Infectious Disease
Problem: Infectious diseases are being spread among Carver County residents.

Goal:           Reduce infectious disease.

The Minnesota Department of Health (MDH) reports that                     assessment, monitoring, development, implementation and
public health has been in the forefront of the decline – and in           evaluation efforts needed to prevent and respond to infectious
some case the eradication – of infectious diseases in the 20th            diseases.1
century. Among the most dramatic improvements have been
the elimination of smallpox worldwide and the elimination of              Carver County Community Health Services (CCCHS) sees its
diphtheria and poliomyelitis in the U.S. Much of the progress             role as one of providing the community with communicable
resulted from water treatment, pasteurization of milk, basic              disease reports and interpretation of those reports. It is
hygiene and improvement in living standards. The widespread               currently in the process of developing a database to collect
use of childhood vaccines has contributed greatly to the control          information and a system to communicate with schools, local
of many infectious diseases and remains an important control              hospitals, clinics, and the general resident community on
strategy.1                                                                infectious diseases and vaccination programs.

There is, however, a re-emergence of older infectious diseases            Sexually Transmitted Diseases
in the U.S., such as tuberculosis, and an emergence of new                Sexually transmitted diseases (STDs) are the most commonly
diseases such as Severe Acute Respiratory Syndrome (SARS).                reported infectious diseases in Carver County and in
Difficulty in preventing and controlling sexually transmitted             Minnesota. By law, medical providers are required to report
diseases and infections remains, and the need for diligence in            cases of chlamydia, gonorrhea and syphilis to the MDH.
promoting programs that focus on vaccination-preventable                  Medical providers are not required to report other STDs such
diseases continues. In the last two years, planning efforts have          as herpes simplex virus (HSV) genital herpes or human
been undertaken at the state and county level to prevent and              papillomavirus (HPV) genital warts. The MDH cautions that
respond to potential bio-terrorism attacks that would involve             STD cases are most likely undercounted due to inconsistent
the spread of infectious diseases such as smallpox.                       protocol for medical providers regarding the testing of
                                                                          individuals for STDs and a lack of universal reporting.
The diligence and cooperation of a wide variety of public and
private organizations is needed to continue the vital

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STDs are often asymptomatic and therefore can go undetected               about the real risks of unprotected sexual activity. The focus
and untreated. Left untreated, STDs can have serious long-term            needs to be on being responsible in terms of one’s choice of
consequences such as pelvic inflammatory disease, infertility             partners and sexual activities. Safer-sex practices such as the
and cancer. STDs occurring during pregnancy can result in                 use of condoms and dental dams should be encouraged.1
fetal death or physical and developmental disabilities of the
infant. The risk of transmitting and acquiring HIV is greater             The MDH recommends parents, schools, nonprofit agencies
among people with other STDs, according to the MDH.1                      and the private and public health systems work together to
Not all STDs can be cured through treatment, and treatment                educate youth about STDs. Particular attention needs to be paid
does not make an individual immune to contracting the disease             to encouraging consistent screening by medical providers and
again if they are re-exposed to the STD. Some STDs, such as               the consistent use of safer-sex practices by sexually active
genital herpes and genital warts, are chronic conditions that             adolescents and young adults.1
cannot be cured.
Transmission of STDs is primarily through unprotected sex.                Chlamydia is the most commonly reported STD in Carver
The MDH recommends that prevention programs focus on the                  County and in Minnesota. Reported rates of chlamydia have
importance of developing self-esteem and healthy                          risen steadily from 1999 to 2002 in the county.2 Some of this
relationships, that they offer abstinence as an option, and that          rise may be due to increased screening and reporting by
they give facts about STDs. Those who choose to engage in                 medical providers. Rates of chlamydia have risen consistently
sexual behaviors must be given clear and repeated messages                in Minnesota since a decade low in 1996.

Figure 7.1 shows the increase in chlamydia rates from 1999 and 2002 in both Carver County and Minnesota.2

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Figure 7.1: Chlamydia Rates for Carver County/Minnesota 1999-2001
                                                                Chlamydia Rate

  Rate per 100,000 Population

                                200                                     170
                                                          166                                          Carver County

                                100                                              74

                                      29                         33

                                      1999         2000          2001            2002

Source: Minnesota Department of Health

In addition to being the most reported STD, chlamydia has the                                        gonorrhea is available. If left untreated, serious health concerns
highest reported rates among adolescents and young adults.                                           can occur, particularly to women.
Many people with chlamydia experience no symptoms. If left
untreated, it can lead to ectopic (tubal) pregnancies, infertility,                                  Syphilis
and premature delivery and low-birth-weight births. It can also                                      Syphilis can have very serious health consequences for those
be passed to newborns during childbirth and cause serious eye                                        infected and for their partners. While there have been cases of
infections or pneumonia.                                                                             syphilis in Carver County, the number of cases in the county
                                                                                                     has been less than 10 per year.2 The total number of cases in
Gonorrhea                                                                                            Minnesota has increased in recent years, and that has raised
Gonorrhea is the second most common reportable STD and is                                            concerns about the possibility of rates increasing in the county.
often seen in conjunction with chlamydia. Rates show no clear
trend in Carver County since 1999, and the rates have held                                           The majority of reported syphilis cases in 2002 and 2003 in
steady in Minnesota during the last decade.2 Treatment for                                           Minnesota occurred among males. Of the 74 early syphilis
                                                                                                     cases in 2003, 69 (93 percent) are males. Of the reported cases,
                                                                                                     54 cases were among men who have sex with men.3

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The MDH reports that syphilis cases continue to be                          metro area, excepting the cities of Minneapolis and St. Paul)
concentrated in the Twin Cities metropolitan area. The city of              and 34 percent of the cases in 2003 were suburban residents.4
Minneapolis had the 12th highest syphilis rate in 2002 among
major cities in the U.S. and previously ranked 30th for syphilis            The state health department states that since the HIV virus is
rate in 2000 according the CDC rankings for major U.S. cities.3             spread through unprotected sex, safer-sex practices can reduce
                                                                            the spread of the HIV virus. Continued prevention education is
HIV/AIDS                                                                    needed in the area of safer-sex practices, particularly since the
In 2001, the MDH changed how it reports HIV (Human                          media’s focus on HIV/AIDS and deaths from AIDS that was so
Immunodeficiency Syndrome) and AIDS (Acquired                               prevalent during the 1980s has diminished. Those who are too
Immunodeficiency Syndrome) cases. Instead of reporting the                  young to remember the media’s focus on AIDS are less likely
number of new HIV (non-AIDS) cases and new AIDS cases                       to realize the seriousness of HIV/AIDS and its prevalence in
separately, as it had done previously, MDH began reporting all              the U.S.
newly diagnosed cases of HIV infection that were either HIV
or AIDS at first report. With this reporting method, changes in             Genital warts/HPV
the occurrence of HIV can be observed more accurately from                  Genital warts are caused by the human papillomavirus (HPV).
year to year: The MDH can track when people with HIV                        Although the warts can be treated, HPV cannot be cured. If left
acquire AIDS, and when, and if, those with AIDS go into                     untreated, genital warts can be passed to newborns during
remission.4                                                                 childbirth. Some virus strains lead to abnormal Pap tests and
                                                                            increased risk of cervical or penile cancer, but these strains do
The MDH reported there were no new cases of HIV infection                   not cause visible warts. The MDH does not require that doctors
reported in Carver County in 2001 and five new cases reported               report cases of genital warts.
in 2002. It reports that there are currently 23 people living with
HIV/AIDS in Carver County. This number does not take into                   Genital Herpes
account people who are HIV positive and unaware of their HIV                Herpes cases are also not reported to the MDH. Genital herpes
status.4                                                                    is caused by herpes simplex virus (HSV) types 1 and 2. There
                                                                            is no cure, although taking an antiviral medication may prevent
In Carver County, there were 12 HIV cases diagnosed (HIV or                 or reduce recurrent episodes. Newborns may acquire infection
AIDS at first diagnosis) between 1982 and 1991, and 18 HIV                  from their mother during delivery, which can cause death, or
cases diagnosed between 1992 and 2001. It reports these data                severe damage to the brain, lungs and liver. However, most
are consistent with a gradual trend over the past 10 years in the           pregnant women with recurrent herpes deliver normal infants.
metropolitan area of an increasing percentage of HIV                        The risk is highest for infants born to mothers who have first
diagnoses occurring among suburban (as opposed to urban)                    episodes of genital herpes during pregnancy, according to the
residents: 20 percent of all Minnesota HIV cases in 1993 were               MDH.
suburban residents (defined as residents of the seven-county

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Hepatitis B & C                                                          18-49 from across the U.S. The study found that 50 percent of
Among the hepatitis strains, hepatitis B and C are the two most          the women surveyed said that they had not discussed HIV
common forms of hepatitis that can be sexually transmitted.              testing with their current partner, and 60 percent of the women
                                                                         said that they had not discussed testing for more common
Hepatitis B is spread by sexual relations, sharing needles and           STDs with their current partner.10
sharing personal items. Untreated infection can lead to chronic
liver disease, liver cancer and death. Infected persons can              The survey also found many information gaps about HIV and
become chronic carriers, and mothers can pass the virus to a             other STDs among those surveyed. Four-out-of-five women
newborn, who in turn can become a chronic carrier.                       underestimated or did not know current STD rates, and almost
Vaccination against hepatitis B is now recommended for all               half of the women surveyed said they would know it they were
infants, kindergartners and seventh graders. The MDH reported            infected with an STD, despite the asymptomatic nature of
less than 10 cases of hepatitis B in Carver County between               many STDs. Three-in-five women did not know that women
1999 and 2002.5-9                                                        are at an increased risk of contracting STDs; about half did not
                                                                         know that STDs increase the risk of contracting HIV
Hepatitis C is primarily spread through sharing needles. A               infection.10
small percentage of cases are spread through sexual relations,
or by infected mothers who pass the virus to their newborn.              The study sponsors commented that even though STDs are an
Some cases of hepatitis C have been reported in recipients of            important area of health care for women, the stigma associated
clotting factors made before 1987. There were no reported                with STDs keeps them from talking about this with closest
cases of hepatitis C in Carver County from 1999 to 2002.5-9              friends, health care providers and intimate partners.10

Sexual behavior and STD/STIs                                             The 2001 Minnesota Student Survey found that sexually active
In the summer of 2003, the Kaiser Family Foundation and                  teens were somewhat more likely to talk to their partners about
SELF Magazine published their joint survey on women and                  safe-sex practices.
sexually transmitted diseases. They surveyed 800 women ages

Table 17.2 shows the responses for Carver County students when asked about talking about safe sex practices and condom use.11

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Table 7.2: Sexual Behavior Regarding Safe Sex/Condom Use for Carver County Students

                                                          9th GRADE             12th GRADE
                                                         Male    Female        Male    Female
Report having NEVER talked with their partner(s) about
protecting yourselves from getting STDs/HIV/AIDS         31%      30%          32%        15%

Report that they or their partner did NOT use a condom
the last time they had sexual intercourse                26%      41%          45%        51%
Source: Minnesota Student Survey, 2001

More than two-thirds of the sexually active adolescents                        throat, and lungs. Influenza symptoms come quickly in the
surveyed in Carver County said they had discussed protection                   form of fever, headache, tiredness, dry cough, sore throat, nasal
against STDs/HIV/AIDS with their partners. The highest                         congestion, and body aches. These symptoms can be severe
percentage came from 12th grade girls; 85 percent said they                    and debilitating for a number of days.
discussed safer-sex practices with their partners. About one-
third of ninth grade boys (32 percent), ninth grade girls (30                  The Minnesota Department of Health states that the best way to
percent) and 12th grade boys (32 percent) said they never talked               avoid influenza is to get a flu shot. Because influenza viruses
with their partners about preventing STDs/HIV/AIDS.11                          mutate, the influenza strain can vary from one flu season to the
                                                                               next. A person must have a flu vaccination every year in order
Twelfth grade girls, however, were least likely to report                      to be protected.
condom use during the last time they had sexual intercourse.
More than half of the 12th grade girls (51 percent) said their                 The Minnesota Department of Health (MDH) recommends flu
partner did not use a condom the last time they had sexual                     vaccination every year for the following people:
intercourse; 45 percent of the 12th grade boys reported that                              • Persons 65 years of age or older
condoms were not used the last time they had sexual                                       • Residents of nursing homes and other chronic-
intercourse. For ninth graders, 26 percent of the boys and 41                                care facilities
percent of the girls reported that condoms were not used the                              • Adults and children who have chronic disorders
last time they had sexual intercourse.11                                                     of the pulmonary or cardiovascular systems,
                                                                                             including children with asthma
Influenza                                                                                 • High-risk and healthy children aged 6-23
                                                                                             months as children in this age group are at
Influenza is a potentially life-threatening disease, especially for
                                                                                             substantially increased risk for influenza-related
the chronically ill. It is caused by a virus that attacks the nose,

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            •   Medical and care staff in hospitals, long-term           Tuberculosis
                care facilities, home health care agencies and           Tuberculosis (TB) is caused by bacteria that usually infect the
                those who have household contacts of children            lung but can affect other parts of the body. There is a
                0-23 months.                                             difference between TB infection and TB disease. People with
                                                                         TB infection test positive on a skin test for TB but are not sick
The other important way to prevent the spread of influenza and           and cannot spread the disease to others. Those with TB disease
colds is to wash hands frequently as viruses live on skin or             can spread the disease to others, primarily through the air.
contaminated objects, according the MDH publication
“Minnesota Flu Vaccination Plan for the Season 2002-2003.”12             Certain groups are at higher risk for contracting tuberculosis,
                                                                         including people born outside the United States where TB is
Carver County Community Health Services (CCCHS) provided                 endemic, people living in close quarters such as nursing homes,
information on the MDH “Cover Your Cough” and hand                       jails and prisons, the poor, the homeless, and people with HIV
washing campaign to local schools, clinics and hospitals during          and other medical conditions that weaken their ability to fight
the 2003-2004 flu season. CCCHS also provided flu shots at its           infection.
monthly Immunization Clinics during the flu season. CCCHS
directs and replies to all community inquires for information            In Minnesota, approximately 80 percent of TB cases occurred
received from phone calls on a daily basis and records them in           in persons born outside the U.S. In order to reduce cases in this
its Intake & Referral database.                                          population, culturally appropriate prevention and control
                                                                         strategies need to be identified, developed and implemented,
Pneumonia                                                                the Minnesota Department of Health (MDH) reports.13
Pneumonia is another potentially life-threatening disease,
especially for older adults and those with chronic health                Although, Carver County has had less than 10 cases of TB
conditions. Persons who are recommended to get the                       within the last three years, TB screening and follow-up at the
vaccination include:                                                     county level have taken significant public resources.6-8
           • Persons 65 year and older                                   Surveillance, direct observation therapy and home visits to
           • Adults and children two years and older who                 patients are required by state mandates. As Carver County’s
               have chronic diseases.                                    population grows and becomes more diverse, it is expected that
                                                                         the importance of culturally appropriate methods to treating TB
Carver County Community Health Services provides                         will be even more important.
pneumonia vaccinations during it monthly Immunization
Clinics.                                                                 Currently, Carver County Community Health Services
                                                                         provides TB screening and follow-up to inmates at the Carver
                                                                         County Jail and to the immigrant population in the county.

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SARS                                                                      investigation assistance, (3) assure case access to medical care,
The winter of 2002-03 saw the emergence of a new respiratory              (4) assist in the collection and transport of specimens, (5)
illness called Severe Acute Respiratory Syndrome (SARS).                  assure timely information on infection control in patient
There were no confirmed cases of SARS reported in Minnesota               settings and how to manage the disease, and (6) provide
in 2002-2003; however some suspected cases in the state were              general information and risk communication to the community.
                                                                          Vector-Borne Illnesses
The primary way that SARS appears to spread is by close                   The most common vector-borne illnesses in Carver County
person-to-person contact. Potential ways SARS can be spread               include La Crosse Encephalitis and West Nile Virus, which are
include touching the skin of other people or objects that are             spread by mosquitoes, and Lyme Disease, which is spread by
contaminated with infectious droplets, and then touching your             ticks.
eyes, nose or mouth. It is also possible that SARS can be
spread more broadly through the air.14                                    La Crosse Encephalitis causes flu-like symptoms. Most
                                                                          reported cases occur in children under the age of 16 with the
Health care workers are at particular risk for contracting SARS           average age being 6 years old. There were eight reported cases
from infected patients. Carver County Community Health                    of La Crosse Encephalitis in Carver County between 1985 and
Services (CCCHS) is working to educate health care providers              2002, according to the Minnesota Department of Health
about how to protect themselves from the spread of SARS and               (MDH).15
other similar infectious diseases. These efforts include the
“Cover Your Cough Campaign” which emphasizes frequent                     West Nile Virus is transferred to humans and animals through
hand washing and the need for coughing patients and for health            mosquito bites and can develop into West Nile Encephalitis (or
care providers to wear masks.                                             brain inflammation). The most severe cases occur in people
                                                                          aged 50 and older and about 10 percent of those cases are fatal.
In the event of a local SARS outbreak, the roles of the MDH               There were no cases of West Nile Virus in Carver County in
and local public health agencies are dependent upon the                   1999. In 2002, there were 48 confirmed human cases of West
number of cases and the geographic scope of the SARS case(s).             Nile Virus in Minnesota and two of those were in Carver
The MDH leads the SARS epidemiology, infection control, and               County, according to the MDH.15
prevention efforts. The role of local public health agencies, or
CCCHS, is to provide assurance and assistance to the MDH as               Lyme Disease is a bacterial infection transmitted by deer ticks.
necessary. The following assistance and assurance roles may               The risk of getting a tick-borne disease is small, especially if
vary depending upon the need and circumstance: (1) assure                 the tick is removed soon after it becomes attached, the MDH
quarantine in Carver County residents and maintain and                    reports. Early symptoms of Lyme disease typically include a
monitor those who are in quarantine, (2) provide contact                  characteristic “bulls-eye” rash that appears as a red ring with

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central clearing. Not everyone develops or notices the rash.          Vaccinations for Children
Some people with Lyme Disease may have flu-like symptoms.             The Minnesota Department of Health (MDH) 2003 Public
Carver County has had minimal numbers of reported Lyme                Health Strategies document states, “The widespread use of
disease from 1999-2002.6-9                                            immunizations is considered to be one of the top 10 public
                                                                      health accomplishments of the 20th century. Immunizing babies
To prevent West Nile and La Crosse Encephalitis, it is
                                                                      and young children against vaccine-preventable diseases
recommended that residents:
                                                                      reduces illness, prevents suffering and saves the lives of
         • Wear long-sleeved, light colored shirts and
                                                                      children. From birth to age 5, children are the most vulnerable
                                                                      to severe consequences of vaccine-preventable diseases such as
         • Use insect repellents that contain no more than            pertussis (whooping cough), hepatitis B and measles.”
            30 percent DEET for adults and 10 percent or
            less DEET for children                                    In 2001, the MDH conducted its third comprehensive
         • Avoid being outside when mosquitoes are most               immunization survey of kindergartners throughout Minnesota.
            active, usually dawn and dusk                             The first one was in 1992 and the second in 1996.
         • Always change water in birdbaths or any other
            standing water that has been sitting for a few            The school-based surveys identify the number and percentage
            days to prevent mosquito larva from developing.           of children who have received all recommended immunizations
                                                                      (referred to as “up-to-date”) at various points. The survey
To prevent Lyme disease, the MDH recommends that                      focused on the goal points of four months, six months, eight
residents:                                                            months, 17 months, and 20 months. These five age points
           • Wear long-sleeved, light colored shirts and              represent the recommended dates of the primary immunization
             pants with socks tucked in pants                         series of recommended vaccinations, which include four doses
           • Use insect repellants that contain DEET or one           of DTaP, three doses of polio and one dose of measles-
             containing permethrin                                    containing vaccine.
           • Avoid possible tick habitats of wooded, brushy
             areas during peak time of year, mid-May
             through Mid-July.

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The following two graphs show the percentage of Carver County children who received age-appropriate vaccinations and the
percentage that are up-to-date for vaccinations.16

Figure: 7.3: Percent of Carver County Children with Age-Appropriate Vaccinations
                               Graph 1: Percent of Children with Age-Appropriate
                               Vaccination by Age in Months, Kindergarten Survey
                                             2001-02 Carver County

   Percent Immunized

                                                                                 Primary Series

                             2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48
                                                      Age in Months
 Source: Minnesota Department of Health, Carver County Retrospective Kindergarten Survey, 2001-2002

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Figure 7.4: Vaccination Status of Carver County Children

                             G r a p h 2 . V a c c in a tio n S ta tu s b y A g e in M o n th s
                                          K in d e r g a r te n S u r v e y , 2 0 0 1 -0 2
                                                      C a rve r C o u n ty

                             N o V a c c in e s             B e h in d O n e o r M o re D o s e s
   Percent Immunized

                                                                                                U p -to -D a te
                             2   4   6   8   10   12   14   16   18    20   22   24   26   28   30   32   34   36   38   40   42   44   46   48

                                                                      A g e in M o n th s
Source: Minnesota Department of Health, Carver County Retrospective Kindergarten Survey, 2001-2002

The Minnesota goal is to have 90 percent of children                                                                     vaccinations at four, six, eight and 17 months. There is a drop
immunized at each of the five age goals of four, six, eight, 17                                                          in the percentage of Carver County children who are up-to-date
and 20 months, allowing a two-month grace period to receive                                                              on their vaccines at age 20 months. By 26 months, at least 90
the vaccine(s). Using these criteria, 90 percent or more of                                                              percent Carver County children were up-to-date with the
Carver County children are up-to-date for the primary series of                                                          primary series of vaccinations.16

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Figure 7.5 compares the vaccination levels of Carver County children from the 1996-97 survey and the 2001-02 survey.16-17

                          Graph 3. Comparison of Vaccination Levels Between
                              1996-97 and 2001-02 Kindergarten Surveys
                                           Carver County
                                                                                                                            90 %

                      90                                                                                                    Goal
      Percent Immunized

                      40                                                                                 2001-02

                                   Goal 1

                                            Goal 2

                                                     Goal 3

                                                                                Goal 5
                                                                       Goal 4

                               2       4         6        8   10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48

                          Primary series                                        Age in Months

Source: Minnesota Department of Health, Carver County Retrospective Kindergarten Survey, 2001-2002

In comparing the vaccinations levels of Carver County children                                                Most Carver County schools, licensed day cares and pre-
in 1996-97 with 2001-02, the data shows improvement at                                                        schools have a “No Shots, No School” policy for students. This
almost all goal points. In 1996-97, the county fell short of the                                              strategy, adopted by numerous Metropolitan School Districts,
goals at eight, 17, and 20 months. In 2001, with a two-month                                                  helps promote up-to-date immunizations.
grace period for receiving vaccinations, goals were met for all
but the 20-month-old children, according to the study.16-17
                                                                                                              Carver County Community Health Services (CCCHS) offers
                                                                                                              monthly walk-in immunization clinics as well as providing
                                                                                                              home visits to young families with children. Minnesota

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Vaccines for Children (MnVFC) are also available to                           Maintain leadership for the coordination and
qualifying children ages 0-18 and low-cost vaccines to the                management of public health planning for bio-
general public through CCCHS.                                             terrorism, other outbreaks of infectious disease, and
                                                                          other public health threats and emergencies. This
Emergency Preparedness                                                    leadership coordinates all activities assuring the ability
In the wake of September 11, 2001, the federal government                 to respond to a public health emergency.
authorized local state and local counties to assess and plan for             Complete and analyze an integrated assessment of
potential terrorist attacks, including bio-terrorism that would           local public health capacity to respond to bio-terrorism,
involve infectious disease outbreak emergencies.                          other outbreaks of infectious disease, and other public
                                                                          health threats and emergencies.
In Minnesota, Community Health Boards are required to                         Develop and exercise comprehensive plans that
maintain leadership for the coordination and management of                support local response to incidents of bio-terrorism,
public health planning for bio-terrorism, other outbreaks of              catastrophic infectious disease, such as pandemic
infectious disease, and other public health threats and                   influenza, other infectious disease outbreaks, and other
emergencies, according to the Minnesota Department of Health              public health threats and emergencies. This response
(MDH). Carver County commissioners serve as the                           may include a mass dispensing clinic or distribution of
Community Health Board for Carver County.                                 the Strategic National Stockpile.
                                                                            Participate in regional planning efforts and coordinate
Carver County Community Health Services (CCCHS) began                     local planning to effectively manage the CDC Strategic
planning for bio-terrorism in 2002 and those efforts are                  National Stockpile (SNS), should it be deployed to
continuing. It is working with internal and external partners in          Carver County.
the county to assess the current capacity of the county to                   Lead or participate in the response to any event of
respond to a public health emergency. As part of its                      bio-terrorism, other outbreaks of infectious disease, and
Emergency Preparedness plan, CCCHS is developing methods                  other public health threats and emergencies within
to support local response of incidents of bio-terrorism,                  Carver County.
catastrophic infectious diseases, such as pandemic influenza,                Promote provider compliance of infectious disease
other infectious disease outbreaks, and other public health               reporting, especially of illnesses and conditions
threats and emergencies.                                                  possibly resulting from bio-terrorism, other infectious
                                                                          disease outbreaks, and other public health threats and
CCCHS received a Public Health Emergency Preparedness                     emergencies, as outlined in the DP&C Common
Grant. A summary of CCCHS duties outlined in that grant are               Activities Framework.
as follows:

CARVER COUNTY COMMUNITY HEALTH SERVICES/PUBLIC HEALTH              -75-                                     2004-2008 ASSESSMENT
          Make staff available to participate in specimen                 communications processes and technology. Its staff
        collection, as needed by the state health department,             participated in establishing the county’s Emergency Operations
        during times of infectious disease outbreaks.                     Center (EOC) and was involved in cooperative planning with
          Establish and maintain a network that will: (a)                 Carver County Risk and Emergency Planning.
        support exchange of key information and training over
        the Internet by linking public health and private                 Summary
        partners on a 24/7 basis; (b) provide for rapid                   Carver County does have lower levels for many of the reported
        dissemination of public health alerts to the response             infectious diseases than the state, yet risks of infectious disease
        community; (c) ensure secure electronic data exchange             transmission remains for county residents especially as the
        between public health partners’ computer systems; and             population continues to grow. Many Carver County
        (d) ensure protection of data, information, and systems,          adolescents and young adults are at risk for STDs due to high
        with adequate backup, organizational, and surge                   levels of unprotected sex. Chlamydia continues to be the most
        capacity to respond to bio-terrorism, other infectious            commonly reported disease for Carver County; however, other
        disease outbreaks, and other public health threats and            common STDs such as syphilis and gonorrhea are beginning to
        emergencies.                                                      increase.
          Maintain a written plan that describes roles and
        responsibilities regarding the provision of information           It is recommended that Carver County medical providers
        to the media, the public, and special populations during          routinely screen patients for STDs and be diligent in reporting
        an event of bio-terrorism, other outbreaks of infectious          the appropriate STDs to the Minnesota Department of Health.
        disease, and other public health threats and                      Carver County Public Health is in the initial stages of working
        emergencies.                                                      with community medical providers to increase disease
          Assure a basic level of knowledge in key staff,                 reporting in the County and to assess what education is being
        including, but not limited to, knowledge in the                   provided on STDs to the priority populations. They are also
        following areas: Minnesota Incident Management                    focusing on the development of an action plan based on the
        System (MIMS); the state public health emergency                  findings.
        preparedness plan and the local role in it; the local
        public health emergency preparedness plan; and bio-               Parents, schools, public health and private medical providers
        terrorism agents, including their transmission, control,          need to work together to improve and maintain child
        and treatment; other outbreaks of infectious disease;             immunization rates. Vaccination levels for Carver County
        and other public health threats and emergencies.                  residents have generally been at or above the 90 percent goal
                                                                          set by the state. However, vaccinations generally fall off
In 2002-2003, CCCHS participated in a regional smallpox                   around the toddler years for several key vaccine series. Carver
immunization program and worked to improve the county-wide                County Community Health Services (CCCHS) will continue to

CARVER COUNTY COMMUNITY HEALTH SERVICES/PUBLIC HEALTH              -76-                                              2004-2008 ASSESSMENT
provide monthly walk-in immunizations as an option for those
who may not have access to vaccines from health care
providers. The county has participated in a metro-county
immunization registry and will be switching to a state-wide
immunization registry in 2004.

CCCHS will continue to direct education at older adults and
those with chronic diseases to stress importance of influenza
and pneumonia immunizations. It will continue its “Cover
Your Cough” campaign and efforts to educate the public that
washing hands as a good way to prevent the spread of colds,
influenza, and other emerging respiratory viruses such as

Public health continues to monitor trends in infectious disease
rates and is working to communicate this information to local
schools, health care providers and the community. It will
continue its work on emergency preparedness in terms of bio-
terrorism and the potential for emergency outbreaks of
infectious disease. CCCHS will monitor the occurrence and
spread of emerging viruses and new antibiotic-resistant strains
and provide education to the public and health care providers
as it becomes available. CCCHS is also continuing to develop
and expand its data capacity to better serve the data needs of
the community and surrounding area agencies.

References                                                                 9. Minnesota Department of Health. 1999 Carver County
    1. Minnesota Department of Health. Strategies for Public                   Disease Report Summary. St. Paul, MN. Infectious
       Health: A Compendium of Ideas, Experiences, and                         Disease Epidemiology, Prevention and Control Section.
       Research      from     Minnesota’s       Public    Health               2003.
       Professionals. Volume 2. Division of Community                      10. Henry J. Kaiser Foundation & SELF Magazine. (2003,
       Health. 2002.                                                           June 18). Stigma and information gaps contribute to
    2. Minnesota Department of Health. 2002 Minnesota                          silence on sexual health matters. July, 2003.
       Sexually Transmitted Disease Statistics. St. Paul, MN.              11. Minnesota Department of Human Services &
       Infectious Disease Epidemiology, Prevention and                         Minnesota Department of Children, Families &
       Control Section. 2003.                                                  Learning. 2001 Minnesota Student Survey.
    3. Minnesota Department of Health. (2004, January 6).                  12. Minnesota Department of Health. Minnesota Flu
       News Release 1/06/04-Continued increase in syphilis                     Vaccination Plan for the 2002-2003 Season. Infectious
       rate concerns state health officials. Retrieved January 6,              Disease Epidemiology, Prevention and Control Section.
       2004 from                                                               Retrieved December 18, 2003 from       
       lis/index.html                                                          dex.html
    4. T. Sides (personal communication, January 9, 2004)                  13. Minnesota Department of Health. TB Statistics.
    5. Minnesota Department of Health. 2002 Minnesota                          Retrieved December 12, 2003 from
       Sexually Transmitted Disease Statistics. St. Paul, MN.        
       Infectious Disease Epidemiology, Prevention and                         ts.html
       Control Section.                                                    14. Centers for Disease Control and Prevention. Severe
    6. Minnesota Department of Health. 2002 Carver County                      Acute Respiratory Syndrome (SARS). Retrieved August
       Disease Report Summary. St. Paul, MN. Infectious                        4, 2003 from
       Disease Epidemiology, Prevention and Control Section.               15. Minnesota Department of Health. Mosquito-transmitted
       2003.                                                                   disease in Minnesota. Infectious Disease Epidemiology,
    7. Minnesota Department of Health. 2001 Carver County                      Prevention and Control Section. Retrieved August 4,
       Disease Report Summary. St. Paul, MN. Infectious                        2003 from
       Disease Epidemiology, Prevention and Control Section.         
       2003.                                                                   index.html
    8. Minnesota Department of Health. 2000 Carver County                  16. Minnesota Department of Health. Retrospective
       Disease Report Summary. St. Paul, MN. Infectious                        kindergarten survey 2001-2002. St. Paul, MN.
       Disease Epidemiology, Prevention and Control Section.               17. Minnesota Department of Health. Retrospective
       2003.                                                                   kindergarten survey 1996-1997. St. Paul, MN.

CARVER COUNTY COMMUNITY HEALTH SERVICES/PUBLIC HEALTH               -78-                                        2004-2008 ASSESSMENT

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