B 0 0.00 0 0.00 4 0.91 4 0.91 1 0.23 1 0.23 3 0.68 3 0.68 1 0.23 1 0.23E.coli-Unknownserotype

B 0 0.00 0 0.00 0 0.0 1 0.23 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0

Giardiasis B 18 4.07 19 4.30 9 2.04 9 2.04 13 2.94 13 2.94 7 1.58 7 1.58 15 3.4 15 3.40Hemolyticuremicsyndrome(HUS)

B 0 0.00 0 0.00 1 0.23 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Listeriosis B 0 0.00 0 0.00 1 0.23 1 0.23 3 0.68 3 0.68 2 0.45 2 0.45 0 0.0 0 0.0Salmonellosis B 43 9.73 43 9.73 37 8.37 37 8.37 53 12.00 53 12.00 52 11.77 52 11.77 81 18.33 81 18.33Shigellosis B 13 2.94 13 2.94 19 4.3 19 4.3 7 1.58 7 1.58 11 2.49 11 2.49 31 7.02 31 7.02Trichinosis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Typhoidfever B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Vibrioparahaemolyticusinfection

B 0 0.0 0 0.0 0 0.0 0 0.0 2 0.45 2 0.45 1 0.23 1 0.23 0 0.0 0 0.0

Yersiniosis B 2 0.45 2 0.45 1 0.23 1 0.23 1 0.23 1 0.23 2 0.45 2 0.45 1 0.23 1 0.23

Table4:RatesandCountsofEntericDiseasesinLucasCountyOhio2011-2015

2015 2014 2013 2012 2011

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

HEPATITIS

HepatitisA B 0 0.00 0 0.00 0 0.0 0 0.0 1 0.23 9 2.04 2 0.45 7 1.58 2 0.45 5 1.13HepatitisB-PerinatalInfection

B 0 0.0 1 0.23 0 0.0 7 1.58 0 0.0 2 0.45 0 0.0 1 0.23 0 0 18 4.07

HepatitisB-acute

B 4 0.91 6 1.36 1 0.23 6 1.36 0 0.0 10 2.26 4 0.91 17 3.85 2 0.45 7 1.58

HepatitisB-chronic B 130 29.42 280 63.37 57 12.90 253 57.26 52 11.77 111 25.12 38 8.60 66 14.94 87 19.69 134 30.33

HepatitisC-acute

B 2 0.45 2 0.45 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 0.45 0 0.0 0 0.0

HepatitisC–chronic

B 466 100.95 466 100.95 237 53.64 756 171.11 292 66.09 631 142.82 242 54.77 478 108.19 443 108.19 794 179.71

HepatitisE B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Table5:RatesandCountsofHepatitisinLucasCountyOhio2011-2015(Note:duetochangesincaseclassificationovertime,duplicatesmayexistwithinhepatitisreporting)

2015 2014 2013 2012 2011

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Chancroid B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Chlamydiainfection

B 2641 597.76 2641 597.7

6 3231 731.30 3231 731.3

0 2267 513.11 2267 513.1

1 3210 726.55 3210 726.5

5 2359 533.93 2359 533.93

Gonococcalinfection

B 693 156.85 693 156.8

5 995 225.21 995 225.2

1 819 185.37 819 185.3

7 1349 305.33 1349 305.3

3 805 182.20 805 182.20

Herpes-congenital

B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

HIV/AIDS - - 33* 7.47 - - 54* 12.22 - - 39* 8.83 - - 64* 14.49 - - 56* 12.67

Syphilis B - - 40* 9.05 - - 59* 13.35 - - 26* 5.88 - - - - - - - -

Table6:RatesandCountsofSexuallyTransmittedInfectionsinLucasCountyOhio2011-2015*OnlyConfirmedCounts

Table7:RatesandCountsofVaccinePreventableIllnessesinLucasCountyOhio2011-2015

2015 2014 2013 2012 2011

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

VACCINEPREVENTABLE

Diphtheria A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Haemophilusinfluenzae(invasive)

B 5 1.13 5 1.13 8 1.81 8 1.81 9 2.04 9 2.04 5 1.13 5 1.13 14 3.17 14 3.17

InfluenzaA-novelvirusinfection

A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Influenza-associatedhospitalization

B 117 26.48 117 26.48 322 72.88 322 72.88 161 36.44 161 36.44 59 13.35 59 13.35 121 27.39 122 27.61

Measles A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Meningococcaldisease-Neisseriameningitidis

A 0 0.0 0 0.0 1 0.23 1 0.23 0 0.0 0 0.0 1 0.23 1 0.23 3 0.68 3 0.68

Mumps B 0 0.0 0 0.0 1 0.23 1 0.23 0 0.0 0 0.0 1 0.23 1 0.23 1 0.23 2 0.45Pertussis B 9 2.04 13 2.94 26 5.88 34 7.70 36 8.15 40 9.05 6 1.36 10 2.26 14 3.17 18 4.07Poliomyelitis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Rubella B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0Tetanus B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0Varicella B 0 0.0 0 0.0 13 2.94 16 3.62 12 2.72 13 2.94 13 2.94 14 3.17 17 3.85 17 3.85

2015 2014 2013 2012 2011

ReportableCondition

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

ZOONOTICORVECTOR‐BORNE

Anaplasmosis/Erlichiosis 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0Brucellosis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Chikungunyavirus B 0 0.0 0 0.0 Notreportablepriorto2015Dengue B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Encephalitis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0LaCrossevirusdisease B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0LymeDisease B 2 0.45 8 1.81 2 0.45 13 2.94 3 0.68 12 2.72 1 0.23 17 3.85 6 1.36 10 2.26Malaria B 2 0.45 2 0.45 1 0.23 2 0.45 2 0.45 2 0.45 0 0.0 0 0.0 1 0.23 2 0.45Otherarthropod-bornedisease

B 1 0.23 1 0.23 1 0.23 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Psittacosis B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0QFever B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Rabies-Human A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0SpottedFeverRickettsiosis B 1 0.23 1 0.23 0 0.0 1 0.23 1 0.23 2 0.45 0 0.0 1 0.23 2 0.45 2 0.45Tularemia A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Typhusfever B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0ViralHemorrhagicFever(VHF)

A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

WestNileVirus B 5 1.13 6 1.36 0 0.0 1 0.23 8 1.81 9 2.04 4 0.91 4 0.91 6 1.36 6 1.36YellowFever A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Table8:RatesandCountsofZoonoticorVector-BorneIllnessesinLucasCountyOhio2011-2015

2015 2014 2013 2012 2011

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

OTHERREPORTABLE

Anthrax A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Botulism-foodborne A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Coccidioidomycosis B 3 0.68 3 0.68 1 0.23 1 0.23 1 0.23 1 0.23 0 0.0 1 0.23 1 0.23 1 0.23Creutzfeldt-JakobDisease B 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Cytomegalovirus-congenital(CMV)

B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.23 1 0.23 1 0.23 1 0.23

Ehrlichiosis-Ehrlichiachaffeensis

B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 0 0.0

Legionellosis B 10 2.26 13 2.94 6 1.36 6 1.36 18 4.07 18 4.07 4 0.91 5 1.13 7 1.58 7 1.58Meningitis-aseptic/viral

B 55 12.45 56 12.67 38 8.60 41 9.28 55 12.45 55 12.45 46 10.41 46 10.41 73 16.52 73 16.52

Meningitis-bacterial(NotN.meningitidis)

B 6 1.36 6 1.36 7 1.58 7 1.58 6 1.36 6 1.36 7 1.58 7 1.58 2 0.45 2 0.45

MiddleEastRespiratoryVirus(MERS)

A 0 0.0 0 0.0 Notreportablepriorto2015

Mycobacterialdisease-otherthantuberculosis B 35 7.92 35 7.92 39 8.89 39 8.83 32 7.24 32 7.24 27 6.11 27 6.11 28 6.34 28 6.34

Plague A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0SevereAcuteRespiratorySyndrome(SARS)

A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Smallpox A 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0Staphylococcalaureus-intermediateresistancetovancomycin(VISA)

B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0

Streptococcal-GroupA–invasive B 10 2.26 13 2.94 15 3.40 15 3.40 13 2.94 13 2.94 12 2.72 12 2.72 19 4.30 19 4.30

Streptococcal-GroupB-innewborn

B 3 0.68 3 0.68 0 0.0 0 0.0 4 0.91 4 0.91 3 0.68 3 0.68 3 0.91 3 0.91

Streptococcaltoxicshocksyndrome(STSS)

B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5 1.13 5 1.13 4 0.91 4 0.91

2015 2014 2013 2012 2011

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

Confirmed+

Probable

AllStatuses

OTHERREPORTABLE

Streptococcuspneumoniae-invasiveantibioticresistanceunknownornon-resistant

B 26 5.88 26 5.88 19 4.3 19 4.30 32 7.24 32 7.24 33 7.47 33 7.47 36 8.15 36 8.15

Streptococcuspneumoniae-invasiveantibioticresistant/intermediate

B 11 2.49 11 2.49 9 2.04 9 2.04 14 3.17 14 3.17 10 2.26 10 2.26 12 2.72 12 2.72

Toxicshocksyndrome(TSS)

B 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0 0 0.0 1 0.23 0 0.0 0 0.0

Tuberculosis B 8 1.81 8 1.81 2 0.45 3 0.68 7 1.58 7 1.58 4 0.91 4 0.91 4 0.91 4 0.91

Table9:RatesandCountsofOtherReportableDiseasesinLucasCountyOhio2011-2015

GEOGRAPHIC DISTRIBUTION OF SELECTED DISEASES

GeographicDistributionofSelectedDiseases

OVERVIEW

HighlightedbelowisageographicdistributionofselecteddiseaseswithinLucasCounty.

AspecialthankyoutotheToledoAreaSanitaryDistrictinpartneringandsharingdataregardingmosquitotrappingandtesting.

OUTBREAKS

Outbreaks

OVERVIEW

Forthe2015calendaryear,therewere25suspect,probableorconfirmedoutbreaksthatwereinvestigatedinLucasCountybytheepidemiologystaff.

OutbreaksareClassCreportableconditions,unlessotherwisespecified.OhioDepartmentofHealthclassifiesoutbreaksintoanumberofcategoriesincludingCommunity,Foodborne,Healthcare-Associated,Institutional,Waterborne,andZoonotic.DefinitionsforeachtypeofoutbreakcanbefoundintheInfectiousDiseaseControlManual(IDCM)(http://www.odh.ohio.gov/pdf/idcm/intro1.pdf).

Table11:OutbreaksInvestigatedbyEpidemiologistsatToledo-LucasCountyHealthDepartment,2015

Status OutbreakType Agent Count NumberofIll

Confirm

ed Foodborne Norovirus 1 4

Healthcare-associated MOTT 1 4Norovirus 2 83

Institutional Norovirus 1 73Shigella 1 7

Total 6 171

Probable Foodborne Norovirus 1 2

Institutional Parainfluenza 1 7Sarcoptesscabiei 1 11

Total 3 20

Suspected

Foodborne UnknownAgent 8 18Healthcare-associated Sarcoptesscabiei 1 15Institutional Hand,Foot,andMouth

Disease3 7

Influenza 1 14Norovirus 1 71Sarcoptesscabiei 1 5

Waterborne Legionellaspp 1 20Total 16 150

GrandTotal 25 341

OUTBREAKS

02468101214161820

Community

Foodborne

Healthcare-Associated

Institutional

Zoonotic

Community

Foodborne

Institutional

Zoonotic

Community

Foodborne

Institutional

Zoonotic

Confirmed Probable Suspected

OutbreaksinLucasCountyfrom2009-2015

2015(n=25) 2014(n=28) 2013(n=19) 2012(n=21) 2011(n=16) 2010(n=16) 2009(n=11)

DISEASE HIGHLIGHTS

Mycobacteriumchelonae

OVERVIEW

InFebruaryof2015,anInfectionControlPreventionist(ICP)attheUniversityofMichiganMedicalSystemnotifiedtheToledo-LucasCountyHealthDepartmentthattwoindividualshadcontractedMycobacteriumchelonaeafterundergoingLASIKeyesurgeryataLucasCountyfacilityinJanuaryof2015.ItwasnotedthattheToledo-LucasCountyHealthDepartmentlaunchedanimmediateinvestigationintothematter.TLCHDnotifiedmultipledepartmentsincluding:WoodCountyHealthDistrict(duetothefactthatthetwoindividualsinfectedresidedinWoodCounty),theOhioDepartmentofHealth(ODH),theOutbreakResponseandBioterrismInvestigationTeam(ORBIT),andtheBureauofInfectiousDiseases(BID).Basedonepidemiologicalandtracebackinvestigations,4case-patientswereidentifiedinLucasCountyandtheTLCHDrecommendedthefacilityceaseallproceduresuntiltheinfectionsitewasdetermined.

Duringthecourseofthisinvestigation,itwasdeterminedthatasmallhumidifier,intheroomduringsurgery,wasthereservoirofinfection.DuetothefactthatMycobacteriumchelonaecanbepresentinwater,itislikelythatthemistcreatedbythehumidifiercausedtheinfectionintheeyeofthefourpatients.TheTLCHD,alongwiththeODHandCDC,recommendedthattheLucasCountyfacilitydiscontinuetheuseofthesmallhumidifierinthesurgicalsetting.Themistingofwaterfromthehumidifierincreasestheopportunityformicroorganismstobeintroducedintotheenvironment.TheTLCHDalsorecommendedthatthefacilityimplementaregularcleaningscheduleofhumidifiersandthewaterusedinthathumidifier.Itwasalsorecommendedthatanenvironmentalsamplebetakenafterimplementingtheseprocedurestoensurethattheissuehasbeenresolved.

EpidemiologyoverviewofMycobacteriumchelonaeInfectiousagents:AgroupofbacteriumnamedMycobacteriumchelonae

Modeoftransmission:Mycobacteriumchelonaeiscommonlyfoundinwater,soil,anddustandisknowntocontaminatemedicalproducts.Thereisverylittleriskoftransmissionfrompersontoperson.

Symptoms:Lightsensitivity,pain,blurryvision,abilitytoseeinfectionwithnakedeye

Prevention:Implementationofinfectioncontrolpoliciesatsurgicalandmedicalfacilities,including:protocolsforcleaning,disinfecting,andsterilizingmedicalequipmentshouldmitigatefutureinfections.Theuseofhealthcare-approvedhumidifiersinasurgicalsettingshouldalsohelptopreventfurtherinfection.

Formoreinformation:http://www.odh.ohio.gov/

DISEASE HIGHLIGHTS

Legionnaires’Disease

OVERVIEW

In2015,theToledo-LucasCountyHealthDepartment(TLCHD)wasnotifiedofapotentionalrespiratoryoutbreakassociatedwithaninstitutioninToledo,Ohio.TheEnvironmentalHealthDirectorwasinformedofanumberofindividualsthatwerediagnosedwithpneumoniaandotherswhohadpneumonia-likesymptoms,allofwhomworkedinthesamebuilding(FacilityA).

Aninvestigationwaslaunchedimmediatelyandaquestionnairewasdevelopedtobegincallingtheindividualsforaninterview.TheOhioDepartmentofHealth(ODH)wascalledtodiscusstheoutbreakandtheyalsocoordinatedaspecimenshipmentfortestingattheCenterforDiseaseControlandPrevention(CDC).ThelocalhospitalswereputonheightenedalertforpossiblepneumoniaandLegionnaires’diseasecases.

Followingthelaunchoftheinvestigation,HazcorpEnvServicescompletedairtestingofFacilityAandportableHEPAfilterswereinstalledovertheweekend.TimKeane,anengineeringconsultantspecializinginwaterbornepathogenoutbreakinvestigationandremediaion,wasbroughtforguidanceonapotentialwaterbornediseaseatFacilityA.WiththehelpoftheODHandtheCDC,threeindiviualsthatwereconfirmedintheoutbreakwereaskedtovisitTLCHDforadditionaltesting.AhotlinewasestablishedwiththeTLCHDonSeptember3,2015forcommunitymemberswhowereclientsofFacilityA,whohadbeeninthebuildingbetweenJune13-August4,2015andwereexperiencingpneumonia-likesymptoms.Afterextensivetestingandvalidations,thesummaryshowedLegionellalevelshavebeenwellbelowOccupationalSafetyandHealthAdministration(OSHA)upperlimits.

Ultimately,therewere31casesofillemployeesreportedtoTLCHDfromFacilityA.Afterapplyingthecasedefinition,20individualswereindentifiedasmatchingthecasedefinitionas‘confirmed’or‘suspect’.FacilityAworkedwiththeTLCHDtofindthesourceofillnessandelmininateitimmediately.Anewcompanywashiredtoimplementnecessaryimprovementsandperformroutinepreventativemaintencance.

EPIDEMIOLOGY OVERVIEW OF LEGIONELLA

Infectiousagents:Legionellaspp.,averyserioustypeofpneumonia(lunginfection)Modeoftransmission:Spreadthroughwaterdropletsthatifbreathedin,cancauseLegionnaires’disease.Legionnaires’diseaseisnotspreadfromperson-to-person.IncubationPeriod:2-10daysSymptoms:Cough,muscleaches,highfever,shortnessofbreath,headacheTreatment:Legionnaires’diseaseistreatedwithantibioticsPrevention:CertainfactorscanputapersonathigherriskforcontractingLegionnaires’disease.Theseinclude:beingacurrentorformersmoker,havingchroniclungdiseasesuchasemphysema,orchronicobstructivepulmonarydisease(COPD),orhavingaweakenedimmunesystem.Formoreinformation:http://www.odh.ohio.gov/

TIMELINESS OF DISEASE REPORTS

TimelinessofDiseaseReports

OVERVIEW

Examiningthetimelinessofdiseasereportingisakeypartofgoodpublichealthpractice.Timelinessrequirementsforeachreportablediseasevarybasedonthecommunicabilityandseverityofthedisease.

IntheOhioDiseaseReportingSystems(ODRS)application,itispossibletoquerythedatewhenahealthcareproviderdiagnosedanillnessandthedatewhenthelocalhealthdepartmentreceivednotificationoftheillness(i.e.,thedatethecasewasenteredintoODRS).Whenthedateofdiagnosiswasunavailable(forsomecases),thedatelaboratoryresultswereavailablewasused.Ifbothoftheaforementioneddateswereabsentfromcasefiles,thedatespecimen(s)werecollectedserveasthedatethehealthcareproviderwassuspectingillness.Thisabsenceofdataisanareathatthedepartmentofepidemiologywillbefocusingontoimprovein2015.

Thetablebelowlistsselecteddiseasesandthecorrespondingmedianandmeannumberofdaysbetweenhealthcareproviderdiagnosisandreportingtothelocalhealthdepartmentin2015.Thisincludesanycasereportedtothehealthdepartment,regardlessoffinaldiseaseclassification.In2009,E.coli,hepatitisA,listeriosis,mumps,pertussis,andsalmonellosisbecameClassB(1)reportableconditions,whicharerequiredtobereportedbytheendofthenextbusinessdayaftertheexistenceofacaseisknown.Measles,meningococcaldisease,andrubellaareClassAreportableconditions(designatedinredinthefollowingtable)duetotheirseverityandpotentialforepidemicspread;ClassAreportableconditionsarerequiredtobereportedimmediatelyviatelephoneuponrecognitionofacase,suspectedcase,orpositivelaboratoryresult.

Reportinglagisdefinedasthedifferencebetweenthediagnosisdateandwhenthecasewasreportedtothelocalhealthdepartment.Itistobenotedthatanincreaseinthelagtimeofsomediseasesthatrequireminimalhealthdepartmentfollow-up(e.g.chlamydia,hepatitisB,hepatitisC,gonococcalinfection)isinflated,duetomanagementofhighvolumeofcasesreceivedbyTLCHD.

TLCHDwillperiodicallymonitorthereportinglagtimesforselecteddiseases.Regularmonitoringwillhelpaddresstwokeyissues:latereportersandmissingdata.Ifspecificreportersarefoundtobecontributingtolongerlagtimes,thisinformationwillbesharedwiththem,challengestotimelyreportingwillbeidentifiedandaddressed,andclosermonitoringofreportswillfollow.Additionally,fillinginmissingorincorrectdateswillaidinbetter,timelierinterventionsandpreventionefforts.

TIMELINESS OF DISEASE REPORTS

ReportableCondition LagTime (indays)2014

LagTime(indays)2015

Amebiasis 1.00 2.00Anaplasmosis-Anaplasmaphagocytophilum 8.00 0.00Botulism,foodborne 4.00 0.00Campylobacteriosis 3.84 2.54Chlamydiainfection 32.71* 2.27Coccidioidomycosis 1.00 2.67Cyclosporiasis 1.00 0.00Diphtheria 1.00 0.00E.coli 1.57 0.80Giardiasis 6.82 1.65Gonococcalinfection 79.15* 2.12Haemophilusinfluenzae(invasivedisease) 6.63 2.00HepatitisA 7.00 0.50HepatitisB(includingdelta)-acute 1.83 1.00HepatitisB(includingdelta)-chronic 178.11* 2.94HepatitisC–chronic 105.14* 51.65Influenza-associatedhospitalization 2.46 2.02Legionellosis-Legionnaires'Disease 67.00 3.73Listeriosis 0.00 0.00LymeDisease 10.41 0.78Malaria 35.67 3.00Measles 5.00 0.00Meningitis-aseptic/viral 3.68 2.21Meningitis-bacterial(NotN.meningitidis) 5.14 2.43Meningococcaldisease-Neisseriameningitidis 0.00 0.00Mumps 3.75 0.00Mycobacterialdisease-otherthantuberculosis 6.00 0.03Otherarthropod-bornedisease 8.00 1.00Pertussis 4.55 0.95Salmonellosis 20.26 2.35Shigellosis 7.65 0.64SpottedFeverRickettsiosis,includingRockyMountainspottedfever(RMSF)

4.00 3.00

Streptococcal-GroupA-invasive 4.38 2.92Streptococcuspneumoniae-invasive 3.79 3.41Toxicshocksyndrome(TSS) 4.00 0.00Tuberculosis 0.00 0.00WestNilevirusdisease(alsocurrentinfection) 2.83 1.00Yersiniosis 1.00 0.00

DiseasesdesignatedinRedareClassAReportableDiseases*Itistobenotedthatanincreaseinthelagtimeofsomediseasesthatrequireminimalhealthdepartmentfollow-up(e.g.chlamydia,

hepatitisB,hepatitisC,gonococcalinfection)isinflated,duetomanagementofhighvolumeofcasesreceivedbyTLCHD.In2015,TLCHDwasabletohavefull-timeclericalsupportenteringmanydiseasereports,thusreducingtimefromreceipttoinputintodatabase.

ENVIRONMENTAL HEALTH INTRODUCTION

EnvironmentalHealthIntroduction

OVERVIEW

TheToledo-LucasCountyHealthDepartment’sDivisionofEnvironmentalHealthisresponsibleforinspections,permits,andlicenses.TheDivisioncoversover50differentprograms,including,butnotlimitedto:food,wells,septicsystems,andpublicswimmingpools.Inadditiontoregulatoryresponsibilities,theDivisionconductseducationalsessionsintheaforementionedprograms.

FOOD PROTECTION

FoodProtection

OVERVIEW

TheFoodSafetyProgramisresponsiblefortheinspectionsoffoodserviceoperations,temporaryfoodserviceoperations,foodvendingmachines,micro-markets,mobilefoodoperations,andretailfoodestablishments.Theseinspectionsareconductedwithconsumersafetyinmind.LocalhealthdepartmentshavetheauthoritytoenforcestatestandardsforsafetyandsanitationinFoodServiceOperationsandRetailFoodEstablishments.

WHY IT IS A PUBLIC HEALTH CONCERN

Foodborneillnessisaseriouspublichealththreat.AccordingtotheCentersforDiseaseControlandPrevention,eachyearintheUnitedStates,76millionpersonssuffersymptoms(e.g.vomiting,diarrhea)causedbymishandled,tainted,orspoiledfood.ItisthegoaloftheFoodProtectionDivisionofEnvironmentalHealthtoreducetheriskoffoodborneillnessesthroughinspection,education,andenforcement.

PROGRAMMATIC UPDATE

FoodfacilityinspectionsthathavebeenconductedasofJuly9,2015areavailableon-linethroughtheToledo-LucasCountyHealthDepartment.ThisadvancementillustratesourcontinuedcommitmenttoincreasedcommunicationandimprovingthehealthofLucasCountyresidents.

2015 SNAPSHOT THE TOP SPOT AWARD

FoodServiceOperations Licensed 1,769 InspectionsCompleted 5,298FoodServiceMobile Licensed 101 InspectionsCompleted 120FoodService‐TemporaryLicense Licensed 321 InspectionsCompleted 321FoodService‐VendingMachines Licensed 282 InspectionsCompleted 234RetailFoodEstablishment Licensed 733 InspectionsCompleted 1,262

Inanefforttoincentivizefoodestablishmentsforoverallcleanlinessandtominimizeviolations,theToledo-LucasCountyHealthDepartmentcreatedtheTopSpotAward.ThisisacompletelyvoluntaryprogramwherefoodestablishmentswhomeetguidelinessetforthbytheTLCHDcanbeawardedTheTopSportAward.Criteriaforthisprograminclude:havingnoconfirmedfoodborneillnesseswithin2years,havingthesamelicenseeforatleast1fulllicensingyear,havingnoviolationsfromtheliquorcontrolorsmokingprogram,amongothercriteria.Theawardrecognizesfoodestablishmentsforapplyingandmeetingtheserequirements.For2015,74foodestablishmentswererecognizedfortheTopSpotAward.

LEAD PREVENTION

LeadPrevention

OVERVIEW

“LeadPoisoning”isdefinedasaconfirmedlevelofleadinhumanbloodoftenmicrogramsperdeciliter(10µ/dL)orgreater.TheStateofOhiomandatesbloodleadscreeningforallhighriskchildren72months(6years)ofageandbelow.Highriskchildrenaredefinedasachildthatmeetsoneormoreofthefollowingcriteria: Livesinorregularlyvisitsahousebuiltbefore1950.(Thisincludesadaycarecenter,preschool,or

homeofababysitterorrelative.) Livesinorvisitsahousethathaspeeling,chipping,dustingorchalkingpaint. Livesinorvisitsahousebuiltbefore1978withrecent,ongoing,orplannedrenovation/remodeling. Hasasiblingorplaymatewhohasordidhaveleadpoisoning. Frequentlycomesincontactwithanadultwhohasahobbyorworkswithlead.Examplesare

construction,welding,pottery,painting,andcastingammunition. Oranychildresidinginoneofthefollowingzipcodes:

43402 43460 43551 43602 43604 43605

43606 43607 43608 43609 43610 43611

43612 43613 43614 43615 43620 43624

Forthe2015calendaryear,973childrenwerescreenedbytheToledo-LucasCountyHealthDepartmentand70ofthoseresultedinleadcasesthatthehealthdepartmentmanaged.Overall,39RiskAssessments(Inspections)wereconductedfromJanuarytoDecemberof2015.

LEAD PREVENTION

Leadcandamagenearlyeverysysteminthehumanbody,andhasharmfuleffectsonbothadultsandchildren.LeadpoisoningisthegreatestenvironmentalthreattochildreninOhio.

Signsofleadpoisoningarenotalwayseasytosee.Childrencanbepoisonedbyleadandmaynotlookoractsick.Sometimesthenon-specificsymptomsmaybemistakenforsimilarillnesses(e.g.upsetstomach,influenza).Somepossiblesignsandsymptomsofleadpoisoningarelistedbelow.

CHILDREN ADULTS

Tirednessorlossofenergy TirednessorweaknessHyperactivity IrritabilityIrritabilityorcrankiness TroublesleepingReducedattentionspan HeadachePoorappetite DifficultyconcentratingWeightloss AchesorpainsinstomachTroublesleeping LossofappetiteAchesorpainsinstomach Constipation Nausea Weightloss

Leadpoisoningcanaffecteveryorganandsysteminthebody.Veryhighlevelsofleadexposurecancausecoma,seizures,andevendeath.Evenalittleleadcanmakechildrenslowlearners.Otherhealtheffectsinclude:

CHILDREN ADULTS

Behaviorandlearningproblems ImpotencyHyperactivity BrainandnervoussystemdamageImpairedspeechandlanguage HighbloodpressureSlowedgrowth DigestiveproblemsKidneyandliverdamage KidneyproblemsHearingdamage Anemia Reproductivesystemproblems Hearing,vision,andmusclecoordination

problemsChildrenandadultscangetleadintheirbodiesbyswallowingorbreathingindustthatcontainslead.Someindividualsalsohaveoccupationalexposurestoleadthatputthemathigherrisksofelevatedbloodleadlevels.Yourhealthcareprovidercanaskyousomequestionstoseeifyouoryourchildisatriskforleadpoisoningandthencanrequestbloodtobetested.Thebloodtestingisusedtofindouthowmuchleadisinaperson’sblood.

SEPTIC AND WATER

SepticandWater

OVERVIEW

TheprimarypurposeoftheSepticandWellProgramistopreventdiseaseresultingfromhumanconsumptionofcontaminatedwater.Thisisaccomplished,inpart,byassuringthatwaste-waterhandlingsystemsdonotcontaminatetheaquifersandsurfacewatersourcesofdrinkingwater.

Animportantcomponentofthehouseholdsewagetreatmentsystemprogramistoensurethatallsewagesystemsareinstalledproperlyforeffectivetreatmentofsewageeffluenttopreventcontaminationofdrinkingwater.TheToledo-Lucashealthdepartmentoverseessewagesystemdesignsandinstallationincludingconductingsitereviewspriortosewagesystemapprovaltofinalinspectionstoensureproperinstallation.Thehealthdepartmentalsoassistshomeownerswitheducationonpropermaintenanceofsewagesystemtoprolongthelifeofthesewagesystemandtopreventsystemfailures.

Inadditiontothehouseholdsewagetreatmentsystemprogram,theTLCHDoverseesproperinstallationsandmaintenanceofprivatewatersystemsincludingwellsandhauledwaterstoragetanks.Properinstallationofprivatewatersystemsisverycrucialinprovidingsafedrinkingwaterforthehomeowners.Aspartofmonitoringthesafetyoftheprivatewatersystem,theTLCHDconductswatersamplesandtransportthewatertoalabtobetested.

HouseholdSewageTreatment Permits 67 Inspections 94PotableWaterSystems Permits 47 Inspections 34 WaterSamples 229

SEWAGE TREATMENT SYSTEM PROGRAM

Thereareover12,000householdsewagetreatmentsysteminLucasCountythatifproperlymaintained,canbeasafeandeffectivemeanofwastewaterdisposal.However,failedorimproperlydischargingsewagesystemcancausesewagetocontaminateoursurfaceandgroundwater,thesamewaterthatweallswimanddrink.ThemissionoftheTLCHDistominimizethethreatofsurfacewaterandgroundwatercontaminationfrommalfunctionedorimproperlydesigned,installedormaintainedhouseholdsewagetreatmentsystemsinordertopreventdiseasetransmissionandtoprotectthequalityofsurfaceandgroundwater.TLCHDperformsinspections,regulatecontractors,educatehomeowners,andenforcesewageregulations.

SEPTIC AND WATER

SEWAGE TREATMENT SYSTEM ASSESSMENT PROGRAM

EffectiveJanuary1,2016,thesewageregulationrequiresallhealthdepartmentstodevelopaprogramfortheadministrationofoperationandmaintenance(O&M)managementforsewagetreatmentsystemsandsystemownereducation.TodeveloptheO&Mprogram,TLCHDisconductinganassessmentofallHSTSinLucasCountytodeterminethetype,age,condition,andcomplexityoftheHSTS.Thecomplexityofthesystemreferstowhetherthesystemusesmechanicalcomponentstotreatthesewageeffluentortodosethesewageeffluentintothepipesfordispersal.SurfacewatersamplingisalsobeingconductedaspartoftheassessmenttotestforfecalcoliformandE.coli.Theassessmentisonlybeingconductedfordatacollectionandmonitoringpurposesbutnofeeisbeingassessedtothehomeowners.CurrentlytheassessmentisconductedbytwostaffsanitariansandtheimplementationoftheprogramstartedinAugust,2015.

Assessmentscompletedin2015 324SurfaceWatersamplescollectedin2015 93

PRIVATE WATER PROGRAM

Aprivatewatersystemisanywatersystemotherthanapublicwatersupplysystemthatprovideswaterforhumanconsumption.Themostcommonexamplesofprivatewaterssystemsincludewells,hauledwatersystems,cisternsanddrinkingwaterponds.Theconstruction,alterationorsealingofaprivatewatersystemwillrequireapermitfromthehealthdepartment.Onlyregisteredwatersystemcontractorsmayconstruct,alterorsealprivatewatersystems,drillwaterwells,andinstallpit-lessadapters.

HOUSEHOLD SEWAGE TREATMENT SYSTEM REPLACEMENT AND REPAIR SYSTEM

TheOhioEnvironmentalProtectionAgencyandtheOhioDepartmentofHealthawardedtheToledo-LucasCountyHealthDepartment$300,000toassistOhiohouseholdswithnoorlittlefinancialmeanstorepairorreplacefailinghouseholdsewagetreatmentsystems(HSTS)withanemphasisintheSwanCreekWatershed.TheprogramrequiresthathouseholdsthatarelocatedintheSwanCreekWatershedandwhoseincomeisatorbelow100%,200%,or300%oftheU.S.DepartmentofHealthandHumanServicespovertyguidelinesbeprioritizedforthereplacementorrepairprogram.Thefundingcoverssuchexpensessuchsoilevaluation,designs,applicablepermits,andinstallationincludingmaterials.ThereplacementorrepairsofHSTSisbefullyreimbursableforhomeownerswhoseincomesareatorbelow100%ofthepovertylevel.TheprogramwillalsoassistLucasCountyhouseholdswhosepovertylevelisatorbelow200%andisatorbelow300%withlesseramountofreimbursementsofcost.Ifmoneyisstillavailable,theprogramwillopenuptotherestofLucasCountyoutsideoftheSwanCreekWatershed.

WOLF CREEK WATERSHED SEPTIC SYSTEM EDUCATION PROGRAM

InconjunctionwiththeToledometropolitanareaofcouncilofgovernment(TMACOG),theCityofOregon,andtheLucasCountySoil&WaterConservationDistrict,theTLCHDbegantheWolfCreekWatershedSepticSystemEducationProgram.TheprogramisaimedateducatinghomeownersintheWolfCreek

SEPTIC AND WATER

watershedonhowtoproperlymaintaintheirhouseholdsewagetreatmentsystem.ThehomeownersareassessedregardingtheirknowledgeofHSTSandthenprovidedwitheducationalmaterialonpropermaintenanceofHSTS.AvideowhichcanbeseenontheTLCHDwebsitehasalsobeencreatedtoprovideinformationonHSTSandhowtomaintainthem.

CHAMBERS INSTALLATION FIELD DAY—TRAINING OPPORTUNITY FOR SEWAGE CONTRACTORS

May5,2015,atrainingwasprovidedforsewagecontractorsusingalivedemonstrationofasewagetreatmentsystembeinginstalledusing“chambers”.PriortotheadoptionofthenewsewageregulationsinJanuary1,2015,manyofthelocalsewagecontractorsinstalledtraditionalstoneandpipesforleachfields.TheChambersinstallationfielddaywhichwassponsoredbyInfiltratorSystemsInc.andJohnHelminiak&SonsExcavating,alocalsewagecontractor,wasusedtodemonstrateanothermethodfortheinstallationofleachfields.Chambersaregravel-lesssystemsandcanbeinstalledusingasmallerinfiltrativeareathantraditionalleachfields.OvertwentyfivepeoplewereinattendanceandcontractorswereabletoobtainCEU’swhicharerequiredtobecomeregisteredtoconductsewageworkinLucasCounty.

Safesepticandsewagetreatmentisanimportantcomponenttopublichealth.Sewagehasthepotentialtopollutewatersystemswithpathogens,excessnutrients,heavymetals,andothertoxins.Improperlymanagedsewagesystemscannegativelyimpactaquaticlifeandcontributetobacterialgrowthinbodiesofwater.Pathogenscarriedinsewagecanalsoendupindrinkingwatersuppliesandswimmingareas,ifsystemsarenotproperlymaintained.TheEnvironmentalProtectionAgencyestimatesthatupto3.5millionindividualsfallillfromswimminginwaterscontaminatedbysanitaryseweroverflowsaloneevery

SEPTIC AND WATER

year.Listedbelowareanumberofpathogens,parasitesandvirusesthatcanbeimplicatedincontaminatedwatersystems:

AGENT ACUTE EFFECTS

BACTERIA

E.coliO157:H7 DiarrheaLegionellapneumonia Fever,pneumoniaHelicobacterpylori GastritisVibriocholera DiarrheaVibriovulnificus SkinandtissuedamageCampylobacter DiarrheaSalmonella DiarrheaYersinia DiarrheaShigella DiarrheaCyanobacteria DiarrheaLeptospirosis Fever,headache,chills,muscleaches,vomitingAeromonashydrophila DiarrheaPseudomonasaeruginosa Fever,lethargy

PARASITE

Giardialamblia DiarrheaCryptosporidium DiarrheaToxoplasmagondii Newbornsyndrome,hearingandvisualloss,mentalissuesMicrosporidia DiarrheaEntamoebacayetanensis Amebiasis,amoebicdysentery,abscessesinliverorotherorgans

Hepatitisvirus LiverinfectionAdenoviruses Eyeinfections,diarrhea,respiratorydiseaseCaliciviruses DiarrheaCoxsackieviruses Encephalitis,asepticmeningitisEchoviruses AsepticmeningitisPolyomaviruses GastroenteritisNorovirus Nausea,vomiting,abdominalpainorcramps,wateryorloose

diarrhea,malaise,low-gradefever,musclepainListingisnotcomprehensivetocoverallwaterborneillnesspathogens/bacteria/viruses.Alsonotincludedare

chemicalsthathavebeenimplicatedinpreviouswaterborneillnesses.

RECREATIONAL VEHICLE PARKS

RecreationalVehicleParks

OVERVIEW

TheToledo-LucasCountyHealthDepartmentismandatedbytheOhioDepartmentofHealthtoenforcerulesrelatingtorecreationalvehicleparks;theserulescanbefoundintheOhioAdministrativeCode(OAC)inChapter3701-25.Minimumstandardshavebeenestablishedandaretobeenforcedforthedesign,installation,operation,andmaintenanceoftheseparkstoprotectthepublicfrominjury,minimizethepotentialfordiseasetransmission,andprovideasafeandhealthyrecreationalenvironment.

2015 SNAPSHOT

For2015,14facilitieshavebeenlicensedand17inspectionshavebeenconductedduringthecalendaryear.

RODENT PROGRAM

RodentProgram

OVERVIEW

Therodentcontrolprogramisdesignedtomanageoneoftheoldestpublichealthproblemsknowntohumans.Rodentsdestroyproperty,havethepotentialtocontaminatefoodsupplies,andalsocarrydiseases.Ourgoalistocontrolthespreadofdiseasebylimitingthegrowthofrodentpopulationsandtocorrectconditionsthatcontributetorodentbreeding.Toaccomplishthisgoal,therodentcontrolprogramconductsfieldinspections,issuesorderstoabateconditionsthatareconducivetoproliferationofrodents,baitpublicareas,andmeetwithneighborhoodgroupstoprovideeducationonmethodsofrodentcontrolandapplicationofpesticides.

2015 SNAPSHOT

Forthe2015calendaryear,therodentprogramconducted1,404inspectionsandapplied233poundsofbaitwithinLucasCounty.

COMMUNITYDEVOLOPMENTBLOCKGRANT(CDBG)41stYEARUPDATE

TherodentprogramalsoworksundertheCommunityDevelopmentBlockGrant(CDBG)whenconductingrodentcomplaintanddemoinspectionswithintheCityofToledo.TheareaforthisgrantincludesallareasintheCityofToledowithanemphasisinareaswithlowtomoderatelevelsofincome.Whencompilingdataforthisgrant,onlytheinitialcomplaintanddemoinspectionarereported.Inthepast18months,theToledo-LucasCountyHealthDepartmentcompletedatotalof1,080rodentabatementinspectionsatdemolitionsitesintheCityofToledo.Ofthe1,080inspections,81%or875inspectionswereconductedinthelowandmoderatehouseholdincomeareasaccordingtothe2013MedianHouseholdIncomeMap.Demolitioninspectionsinthelowincomelevelscompletedtotaled48.33%or522inspectionsandareasofmoderateincomehadatotalof32.6%or353demolitioninspections.Thedatashowsthatwewereabletomeettheneedsofourtargetedarea.

TotalNumberofDemolitionInspectionsConducted

LowHouseholdIncomeper2013CensusTract

522DemolitionInspectionsCompleted48.33%

ModerateHouseholdIncomeper2013CensusTract

353DemolitionInspectionsCompleted32.69%

OtherCensusTractAreas 205DemolitionInspectionsCompleted 18.98%

TotalNumber:1,080DemolitionInspectionsCompletedintheCityofToledo 100%

RODENT PROGRAM

Inthepast18monthstheToledo-LucasCountyHealthDepartmentreceivedatotalof1,190rodentcomplaintsintheCityofToledo.Ofthe1,190complaintsreceived,70.25%or836complaintswerereceivedinthelowandmoderatehouseholdincomeareasaccordingtothe2013MedianHouseholdIncomeMap.Complaintsreceivedinthelowincomelevelareastotaled38.66%or460totalcomplaintsandareasofmoderateincomehadatotalof31.60%or376totalcomplaintsreceived.Thenumberofcomplaintsreceivedarecountedbyaddressandnotthenumberoftimesaninspectorwillvisitthehometoconductaninspection.

Asidefromtheobviousconcernsrelatingtothepresenceofrodents,manydiseasescanbedirectlytransmittedbyrodents.Listedbelowarejustafewofthesediseases:

Hantaviruspulmonarysyndrome Hemorrhagicfeverwithrenalsyndrome Lassafever Leptospirosis LymphaticChorio-meningitis(lcm)

Omskhemorrhagicfever Plague Rat-bitefever Salmonellosis SouthAmericanarenaviruses Tularemia

Rodentsalsocanindirectlytransmitmanydiseasestohumans.Thesediseasesinclude,butarenotlimitedto:

Babesiosis Coloradotickfever Cutaneousleishmaniasis Humangranulocyticanaplasmosis Lacrosseencephalitis Lymedisease Murinetyphus

Omskhemorrhagicfever Powassanvirus Scrubtyphus Rickettsialpox Relapsingfever Rockymountainspottedfever Sylvatictyphus WestNilevirus

TotalNumberComplaintsReceivedJuly1,2014‐December31,2015LowHouseholdIncomeper2013CensusTractArea

460RodentComplaintsReceivedfortheseareas 38.66%

ModerateHouseholdIncomeper2013CensusTract

376RodentComplaintsReceivedfortheseareas 31.60%

OtherCensusTractAreas 354RodentComplaintsReceivedfortheseareas 29.75%

TotalNumber: 1,190RodentComplaintsReceived 100%

RODENT PROGRAM

SCHOOLS

Schools

Overview:Forthe2015calendaryear,theToledo-LucasCountyHealthDepartmentinspectedallpublicandprivateschoolsforenvironmentalhealthandsafetyrisksfactors.InaccordancetotheU.S.DepartmentofEducation,officeoftheunderSecretary,“Inadequateindoorenvironmentinschoolsmaydecreaseperformancebycausinghealtheffectsthateitherdirectlyimpairconcentrationsormemoryorindirectlyaffectlearning.”Ourgoalistoinspectschoolstwiceaschoolyearandinformtheschoolofficialsoftheenvironmentalhealthandsafetyrisksfoundduringourinspectionsandprovideguidanceoncorrectinganydeficiencies.Whilethisprogramisunfundedandtherearenoregulatoryrequirementsforschoolstocorrectanydeficiencies,webelievethatthisprogramhashelpedprovidedasafeschoolenvironmentforthechildrenofLucasCounty.

2015 SNAPSHOT

In2015,180facilitieswerelicensedandatotalof299inspectionswerecompleted.

In2010,PresidentObama’sEducationBlueprintstatessafetyandhealthconditionsofschoolenvironmentasanessentialelementtoimprovestudentlearning.Thereisagrowingnumberofliteraturewhichdocumentsthesupportofasafeandhealthyschoolenvironmentforlearning.Decayingenvironmentalconditionspresentinaschoolbuildingcanaffectlearningaswellasthehealthandmoraleofstaffandstudents.Accordingtoa2004reporttotheUnderSecretaryoftheU.S.DepartmentofEducation,“Theoverallevidencestronglysuggeststhatpoorenvironmentsinschools,dueprimarilytoeffectsofindoorpollutants,adverselyinfluencethehealth,performanceandattendanceofstudents.”Oneoftheeasiestwaystocreateahealthyschoolenvironmentistoimproveeverydaymaintenancetokeeptheschoolbuildingsclean,runningsmoothlyandsafely.Unsanitaryconditionsandpoorcleaningpracticescanattractunwantedpests,allowdustsandotherirritantstoaccumulatewhichcontributetoincreasedrespiratoryandasthmasymptomsamongthechildrenandadults.*

*U.S.EPA:AnOverviewofRoutineCleaningandMaintenanceforaHealthySchoolEnvironment*U.S.DepartmentofEducation,OfficeofPlanning,EvaluationandPolicyDevelopment,ESEABlueprintforReform,Washington,D.C.2010*TheAmericanClearinghouseonEducationalFacilities,MaintainingaSafeandHealthySchoolEnvironmentforLearning.Vol.1,No.1,2011.*InformationtakenfromODHSchoolInspectionGuidance,10-29-10

PUBLIC SWIMMING POOLS

PublicSwimmingPools

OVERVIEW

Publicswimmingpools,spas,andspecialusepoolsareregulatedundertheauthorityofChapter2749oftheOhioRevisedCode(ORC)andChapter3701-31oftheOhioAdministrativeCode(OAC)andtheenforcementoftheseregulationswithinLucasCounty,OhiofallstotheresponsibilityoftheToledo-LucasCountyHealthDepartment.

Theseruleswerecreatedtoestablishminimumstandardsforthedesign,installation,operation,andmaintenanceofthesefacilitiesinordertoprotectthepublicfrominjury,minimizethepotentialfordiseasetransmission,andprovideasafeandhealthyaquaticrecreationalenvironmental.Publicswimmingpoolcollectivelyreferencespublicswimmingpools,publicspas,specialusepools,wadingpools,andspraygrounds.

Mostswimmingpoolsareinspectedbyourstaffpriortothepoolsopeningduringtheearlysummermonthsandareinspectedonaperiodicbasisthroughoutthesummer.Therearealsoseveralindoorswimmingpoolsandspasthatarelocatedinhotelsandhealthclubsthatinspectedyearround.Inadditiontoconductingregularinspectionsofswimmingpools,theToledo-LucasCountyHealthDepartmentconductsinspectionsiftherearecomplaintsfromacitizenorifinvestigatingconcernsassociatedwithpossiblewaterborneillnesses.

2015 SNAPSHOT

ThestaffattheToledo-LucasCountyHealthDepartmenthavelicensed254publicswimmingpoolsandconducted620inspectionsfor2015.

Chlorine,acommonpoolcleaningchemical,doesnotkillallgermsinstantly.Somebacteriaandparasiteshavebecomeverytoleranttochlorineand,untilrecently,havenotbeenknowntocausehumanillness.Theseresistantbacteriaandparasitescantakeminutestodaystobekilledbychlorine,soswallowingjustalittlewaterthatcontainsthesegermscanmakeyousick.

Recreationalwaterillnesses(RWIs)arecausedbygermsspreadbyswallowing,breathinginmistsoraerosolsof,orhavingcontactwithcontaminatedwaterinswimmingpools,hottubs,waterparks,waterplayareas,interactivefountains,lakes,rivers,oroceans.RWIscanalsobecausedbychemicalsinthewaterorchemicalsthatevaporatefromthewaterandcauseindoorairqualityproblems.

RWIsincludeawidevarietyofinfections,suchasgastrointestinal,skin,ear,respiratory,eye,neurologic,andwoundinfections.ThemostcommonlyreportedRWIisdiarrhea.DiarrhealillnessesarecausedbygermssuchasCrypto(shortforCryptosporidium),Giardia,Shigella,NorovirusandE.coliO157:H7.WithRWIoutbreaksontherise,swimmersneedtotakeanactiveroleinhelpingtoprotectthemselvesand

PUBLIC SWIMMING POOLS

preventthespreadofgerms.ItisimportantforswimmerstolearnthebasicfactsaboutRWIssotheycankeepthemselvesandtheirfamilyhealthyeverytimetheyswim.

Inthepasttwodecades,therehasbeenasubstantialincreaseinthenumberofRWIoutbreaksassociatedwithswimming.Crypto,whichcanstayalivefordayseveninwell-maintainedpools,hasbecometheleadingcauseofswimmingpool-relatedoutbreaksofdiarrhealillness.AsindicatedintheCentersforDiseaseControlandPrevention’sMorbidityandMortalityWeeklyReportfrom2012,2004to2008,reportedCryptocasesincreasedover200%(from3,411casesin2004to10,500casesin2008).

AlthoughCryptoistoleranttochlorine,mostgermsarenot.Keepingchlorineatrecommendedlevelsisessentialtomaintainahealthypool.However,a2010studypostedintheCentersforDiseaseControlandPrevention’sMorbidityandMortalityWeeklyReportin2010foundthat1in8publicpoolinspectionsresultedinpoolsbeingclosedimmediatelyduetoseriouscodeviolationssuchasimproperchlorinelevels.

Formoreinformationaboutrecreationalwaterillnesses,seewww.cdc.gov/healthywater/swimming/rwi.

BODY ART

BodyArt

OVERVIEW

BodyartinthestateofOhioisregulatedundertheauthorityofChapter3730.01oftheOhioRevisedCode(ORC)andChapter3701-9oftheOhioAdministrativeCode(OAC)and,forthejurisdictionofLucasCountyOhio,istobeenforcedbytheToledo-LucasCountyHealthDepartment.Theseruleswerecreatedtoestablishminimumstandards,applicableacrosstheentirestateofOhio,fortheoperationandmaintenanceofbodyartfacilitiesinordertoprotectthepublicfrominjury,minimizethepotentialfordiseasetransmission,andprovideasafeandhealthyenvironment.

2015 SNAPSHOT

Forthe2015calendaryear,theprograminLucasCountyhaslicensed25facilitiesandconducted60facilityinspections.

Popularityanddecreasedtabooassociatedwithtattooingandbodypiercinghasleftmanyindividualsbelievingthattheseproceduresareextremelysafe,especiallywhenconductedinwhatmayappeartobeawell-respectedtattooartistinaseeminglysterilesetting.Publichealthworkstoensurethatfacilitiesareoperatingwithinlicensingguidelinesandthattheriskofinfectiousdiseasesandhazardoussituationsaremitigated.UnsteriletattooingequipmentandneedlescantransmitdiseasessuchasHIV,hepatitis,andskininfectionscausedbymanybacteria,includingsomespeciesofStaphylococcus.

BATHING BEACHES

BathingBeaches

OVERVIEWTheBathingBeachRegulationadoptedbytheToledo-LucasCountyHealthDepartmentisthesourceofregulationsforbathingbeachespermittedbythisdepartment.TheToledo-LucasCountyHealthDepartmentwillconductannualinspectionsatpermittedbathingbeachesinLucasCounty.Safetyandsanitationofthebathingbeachanddivingareasareevaluatedalongwiththewaterquality.WaterqualitystandardsarebasedonthecurrentU.S.EnvironmentalProtectionAgency(EPA)standards.Currently,thestandardsstatethatE.Colishallnotexceed235E.Colicoloniesper100mlinmorethan10%ofthesamplestakenduringany30-dayperiod.

2015SNAPSHOTIn2015,theToledo-LucasCountyHealthDepartmentissued3bathingbeachpermitsandconducted5inspectionswithwatersampling.AllwatersamplestakenandtesteddidnotexceedtheU.S.EPAstandardof235E.Colicoloniesper100ml.

WHYISITAPUBLICHEALTHCONCERNConductinginspectionsatthepermittedbathingbeachesallowsthisdepartmenttoassureasafeandhealthyaquaticrecreationalenvironmentbyprotectingthebathingpublicfromrisksofcontractingwaterbornediseasesfromexposuretocontaminatedwaters.Gastroenteritiswiththesymptomsofnausea,vomiting,headache,stomachache,feveranddiarrheaarethemostcommonassociatedillnesswhenswimmingincontaminatedwater.Otherillnessesassociatedwithswimmingincontaminatedwaterinclude,eye,ear,noseandthroatinfections.

SMOKE‐FREE WORKPLACE

Smoke-FreeWorkplace

OVERVIEW

PublichealthinLucasCountyhasbeenalong-standingadvocateforsmoke-freeenvironments.In2003,manyuniversitiesacrossOhio,includingsomewithinLucasCounty,bannedsmokingoncampus.TheToledo-LucasCountyHealthDepartmenthasbeenresponsibleforenforcingOhio’sSmoke-FreeWorkplaceActandhasbeeninstrumentalintighteningsmokinglegislationwithinthestate.Ohio’sSmoke-FreeWorkplaceActwasvoteduponinNovemberof2006asIssue5inthestateofOhio;Issue5wasastatutewhichsetintolawarequirementthatallpublicplacesandplacesofemploymentinthestateofOhioprohibitsmoking.

ThenewlawwentintoeffectDecember7,2006,thirtydaysaftervoterspassedthelaw.AdministrativerulefortheOhioRevisedCode3794furtherdefinedthelawandenforcementbyoutliningresponsibilitiesofproprietorsandindividuals.Theyclarifythepostingrequirementsforsigns,outlinedueprocessforproprietorsandindividualsandstatefinesandpenaltiesforviolations.

2015 SNAPSHOT

Forthecalendaryearof2015,theToledo-LucasCountyHealthDepartmentconducted130smoke-freeworkplaceinspections.

SmokingistheleadingpreventablecauseofdeathintheUnitedStates.TheCentersforDiseaseControlandPreventionestimatesthatcigarettesmokingcausesmorethan480,000deathsintheUnitedStatesannually.Smokersarealsomorelikelythannonsmokerstodevelopheartdisease,stroke,andlungcancer.Quittingsmokinglowersyourriskforsmoking-relateddiseasesandcanaddyearstoyourlife.

Secondhandsmokeisthecombinationofsmokefromtheburningendofacigaretteandthesmokebreathedoutbysmokers.Exposuretosecondhandsmokehasimmediateadverseeffectsonthecardiovascularsystemandcancausecoronaryheartdiseaseandstroke.Breathingsecondhandsmokecanhaveimmediateadverseeffectsonyourbloodandbloodvessels,increasingtheriskofhavingaheartattack.Secondhandsmokeharmsnotonlyadults,butchildrenbyincreasingtheirlikelinesstodevelopotherillnesses(e.g.bronchitis,pneumonia,earinfections,asthma).

Foradditionalinformation,seehttp://www.cdc.gov/tobacco/index.htm

ANIMAL BITES

AnimalBites

OVERVIEW

OhioStatelawrequiresthatownersofanyanimalthatmayhavebeeninvolvedinabitefollowspecificrules.Peoplecanbeexposedtodiseases,suchasrabies,whentheyarebittenbyaninfectedanimal,orlesscommonly,whensalivafrominfectedanimalsgetintoanopenwoundorontoamucousmembrane.TheToledo-LucasCountyHealthDepartmentworkswiththeOhioDepartmentofHealthZoonoticDiseaseProgramtoconductactivitiestoprotectOhioresidentsfromthespreadofdiseasescarriedbyanimalsbyprovidingeducation,providingtestingofspecimens,andcollectingandmaintainingdataonrabiesandanimalbiteswithinLucasCounty,Ohio.

2015 SNAPSHOT

Forthe2015calendaryear,701bitereportswerecompleted.81samplesweresenttotheOhioDepartmentofHealthLaboratoriesand0testedpositiveforrabiesvirus.

2015AnimalBiteReportbySpeciesinLucasCountySpecies NumberofBite

ReportsDog 586Cat 89Bat 16Raccoon 3Squirrel 3DomesticRodent 2Monkey 1Opossum 1

Animalbitescanresultinseriousinjuriesandpotentialexposurestodiseasessuchasrabies.Itisestimatedthatnearly5millionpeopleintheUnitedStatesarebittenbydogseachyear,andabout1in4ofthosepeoplerequiremedicalattention.Mammalsarecarriersforrabiesand,thoughthepresumedfearisprimarilyaroundcontractingrabiesfromdogs,themorelikelyexposuretorabiesisthroughthebiteorcontactwithbats.

ANIMAL BITES

Formoreinformation,visithttp://www.odh.ohio.gov/animalrabies

ANIMAL BITES

NUISANCE

Nuisance

OVERVIEW

Apublichealthnuisanceiswhenabuildingorpropertyisinaconditionthatthreatensorpotentiallythreatensthehealthofanypersonorcommunity.TheToledo-LucasCountyHealthDepartmentwilloftenworkwithcities,townshipsandvillagestoabatepublichealthnuisanceconditionsbyinspectionsandenforcementactions.Examplesofpublichealthnuisancesareunsanitaryhousingorlivingconditions,accumulationoftrash,garbage,andotherdebrisonpropertiesandotherconditionsthatattractroachesandrodentswhichmayharbordiseases.

2015 SNAPSHOT

Forthe2015calendaryear,theTLCHDinspected408nuisancecomplaints.

TypeofNuisanceComplaintInvestigated NumberofComplaintsReceived

Pest/Vermin 99Housing/UnsanitaryConditions 95Other 49Rawsewageatadwelling 46Nowateratadwelling 30Mosquito-StagnantWater/Pool 26AnimalIssues 24CityofToledoComplaintsregardingKeepingofChickens 9FeralCats 7Ticks 7SolidWaste 6ScrapTires 4OpenDumping 4Composting 2TotalComplaintsInvestigated 408

RESPONSE AND PREPAREDNESS

ResponseandPreparedness

GROUPOVERVIEW CommunityServices,ResponseandPreparedness(CSRP)wasestablishedin2008tolooktothefuture

andassurecuttingedgeepidemiologicalcapabilities,infectiousdiseasesurveillance,emergencyresponseservices,emergencypreparednesseducationandawarenesstothecommunity.

ThegroupdirectstheHealthDepartment'ssupportandresponseforanypublichealthemergencyorlocaldisasterrelatedeventforLucasCounty

Inaddition,thegrouphousestheRegionalPublicHealthCoordinatorforNorthwestOhio.ThroughtheofficeofCommunityServices,ResponseandPreparedness,Toledo-LucasCountyHealth+DepartmentprovidesemergencypreparednesscoordinationandsupporttotheeighteencountyNorthwestOhioPublicHealthRegion.

EMERGENCY PREPAREDNESS

TheCommunityServices,ResponseandPreparednessgroupisprimarilyfundedthroughthePublicHealthEmergencyPreparedness(PHEP)Grant.Thisgrantisannuallyusedtosupport,sustainandbuildemergencypreparednesscapabilitieswithinLucasCounty,OhioandtheNorthwestOhioRegion.Resourcesobtainedandprojectsaccomplishedwiththeseresourcesbene itthegeneralpopulationwithinToledo-LucasCountyHealthDepartment’sjurisdictions.The11speci iedcommunitysectorswithinLucasCounty(business,communityleadership,culturalandfaith-basedgroupsandorganizations,emergencymanagement,healthcare,socialservices,housingandsheltering,media,mental/behavioralhealth,stateof iceofagingoritsequivalent,educationandchildcaresettings)alsogreatlybene itfromtheseplanningefforts.

TLCHDstrivestoannuallymeettheoutlinedPHEPgrantdeliverablesthatcorrespondtothe15CentersforDiseaseControlandPrevention(CDC)emergencypreparednesscapabilities.SomeoftheseactivitiesincludeupdatingtheStrategicNationalStockpile(SNS)self-assessmentandimprovementplan,conductingtrainingandconductingexercisestoaddressgaps/inefficiencies.

DISASTERRESPONSETEAMTheTLCHDdisasterresponseteamwascreatedin2015.ThepurposeofthisgroupistohavetrainedstaffavailabletoprovideassistancewhenadisasteroccurswithinLucasCountyandthecityofToledo.ThegroupfeaturesstaffmembersfromalldivisionsandprofessionsacrosstheTLCHD.

Theteammeetsmonthlytohearfromdifferentspeakers,visitlocalcommunitypartners,orperformin-houseplanninginitiatives.Teamactivitiesincludethefollowing:

SiteVisits ToledoFireDepartment ProMedicaToledoHospitalEmergencyDepartment LucasCountyEmergencyManagementAgency,

EMA,EmergencyOperationsCenterTraining IncidentCommandStructureTraining PersonalProtectiveEquipmentOverview

EXERCISEPLANNINGANDTRAINING RegionalFitTestingTraintheTrainer

o TLCHD,inconjunctionwithToledoFireSpecialOperationsprovidedfittestingtoalllocalfirstrespondersandpublichealthofficesintheNorthwestOhioregion.

ContinuityofOperationsPlanning(COOP)o TheNorthwestOhioregionalfunctionalexerciseinApril2015focusedonCOOP.o Insuchexercisesanorganizationmustshowitsabilitytorelocateandsustainessential

serviceswhenadisasterstrikesitspermanentestablishment. Davis-BesseGradedExercise

o TheLucasCountyEMAconductedafunctionalexerciseandafull-scaleexercisefortheDavis-BesseNuclearPowerPlaninthespringof2015.

o TheLucasCountyEMAisrequiredtoperformanactivationoftheirEmergencyOperationsCenterindowntownToledo,aswellasanactivationoftheircommunityreceptioncenterinOregon,OhiointheeventadisasteroccursatDavis-BesseNuclearPowerPlantinOttawaCounty.

ResponseteamvisittoToledoFireStationNo.5

o TheexercisewasgradedbytheFederalEmergencyManagementAgency(FEMA)forcomplianceofcurrentnuclearregulations,stakeholderresponse,andcommunityresiliency.

o LucasCountyleadsthenationinemergencypreparednessbyprovidingapetreunificationcenterforresidentsutilizingthecommunityreceptioncenter.ThismeasureisnotrequiredbyFEMAandisonlydonebyaselectfewagenciesacrossthenation.

Multi-AgencyCoordinationPlanTabletopExerciseo TheLucasCountyIntegratedHealthcareCoordinationTeam(localhealthcarecoalition)

conductedatabletopexercisewithallmemberstoreviewtheactivationandresponsibilitiesoftheLucasCountyMulti-AgencyCoordinationPlan.

St.Luke’sHospitalFluClinico Theemergencypreparednessteampartneredwithhealthservicestoprovideacommunityflu

clinicinNovember2015.o Thefluclinicprovidedbothpediatricandadultfluimmunizations.o ThisfluclinicfulfilledaPHEPgrantrequirementforapointofdispensingactivationsite.

EMERGENCY RESPONSE PLAN REVISIONS

TheTLCHDemergencyresponseplansareintheprocessofbeingcompletelyrewrittenandreformatted.AllplanswillnowbeinlineandreflecttheCentersforDiseaseControlandPrevention’sPublicHealthPreparednessCapabilities.Thefollowingplanshavebeenupdatedduringthe2015calendaryear:

o All-HazardsEmergencyResponsePlano ContinuityofOperationso DemobilizationandRecoveryo QuarantineandNon-PharmaceuticalInterventionso VolunteerManagemento EpidemiologyandSurveillanceo HazardVulnerabilityAnalysiso TrainingandExercise(LocalandRegional)o EmergencyPublicInformationandWarningo BloodBornePathogens

EBOLAVIRUSDISEASESUPPLEMENTALGRANTInApril2015,thedivisionofCommunityServices,ResponseandPreparednesswasawardedasupplementtoitsPHEPgrant.ThissupplementaimstoincreaselocalandstatepreparednessplanningandcoordinationwithregardtotheconcernsaroundtheEbolaVirusDisease(EVD)andotherspecialpathogens.TheseeffortswillresultinthecreationoftheNorthwestOhioEbolaandOtherSpecialPathogensConceptofOperationsPlan.

ThedivisioniscurrentlycollaboratingwiththeseventeencountiesintheregiontocreateregionalandlocalEbolaVirusDiseaseplans.ThisgrantenabledthedivisiontohireaRegionalEbolaCoordinatortohelpcoordinatethepreparednessplanningintheregionandpartiallyfundanotherteammembertowritethelocalplanforLucasCounty.

NorthwestOhioEbolaandOtherSpecialPathogensConceptofOperationsPlanconsiderations:

LocalHealthDepartmentRoles FirstResponderPPETraining PatientTransportationGuidelines HospitalGuidelines

Isolation&Quarantine ManagementofHumanRemains WasteMangement InformationSharingGuidelines

CreatingtheNorthwestOhioEbolaandOtherSpecialPathogensConceptofOperationsPlanhasbeenverytimely,sincemanyNorthwestOhioepidemiologistshavemonitored“travelers”(personswhohavetraveledthroughregionsunderCDCrestrictions)intheirrespectivecountiesforEboladisease.

Regionalplanchallenges:

IdentifyingEMSprovidersthroughoutNorthwestOhiowhoareproperlytrainedandequippedtotransportsuspectedorknownEbolapatientstotheappropriatehospital.

Waitingforhospitalclassifications.Currently,OhiohasOneEbolaTreatmentHospital(MetroHealthMedicalCenter)inCleveland,OhioandeightEbolaAssessmentHospitals.TheonlyassessmenthospitalinNorthwestOhiois,St.Rita’sMedicalCenter(Lima,Ohio).Allotherhospitalsareconsideredfront-linehospitals.

HospitalDefinitions:Frontlinehospitalswillidentify,evaluate,andisolatesuspectedEbolaViruspatientsandarrangefortransporttoahigherlevelofcare.AssessmenthospitalsacceptsuspectedEbolaViruspatientsupto96hourstoperformtestingtoconfirmorexcludeinfection.TreatmentCentersserveasastateresourcetoacceptandtreatpatientswiththeEbolaVirus.

PlanningforthecareofpediatricEVDpatients.NorthwestOhio’sonlyEbolaassessmenthospital,St.Rita’sMedicalCenter,doesnothavethecapacitytocareforpediatricEbolapatientssothesepatientsmayrequiretransporttoachildren’sassessmenthospitalinCleveland,OhioorColumbus,Ohio.Securingtransportationinthiscasehasbeendifficult.

AdditionalActivitiesAssociatedwiththeGrant:

InOctober,2015Toledo-LucasCountyHealthDepartment,ToledoFire&Rescue,LucasCountyEMS,TheHospitalCouncilofNorthwestOhio,andtheLucasCountyProsecutorsOfficesponsoredtheNorthwestOhioEbolaUpdateProgram.TheprogramwasheldattheUniversityofFindlayandwasdirectedtoallfirstresponders(Fire,EMS,LawEnforcement,EMA,Hospitals,andPublicHealth)throughoutNorthwestOhiotoprovidethemwithupdatesandthelatestinformationonresponsetoEbolarelatedincidents.

InDecember,2015theLucasCountyEbolaPlanCoordinatorandtheRegionalEbolaCoordinatorwereinvitedtoattendanEbolaexerciseatProMedicaToledohospital,toseehowthatfacilitywouldtorespondifsomeonewithEbolaweretowalkinunannouncedintheiremergencydepartmentfortreatment.Theirresponsefollowedtheirfacility’sEbolaPlan.TheexerciseconcludedwhenProMedicaTransportationNetworktransferredthepatienttoanEbolaassessmenthospital.

CSRPhaspurchasedadditionalpersonalprotectiveequipment(PPE)tobetterprepareforanemergencyevent.

POINTOFDISPENSING(POD)SITES

IntheeventthattheentirepopulationofLucascountyneedstoobtainmedicalcountermeasures(MCM),thehealthdepartmentlackstheresourcestosingle-handedlyrespondtosuchanincident.Suchaneventmaybecausedbyanactofbioterrorism,epidemicorpandemicdisease,ornovelandhighlyinfectiousagentposesaseriousrisktothepublic.

Toprepareforthiskindofpublichealthemergency,TLCHDhasaPointofDispensing(POD)plan.Inthisplan,wehaveestablishingMemorandumsofUnderstandingswithpartnerstousetheirfacilitiesand/orstafftodistributemedicalcountermeasuresinapublichealthemergency.ThesePODpartnerscurrentlyinclude,faithbasedorganizations,schools,businesses,andotherlocalorganizations.

TypesofPODSOpen TLCHDhas19openPODpartnersofferingtheuseoftheirfacilityuseand/orvolunteers

Closed ClosedPODsareestablishedataprivatebusinessesororganizations.TheytypesofPODsarespecificallymeanttoserveaspecificpopulation,usuallythebusinessororganization’semployeesandtheirfamilies.

Thehealthdepartmenthasmemorandumofunderstandingswith34closedPODpartnersconsistingofbusinessesandorganizations

BothclosedandopenPODpartnerswouldserveasthesitewherepharmaceuticalsfromtheStrategicNationalStockpilecouldbedelivered,andmedicalpersonnelatthesesiteswoulddispensethesemedicationsduringapublichealthemergency.AgreementswithtruckingcompaniestoassistinthetransferofsuppliestoourPODpartnersarealsoinplace.

ThePODagreementsensurethatwecanofferantibiotics,vaccines,orothermedicalcountermeasurestoasmanypeopleasexpeditiouslyandefficientlyaspossibletominimizemorbidityandmortalityamongstthepopulation.

MEDICALRESERVECORPS

TheMedicalReserveCorps(MRC)isavoluntaryorganizationcomprisedofphysicians,nurses,dentists,andothermedical/non-medicalprofessionalstoassistpublichealthduringanemergency.

Asofthebeginningof2016,theLucasCountyMRChas128registeredvolunteers.

NewlearningplansforemergencytraininghavebeencreatedtohaveallMRCvolunteerstrainedforavarietyofdisasters.

In2015,aclimatesurveywasgiventoallvolunteerstogaugewhatinterestsvolunteerswouldlikeincorporateinthecomingyear.Inresponse,differenttrainingandoutreachopportunitieswillbeconductedfor2016.

Improvementshavebeenmaderegardingbadging,credentialing,anddeploymentlogisticswiththeUnitedWayofGreaterToledo.

REGIONALCOORDINATIONBYTLCHDTheDivisionofCommunityServices,ResponseandPreparednesshousestheRegionalPublicHealthCoordinationTeamforNorthwestOhio.ThisteamprovidesthefollowingservicesfortheNWOhioRegion:

Facilitatorformeetings/trainingsfortheNWOhioPublicInformationOfficers,DisasterPlanners,EpidemiologistsandHealthCommissioners

LiaisonforHospitalPlannersinNWOhio 24/7liaisonwithOhioDepartmentofHealth,LocalHealthDepartments

andtheRegionalHealthcareCoalitiontoassistwithinformationsharingduringaresponse

INTRA-AGENCYCOORDINATIONThePHEPgranthasaffordedTLCHDtheopportunitytoworkwiththeHospitalCouncilofNorthwestOhio(HCNO)tolocallydeveloptheLucasCountyIntegratedHealthcarePlanningCoalition,andtoregionallydeveloptheNWOhioHealthcareEmergencyManagementCoalition(NWO-HEMC).BothofthesegroupsareagreatsuccessinhowpartnershipswithEMA,hospitals,andotherstakeholderscanworktogetherinhealthcareplanning.Bothgroupsmeetregularly;TLCHDandtheHospitalCouncilofNWOhiositonthesteeringcommitteesforbothcoaltions.Fortheupcomingyear,publichealth’smembershiponthesteeringcommitteewillbere-evaluatedduetothelanguageinthecurrentRFPthatregionally,PHEPandHPParetoco-leadhealthcarecoalitionactivities.NWOHEMCmission:

Topromoteregionalcooperationandthesharingofhealthcaresystemandregionalhealthcareresources,theNWO-HEMCwillcontinuetopreparethroughcooperativeplanning,training,andexercisingtojointlyrespondtoman-madeornaturalemergencies.

PUBLIC HEALTH ACCREDITATION

PublicHealthAccreditation

OVERVIEW

PublicHealthAccreditationisavoluntaryprogramdevelopedtomeasurehealthdepartmentperformanceagainstanestablishedsetofnationallyrecognized,practice-focused,andevidenced-basedstandards.Itprovidesasystematicapproachforperformanceassessmentandimprovementacrosstwelvedomainsofpublichealthpractice.ThePublicHealthAccreditationBoard(PHAB)modeledtheseaccreditationrequirementsontheTenEssentialPublicHealthServicestoensureallapplicantsmeetorexceedanestablishedbaselineofcareandservicetotheirconstituents.TheunderlyinggoalforthisprogramistoadvancethequalityandperformanceofpublichealthdepartmentsinanefforttoimproveandprotectthehealthoftheentireU.S.population.

ThestateofOhiohasmandatedthatallpublichealthdepartmentsreachanaccreditedstatusbytheyear2020.ThefollowingisaperformancesnapshotoftheToledo-LucasCountyHealthDepartment'sprogresstowardsaccreditationreadinessinthe2015calendaryear.

2015 SNAPSHOT

TheToledo-LucasCountyHealthDepartment(TLCHD)continuedtomakesignificantprogresstowardstheirapplicationforPublicHealthAccreditation.AsofJanuary1st,2015,TLCHDhadcollectedandverified35.11%oftherequireddocumentationinPHAB'sstandardsandmeasures.Throughouttheyear,theTLCHDAccreditationTeamcollectedandpreparedanadditional35%oftherequireddocumentationnecessarytodemonstrateourcommitmenttowardsimprovingourpublichealthstandardsandservices.

Inadditiontodocumentationpreparation,agencyadministratorsandsupervisorscompletedbothPerformanceManagementandWorkforceDevelopmentself-assessmentsinpreparationforwiderstaffengagementin2016.

TheQualityAssuranceCoordinatorsalsofacilitatedanall-staffMoraleSurveyonbehalfoftheHumanResourcesdepartment.Theresultsofthissurveyhighlightedareasforimprovedcommunicationandprovidedabaselineforsubsequentstaffmoralesurveys.Asummaryoftheseresultswerepresentedatthe2015all-staffWinterRetreat.ApresentationonthefundamentalsofPHABAccreditationwasalsodeliveredtoallstaffattheWinterRetreatbytheQACoordinators.

Theagency'saccreditationreadinesshasmovedclosertotherealizationofbecominganationallyaccreditedbody.Applyingforaccreditationisourpromisetothecommunitythatourhealthcarestandardsarehigh,ourvisionforahealthierLucasCountyisclear,andourcommitmenttothepublic'swellbeingremainsourhighestpriority.

PUBLIC HEALTH ACCREDITATION

1 2 3 4 5 6 7 8 9 10 11 12

Dec2014 38.8 29.7 44.4 33.3 44.0 63.6 20.0 13.3 6.67 16.6 24.2 45.4

Nov2013 5.41 23.6 8.33 0.00 22.0 5.00 0.00 0.00 0.00 0.00 15.6 30.0

Domain Percentages

PHAB Domain Completion Progress

Dec2014

Nov2013

QUALITY IMPROVEMENT

QualityImprovement

OVERVIEW

QualityImprovement(QI)inPublicHealthisaformalizedprocessdesignedtoexamineandimprovethedeliveryandefficacyofpublichealthservices.QIinvolvestheuseofadeliberateanddefinedimprovementprocess,suchasPlan-Do-Study-Act(PDSA),todissectaproblem,discoveritsrootcause,implementasolution,andmeasurethesuccessorfailureofthechangeinitiative.QIisacontinuousprocessthatempowersemployeesatalllevelsofanorganizationtosupportandparticipateintheimprovementofprocesses,programs,andservicestheydelivertothepublic.

QualityImprovementismostsuccessfulwhenembeddedwithinthecultureoftheorganization.Organizationalcultureistheveryessenceofhowworkisaccomplished;itmaturesoverseveralyears,duringwhichnormsarepassedonfromonegenerationofstafftothenext.Becauseitisingrainedwithinanorganization,transformingculturetoembraceQIrequiresstrongcommitmentandsupportfromagencyleadershiptodrivethechangeovertime.

2015 SNAPSHOT

In2015,theToledo-LucasCountyHealthDepartment'sQualityImprovementCouncilmeteighttimestoexamineQIprojectsuggestionsandassociateddata.ThreeQIprojectswereselectedtomoveforwardbasedontheevidencepresentedtotheCouncil.

NewEmployeeOrientationProject(NEO)

TheaimofthisprojectwastoimprovetheNewEmployeeOrientationprocessthroughbetterstaffcommunicationandpreparationpriortonewemployee’sarrivalandconductingamorepersonalorientationdayforeachnewemployee.Theprocessstartsthedayofhireandendswhentheemployeeorientationevaluationiscomplete.Successwillbemeasuredbyimprovingtheoverallsatisfactionscoreonthenewemployeeorientationsurveyby20%.Toachievethesemeasures,theNEOProjectteamsurveyednewemployeeshiredwithin14monthspriortothestartoftheproject.Additionally,directorsandsupervisorsweresurveyedtoassesstheirreadinessfororientingnewemployees,iftheyareproperlynotifiedinadvance,andtheiroverallsatisfactionwiththeexistingprocess.Theteamidentifiedpotentialimprovements,includingtheprovisionofguidancetodirectorsandsupervisorsonthenewemployeeorientationprocess;sendingwelcomeletterstonewemployeespriortotheirstartdate;arrangingawelcomepacketwithimportantinformationandhealthdepartmentbranded"swag;"assigningabuddytoguidethenewemployeethroughtheirorientationprocess;redesigningtheorientationprocesstotakeplacethecourseofamonthratherthanasingleday;andstandardizingasingleorientationdayonceamonthforallnewemployeeshiredsincethelastorientationday.TheNEOProjectteamdevelopedmaterialforawelcomepacket,anemployeehandbook,andworkedwiththeHumanResourcesdepartmenttodeterminethebestmethodstochangethecurrentprocess.Thisprojectiscurrentlyon-holdpendingadministrativeapprovals.(SeeFishboneDiagramon48)

QUALITY IMPROVEMENT

TheDailyQIProject

Theaimofthisprojectwastodevelopastandardizedprocedureforcodingthedailylogstoallowproperreportingofinformationtobothourinternalandexternalstakeholders.TheDailyQIProjectteamhelditsfirstmeetinginlateNovember,andsetascheduletomeetonceperweekthereafter.Theteamidentifiedpotentialimprovementsincludingthedevelopmentofastandardpolicyandproceduresforcompletingthedailylogs;developmentofatrainingprogramandexamplematerials/referencebook;arevisedversionofthedailycodelist;andapossiblerevisionofthedailyformitself.Bytheendof2015,theteamhadalreadybegunanopendialoguetoexamineandreclassifythecodesusedfordailylogreporting.TheteamexpectstohaveallmaterialsreadyforreviewbytheenvironmentalsupervisorsandstaffbylateFebruaryorearlyMarch.(SeeFishboneDiagramon49)

TheAfter‐HoursQIProject

Theaimofthisprojectistostandardizetheresponsetodisastersafterbusinesshourscounty-wide.

TheAfter-HoursQIProjectteamfirstmetinDecembertoexaminethecurrentprocessofthe24/7C.L.I.C.line.Thislineservedasthemeansforthegeneralpublicandcommunitypartnerstocontactthehealthdepartmentintheeventofanemergency.ThecurrentprocessoftenresultedinthewrongadministratororsupervisorbeingcontactedasthePublicUtilitiesstaffmanningthelineafternormalbusinesshoursfollowedastaticcall-downlistthatdidnotproperlyaccountforareaofexpertiseorjobfunction.

Theteamisultimatelylookingtodecreaseresponsetime,developaprocesstoensureallstakeholderneedsaremet,andtoreducecosttothehealthdepartmentbyavoidingunnecessarycall-outsandovertimecharged.(SeeFishboneDiagramon50)

QUALITY IMPROVEMENT

New Employee Orientation Project Fishbone Diagram

QUALITY IMPROVEMENT

Daily QI Project Fishbone Diagram

QUALITY IMPROVEMENT

After-Hours QI Project Fishbone Diagram

CONTACT INFORMATION

ContactInformation

Toledo-LucasCountyHealthDepartment

635NorthErieStreetToledo,Ohio43604

Tel419-213-4100

Fax419-213-4546

www.lucascountyhealth.com

EricZgodzinski,MPH,RS,CPHDirectorofCommunityandEnvironmentalHealthZGODZINE@CO.LUCAS.OH.US

AliaKadri,MPHPHABCoordinator/QualityAssuranceKADRIA@CO.LUCAS.OH.US

DanBaker,MPHCommunityResponsePlanner/MedicalReserveCorpsCoordinatorBAKERD@CO.LUCAS.OH.US

ShannonLands,MBAPublicInformationOfficerLANDSS@CO.LUCAS.OH.US

JerryBingham,RSEnvironmentalHealthSupervisorBINGHAMJ@CO.LUCAS.OH.US

LaurenLiebich,MPHEpidemiologistLIEBICHL@CO.LUCAS.OH.US

DanielleBoyd,MPHPublicHealthAssociateBOYDD@CO.LUCAS.OH.US

GregMoore,MBARegionalCoordination/BioterrorismCoordinatorMOOREG@CO.LUCAS.OH.US

SamanthaEitniear,MPH‐VPH,CPH,SITBioinformaticsAnalystEITNIEAS@CO.LUCAS.OH.US

JoshuaNiese,RSEnvironmentalHealthSupervisorNIESEJ@CO.LUCAS.OH.US

PattiFraker,RD,LDEpidemiologistFRAKERP@CO.LUCAS.OH.US

BrandonPalinski,MPH‐VPHPHABCoordinator/QualityAssurancePALINKSB@CO.LUCAS.OH.US

JenniferGottschalkEnvironmentalHealthSupervisorGOTTSCHJ@CO.LUCAS.OH.US

BradSherrick,RSEnvironmentalHealthSupervisorSHERRICKB@CO.LUCAS.OH.US

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