Issue The Pulse Newsletter Vol Issue dengue fever by mikeholy


									Volume 7 Issue 3

  Unraveling the
Mysteries that
 can threaten
PUblic health

                   v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
    2                                                                                                                                                               The Pulse

                                From the Director
                                 Y     our good health is always
                                       in the forefront of what
                                       we do here at the Health
                                                                                                increased and ways you
                                                                                                can prevent becoming
                                                                                                a victim. We will look
                                                                                                into the overall school
                                                                                                immunization program
                                Our goal is to Focus on                                         and ways you can get
                                Prevention by keeping you aware                                 your elementary school
                                of issues affecting your health.                                child protected against
                                One of the first steps is through                               the flu this season.
                                surveillance and investigations                                 Finally, we will give you
                                of diseases and other issues                                    some tips on what we have found
                                that may affect you and the                                     in the environment and ways to
                                community. This is accomplished                                 avoid mosquito borne diseases
                                through many areas, from looking                                and spot issues before they affect
                                at the overall environment to                                   you.
                                specific disease investigations, all
                                of which lead us to the question                                We at the Health Department
                                of, “Was this preventable?”                                     are here for you 24 hours a day
                                                                                                365 days a year and want to be
                                This issue of PULSE will give you                               your Champion for the Healthiest
                                an idea of some of the issues                                   Community in the Nation.
                                we deal with every day and
                                ways that you can prevent them
                                from happening to you. We’ll
                                feature how our epidemiological
                                investigation of carbon monoxide                                Alina Alonso, M.D. Director
                                poisonings in the county showed                                 Palm Beach County Health Department
                                the alarming rate that they have

    inside this issue....
	   Article	..................................................................................................................................................................... Page
    From	the	Director	......................................................................................................................................................... 2
	   The	Investigators	“EPIDEMIOLOGY”	........................................................................................................................ 3
	   The	Investigators	“ENVIRONMENTAL	PUBLIC	HEALTH”	.................................................................................... 5	
	   Safe	Water	..................................................................................................................................................................... 7
    Healthy	Beaches	........................................................................................................................................................... 8
	   Swimming	Pools	........................................................................................................................................................... 8
    Air	&	Waste	Program	 ................................................................................................................................................... 8	
	   Tricks	to	Avoid	Overindulging	Treats	for	Halloween	.................................................................................................. 	9	
	   Department	Operations	Center	................................................................................................................................... 10
	   Acreage	Update	Update	.............................................................................................................................................. 10	
	   PODS	.......................................................................................................................................................................... 10	
    Endodontists	Honored	for	Saving	Underprivilaged	Teens’	Teeth	 .............................................................................. 11
	   Flu	News	..................................................................................................................................................................... 11

                                              v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
   Volume 7 Issue 3                                                                                                             3

Palm Beach County Health Department
Division of Epidemiology and Disease
Control staff investigates and reports
identified diseases and conditions in
                                              concerned                                    other
Palm Beach County as required by
                                              citizens, school                             tropical
Florida law. These include: bioterrorism
                                              officials, workplaces, and outside           regions
agents, vaccine preventable diseases,
                                              agencies. These consultations include        among residents
enteric diseases, pandemic influenza,
                                              general health information, clinical         with resulting importation
multi-drug resistant organisms, viral
                                              consultation, and public health guidance.    of some of the endemic
hepatitis, and zoonotic diseases.
                                                                                           diseases on their return. Increased
The Division of Epidemiology is also
                                              So far this year 2,245 cases of reportable   mosquito borne illness activity this
responsible for conducting population-
                                              disease have been received by                summer within endemic areas in close
level surveillance for influenza,
                                              Epidemiology. This does not include the      proximity to South Florida has resulted in
bioterrorism, and disease outbreaks.
                                              number of cases investigated that did
In addition to these core functions,
                                              not meet the state’s case definition for
the epidemiology division staff are
                                              reporting. The most frequently reported
accountable for responding to public
                                              diseases and conditions investigated
health inquiries, documenting and
                                              were 2009-2010 Novel A Influenza
investigating complaints of foodborne
                                              H1N1, salmonellosis, shigellosis,
illness, acting as liaisons with the local
                                              campylobacteriosis, giardiasis,              increased importation of these illnesses.
healthcare community, responding to
                                              cyclosporiasis, escherichia coli, chronic    Dengue Fever is an acute mosquito-
public health emergencies, investigating
                                              hepatitis B and C, and lead poisoning.       borne viral illness. The disease is most
and controlling disease outbreaks,
                                              Division staff has also investigated         widespread in the tropical developing
and working with regulatory agencies
                                              20 outbreaks of disease for the year         urban areas of Africa, the Americas, Asia,
such as the Agency for Health Care
                                              2010, some resulting in comprehensive        the Caribbean, and the South Pacific.
Administration and the Department of
                                              epidemiological investigations involving     In the early 1920’s through mid 1930’s
Business and Professional Regulation.
                                              illnesses such as norovirus and acute        dengue epidemics accounted for 6,000
Public health investigations are
                                              hepatitis B in long term care facilities.    cases in Florida. The last case of locally
often conducted in conjunction with
                                                                                           acquired dengue in Florida was reported
neighboring counties and surveillance
                                              The division staff also routinely conducts   in the early 1960’s. Since that time
activities span the entire region.
                                              surveillance for mosquito borne illness      virtually all cases of dengue have been
                                              activity. During 2010, 13 cases of           imported from dengue endemic areas by
The epidemiological surveillance and
                                              imported malaria and 7 cases of imported     travelers to those regions. However, in
investigation capability is the ability
                                              dengue fever have been reviewed.             September 2009 dengue fever returned
to rapidly conduct investigations. It
                                              Mosquito populations are greatest in         to Florida. A case of dengue fever was
includes exposure and disease detection
                                              the early fall, which is why the rate of     diagnosed in an out of state resident who
(both deliberate release and naturally
                                              the disease increases in late August         had recent travel to Key West in Monroe
occurring); rapid implementation of
                                              and September. The risk of disease           County. Over the next few months 27
appropriate surveillance methods;
                                              decreases as the weather becomes             additional cases were identified in Key
maintenance of ongoing surveillance
                                              colder and mosquitoes die off.               West. With an intensive effort at mosquito
activities; epidemiologic investigation
                                              Further, division staff has closely          control, physician awareness and public
and analysis; and communication with
                                              monitored the Key West dengue fever          information, no further cases were
the public and providers about reporting
                                              outbreak, as the primary dengue fever        identified after October 2009. Spring of
procedures, disease risk, mitigation
                                              transmitting mosquito is present in the      2010 brought a return of dengue activity
and prevention, and recommendations
                                              county and the potential for this illness    to the Key West area.
regarding control measures. A substantial
                                              to impact the community exists. During
function of the Division is to respond to
                                              the summer months there is typically an      The species of mosquitoe that transmits
inquiries from the public. Daily, division
                                              increase in travel to the Caribbean and      Dengue Fever is present in Palm Beach
staff handle inquiries from local hospitals
                                 v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
 4                                                                                                                    The Pulse

County and the surrounding areas.           not passed from an infected horse to
Travelers from endemic or outbreak          humans.                                       These incidents are atypical. Carbon
areas may introduce this illness into                                                     monoxide poisoning incidents in Palm
our county upon their return. The Palm      There is no Dengue Fever, West                Beach County usually occur after
Beach County Health Department              Nile virus or EEE vaccine available           weather related events such as a
has issued an advisory notice to all        for humans, therefore it is extremely         hurricane or extreme cold temperatures
physicians and hospitals in the area        important for the public to take preventive   when generators and outdoor cooking
providing them with anticipatory guidance   measures to reduce the risk of mosquito       devices are used incorrectly. In these
regarding the possible risk of acquiring    bites. Palm Beach County Mosquito             previous CO incidents, generators were
dengue fever in Florida.                    Control is continuing ground and aerial       not properly ventilated and outdoor grills
                                            spraying in an effort to eradicate rising     were incorrectly used indoors.
There are four types of the dengue virus,   mosquito populations.                         Carbon monoxide is difficult to detect as
so the potential exists for a person to                                                   it is an odorless, colorless gas.
be infected up to four separate times.      Residents and visitors are advised to take    Signs and symptoms of CO poisoning
Signs and symptoms of the illness           preventive measures to minimize risk of       include headache, dizziness, weakness,
appear within 3 to 14 days after the bite   contracting mosquito borne illnesses:         nausea, vomiting, chest pain, and
of an affected mosquito. The hallmark       DRAIN AND COVER!!                             confusion. Due to the non-specific nature
of classic dengue fever is high fever                                                     of these symptoms, they may be easily
combined with aches such as headache,         • Avoid mosquito bites! Wear protective
                                                clothing such as long pants and long      attributed to other causes. Inhalation
muscle and joint pain among other                                                         of high levels of CO can cause loss of
symptoms and it is not uncommon for             sleeve shirts when outdoors and use
                                                insect repellents properly.               consciousness and death.
dengue infection to be present with no
signs or symptoms. Symptoms of the            • Check your door and window                Since it can cause sudden illness and
illness usually lasts one week, however         screens and repair any holes or tears.    death it is important that community
after effects may continue for several                                                    members, particularly the elderly, are
weeks. Rapid reporting of dengue cases,       • Get rid of mosquitoes around your
                                                                                          aware of important prevention measures.
helps ensure prompt mosquito control            home: DRAIN all standing water
                                                                                          These prevention measures include;
efforts.                                        (even the smallest of containers
                                                that can collect water could become a
                                                                                            • Install a CO detector in homes near
Other mosquito borne illness activity,          breeding ground for hundreds to
                                                                                              the garage and educating all
such as West Nile virus and Eastern             thousands of mosquitoes). Keep
                                                                                              household members about the signs
Equine Encephalitis, are monitored              pools clean and chlorinated.
                                                                                              and symptoms of CO poisoning.
through the use of early detection
systems such as sentinel chickens.
Recently the sentinal chickens have
                                            On the case of                                  • Never run a car or truck in the garage
                                                                                              with the garage door shut. CO can
tested positive for West Nile virus         Tracking an Odorless,                             build up quickly while cars or trucks
throughout Palm Beach County. West                                                            are running in a closed garage.
Nile virus is a disease spread by                     Colorless,                            • Always double check that the
mosquitoes and most often causes
flu-like symptoms. Researchers believe                and Deadly                              automobile is turned off before exiting
                                                                                              the vehicle if parked in a garage.
West Nile virus is spread when a
mosquito bites an infected bird and then
                                                                                            • A vehicle should not be driven with
bites a person.                             This summer Epidemiology has been                 the tailgate open,
                                            tracking an increase in the number of
The Eastern Equine Encephalitis (EEE)                                                       • A car’s exhaust system should
                                            carbon monoxide poisoning cases. As
virus is an arbovirus spread by infected                                                      be checked yearly. A small leak in the
                                            of September, 30 poisonings have been
mosquitoes, which can sometimes                                                               exhaust system can lead to a build
                                            investigated as compared to four at this
transmit the infection to horses, other                                                       up of CO in the vehicle.
                                            time last year. Seven incidents were
animals, and, in rare cases, people. In     related to automobiles left running in          • Use generators outdoors in well
addition, Palm Beach County has had         homes with attached garages resulting             ventilated areas
two confirmed cases of Eastern Equine       in 17 poisonings and two deaths, three
Encephalitis in horses. So far, this year   were the result of using a grill indoors        • Never use an outdoor grill in a
sentinel chickens in Palm Beach County      resulting in 11 poisonings, and one               house.
have not tested positive for the EEE        incident was related to a boat resulting in
virus. Eastern Equine Encephalitis is       two poisonings with one death.
                                 v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
   Volume 7 Issue 3                                                                                                                 5

The Division of Environmental Health is
the focal point of the Palm Beach County
Health Department’s effort to protect you
and your family from the harmful effects of       • Permitting
toxic chemicals, wastes, disease vectors,           and
safety hazards, natural disasters, and              licensing of
contaminated air, food, and water. The              air pollution sources
                                                                                              with recycling
Palm Beach County Health Department
                                                  • Conducting inspections and enforcing      activities are present
Environmental Public Health program
                                                    air pollution regulations                 (fiberglass fragments
monitors, regulates and investigates
                                                                                              and fibers are typical “finger prints” of
different disciplines including Air Pollution     • Encouraging effective growth              construction demolition debris). Adequate
Control, Solid Waste, Bio-medical and               management programs, including            dust control measures are demonstrated
Hazardous Waste, Indoor Air Quality and             transportation planning, that help to     by a reduction to near zero of fiberglass
Public Outreach, Water Treatment, Waste             minimize air pollution                    fibers/fragments. At this local facility,
Water Treatment, Septic Tanks (OSTDS),
                                                  • Investigating air pollution complaints    watering controls, fence screening
Sanitary Nuisances, Institutions, Childcare
                                                                                              and relocation of fire hoses used for
facilities, Pools and Beaches and Animal          • Promoting pollution prevention and        water control of truck loads released
& Insect Borne Diseases. All of these               conservation                              into the work area greatly improved
varied programs have their investigative
                                                                                              dust emissions leaving the property.
“tools-of-the-trade”.                             • Technical assistance to residents
                                                                                              Complaints dropped from several
                                                    reporting indoor air pollution
                                                                                              complaints a month with an indication
Clean air is a most important natural
                                                  • Control of open burning                   that dust problems occurred daily, to one
resource. Air pollution is produced from
                                                                                              or two a year indicating dust only when
many human activities, primarily from
                                                  • Asbestos abatement and building           complaints were made.
combustion of fossil fuel for transportation
and power generation. Our air program               demolition
                                                                                              Another investigation centered around
is responsible for assuring good air              • Molds & Moisture                          Cement dust escaping from a Cement
quality for the community through many
                                                                                              Batching plant’s storage silo baghouse
regulatory and non-regulatory programs,
including:                                      ON THE CASE…                                  (dust control device). In this case
                                                                                              The cement dust generated by wind
                                                                                              drafting across the traffic area of a
Public Outreach is one of our tools used        Environmental Health investigations are       local concrete batching facility. Surface
to alert the community of many ways             conducted by Inspectors who review            sweeping would be required.
they can protect themselves from various        activities of local businesses or even
environmental concerns. Through public          homeowners after receiving complaints         Dust control measures may include
outreach, the community becomes aware           from neighbors or when regular                application of water, seeding, sodding
of various agency programs that may             inspections reveal problems.                  or a combination of these options. Air
address their concerns; they are informed
                                                                                              Pollution Control includes the monitoring
about disposal of household hazardous           One case involved recycling activities        of building demolition and renovation for
wastes, recycling of aluminum, paper,           at a local Construction/Demolition (C&D)      asbestos removal and dust control.
glass and plastics; they are better informed    facility. Our Inspectors reviewed and
about energy saving options for household       monitored control of dust and particulate     PBCHD inspectors worked very closely
lighting, fuels and transportation. The         matter from the site and how water for        with contractors, demolition experts, the
Public Outreach program becomes a               dust control was being used. In these         Florida Department of Environmental
visible resource for the community and          types of cases inspectors use visual aids     Protection and the US Environmental
a liason between residents and various          including clear cellulose packaging tape      Protection Agency to successfully
community agencies through PACE                 for collection of ambient air dust samples.   reduce potential community exposure to
EH (Protocol for Assessing Community            The tape samples are then inspected           asbestos during the implosion demolition
Excellence in Envirnomental Health).            under a microscope to determine if dust       of a thirty story condominium building
                                   v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
 6                                                                                                                     The Pulse

along Flagler Drive in West Palm              in operation for over 25 years. The          sampling of dust residue in the residential
Beach this year. Regulated asbestos           challenge facing air quality for the new     community has shown that dust collected
materials were removed during building        millennium will be met by continuing         now is predominantly ash and soot with
preparations for implosion. Samples           working partnerships with government         occasional cellulose dust particles
of regulated materials are collected for      officials, and with business, community,     present. This is an indication that the
microscopic evaluation by professional        and citizens.                                facility has resolved nuisance dust
laboratories to determine the amount of                                                    sources down to furnace heating box
material present. Regulated materials         Air Pollution Control has been working       (burns wood chips).
are properly removed by asbestos              closely with a local log recycler that
                                              grinds wood into wood chips, shavings        With all the wood dust observed in dust
abatement contractors. Ambient air
                                              and saw dust for local retail markets. The   samples previously collected, inspectors
samples are collected during the
                                              facility has been at the same location for   were unable to see that the furnace was
implosion and analyzed for asbestos.
                                              the past 20 years.                           creating as much of a problem as it now
Microscopic dust samples evaluated
                                                                                           appears to be creating. Dust samples
by the PBCHD demonstrated no fiber            New neighbors moved in within the last 3     now indicate that ash and soot were also
materials present in surface dusts            years and they have been experiencing        a problem, so inspectors are focusing in
collected after implosion.                    wood dust residue on exposed, outdoor        this area for dust control.
                                              surfaces since moving in. They also
Dust from an implosion of this nature is      experience wood dust in the air when         The residential neighborhood has
always substantial, but wind direction        they walk outside, as well as noise          indicated seeing an improvement in their
directed the plume out over the               issues.                                      community with all of the efforts put forth
intracoastal waterway, away from most                                                      by this proprietor. Sometimes persistence
residential areas. Some areas of the                                                       pays.
Town of Palm Beach were impacted
as were some boaters that came to
watch the implosion. Down wind of an
                                                                                            WELL WATER EXPO
implosion of this nature is just not a good
                                                                                           The Palm Beach County Health
viewing location!
                                                                                           Department hosted a Well Water
                                                                                           Information and System Maintenance
                                                                                           Expo at the Acreage Community Park on
                                              The proprietor has implemented various       August 14th.
                                              control options over the past couple of
                                              years in an effort to abate the nuisance
                                              dust and noise concerns with an
                                              encouraging level of success.
                                              A soil and wood mulch berm was
                                              installed to abate noise concerns; slatted
                                              plastic screening has been placed
                                              around equipment to control dust release
                                              from process areas; solid and fabric
                                              barriers (doors) have been installed to      Representatives       from    the     Health
                                              control dust from large storage bins;        Department Water Programs were on-
                                              water sprinkling devices have been           hand to answer questions regarding
                                              installed to control dust from exhaust       regulatory compliance and provide
                                              sources.                                     guidance based on current EPA/DEP/
                                                                                           PBCHD regulations. Local filtration and
                                              Despite these control efforts, Air           water purifications vendors answered
                                              pollution inspectors continued to            questions and demonstrated products
Listen to the daily AQI (Air Quality Index)   receive complaints from the neighboring      and services. Questions focused on well
recording by calling (561) 837-5092 or        residential community located down           water system maintenance and upkeep,
view our Current AQI Readings online at:      stream of prevailing easterly breezes.       how certain systems are best utilized, and
                                                                                           the different types of systems available.
quality_readings.html                         The proprietor installed an exhaust cap
                                                                                           Vendors also answered questions about
                                              and water sprinkling system that seems
                                                                                           well drilling, well maintenance, well depth,
The Palm Beach County Health                  to have greatly improved the cyclone
                                                                                           filtration methods, and other related topics
Department’s air program has been             exhaust stack emissions. Subsequent
                                                                                           of interest.
                                 v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
   Volume 7 Issue 3                                                                                                            7

SAFE WATER                                     operated in compliance with Federal,
                                               State, and local regulation.
                                                                                            If you have any questions regarding
                                                                                            the public water supply system in your
                            The safety of                                                   area please contact the Drinking Water
                            our drinking       Incidents of contamination are very rare     Section of PBCHD at (561) 837-5900.
                            water supply       because sanitary surveys, inspections,
                                               and sampling are routinely performed         Boil Water Issues normally don’t
                            is critical to                                                  require investigation. The
                            the health of      by PBCHD to verify that water treatment
                                               plants are in compliance with rules and      majority of Boil Water notices
                            residents and                                                   are precautionary actions and
                            visitors of Palm   regulations. Complaints relating to water
                                               quality are investigated on a regular        are issued by the Utility in
                            Beach County.                                                   response to a water main break
                            Waterborne-        basis and necessary enforcement actions
                                               are taken to ensure the safety of the        or planned interruption of the
                            disease                                                         flow of water for maintenance or
                            outbreaks          water supply.
                                                                                            repairs. The water contamination
                            or other           Water supply systems that provide            investigation in the City of
adverse health effects could result from       drinking water to less than 25 persons       West Palm Beach was different.
deficiencies in public water systems,          or less than 15 service connections          In September 2007 the City had
such as inadequate treatment or                are not required to meet the stringent       several fecal coliform positive
improper operation. In addition, water         standards of the Safe Drinking Water Act.    samples in the distribution
resources could become contaminated            However, such systems are monitored for      system. West Palm Beach officials
by natural and man-made pollutants;            compliance with other State and County       contacted the PBCHD and after
such pollutants could include leakage          regulations. PBCHD inspects these            confirmation were placed on a
from waste disposal, discharges from           systems routinely and conducts sampling      City Wide Boil Water Notice. The
factories, accidental spills of chemicals,     for bacteria annually.                       system continued to have issues
illegal dumping, and leakage from                                                           with their total coliform and
underground storage tanks.                     Water wells that supply water to one or
                                                                                            fecal coliform results, so the
                                               two residences (one of which may be
The Palm Beach County Health                                                                Department assisted the City in
                                               a rental) are categorized as “private”
Department regulates public water supply                                                    the investigation. The drinking
                                               systems and are not monitored routinely.
systems under the Safe Drinking Water                                                       water program inspectors were
                                               PBCHD provides guidance to property
Act if drinking water is provided to at                                                     instructed to take surveillance
                                               owners regarding private systems and
least 25 persons or at least 15 service                                                     samples in the distribution
                                               conducts periodic surveys to test the
connections. These include the large                                                        system in the interest of Public
                                               bacteriological quality of well water in
water systems that provide service to                                                       Health. The drinking water
                                               areas that are on septic tank systems.
municipal and incorporated areas as well                                                    supervisors investigated several
                                               Also, those wells in proximity to gasoline
as the small systems that may only serve                                                    cross connection control issues
                                               stations with leaking underground tanks
a convenience store or day care center.                                                     with the City. In addition to the
                                               are periodically tested for petroleum
PBCHD conducts a surveillance program                                                       sampling and the cross connection
to ensure that the systems are being                                                        investigations, the PBCHD advised
                                                                                            the City to switch to free
   A complaint from the community regarding drinking                                        chlorine as a disinfectant until
   water quality is logged and assigned to an inspector                                     the problem could be isolated.
                                                                                            Free chlorine is more effective as
   with a background or familiarity with that particular
                                                                                            a disinfectant than chloramines.
   water system. The inspector makes contact within 24
                                                                                            The City was also instructed to
   hours of receiving the call to determine the scope of                                    bring in engineering/operations
   what may need investigating. A site visit and water                                      consultants to assist with the
   quality assessment to detect odor or clarity issues is                                   investigation. In the end,
   conducted immediately. The inspector then obtains a                                      there were several factors which
   sample and tests for disinfectant residual and takes a                                   contributed to the contamination
   total coliform sample to our lab for analysis. Should                                    event, including pipe and valve
   there be an issue with the quality of the water, the                                     problems and chlorine contact time
   inspector contacts the utility and a report is filed.                                    problems which, in addition to
                                                                                            the other identified issues, were
   At times the water section is called on by EPI to
   assist in waterborne illness investigations.

                                  v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
  8                                                                                                                                 The Pulse

Healthy beaches program samples the beaches on a                          Over 3500 swimming pools are inspected each year.
weekly basis. Should the results be above the MCL or geometric            In addition, a complaint from the community regarding a swimming
mean a resample is taken. If the resample confirms the first result       pool is followed up within 24 hours. It could be cloudy water, a
then the beach advisory is posted. This information is forwarded to the   fecal accident, algae etc. When assigned the inspector contacts
FDEP who will attempt to determine if there was a contamination due       the complainant or visits the pool. If there is a verifiable issue the
to a wastewater discharge.                                                inspector will contact the owner to obtain compliance. The report is
The PBCHD drinking water section was involved in part of an
investigation when the Riviera Beach area had an advisory posted.         The swimming pool section will also assist EPI in waterborne illness
The inspectors and manager surveyed the area in an attempt to             investigations.
locate any type of discharge that may have contributed to the incident.
Nothing was found.

Tools and Activities

                                                                                                      • Air Pollution Control frequently gets
                                                                                                        complaints about sugar cane burning, a
                                                    • Evidence observed that outdoor spray              component of the harvest process.
                                                      painting occurred without overspray             • The burn season begins toward the end
                                                      controls.                                         of October and lasts through the end of
                                                                                                        May or beginning of April the following

  • Inspectors review recycling activities at a
    local Construction/Demolition (C&D)
  • Dust complaints for a facility of this nature
    would be investigated using visual aides
    including clear cellulose packaging tape
    for collection of ambient air dust samples.     • Air Pollution Control includes the
  • At this local facility, watering controls,        monitoring of building demolition and
    fence screening and relocation of                 renovation for asbestos removal and dust
    fire hoses used for water control of truck        control.                                        • During the approach of cold fronts and
    loads released into the work area greatly       • PBCHD inspectors worked very closely              storms, westerly winds (winds from the
    improved dust emissions leaving the               with contractors, demolition experts, the         west) draft smoke into eastern parts of
    property. Complaints dropped from                 Florida Department of Environmental               Palm Beach County.
    several complaints a month with an                Protection and the US Environmental             • Microscopic evaluation of ash samples
    indication that dust problems occurred            Protection Agency to successfully reduce          reveals leaf cell structures that are like
    daily, to one or two a year indicating dust       potential community exposure to                   finger prints of sugar cane ash.
    only when complaints were made.                   asbestos during the implosion demolition
                                                      of a thirty story condominium building
                                                      along Flagler Drive in West Palm Beach
                                                      this year.

  • Cement dust escaping from a Cement
    Batching plant’s storage silo baghouse
    (dust control device).

                                      v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
   Volume 7 Issue 3                                                                                                                    9

Halloween is just the                                                                        “until the chocolate is gone” is not a good
kickoff to a season of sweet                                                                 plan.
indulgences. The following tips
adapted from                                                                             Teach and model moderation!
can help keep you and your                                                                         Do not give candy more status
family on a healthy track                                                                           than it deserves. In some
to avoid weight gain and                                                                            instances, the more something is
overeating.                                                                                        forbidden or overly restricted the
                                                                                                 more desirable it becomes. Teach
Halloween Tips for                                                                              and model moderation. All foods
                                                                                              can fit, if we are reasonable about the
Trick or Treat Night                                                                         amount and frequency.
When you arrive home from work on               The holidays are endless from now until
Trick or Treat night, it seems like the         Valentine’s Day, and each one has its        Do not attach emotions to candy!
bewitching hour already has hit your            own sweet fest! You certainly do not         Try not to use candy to reward, bribe,
house at full tilt. The kids are so excited     need all of this candy around the house.     punish, or convey love.
for the evening’s events that they have         Can you throw half of it out when your
magically changed into their costumes           children are not looking?                    Begin some new family rituals!
and are levitating to the door, drifting past                                                Do not make Halloween all about the
any plans you have made for dinner.             One night of trick or treating does not      candy. Make it a time to begin new family
                                                make a fat child or a bad parent! Here       rituals, such as making a scarecrow
Buy treats you do not like! If you              are a few simple suggestions to help         for the front porch. Carve pumpkins
do not buy it, you will not eat it! Buy         you get through Halloween night and the      and roast the seeds. Hold an annual
Halloween candy or holiday treats that do       other 364 days that follow.                  scavenger hunt. Begin a new photo
not usually appeal to you. If you prefer                                                     album that holds pictures of Halloween
chocolate, buy gummy treats or sugar-           Have a plan                                  celebrations, past and present.
based treats. If you like sugary sweets,        Make a plan after asking for your
purchase chocolate. You are less inclined       children’s input. Feed your children a       Keep it safe
to overindulge if what you have in the          nutritious dinner. A group of hungry,        Above all, have a safe and fun
house does not tempt you.                       dehydrated, sugar-intoxicated goblins        Halloween. Your children are only small
                                                is a frightening picture for any parent      for a short while!
Purchase treats on the day you                  Let them know that you will eat early
need them and not before! Buy                   on Halloween night, so that they will         Candy is a big part of the Halloween season.
treats the day you plan to eat or distribute    have all the energy they will need to for     For a short period of time, your young ones
them. If you are buying candy or goodies        a successful Trick or Treat night. Make       can enjoy this occasion by allowing them to
for a holiday or gathering, keep them in        sure they drink enough fluids. Children       have candy at mealtime and not as snacks
the house for as short a period of time as      can get overheated in Halloween               between meals. Snacking increases the
possible and give away the leftovers.           costumes, especially when it is combined      amount of time that germs in the mouth
                                                with running from house to house              can attack teeth to cause cavities. Other
Consider some alternatives!                     throughout your neighborhood.                 suggestions are:
Pretzels, crackers, granola bars, fruit                                                         • Avoid hard and chewy candies that
leather, books, stickers, bouncy balls,         Set limits in advance!                            stick to your teeth.
toys, and crayons are great alternatives        Ask your children to help you decide on         • Offer sugar free gum!
to candy. Kids are usually thrilled to get      the route you will take, how many doors         • Have children brush after meals and
something unusual.                              you will knock on, and what hour they             snacks with a fluoride toothpaste.
                                                will turn back into “pumpkins.” Having          • Parents of young children and toddlers
Your mind is quickly assaulted by the           an end goal will help you avoid the “just         should help brush and floss their child’s
following questions:                            one more” or “but we have not gone to…”           teeth.
   • “Should I make my children eat             meltdown that persists all the way home.        • Choose healthy snacks, such as fruit,
     dinner or is it not worth the battle?”     Agree on how much candy your children             vegetables, yogurt, and popcorn.
   • “How many houses equate to an              are allowed to eat on Trick or Treat night
     adequate candy supply?”                    and each day thereafter. You may want         Your child can enjoy Halloween with
   • “What about the increase in                to make a similar confidential agreement      these simple steps. Like everything else,
     childhood obesity?”                        with yourself. Note: “Unlimited access” or    moderation is the key.

                                    v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
 10                                                                                                                              The Pulse

                                                                                      Acreage Update
                                                                         The investigation into an elevated rate of pediatric brain
Hurricane season is in full swing and your Palm Beach County
                                                                         cancer in the Acreage continues. The Florida Department of
Health Department is ready! Our new Department Operations
Center (DOC) is located at the 800 Clematis Street complex in a          Environmental Protection, conducted seven sampling events in
category 3 hurricane rated facility with emergency generator power       The Acreage between August 2009 and April 2010. In February,
and necessary supplies to support restoration of critical PBCHD          March and April 2010, DEP collected additional water samples
functions in the aftermath of any type of disaster. The DOC would        from residences in The Acreage. DEP also collected 140 soil
most likely be activated in a disaster involving widespread power        samples from 35 case and control residences along with 11
and/or telephone communication failure. Based on the Incident            background locations. These samples were tested for more
Command Structure (ICS), staff from the following Divisions will         than 200 individual chemicals used currently or historically in
have active roles: Operations/Administration, Planning, Human
                                                                         industrial or agricultural operations. Fortunately the latest round
Resources, Safety/Risk Management, Public Information, Logistics,
Information Technology, EPI, Health Access, WIC/Nutrition, CMS,          of environmental test results of soil sampling have found no
and EPH. The DOC can also accommodate 24 hour activities if              apparent contaminate linked to pediatric brain cancers. Although
necessary, as the building has a coed dormitory, equipped with           contaminants were detected in some samples, the investigation
portable sleeping cots and both male and female locker rooms.            found no evidence of substantial spills, dumping or area-wide
General services has made arrangements for the delivery of meals         contamination. Proper maintenance of a homeowners filtration
if necessary.                                                            system was imperative. Mary Jean Yon, the DEP Director of
                                                                         Waste Management said, “Overall, DEP’s sampling analyses
The DOC is stocked with laptop computers for field operations,
                                                                         showed the water quality in The Acreage is generally good and
an analog telephone processing call center, basic office supplies,
                                                                         residential property in The Acreage is safe for families to enjoy
personal protection equipment, megaphones, tools, redundant
communication systems (portable radios) and refrigerators and            outside activities in their yards.”
freezers to maintain medications and vaccines among other
necessary inventory.                                                     The results of detailed case and control homes interview
                                                                         analysis has also been completed following countless hours of
A highly successful activation drill took place on August 25, 2010.      review, data entry and concurrence from the Centers for Disease
A new “call down tree” to alert and activate employees (designed         Control and Prevention (CDC). The Florida Department of Health
by Finance and Administration) was tested. More are planned in           reviewed multiple variables and found that none of those factors
the future.
                                                                         have been identified as a risk for causing pediatric brain tumors
Our DOC is supplemental to meet community needs for public               among study participants. It has also been determined by the
health systems in close interface with the Palm Beach County             findings that having a longer residency in the Acreage study
Emergency Operations Center.                                             area posed no higher risk for brain tumors among children. The
                                                                         reports are available online at

An Innovative Approach to Improving Dispensing Outcomes
Palm Beach County is the third most populous     The presentations explain life saving PEP        Volunteers performing a service, and are
county in Florida, home to 1.3 million people.   for inhalation anthrax and how residential       provided state liability protection under Florida
To provide 100% post-exposure prophylaxis        communities could become “closed” PODs           Statute Chapter 110. Resident-volunteers
(PEP) within 48 hours, the Palm Beach County     and recruit volunteers to dispense medication    are provided state liability protection and
Health Department has developed a hybrid         to their residents. This hybrid network of       workmen’s compensation.
of public and private Points of Dispensing       “closed” PODs has expanded to municipalities,
(PODs).                                          large businesses, faith-based organizations,     Palm Beach County Health Department’s
                                                 and colleges. Our program was highlighted        hybrid POD Model is reproducible and may be
Health Department Cities Readiness Initiative    by the National Association of County and City   effective anywhere in the United States.
(CRI) coordinators reached out to Residential    Health Officials (NACCHO).
Associations, Citizens on Patrol (COP) and                                                        It’s a “win-win” for everyone. Residents safely
Community Emergency Response Team                Liability issues are addressed through           and conveniently receive medication in their
(CERT) groups to broaden the exposure of the     Memoranda of Agreement. By temporarily           communities. The Health Department reduces
program. This exposure resulted in invitations   donating a portion of their real property        dependence on large numbers of volunteers to
to present our plan to gated communities.        to the Health Department for dispensing          operate the public PODs.
                                                 medication, governing Boards are classified

                                   v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
   Volume 7 Issue 3                                                                                                                             11

                             LU County Health Department is gearing up
       FOR SAVING        for 2010-2011 Flu Season! The newest edition of our popular
                         “Flu Ready Cards” have been distributed to local pharmacies,
                         supermarkets, hospitals, health care providers, community
  UNDERPRIVILEGED TEENS’ response partners, all K-12 public and charter schools, and
                         businesses. These complimentary cards are designed to inform
         TEETH           the public on “Ways to Fight Flu” and the opposite side provides
                         a flu shopping list of items you can keep at your home in case of
                                                                                   a flu outbreak.
The Palm Beach County Health Department Dental
Program recently honored nine endodontists who                                     The Palm Beach County Health Department’s Community
have sponsored the “Save a Molar” program for the                                  Immunization Services is pleased again this year to provide a
underprivileged teenagers in need of a root canal. Until                           limited amount of influenza vaccinations free to students at all of
                                                                                   our public elementary schools. The mist vaccine is an intranasal-
these doctors began the program, the only alternative for                          spray flu vaccine and is administered without scary needles or
these teens was extraction of the affected tooth through                           injections. The vaccines are made possible by a $206,640.00
the Dental Program at the Palm Beach County Health                                 grant from the Florida Department of Health, Bureau of
Department. Upon referral from the Health Department,                              Immunizations to provide 28,000 doses.
young patients are treated at no charge in the private                             “Flu and other vaccines are a very cost effective way of preventing
offices of these generous dentistry specialists, where the                         and stopping the spread of communicable diseases in our
tooth is saved for the teen.                                                       community,” said Health Department Director Dr. Alina Alonso.

                                                                                   Vaccinations will be offered to students from October 11th
“These doctors are all very dedicated to preserving healthy                        through December 3rd upon consent from parents.
teeth in all children of the county. I hope that more will
follow their example and participate in this very important                        Vaccination of school children to prevent flu has been shown to
                                                                                   lower illness rates in the community and even lower death rates
program that assures good dental health,” said Dental                              in the elderly by slowing the rate of flu transmission. Children are
Director Dr. Philippe Bilger at the ceremony on July 21,                           at greater risk for flu-related complications, including sinusitis,
2010.                                                                              bronchitis, and pneumonia. Children also spread the flu virus
                                                                                   more readily than adults since symptoms last longer in children
                                                                                   than adults.

                                                                                   Nearly 20,000 students participated in the school-based Flu-Mist
                                                                                   Vaccine Program last year in Palm Beach County. The Centers
                                                                                   of Disease Control (CDC) recommends getting an influenza
                                                                                   (flu) vaccination each year as the first and most important step
                                                                                   in protecting against the flu. While there are many different flu
                                                                                   viruses, this years flu vaccine protects against the three main
                                                                                   flu strains (including HINI) that research indicates will cause the
                                                                                   most illness during the flu season.

                                                                                   More information on flu prevention is available at or
                                                                                   by calling our Immunization line at 1-800-810-1225 or by calling

Honorees for their extraordinary work on behalf of the children in Palm Beach
                                                                                   The Office of Public Health Preparedness received a
County include (from Left to Right)                                                $44,000 grant from the National Association of County and
Dr. Jaime Silberman, Dr. Sang Shin, Dr. Rory Mortman (a co- founder of the “Save   City Health Officials (NACCHO) to become an Advance
a Molar” program,) Dr. Theodore Lerner, Dr. Jeff Albert, Dr. Charlyn Bradshaw,     Practice Center Connector Site which will engage in testing,
Dr. Kenneth Bradshaw, and Dr. Bradley Ginzler (Also receiving honors, but not      assessment, and quality improvement of an existing and
pictured were Dr. Bruce Schulman and Dr. Bernard Metric (who donated root          developing online pharmacy tool kit. Opportunities to
canal services to health department for 18 years.)                                 leverage and collaborate with community pharmacies are
                                                                                   an important consideration and one that ultimately better
                                                                                   serves the public during emergencies and disasters.

                                                                                   Back to School Immunizations always keeps our clinics and
                                                                                   Immunization van busy in July and August. This year the Palm
                                                                                   Beach County Health Department administered 12,857 back
                                                                                   to school vaccinations as required for entry.

                                        v i s i t u s o n t h e w e b : w w w. p b c h d . c o m
8                                                                                                         The Pulse
    Services	Provided
The	Palm	Beach	County	Health	Department	is	a	
service	organization	responsible	for	the	health	of	
over	a	million	residents	in	Palm	Beach	County.

The	many	and	varied	core	programs	include	disease	
prevention	and	control,	environmental	public	health,	
school	 health	 and	 health	 education.	 	 In	 addition,	 the	
department	 shares	 responsibility	 for	 primary	 care	 of	
the	medically	indigent	population	of	the	county	with	the	
private	sector	by	providing	millions	of	services	annually	
through	its	seven	health	centers.

The	Palm	Beach	County	Health	Department	has	served	as	
the	model	agency	for	the	State	of	Florida	and	many	other	
states	throughout	the	country.		For	over	60	years	it	has	led	
the	way	with	innovative	programs	that	include:	

    v	 mmunizations	for	children
    v	 arental	education	in	child	care	from	pregnancy		
	    to	birth	and	beyond
    v	 onitoring	the	land,	air	and	water
    v	 onitoring	and	testing	for	potential	epidemics
The	future	holds	many	unknowns,	but	your	Health	Department	
will	be	there	to	serve	your	health	needs.

HEALTH	ACCESS	DIVISION	---------------------------------- (561)	671-4036


ENVIRONMENTAL	PUBLIC	HEALTH	----------------------------(561)	837-5900

COMMUNITY	&	SCHOOL	HEALTH	--------------------- (561)	671-4161

MATERNAL	CHILD	HEALTH	---------------------------- (561)	671-4140

HIV/AIDS/STD/TB	------------------------------------------- (561)	804-7900

IMMUNIZATIONS------------------------------------------- (561)	840-4568

NUTRITION	SERVICES	-------------------------------- (561)		671-4089

	----------------------------------------------------------------- (561)	671-4014

RESIDENCY	PROGRAM	----------------------------(561)	837-5165

DENTAL	PUBLIC	HEALTH	 --------------------- (561)	837-5560

VITAL	STATISTICS	------------------------------(561)	837-5841

WIC	----------------------------------------- (561)	357-6007

                                               v i s i t u s o n t h e w e b : w w w. p b c h d . c o m

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