Safeguarding the Public's Health - Health Agency Response

R2

The San Luis Obispo County Department of Public Health should use only ELITE Program Laboratories to test for the presence of Legionella when there is a known case of disease potentially associated with the samples. Response: The recommendation will not be implemented because it is not warranted. The Public Health Department uses only certified laboratories for the testing of clinical and environmental specimens for Legionella. Centers for Disease Control and Prevention (CDC) Environmental Legionella Isolation Techniques Evaluation (ELITE) designation is a voluntary status. Many reputable laboratories choose not to pursue such a designation and yet deliver reliable testing results.

R3

The San Luis Obispo County Department of Public Health should conduct a vaccination and sanitation outreach program among the homeless population to prevent an outbreak of Hepatitis A in the County. Funding to support the program should be allocated by the San Luis Obispo County Board of Supervisors. Response: The recommendation will not be implemented at this time because it is not warranted. Hepatitis A outbreaks are concerning, particularly because it is a highly contagious virus. Though the California Hepatitis A outbreak has been declared over by the California Department of Public Health, a response plan was developed and Public Health staff are poised to respond through vaccination and outreach and education messages should a similar problem develop in our county. However, the County maintains a 5% contingency within its annual budget so that it has the ability to address emergencies or unbudgeted issues that occur mid-year. The County of San Luis Obispo (SLO) Public Health Department closely monitored the 2017- 18 Hepatitis A outbreak that occurred predominantly in San Diego and to a lesser extent in Santa Cruz counties. The California Department of Public Health issued frequent updates and guidance as to which counties met outbreak criteria and should take specific actions to control the outbreak. Routine reporting to our Public Health Department of new cases of Hepatitis A viral infection is ongoing. Should such reports indicate a new outbreak, action would be taken accordingly.

R4

The cost of starting and operating a comprehensive mosquito abatement program (Vector Control) is known. Funding commensurate with that cost should be set aside each year by the San Luis Obispo County Board of Supervisors and County Administration, so that when it becomes necessary, the money will be immediately available. Response: This recommendation has been partially implemented. Funding has been made available for mosquito surveillance but not mosquito abatement. On two occasions, in November 2017 and March 2018, the Board received an analysis of options for re-instating a local surveillance and control program. At the latter of these meetings, the Board voted to delay consideration of reinstating a mosquito control program until the next budget cycle. However, the County maintains a 5% contingency within its annual budget so that it has the ability to address emergencies or unbudgeted issues that occur mid-year.

R5

The San Luis Obispo County Department of Public Health has a program to educate the public about mosquitoes, how to avoid acting as their host, and how to minimize the risk of becoming infected with the diseases they carry. Before mosquitoes carrying the Zika Virus arrive in this County, additional funding should be allocated by the San Luis Obispo County Board of Supervisors to support expansion of EHD’s public education efforts. Response: This recommendation has been implemented, to some extent. The Public Health Department was allocated an additional $50,000 from the County General Fund, beginning in Fiscal Year 2016-17 to conduct targeted surveillance of Aedes species and other types of mosquitoes. The actual expense for the surveillance work has been lower than anticipated such that Public Health has been able to leverage a portion of these resources for staff time to develop public education information. This information has been posted online, including the development of a map based GIS viewer on the Environmental Health Services Division website, some press releases have been developed, information has been shared on social media, and more recently, outreach has been conducted at a local elementary school. On July 25, 2017, the Public Health Department, at the request of the Board of Supervisors, presented several program and fiscal options for further enhancing mosquito surveillance and/or control. One of those options was to fund an additional $20,000 for more robust public education activities. Public Health was asked to return to the Board of Supervisors with a focus on restoring a local surveillance and control program. This presentation occurred on November 14, 2017 with no action taken. On March 20, 2018, at the Board’s request (after the updated February 2018 financial forecast), Public Health returned to the Board with an option for re-instating a small local surveillance and control program. Due to anticipated Fiscal Year 2018-19 budgetary constraints, the report was received and not acted upon at that time and the Board voted to delay consideration of any mosquito control program efforts until the next budget cycle. However, the County maintains a 5% contingency within its annual budget so that it has the ability to address emergencies or unbudgeted issues that occur mid-year.

R6

The San Luis Obispo County Department of Public Health website’s statistics should be updated at least quarterly. Response: The recommendation will not be implemented because it is not warranted. Posting statistics more frequently than annually could provide incomplete and misleading information to the public. In an effort to present the most accurate and statistically valid data, the Public Health Department often pools multiple years of data to support its findings and to be able to conduct trend analysis. Cc: Mike Hill, Health Agency Director