Drought and Public Health Emergency Preparedness Workshop 24 June 2015 Mark Starr, DVM, MPVM Deputy Director for Environmental Health California Department of Public Health SaveOurWater.com
At/From Mt. Tallac (9738 ft. elevation) 31 May 2015
Outline Drought conditions Potential public health impacts of drought (recap) CDPH: 2014 activities CDPH: 2015 (and beyond) Drought Task Force / state agencies PH role
Drought Conditions 2014-15: Severe (or worse) drought; 4 th year Snowpack (1 June): ~0% of normal Reservoirs (7 June): 53% of average (Range: 19%-63%) Private wells (2 June): ~2,000 dry (~9,800 pop.) Nearly 90% in Central Valley
Snowpack and Reservoirs DWR
USDA Drought Monitor
A Few Drought Impacts Wildland fires (2 June): ~50% over 5-year average Projected 2015 agricultural impact (UC Davis): 564,000 acres fallowed 18,597 total jobs lost $2.7 billion total costs Unemployment (April): State: 6.1% Selected San Joaquin Valley counties: ~11% Mendota: 19.9%
Potential Health Effects of Drought http://currents.plos.org/disasters/article/dis-13-0001-health-effects-of-drought-a-systematic-review-of-the-evidence/
CDPH: 2014 activities MHCC (EOC) activation: Feb 1 st Sep 10 th Surveillance and monitoring West Nile virus surveillance Coccidioidomycosis (Valley Fever) surveillance Respiratory disease surveillance (asthma) WIC participation data review Healthcare facility incident reports Prevention and control, messaging, guidance
West Nile Virus Transmission Cycle Many factors influence WNV activity Climate Temperature, precipitation Mosquito abundance and type Number and types of birds Level of immunity; survive previous infection
CA WNV Surveillance Program 1. Dead Bird Testing 2. Mosquito Testing 3. Sentinel Chicken Testing 4. Human Case Surveillance
Clinical spectrum of human West Nile virus (WNV) infections Neuroinvasive disease* (<1%) Febrile illness (20-30%) Asymptomatic infection (70-80%) *Infections of central nervous system such as meningitis, encephalitis, or myelitis
Human WNV Cases in CA, 2004 2014 4,802 cases (176 fatal) Number of Cases 1,000 800 600 400 200 779 unknown 880 WNND 801 WNF 305 WNND 561 WNND 445 479 380 379 278 158 112 111 2004 2006 2008 2010 2012 CDC: Each WNND case equates to 30-70 non-neuroinvasive cases 2014: Up to 40,000 cases 2014
Climatic Conditions in 2014 Record WNV Activity Warmest year on record (avg temp = 61.5 o F) Severe drought WNV records set in 2014 West Nile neuroinvasive disease case count Number of fatal cases Proportion of infected mosquitoes Prevalence of infected dead birds Second highest number of cases
Temperature and Precipitation Warm spring temperatures earlier mosquito activity and longer virus amplification period Hot temperatures increased WNV activity Increased mosquito development and activity Faster viral replication within the mosquito The role of rainfall is less clear cut than temperature: Drought generally associated with increased WNV activity Prevents the washing out of underground mosquito populations in urban waste water systems Drought may bring birds and mosquitoes into closer contact around limited water sources (e.g., urban areas), increasing viral transmission and amplification
WNV Prevention: Personal Protection: The 3 D s DRAIN: Mosquitoes lay their eggs on standing water. Young mosquitoes grow in the water. Get rid of standing water around the home. Empty water out of buckets, old tires, flower pots, and toys. DEFEND: Use an EPA-registered insect repellent with DEET, picaridin, IR3535 or oil of lemon eucalyptus in it. Put the repellent on your skin that is not covered by clothes. Follow the directions carefully. Maintain window/door screens. DUSK and DAWN: Mosquitoes that transmit West Nile virus bite in the early morning and early evening hours, and sometimes throughout the night. When outside in the early morning or evening hours, wear long pants and a long sleeved shirt.
Mosquito Control Local mosquito and vector control agencies use multiple approaches to control mosquitoes following the California Mosquito-borne Virus Surveillance and Response Plan
West Nile Virus Resources
Background on Coccidioidomycosis Also called Valley Fever or cocci Caused by Coccidioides spp., a soildwelling fungus Fungal spores can become airborne and inhaled when soil is disturbed by natural events or by activities Infects lungs Not transmitted from person-to-person
Endemic Areas for Cocci Thrives in areas with hot summers, mild winters, desert climate Southwestern U.S. California (Central Valley), Arizona, Nevada, New Mexico, Texas Mexico, parts of Central and South America
Cocci: Spectrum of Disease 60% of infected persons do not have symptoms 40% will develop symptoms, often flu-like Cough, fever, fatigue, malaise, headache, rash Can last for weeks to months Severe lung disease is rare Disseminated or extrapulmonary infection in <5% Infection can spread to meninges, bone, skin, joints, or other organs Meningitis is most severe form of infection
Cocci Surveillance Year Reported cases (as of April 21) Final 2012 (as of April 21, 2013) 4,080 4,147 2013 (as of April 21, 2014) 3,252 3,318 2014 (as of April 21, 2015) 2,217 pending Historical data:
From Valley Fever Fact Sheet: Valley Fever Brochure
Asthma in California 1 in 8 Californians has asthma (about 5 million) Asthma causes 11.8 million days of missed work and 1.2 million days of missed school per year In 2013, there were 30,663 asthma-related hospitalizations and 183,949 asthma-related ED visits Asthma costs California $11.3 billion per year People in low income areas are 4 times more likely to visit the ED or be hospitalized for asthma Asthma Surveillance Potential indicator of respiratory disease impact of drought (e.g., dust, smoke, allergens)
Data Sources for Asthma Surveillance in California Hospital Administrative Data from the Office of Statewide Health Planning and Development (OSHPD) Hospital discharges Emergency department visits Survey Data California Health Interview Survey (CHIS) Behavioral Risk Factor Surveillance System (BRFSS) BRFSS Asthma Call-Back Survey (ACBS) Vital Statistics Data Death records
Asthma ED Visits by Month and Age, California 2008-2013 Children Adults 16000 14000 12000 Number of ED Visits 10000 8000 6000 4000 2000 0 2008 2009 2010 2011 2012 2013 J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D Month Data Source: OSHPD 27
Asthma Hospitalizations by Month of Admission and Age, California 2008-2013 Children Adults 3500 3000 Number of Hospitalizations 2500 2000 1500 1000 500 0 2008 2009 2010 2011 2012 2013 J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D Month Data Source: OSHPD 28
http://www.bepreparedcalifornia.ca.gov/documents/wildfiresmokea GuideforPublicHealthOfficialsRevisedJuly2008FINAL.pdf
Women, Infants and Children (WIC) Federally-funded nutrition and health education program; over $800 million/yr in food expenditures and $300 million for local clinic services Eligibility: Pregnant, breastfeeding, and postpartum women, infants and children (< 5 yrs); low-income; at nutritional risk Provides vouchers to purchase WIC-approved healthy supplemental foods, provides nutrition education, and provides referrals for healthcare/other services 84 WIC agencies, over 650 sites, and approximately 1.3 million participants/mo Regional WIC Participation Data Potential indicator of socio-economic impact of drought
2.0 Percent Change in CA WIC Participation Counts Since January 2014, by Region and State Totals, January 2014 - March 2015 State Total 0.0 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Jan 15 Feb 15 Mar 15 Central Valley* East Bay -2.0 Great South -4.0 LA Basin -6.0-8.0-10.0 North Coast Orange Sacramento Delta Sierra Cascade -12.0-14.0 Sierra Gold South Bay * Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Luis Obispo, Tulare
Healthcare Facility Incident Reports Licensing and Certification Program Situation Alert report process: Healthcare facilities must report events/situations involving imminent danger to health, safety, and/or welfare of residents/patients/clients Incident Report / Situation Alert Data (2014) No water supply incidents 2014 vs 2013 fire/smoke situations: 2013 2014 Fire/smoke (external) 9 10 Total facility reports 43 14 Evacuations (patients) 19 69* *55 from Boles fire
CDPH: 2015 (and beyond) Continue 2014 activities (i.e., surveillance and monitoring, prevention and messaging) Expanded analyses as warranted (e.g., vital statistics, county-level asthma, BRFSS) Consider other impacts (e.g., mental health, harmful algal blooms) Utilize other information sources (e.g., regional/local impacts) Evaluating use of CASPER: CDC Needs Assessment Tool Consider expanded situation-based (e.g., hygiene, mental health) or vulnerability-based (e.g., elderly) messaging or other approaches
Heat-related Deaths (2006) (Vital Statistics Example) http://www.ehib.org/papers/heat _Vulnerability_2007.pdf
Public health role of Governor s Drought Task Force / State agencies http://www.cdc.gov/nceh/e hs/docs/when_every_drop _Counts.pdf
One Health Approach The One Health approach is based on the growing recognition of the connection between the health of animals, people and the environment. The activities and conditions of each domain affect the health of the others. One Health is the collaborative effort of multiple disciplines and institutions to attain optimal health for people, domestic animals, wildlife, plants, and our environment. https://www.onehealthcommission.org/ http://onehealthinitiative.com/
N W From Mt. Whitney (14,505 ft. elevation) 22 June 2015 E S