Epidemiological Bulletin · 2007-04-20 · Obesity task force began meeting in April 2005. Partners...

Summer 2005 Volume IV, Number III

Epidemiological BulletinEpidemiological Bulletin

San Mateo County Health Department Disease Control and Prevention • Epidemiology Unit 225 - 37th Avenue • San Mateo • California • 94403

Telephone: 650.573.2346 • Fax: 650.573.2919 [email protected]

http://www.smhealth.org/epi_bulletin

Healthy Communities San Mateo County: A Community Health Improvement Initiative to Eliminate Health Disparities

Michelle Oppen, MPH and Cristina S. Heinz, MPH; Health Policy, Planning & Promotion Unit

Introduction Health status is not only influenced by an individual’s biology or behaviors, but also his/her social and physical envi-ronment, policies and interventions, and access to health care.1 In other words, there are underlying factors — such as gender, race or ethnicity, language, immigration status, and education — that affect health. These underlying factors have a direct effect on disease outcome, as well as an indirect effect, by influencing risk behaviors, which, in turn, affect morbidity and disease. While this association can be seen in individuals, it is impor-tant to note its added effects on entire populations. These health disparities are the differences in incidence, preva-lence, mortality, burden of diseases, and other adverse health conditions among specific population groups.2

(continued on page 2)

San Mateo County Epi Bulletin -2- Summer 2005

(Healthy Communities, cont.)

Background San Mateo County community members and organizations recognize that health disparities exist throughout many arenas of healthcare and health outcomes in this county. As a community, we denounce these health disparities and are committed to their elimination. With guidance and support from Supervisor Rose Jacobs Gibson and the Health Department, the County community came together in May 2004 for the first Healthy Communities Summit to begin identifying local disparities and developing a plan to reduce them on a county-wide level. The community and organizations involved in this process chose three priority areas on which to concentrate through a strategic planning process: Childhood Obesity Prevention; Alcohol, Tobacco and Other Drug Prevention; and Lin-guistic Access to Healthcare.§ The initiative, Healthy Communities San Mateo County: A Community Health Im-provement Initiative to Eliminate Health Disparities, chose these issue-specific areas due to the high rates of over-weight/obesity and substance use/abuse in communities that experience increased health disparities. These issues have been chosen because of their severe consequences for morbidity and mortality in these communities, as illus-trated in the diagram below. Significant disparities in health outcomes have also been identified in populations that lack linguistic access to services and programs.

Source: Healthy Community Collaborative of San Mateo County. 2004 Community Assessment: Health and Quality of Life in San Mateo County.

Purpose The purpose of an initiative focusing on eliminating health disparities is to improve the overall health and well-being of San Mateo County residents, paying particular attention to communities with adverse health outcomes and mor-bidity/mortality rates higher than other areas/communities. (Note that here “health” is defined according to the World Health Organization as “a state of complete physical, mental and social well-being and not merely the ab-sence of disease or infirmity.”) The specific goals of these efforts are to The specific goals of these efforts are to re-duce rates of overweight and obesity in children, use of alcohol, tobacco and other drugs, and linguistic barriers to care in those populations most vulnerable to poorer health outcomes. § Mental health was also discussed as a priority area and is being addressed separately by the Mental Health Services Act (Prop. 63) planning. The results of this effort will also be linked to the three directives discussed in this article.


Summer 2005

-3- San Mateo County Epi Bulletin

The planning process entails the formation of working task forces focusing on each priority area, as well as forma-tive research activities that will result in written recommendations and strategic plans. Strategies The Healthy Communities Initiative uses the Spectrum of Prevention model, which is a framework that encourages a multifaceted scope of solutions to a given problem, and is described in the table below.3 Strategic plans that incorpo-rate solutions from all levels of the Spectrum are more successful and sustainable. The Spectrum incorporates differ-ent levels of stakeholders or strategies including individual and community approaches, as well as policy and legisla-tion.

Source: The Prevention Institute. Available at http://www.preventioninstitute.org/spectrum_injury.html, last verified 06/23/05. Focus Areas Prevention of Childhood Obesity Partnering with almost 200 stakeholders in many different arenas in San Mateo County, the Prevention of Childhood Obesity task force began meeting in April 2005. Partners include representatives from schools, parks and recreation departments, healthcare systems, community-based organizations, policy makers, and County departments among others. This task force continues to meet monthly to guide the strategic planning process and assign roles to the stakeholder groups and organizations that are collaborating to improve nutrition and physical activity access for chil-dren in San Mateo County. In conjunction with these meetings, qualitative data is being collected to ensure that the process and plan are evi-dence-based. Focus groups with children, youth, parents and teachers, along with key informant interviews, are be-ing conducted over the summer months of 2005. In addition, we are creating a database of all childhood obesity pre-vention projects already in existence in this county to assess best practices, successes, challenges, and lessons learned, to ultimately provide guidance to future efforts. Literature reviews of best practices will also add to the for-mative research process. The blue print of how San Mateo County will address childhood obesity is expected to be completed by the end of 2005. Alcohol, Tobacco, and Other Drug (ATOD) Prevention The ATOD Prevention Task Force was formed in March 2005 with the objective of developing a comprehensive, county-wide action plan to prevent alcohol, tobacco, and other drug use/abuse that can be modified and/or applied to local/regional situations. The task force meets monthly or bimonthly, depending on activities. This task force incor-porates stakeholders from a wide variety of county agencies and community-based organizations. Thus far, activities have involved developing guiding principles specific to the task force; reviewing existing data and needs assess-ments; and gathering information on existing prevention programs and other program assets. The task force is also

Level of Spectrum Definition of Level Strengthening Individual Knowledge and Skills

Enhancing an individual's capability of preventing injury or illness and pro-moting safety

Promoting Community Education Reaching groups of people with information and resources to promote health and safety

Educating Providers Informing providers who will transmit skills and knowledge to others

Fostering Coalitions and Networks Bringing together groups and individuals for broader goals and greater impact

Changing Organizational Practices Adopting regulations and shaping norms to improve health and safety

Influencing Policy Legislation Developing strategies to change laws and policies to influence outcomes

Spectrum of Prevention




collaborating with the Center for Applied Local Research (Richmond, CA) on an extensive needs assessment for prevention efforts. In addition, the task force is looking at existing prevention programs, projects or services in the county to assess best practices, successes, challenges, and lessons learned. These results will guide the task force’s efforts and action plan. The expected date of completion for the plan is early 2006. Linguistic Access in Healthcare Assessment (Request for Proposal — RFP) We are in the process of contracting with an agency to conduct a complete assessment of linguistic access in health-care and other health services programs in San Mateo County. The assessment will include a set of recommendations for the Health Department to improve linguistic access for populations that are Limited English Proficient (LEP) or monolingual. This project is scheduled to begin in September of 2005 and complete in mid-2006. References 1. Marmot, M. (2005) Social determinants of health. Lancet 2005;365:199-1104. 2. The NIH Strategic Plan to Address Health Disparities, Washington, D.C., April 19, 2000. 3. Cohen, L and Swift S. (1999) The spectrum of prevention: Developing a comprehensive approach to injury prevention. Injury Prevention

1999;5:203-207.

Expanded Access for Diagnosis and Treatment of Sexually Transmitted Diseases in San Mateo County

John Conley, Deputy Public Health Director

Focus Area Contacts If you would like to receive further information or participate in the Healthy Communities efforts, please contact:

Childhood Obesity Prevention Task Force: Michelle Oppen, [email protected] Alcohol, Tobacco and Other Drug Prevention Task Force: Cristina Heinz, [email protected]

Linguistic Access in Health Care Assessment: Michelle Oppen, [email protected]

In December 2004, San Mateo County expanded its sexually transmitted disease (STD) services eight-fold. Prior to December, a single, two-hour clinic was held weekly. Currently, two four-hour evening STD clinics are offered each week. STD services include screening, testing, examination, evaluation, and treatment for most common STDs. Epidemiol-ogical treatment (i.e., prophylaxis) is provided for those who may have been exposed to an STD by a sexual partner. Risk-reduction counseling is available, as well as assistance with partner notification (if desired). All services are provided on a confidential basis. Anonymous HIV testing is available upon request, if an individual wishes to be tested only for HIV. When an HIV test is requested in addition to other STD testing (e.g., syphilis, gonorrhea, chla-mydia, etc.), all testing is confidential rather than anonymous. On Tuesdays, the STD clinic is open from 4 PM to 8 PM, and on Fridays the clinic is open from 3 PM to 7 PM. Patients must register no later than an hour before the clinic closes. While a donation of $20 is requested, no one is denied service due to inability to provide the requested donation. STD clinic services are available to all San Mateo County residents, on a “drop-in”, first-come, first-serve basis. The STD clinic is held in The Edison Clinic on the main floor of the San Mateo Medical Center on 39th Avenue in San Mateo.



Summer 2005


Rates of Chlamydia, Gonorrhea, and Syphilis in San Mateo County

by Year of Diagnosis, 1999-2004

San Mateo County STD Clinic Information: (650) 573-2346

Hours Tuesdays 4 PM to 8 PM Fridays 3 PM to 7 PM

(STD Clinic Update, cont.)

Mapping the Spread of Tuberculosis in the Workplace Tracy Marshall Morton MPH, Epidemiologist; Diana D. McDonnell PhD, Epidemiologist;

Tony Conception, Communicable Disease Investigator

In Fall 2004, the Tuberculosis (TB) Control Program at San Mateo County Health Department was notified of a smear-positive, culture-positive case of pulmonary and laryngeal TB. The TB Control program initiated a worksite investigation to determine the prevalence of latent TB infection and associated risk factors. Risk of infection was assessed through geographic layout of the office space, airflow and ventilation systems, amount of contact with the index case, and proximity to the index case’s office space. The results of this investigation were presented in poster format at the May 2005 California Tuberculosis Controllers Association Meeting in Emeryville, CA. As described in the poster, it was found that those seated in the same quadrant of the work space as the index case were 8.7 to 11.6 times more likely than those in the other three quadrants to have positive tuberculin skin tests (TSTs). Spatially as-sessing risk factors and behavior increased the understanding of disease transmission. Factors to consider in a spa-tial representation of disease investigation are workplace environmental characteristics, clinical characteristics of the index case, and the country of birth.

A copy of this poster is on pages 6 and 7

(continued on pages 6 –7)

Mapping the Spread of Tuberculosis in the Workplace Tracy Marshall Morton, MPH; Diana D. McDonnell, PhD; Tony Concepcion, CDI

San Mateo County Health Department, Disease Control and Prevention ABSTRACT Brief Description: After a smear-positive, culture-positive case of pulmonary and laryngeal tuberculosis was reported, the San Mateo County TB Program initiated a worksite contact investigation to determine the prevalence of latent TB infection (LTBI) and associated risk factors in the office of the index case. Methods: Risk of infection was assessed through geographic layout of the office space, airflow and ventilation systems, amount of contact with the index case, and proximity to the index case’s office space. 64 of 82 employees were evaluated by tuberculin skin test (TST); the rest were either away from work during the infectious period, refused a test, or had previous history of a positive TST. An outside contractor conducted a detailed assessment of the ventilation system. For analysis, we divided the affected floor of the office building into quadrants and analyzed the likelihood of a positive TST among employees who had no previous record of a positive test. Findings: Of the 64 employees tested, 59% were foreign-born. Eleven of these 64 employees, including the index case, had positive TSTs, and all positives were foreign-born. Of the 64 tested, 15 (23%) were in quadrant A, 17 (27%) in B, 19 (30%) in C, and 13 (20%) in D. The workspaces for seven cases as well as the index case were located in quadrant C. Employees in quadrant C were 8.7 to 11.6 times more likely than those in the other three quadrants to have positive TSTs (quadrant D, OR 8.7; quadrant A, 10.2; quadrant B, 11.6). Conclusion: Spatially assessing risk factors and behavior increases the understanding of disease transmission. Factors to consider in a spatial representation of disease investigation are workplace environmental characteristics, clinical characteristics of the index case, and country of birth. Standard guidelines for workplace investigations, written workplace investigation policies, and standard data collection practices are needed to better control the spread of infection in the workplace. BRIEF DESCRIPTION On September 29, 2004, an active tuberculosis (TB) case was reported to the Santa Clara County TB Clinic. The case was a 32 year old male immigrant from China who moved to the United States in June 1999. Further testing determined he had TB that was:

Smear-positive Culture-positive Pulmonary and laryngeal Resistant to isoniazid (INH)

As he reported coughing beginning March 2004, the infectious period was considered to be between March 2004 and September 2004. Santa Clara County TB Control initiated a contact investigation for household members of the index case. All household contacts were born in China and had no prior tuberculin skin test (TST) documentation. Five of the nine contacts had a positive TST. All five with positive TSTs had normal chest x-rays. Because the employer of the index case was in San Mateo County (SMC), SMC TB Control initiated a worksite investigation, including:

Visiting the worksite, Observing the geographic layout, and Interviewing co-workers to determine close contacts.

SMC TB Control recommended TST and/or evaluation for all 82 employees working on the floor. An assessment of the ventilation system of the building was also recommended. METHODS Risk of infection was assessed through:

Airflow and ventilation systems Geographic layout of the office space Amount of contact with the index case Proximity to the index case’s office space

A contractor assessed the airflow and ventilation system on January 17 and January 29, 2005. Measurements were conducted in the areas surrounding the index case’s office and in nearby hallways. Airflow measurements were conducted using an anemometer, balometer, magnehelic gauge, and smoke dispersion tests. The measurements were conducted with the heating ventilation and cooling (HVAC) system on maximum heating and maximum cooling, with the door to the index case’s office both open and closed. TSTs were voluntarily administered to employees who worked on the same floor as the index case. A survey tool (including date of birth, country of origin, date began working at current desk, history of TB or treatment for self or family members, TST history, current TB symptoms, and immunosuppressive conditions) was developed by SMC and administered to all employees who received a TST. The employer also provided a map of the index case’s floor. For analysis, the affected floor of the office building was divided into quadrants (A, B, C, and D). The likelihood of a positive TST among employees who had no previous record of a positive test was analyzed by quadrant. Data were analyzed using SPSS 13.0 for Windows. Measures with continuous distributions were evaluated descriptively using means and those with discrete distributions were evaluated using χ2 test. Statistical significance was set at the 5% level.

FINDINGS For purposes of comparing people in closer proximity to the index case with others in the office, the facility was divided into quadrants: Quadrant A: n=15 (23%), Quadrant B: n=17 (27%), Quadrant C: n=19 (30%), and Quadrant D: n=13 (20%)

The age of employees who received TSTs ranged from 27 to 55 years, with a mean of 37.7 years (standard deviation ± 7.2). More than half (59%, n=38) were foreign born, with the majority from India and China. Eleven people (17%), including the index case, had positive TSTs. All quadrants had at least one positive TST. However, the section with the index case (quadrant C) had the largest proportion of people with positive TSTs (42%).

Positive Tuberculin Skin Test

17%

7% 6%

42%

8%

0%

10%

20%

30%

40%

50%

Overall(n=64)

A(n=15)

B(n=17)

C(n=19)

D(n=13)

Quadrant

% P

ositi

ve

p=.008

The following algorithm depicts screening for latent TB infections via TSTs and chest x-rays among employees at the index case’s worksite: Proximity to the index case could not be evaluated independent of place of birth because all people with positive TSTs were foreign born. Assessment of the airflow and ventilation system found the following with the index case’s office door closed:

Smoke migrated through office door crack into the outside corridor

No consistent measurable air velocity Minimal positive pressure in the office

The following results were found with the door open:

20% of supply air to office migrated toward the corridor during maximum cooling mode

No consistent measurable air velocity • Equal pressurization between the office and corridor

CONCLUSION Spatially assessing risk factors and behavior increased the understanding of disease transmission. Airflow and ventilation of the facility was adequate. We hypothesize that walking patterns of the index case to the coffee room and restroom may have acted as a mode of illness transmission. Factors to consider in a spatial representation of disease investigation are workplace environmental characteristics, clinical characteristics of the index case, and country of birth. Standard guidelines for workplace investigations, written workplace investigation policies, and standard data collection practices are needed to better control the spread of infection in the workplace. ACKNOWLEDGMENTS Nancy Anderson, Jackie Dugyon-Escalante, Vera Edstrom, Sara Ehlers, Antonio Fajardo, Anju Goel, Michael Leach, Lisa Netherland, Dennis Silva, Sam Stebbins, and the Santa Clara County Tuberculosis Control Group.

82 employees recommended for evaluation

68 employees evaluated

28 Hx of negative TST

14 employees not evaluated

38 unknown TST Hx

4 Hx of positive TST

25 negative TST

3 positive TST 8 positive TST 28 negative TST

3 normal chest x-rays

1 abnormal chest x-ray

INDEX CASE7 normal

chest x-rays

Quadrant TST Results Odds Ratio for Quadrant C

Positive Negative

C 8 11

A 1 14 10.2 (C v. A)

B 1 16 11.6 (C v. B)

D 1 12 8.7 (C v. D)


HIV/AIDS Surveillance in San Mateo County - Update Terri Lopez, Communicable Disease Investigator

According to the Centers for Disease Control and Prevention (CDC), more than a million people in the United States are believed to be living with Human Immunodeficiency Virus (HIV), the organism that causes Acquired Immuno-deficiency Syndrome (AIDS). In San Mateo County, over 1,100 people are currently living with HIV and/or AIDS, as of the latest report in May 2005. HIV reporting in California began on July 1, 2002, and is by Non-Name Code Regulations. Healthcare providers and laboratory staff must report confirmed HIV test results to their local health department using the California Depart-ment of Health Services’ HIV/AIDS Confidential Case Report form. The HIV/AIDS surveillance staff at the San Mateo County Health Department collects information on active cases through these reports, as well as through ICD-9 discharge reviews and death certificates. Any unreported cases are researched and entered into the HIV/AIDS Re-porting System (HARS). The Communicable Disease Investigator (CDI) sends information about the unreported (i.e., new) cases to the California State Office of AIDS on a monthly basis. The diagram on the next page describes how information about HIV cases flows through the reporting system. When the healthcare provider submits a specimen to the laboratory, the following information should also be included:

When the laboratory reports a positive result back to the provider (ideally within 7 days), they should also include:

Both the healthcare provider and laboratory are then required to report the positive case within 7 days to their local county health department with the following information:

Additionally, the provider is required to submit an adult or pediatric HIV/AIDS Confidential Case Report form and the lab is required to report:

The county health department reviews all information and submits unduplicated HIV cases with completed HIV/AIDS Confidential Case Report forms using the non-name code to the California Department of Health Services, Office of AIDS within 45 days of the report. The State then submits aggregate HIV case data (i.e., without the non-name code) to the CDC every month. CDIs also work with health department epidemiologists to submit a semi-annual HIV/AIDS report to the state. The report highlights active surveillance activities, epidemiological investigations of AIDS cases, and partner counseling and referral services (PCRS). The report also evaluates the HIV/AIDS surveillance system. For the latest report, covering July through December 2004, the HIV/AIDS Surveillance section reviewed charts for 449 suspect and/or confirmed cases of HIV/AIDS. Of those, 57 were previously unreported San Mateo County cases. The overall

• Non-name code • Lab-generated report number • Provider name, address, phone number

• Date specimen was tested • Lab name, address, phone number • Lab findings of the test performed


• Partial non-name code (based on Soundex number, date of birth, and gender) • Lab-generated report number specific to the test

• Last name • Date of birth • Gender • Date specimen collected • Provider name, address, phone number

Summer 2005


If you have further questions concerning HIV/AIDS reporting or need HIV/AIDS Confidential Case Report Forms, please contact Terri Lopez at:

(650) 573-2609 [email protected]

Thank you very much for your continuing efforts to control HIV disease.

(HIV/AIDS Surveillance, cont.) promptness of HIV/AIDS reporting in San Mateo County was as follows:

⇒ For AIDS, only 44% of cases were reported within one year of diagnosis; 31% were reported within six months.

⇒ For HIV, only 40% of cases were reported within one year of diagnosis; 26% were reported within

six months. It is important that both HIV and AIDS cases are reported in an accurate and timely manner because future state and federal funds will be allocated based on HIV incidence within jurisdictional boundaries. As HIV infection rates re-flect current transmission trends more accurately than AIDS diagnoses (which usually reflect infection many years previously), these data will allow the State Office of AIDS to more effectively target resources for prevention and care that best meet the needs of our communities.

Healthcare Provider Laboratory

Source: California Department of Health Services, Office of AIDS. Proposed HIV Reporting Regulation as of October 15, 2001.

within 7 days within 7 days

HIV Reporting Process

Local Health Department

California Department of Health Services, Office of AIDS

Centers for Disease Control and Prevention

Specimen

Test Results

within 45 days

monthly

within 7 days


Selected Reportable Diseases in San Mateo County Residents

Year of Diagnosis Year of Diagnosis

2005

(to date) 2004 2003 2005

(to date) 2004 2003

Acquired Immune Deficiency Syndrome (AIDS) 7 31 43 Mumps - - -

Amebiasis 2 1 17 Non-Gonococcal Urethritis (NGU) 26 64 37

Anisakiasis - 1 - Pertussis 32 48 24

Anthrax - - - Pelvic Inflammatory Disease (PID) 22 6 5

Botulism: Psittacosis - - -

- Foodborne - - - Q Fever 1 1 2

- Infant - - - Rabies:

- Wound - 1 - - Animal - - 1

Brucellosis - 1 1 - Human - - -

Campylobacteriosis 60 191 228 Relapsing Fever - 1 -

Chlamydial Infection 543 1485 1364 Rocky Mountain Spotted Fever - 1 -

Cholera - - - Rubella - - -

Ciguatera Fish Poisoning - 1 - Rubella Syndrome, Congenital - - -

Coccidioidomycosis - 6 - Salmonellosis 44 96 131

Cryptosporidiosis 1 11 5 Scromboid Fish Poisoning - 2 -

Cysticercosis - 2 - Shigellosis:

Dengue 1 - 1 - Group A - - 1

Ehrlichiosis - 1 - - Group B 6 16 11

Encephalitis: - Group C 2 - 3

- Arboviral - - - - Group D 6 24 30

- Other Viral - - - - Group Unspecified 2 8 7

E. Coli (0157:H7) 2 5 17 Smallpox - - -

Foodborne Illness Outbreaks - 7 6 Syphilis:

Giardiasis 20 62 60 - Primary 1 5 9

Gonococcal Infection 94 238 224 - Secondary 1 4 5

Haemophilus influenzae Invasive Disease 2 2 5 - Early Latent 1 1 7

Hemolytic Uremic Syndrome (HUS) 1 1 - - Late & Late Latent 11 16 22

Hepatitis: (acute) - Congenital - - -

- Type A 3 17 18 Tetanus - - -

- Type B 7 28 3 Toxoplasmosis - 1 -

- Type C 1 - - Tuberculosis 22 56 53

- Type D - - - Tularemia - - -

- Non-A / Non-B - - - Typhoid Fever - 1 6

- Other Viral - - - Typhus Fever 1 - -

Kawasaki Syndrome - 1 - Varicella (deaths only) 2 2 -

Legionellosis 1 - 2 Vibrio Infections - 6 3

Leprosy - 1 1 Viral Hemorrhagic Fevers - - -

Listeriosis 1 3 2 West Nile Virus:

Lyme Disease 3 3 4 - West Nile Fever - - -

Malaria 1 1 4 - Encephalitis - - -

Measles - - 1 - Meningitis - - -

Meningitis, Viral 10 20 18 Yersiniosis 1 - 1

Cases reported as of June 30, 2005 Sources: Confidential Morbidity Report, HIV/AIDS Confidential Case Report Form, and Report of Verified Case of Tuberculosis Note: This table differs from that in the previous EpiBulletin; incidence rates here are based on date of diagnosis, using San Mateo County data, while previous tables were compiled from the California Department of Health Services, Division of Communicable Disease Control.

Summer 2005


Notes from Disease Control and Prevention (DCP) DCP bids farewell to Deputy Health Officer, Dr. Sam Stebbins. Sam has accepted a position as Executive Director of the Center for Public Health Preparedness at the University of Pittsburgh School of Public Health. The Center is one of 40 such sites funded by CDC; in total, they make up a unique partnership between state and local health departments with accredited schools of public health, dentistry, medicine, and veterinary, and EW focused on preparation and training of the frontline public health workforce. Dr. Stebbins worked for San Mateo County for six years serving as the TB and STD Controller. Dr. Stebbins was also involved in prevention of family and domestic violence, which included leading the development of the Health Department's strategic plan as well as developing and implementing training for all Health Department and many SMMC staff on recognition, reporting, and caring for people suffering from abuse. Dr. Stebbins also represented the Health Department on the County's Domestic Violence Council. Dr. Stebbins was involved in improving overall health and preventing chronic disease in the county by pursuing a multi-year Robert Wood Johnson grant Active for Life and co-leading the Diabetes section of the 2004 Health Disparities Conference. In the future, Dr. Stebbins can be reached at [email protected]. He wishes to thank all of the providers in San Mateo County who strive to improve the health of our community. DCP welcomes three new Office Specialists Gina Fucilla has recently changed positions within the Health Department. Previously, Gina worked as an Office Assistant for Health Administration and is now an Office Specialist for Disease Control and Prevention. Gina will be responsible for data entry into our Automated Vital Statistics System (AVSS), telephones, LanFax preparedness, and other various tasks. Gina is currently attending Cañada College working towards completing her general education classes with a goal of obtaining a nursing degree. Anabel Tingin has worked for the past year and a half as an Office Assistant with California Children’s Services, specializing in medical and dental claims billing. Anabel will be working on LanFax preparedness with dental providers. She will also work with AVSS and be cross-trained to work in the Public Health Laboratory, Vital Statistics, and the AIDS Program. Anabel has a Bachelor of Science degree in Hotel and Restaurant Management from St. Scholastica College in Manila. Ana Figueroa is working in Vital Statistics. Ana brings with her a wealth of knowledge related to birth and death records and is a welcome edition to our group. DCP welcomes two new Epidemiologists Sarah Knowles received her PhD in Epidemiology from the University of North Carolina at Chapel Hill (UNC). Additionally, Sarah has an MPH in Health Behavior and Health Education and a BA in Psychology. Sarah previously worked as a project coordinator for the North Carolina Environmental Tobacco Smoke Policy Study in the Department of Family Medicine at UNC. She also worked as a Program Analyst in the Office on Smoking and Health at the Centers for Disease Control and Prevention. Evelyn Tu received her MPH from Johns Hopkins Bloomberg School of Public Health. She previously worked as the West Nile Virus Surveillance Coordinator for the California Department of Health Services. She is interested in infectious diseases as well as health disparities. Evelyn has a BA in Molecular and Cell Biology from UC Berkeley. She is excited to return home to California and join the Epidemiology Unit.

San Mateo County Health Department Disease Control and Prevention Epidemiology Unit 225 - 37th Avenue San Mateo, CA 94403

San Mateo County Health Department Disease Control and Prevention

MAIN PHONE NUMBER MAIN FAX NUMBER

(650) 573-2346 (650) 573-2919

Staff Name Nancy Anderson, RN Sonia Baldassarre, MSN Sharon Byrd Vicky Camilleri, RN Sue Chen RN, MPH Tony Concepcion John Conley Vera Edstrom, RN Jackie Escalante, RN Antonio Fajardo Gina Fucilla Sarah Knowles, PhD Lois Korhonen, RN Michael Leach, MPH Gloria Lee Terri Lopez Diana McDonnell, PhD Scott Morrow, MD, MPH Tracy Marshall Morton, MPH Maria Murillo Karen Nakatani Lisa Netherland Judy Ochoa Jim Olson Beth Schulz, RN, MPH Dennis Silva Theresa Smith Anabel Tingin Evelyn Tu, MPH Gloria Tzuang, MPH Dorothy Vura-Weis, MD, MPH

Title TB Control Nurse Public Health Nurse Communicable Disease Investigator Senior Public Health Nurse Public Health Nurse Communicable Disease Investigator Deputy Director, Public Health TB Control Nurse TB Control Program Coordinator, Senior Public Health Nurse Community Worker Medical Office Specialist Epidemiologist Communicable Disease Nurse Supervising Epidemiologist Medical Office Specialist Communicable Disease Investigator Epidemiologist, Editor Epi Bulletin Health Officer Epidemiologist, Editor Epi Bulletin Medical Office Specialist Office Specialist Communicable Disease Investigator Communicable Disease Investigator Senior Communicable Disease Investigator Program Manager, Communicable Disease Control Officer Community Worker Medical Office Supervisor Medical Office Specialist Epidemiologist Epidemiologist Assistant Health Officer

Phone (650) 573-2188 (650) 573-2905 (650) 573-3451 (650) 573-2959 (650) 573-2551 (650) 301-8630 (650) 573-3477 (650) 573-2917 (650) 573-2713 (650) 573-2142 (650) 573-2764 (650) 573-2974 (650) 573-2749 (650) 573-2217 (650) 573-2346 (650) 573-2609 (650) 573-2547 (650) 573-2519 (650) 573-2873 (650) 573-2309 (650) 573-2184 (650) 573-2009 (650) 573-3417 (650) 573-3452 (650) 573-2346 (650) 301-8761 (650) 573-2346 (650) 573-2475 (650) 573-2781 (650) 573-2186 (650) 573-2492

Save paper! Email [email protected]

to received the Epi Bulletin electronically.

Healthy Communities p. 1

STD Clinic Update p. 4

Mapping the Spread of TB p. 6

HIV/AIDS Surveillance p. 8

Selected Reportable Diseases p. 10

Staff Updates p. 11

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