Download Winter 2014 Vol. 25. No. 1 - Branch-Hillsdale

A REGIONAL HEALTH PROFESSIONAL NEWSLETTER
Lyme
Winter, Volume 25, No. 1
Norovirus 2014
From the desk of H. Lauren Vogel, D.O., Medical Director
Norovirus is a very contagious virus that causes gastrointestinal
upset. It is transmitted person to person and from fomites,
contaminated food and water. Common symptoms include
nausea, vomiting, diarrhea and abdominal pain. Fever and
headache are common associated symptoms. The acute illness
may last 1-3 days, with complete resolution expected. Because
Norovirus infection is highly contagious, outbreaks may occur
which involve groups of family members or groups attending a
social function where food is served. Patients can be infectious
with Norovirus in their stool before symptoms appear. The virus
may remain in the stool for up to two weeks after resolution of the
symptoms.
There is no lasting immunity from the infection. Young children
and the elderly are at most risk for complications from the
infection. Complications are most often due to dehydration
secondary to the diarrhea and vomiting associated with the acute
illness.
Norovirus is the most common cause of acute gastroenteritis in
the United States. Each year, it causes 19-21 million illnesses and
contributes to 56,000-71,000 hospitalizations and 570-800 deaths.
Norovirus is also the most common cause of food borne-disease
outbreaks in the United States. Norovirus can spread quickly in
closed places like daycare centers, nursing homes, schools, and
cruise ships. Most Norovirus outbreaks happen from November
to April in the United States.
The Branch-Hillsdale-St. Joseph Community Health Agency
reports laboratory confirmed cases of communicable diseases,
including Norovirus outbreaks, on a monthly basis through its
website at www.bhsj.org. During 2013, each of the three counties
reported the following:
• Branch County – 2 cases,
• Hillsdale County – 1 case, and
• St. Joseph County – 11 cases.
Norovirus 2014
1
Flu Updates
3
Medical Waste
Inspections
4
Health Insurance Deadline
Approaches
4
If you would like to subscribe to
this Newsletter electronically,
please send an email with the words
“subscribe to HP Newsletter”
to Theresa Christner,
Health Education Director
at [email protected].
(continued on page 2)
Page 1
Known Causes of Foodborne
Illness Outbreaks, U.S.,
Norovirus 2014 (continued)
2006-2010
In addition, the health department receives reports of
gastrointestinal illness from both schools and day cares
through its online communicable disease reporting system.
This system allows the health department to monitor
gastrointestinal symptoms on a weekly basis, so that in the
event of an outbreak, it can better identify the source of the
outbreak, the event site and its sentinel case, as well as plan
for the outbreak’s containment.
In 2013 the following
gastrointestinal illnesses were reported for each of the three
counties:
• Branch County – 2,784 cases (which represents an
increase from 2012 when the county reported 2,004
cases);
• Hillsdale County – 1,868 cases (which represents an
increase from 2012 when the county reported 1,359
cases);
• St. Joseph County – 942 cases (which represents an
increase from 2012 when the county reported 793
cases);
Other /
Multiple
4%
Chemicals
6%
Parasites
1%
Norovirus
49%
Bacteria
40%
Source: CDC.gov, 2014
Resources:
• Norovirus Illness: Key Facts
[2
pages]
• Norovirus: Facts for Food
Handlers
[2 pages]
• Norovirus in Healthcare Facilities
Fact Sheet
[2 pages]
• Norovirus in Healthcare Settings
• A Norovirus Outbreak Control
Resource Toolkit for Healthcare
Settings
• EPA’s Registered Antimicrobial
Products Effective Against
Norovirus (Norwalk-like
virus)
[11 pages]
There is no specific treatment for Norovirus gastroenteritis.
Supportive care with maintenance of hydration, control of
nausea and vomiting and pain management as necessary are
appropriate. Antibiotics should not be prescribed unless a
bacterial pathogen is documented. Prevention of infection is
the most important aspect of total patient care.
Guidelines for prevention include frequent hand washing using
running water and soap. This is important to do before
handling food. Alcohol-based hand sanitizers can be used in
addition to hand washing, but they should not be used as a
substitute for washing with soap and water. All fruits and
vegetables should be washed thoroughly before any
preparation. All shellfish should be cooked thoroughly before
consuming. Quick steaming of foods will not kill Norovirus.
Food prepared and not consumed should be discarded.
Parents caring for sick children should not be involved with
food preparation. Patients with gastrointestinal symptoms
should not handle or prepare food for at least 3 days after full
recovery from all symptoms.
Surface areas should be disinfected using a bleach solution.
Use a chlorine bleach solution with a concentration of 1000–
5000 ppm (5–25 tablespoons or 2.5-12 ounces of household
bleach [5.25%] per gallon of water). This solution requires a
contact time of 10 to 20 minutes to be effective. Other
disinfectants registered as effective against Norovirus by the
Environmental Protection Agency (EPA) may also be used.
Whenever possible, gloves should be worn when handling
soiled materials and soiled clothes should be washed with a
detergent at the maximum available cycle length before
machine drying them.
Page 2
Flu Updates
According to the current CDC’s FluView report, flu activity in
Michigan has been categorized as being widespread. Flu
activity is likely to continue for some time. Anyone aged 6
months and older who has not gotten a flu vaccine yet this
season should get one now, especially if they are in a part of
the country where activity is still increasing. All flu vaccines are
designed to protect against 2009 H1N1 viruses which are the
most common flu viruses so far this season. It's also important
that people with high risk conditions who develop flu-like
symptoms or anyone with severe illness consult a health care
provider to see whether influenza antiviral drugs might be
needed. High risk populations include:
• Children younger than 5, but especially children
younger than 2 years old
• Adults 65 years of age and older
• Pregnant women
• Also, American Indians and Alaskan Natives seem to
be at higher risk of flu complications.
In addition, people who have the following medical
conditions are considered high risk:
• Asthma or Chronic lung disease (such as COPD and
cystic fibrosis)
• Neurological and neurodevelopmental conditions
• Heart disease (such as congenital heart disease,
congestive heart failure and coronary artery disease)
• Blood disorders (such as sickle cell disease)
• Endocrine disorders (such as diabetes mellitus)
• Kidney or liver disorders
• Metabolic disorders (such as inherited metabolic
disorders and mitochondrial disorders)
• Weakened immune system due to disease or
medication (such as people with HIV or AIDS, or
cancer, or those on chronic steroids)
• People younger than 19 years of age who are
receiving long-term aspirin therapy
• People who are morbidly obese (BMI of 40 or greater).
A summary of key indicators follows:
• From September 29, 2013 to February 15, 2014, the
Michigan Department of Community Health has
reported 322 laboratory confirmed cases of influenza.
Of these cases, 94% of them were identified as
Influenza 2009 A/H1N1pdm.
• Region 1, which includes Clinton, Eaton, Gratiot,
Hillsdale, Ingham, Jackson, Lenawee, Livingston and
Shiawassee Counties, has reported 317 cases of labconfirmed influenza cases between September 29,
2013 and February 25, 2014. Hillsdale has reported
14 cases. Of these lab-confirmed cases, all but one
•
•
•
•
•
have been identified as type A, and the
majority of those subtyped have been
identified as H1N1. Hillsdale County
already reports one death due to flu in
a senior citizen.
Region 5, which includes Allegan,
Barry, Berrien, Branch, Calhoun, Cass,
Kalamazoo, St. Joseph and Van Buren
Counties, has reported 88 cases of labconfirmed influenza cases between
October 1, 2013 and February 25,
2014. Branch has reported four of
these cases, while St. Joseph has
reported three cases. Of these labconfirmed cases, nearly 1/2 of these
have been identified as type A and the
majority of those subtyped have been
identified as H1N1. St. Joseph County
also reports one senior citizen death.
High rates of hospitalization have been
associated with lab-confirmed cases.
The mean age of those hospitalized is
in the late 40s. This is consistent with
CDC findings which report that 60% of
those hospitalized have been in people
18 to 64 years old. This pattern of more
hospitalizations among younger people
was also seen during the 2009 H1N1
pandemic.
Michigan
Influenza
Antiviral
Resistance Data (as of February
20th): For the 2013-14 season, 95
2009 A/H1N1pdm and 8 A/H3
influenza specimens have been tested
at the MDCH Bureau of Laboratories
for antiviral resistance. None of the
influenza specimens tested have been
resistant.
Influenza-associated
Pediatric
Mortality (as of February 20th): Two
pediatric
influenza-associated
mortalities in Mid-Michigan and Southeast Michigan have been reported to
MDCH for the 2013-14 season. CDC
requires reporting of flu-associated
pediatric deaths (<18 yrs), including
pediatric deaths due to an influenzalike illness with lab confirmation of
influenza or any unexplained pediatric
death with evidence of an infectious
process.
Page 3
Health Insurance Deadline Approaches
The
Branch-Hillsdale-St.
Joseph
Community Health Agency is working
with the Michigan Department of
Environmental Quality (DEQ) to provide
medical waste inspections of healthcare
facilities. The purpose of this new pilot
program is to determine the effectiveness
of Medical Waste Regulatory Program
when conducted by local health
departments.
On March 23, 2010, President Obama signed into law the
Patient Protection and Affordable Care Act (ACA), which
puts into place comprehensive health insurance reforms that
impact many Americans, including those people residing in the
tri-county health jurisdiction. Branch-Hillsdale- St. Joseph
residents now have the opportunity to purchase health
insurance through the Health Insurance Marketplace. While
much of the news media outlets have focused on system
development and connectivity issues, little attention has been
placed on who the law applies to or what it requires.
Between now and March 31, 2014, our
agency’s sanitarians will be contacting 50
medical waste producing facilities to
schedule an inspection time.
These
inspections will include a very basic
evaluation which will be used to
determine the following:
Steve Todd, Health Officer, explains “One of the four key
provisions of the ACA is the individual responsibility
requirement or individual mandate – which provides that all
citizens obtain basic health coverage by March 31, 2014,
obtain an exemption or pay a fee when filing a federal income
tax return.” The law also established the ‘Health Insurance
Marketplace’ which helps consumers know what types of
health coverage are available, as well as if they qualify for
assistance with lowering coverage costs through either
premium tax credits and/or cost sharing reductions. The
Branch-Hillsdale-St. Joseph Community Health Agency is
providing in-person assisters to county residents in need of
support during this enrollment process.
Whether the facility’s registration
is consistent with the type of
medical waste producer activity
Whether the facility has a
complete
medical
waste
management plan.
Whether the medical waste is
properly stored
Whether the facility has records
documenting staff training and
medical waste shipments.
What are in-person assisters? In-person assisters are
professional individuals that are trained to help consumers
looking for health coverage options through the new federal
Marketplace, including help with completing online or paper
applications. Services are free to the public. According to
Steve Todd, “We have nine staff people who have met the
Medicaid/Medicare training requirements and have earned the
title ‘Certified Application Counselor.’ In addition, we have one
staff person who has completed the more extensive 25-hour
Navigator training program. These nine people can help
residents to understand the new law requirements,
exemptions, premium tax credits and cost-sharing reductions,
as well as penalties and appeal procedures.”
At the conclusion of the inspection, you
will be provided a copy of the inspection
report
which
will
include
any
recommendations from the inspector. No
follow-up inspections are anticipated.
What information is needed to apply through the
Marketplace?
•
•
•
•
To learn more about this pilot project or
to receive a copy of the inspection report
form, please feel free to contact the
Rebecca Burns, Environmental Health
Director at 269-273-2161, ext. 228 or at
[email protected].
The following information is needed to make an application for
coverage:
•
•
•
•
Social Security number (SSN)
Birth date
Paystubs, W-2 forms, or other information about your
income
Policy/member numbers for any current health
coverage
(continued on page 5)
Page 4
Health Insurance Deadline Approaches, cont.
•
•
Information about any health coverage from a job that’s
available to you or your family
Document number (if you’re an eligible immigrant who
wants health coverage)
What are the
Categories?
•
•
How is this information used?
First, the information collected through the Marketplace is
verified through the Internal Revenue Service (IRS) and the
Social Security Administration (SSA). Once the information
has been confirmed as being correct, it is used to make
eligibility determinations. In Michigan, when residents apply
for insurance coverage through the Marketplace, their
information will be used to determine if they could be eligible
for Medicaid programs – including the new Healthy Michigan
Plan. Information for these individuals and/or family members
is then shared electronically with the Michigan Department of
Human Services, who makes the final eligibility determination
for Medicaid enrollment.
Each client receives an eligibility determination from the
Marketplace. The eligibility determination indicates if the client
and/or families members are eligible to enroll in a Qualified
Health Plan (QHP), Medicaid or Healthy Kids. It also will let
them know if they can lower their health coverage costs
through premium tax credits or cost-sharing reductions.
What are Qualified Health Plans (QHPs)?
QHPs are health plans that are certified by the marketplace
and that:
• Provide essential health benefits,
• Follow established limits on cost-sharing
• And meet other requirements.
What are Essential Health Benefits?
The ACA requires all health plans to cover a comprehensive
package of items and services, which include:
• Ambulatory Patient Services
• Emergency Services
• Hospitalization
• Maternity and newborn care
• Mental Health and substance use disorder services
(including behavioral health treatment)
• Prescription Drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and Wellness Services and Chronic
Disease Management
• Pediatric Services, including oral care.
•
•
•
Five
Health
Plan
Bronze Health Plan – insurance
company pays 60% of covered
medical expenses;
Silver Health Plan – insurance
company pays 70% of covered
medical expenses;
Gold Health Plan – insurance
company pays 80% of covered
medical expenses;
Platinum
Health
Plans
–
insurance company pays 90% of
covered medical expenses;
Catastrophic Health Plans – meet
all of the QHP requirements, but
cover only three primary care
visits each year until the
consumers meet the plans’
deductible. Only for those under
30 years of age or who receive a
hardship exemption.
What are Premium Tax Credits?
Premium Tax Credits reduce the cost of
QHP premiums to eligible consumers.
Consumers can either claim premium
tax credits during the tax filing process
or request payment directly to insurance
companies (as ‘advance payments’).
Advance payments of the premium tax
credit are reconciled during the tax filing
process. Household size, income and
the cost of available plans determine
premium tax credit eligibility. Therefore,
if a consumer makes more money over
the course of the year than projected at
the time they requested advance
payments of the premium tax credit,
consumers will need to repay the extra
amount via their annual tax return. If
consumers make less money, they can
receive an additional refund on their tax
return.
The Marketplace provides
documentation to the tax filer and to the
IRS to support this process.
If a
consumer requests advance payments,
they must file a tax return.
Page 5
Health Insurance Deadline Approaches, cont.
What are Cost-Sharing Reductions?
Cost-sharing reductions limit the amount of out-of pocket costs for health benefits (like deductibles and
copayments) associated with a QHP through the Marketplace. There are several categories of cost-sharing
reductions based on annual household income and family size. Each insurance company applies these
differently, based on their specific health plan design. Consumers who are eligible for cost-sharing reductions
can review their reduced costs when they go to compare their health plan options. In general, cost-saving
reductions are only available to consumers who select a plan at the silver level of coverage.
When will the Healthy Michigan Plan begin?
The Healthy Michigan Plan, which expands Medicaid to adults (18 to 64 years) with incomes at 133% of poverty,
is expected to roll out in early April. Steve Todd states “In our communities, we currently estimate that there are
over 33,000 people across the three counties that are receiving Medicaid insurance. With the Healthy Michigan
Plan expansion of Medicaid, we expect that number to grow by another 8,000 to 9,000.” With a higher need for
providers that accept Medicaid patients, section 1202 of the Affordable Care Act requires payment by State
Medicaid agencies of at least the Medicare rates in effect in calendar years 2013 and 2014 for primary care
services delivered by a physician with a specialty designation of family medicine, general internal medicine, or
pediatric medicine.
To learn more about the ACA and the Health Insurance Marketplace, visit our website and click on the
Marketplace button. There you will find useful information and tools that can help you, your staff and/or your
patients navigate health care reform.
Deadline for Open Enrollment is March 31, 2014.
BRANCH-HILLSDALE-ST. JOSEPH
COMMUNITY HEALTH AGENCY
Coldwater Office
570 N. Marshall Road
Coldwater, MI 49036
517-279-9561
Hillsdale Office
20 Care Drive
Hillsdale, MI 49242
517-437-7395
Three Rivers Office
1110 Hill Street
Three Rivers MI 49093
269-273-2161