Annual Report 2018

Washington County Public Health Washington County Public Health

415 Lower Main Street Prevent
Hudson Falls, NY 12839 Educate
Phone: (518) 746-2400 Evaluate
Empower
FAX: (518) 746-2461

We continue to move forward and toward s accomplishing higher standards of health and well-
being in our communities.

By partnering with the family and community, Washington County Public Health Service has a commitment to maximize the quality of
life for all, through intervention to eliminate the causes of poor health, education to improve health of families and the community and
provision of support necessary to maintain a healthy Washington County.

The mission of the Early Intervention Program is to identify and evaluate as early as possible those infants and toddlers whose
healthy development are compromised and provide for appropriate intervention to improve child and family development.

Washington County WIC Program is committed to improving the nutrition and health status of women, infants and children by
providing nutritious foods, nutrition and health education and referrals to health and human service providers for all eligible families within
Washington County.

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All programs are in collaboration and support of each other

Prevent epidemics and the spread of disease
Prevent injuries
Promote and encourage healthy behaviors
Respond to disasters and assist communities in recovery
Assure the quality and accessibility of health services
To provide health care education for individuals, families and our community

To provide nutritious supplemental foods to eligible women, infants and children
To improve prenatal health and birth outcomes
To promote breast feeding as the preferred infant feeding method
To promote physical activity at all age levels
To promote healthy eating habits through the Eat Well Play Hard initiative
To link families with health and human service providers

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I am proud to present the Washington County Public Health’s 2017 Annual Report. This agency persistently strives to
provide the highest quality public health services and programs to our communities through best practices and ongoing
quality improvement. 2017 ushered in another year that was dominated by transformation. The New York State Health
Care System is changing over from a system based on fees for services provided, to a more patient centered, value driven
environment.

Our staff is armed with information regarding cultural competence, health literacy, the effect of trauma on health,
and the ravages of poverty on health and the well-being of the people in our county. We cannot underscore the importance
of cooperation and collaboration with community partners on all levels. We contribute our knowledge and expertise which
encompasses local Public Health data, community needs, and resources available within our agency and from community
partners.

I am very proud of the dedicated and professional staff serving our communities at Public Health. They work
diligently to improve quality, efficiency, and maximize investment of time and money while being responsive to our
community’s needs. Their dedication, hard work and determination is the foundation of Public Health in Washington
County.

I present this 2017 Annual Report to you, our leaders and our consumers. The following pages account for our
challenges and great accomplishments for the year passed.

Washington County Public Health continually strives to put our communities first and make this County the healthiest
place to live, work, learn, play and visit!
Sincerely,

Patricia Hunt,
Director
Washington County Public Health

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Introduction………………………………………………….…..........1 Child Find Program……………………………………...........................................37
Responsibilities of the Public Health System……………..2 Early Intervention Program……………………………………………………...38-40
Director’s Message………………………………….…….………....3 Preschool Program for Children w/Disabilities (CPSE)……………………41
Table of Contents…………………………………………………….4 Early Intervention/CPSE Combined Stats………………………………..42-43
Health & Human Services Committee...………….…..….,,,5 Infection Control / Communicable Disease……………………………...44-47
Professional Advisory Committee……………………..…..,,,,6 Communicable/Infectious Disease Data……………………………………....48
Public Health & Preventive Care Services…………..........7 Sexually Transmitted Diseases/STD Clinic Data………….....................49-50
Health Services Unit Summary…………………………...........8 HIV Testing/Perinatal Hepatitis B.……………………………………………..…51
Visits by Town…………………………………………………..........9 Rabies Program…………………………………………....................................52-53
State Aid Funding Analysis…………………………........10-11 Health Education…………………………………………………………………..54-59
Immunization Action Plan…………………….................12-16 WIC……………………………………………………………………………………….60-62
Clinic Hours/Data…………………………………………....17-18 All Hazard Disaster Preparedness Planning…………………………….….63
Lead Poisoning Prevention Program………….........19-26 Glossary………………………………………………………………………………...............64
Maternal Child Health……………………………..….……........27
Prenatal Program……………………………….......................8-29
Postpartum…………………………………………………………..30
Neonatal Abstinence Syndrome…………………...........1-36

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Health & Human Services Committee is a subcommittee of the Washington County Board of Supervisors. They advise the full Board of
Supervisors regarding Health & Human Services concerns. We appreciate the direction and services provided by the 2017 Health & Human
Services Committee Members:

Mr. Robert Shay, Chairman
Mr. Brian Campbell
Ms. Catherine Fedler
Mr. John LaPointe
Mr. Richard Moore
Mr. Seth Pitts

Mr. Mitchell Suprenant
We also thank:

Mr. Robert A. Henke, Board Chairman
Mr. Brian Campbell, Budget Officer

Mr. Chris DeBolt, County Administrator
Mr. Roger Wickes, County Attorney
Ms. Melissa Fitch, Personnel Officer

Mr. Glenn Gosnell, Director of Public Safety
Mr. Tim Hardy, Deputy Director of Public Safety

Mr. Philip Spiezio, Safety Officer

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PROFESSIONAL ADVISORY COMMITTEE

The Professional Advisory Committee consists of a group of professional personnel, including one or more physicians, registered professional
nurses, representatives from therapies and other professional organizations as well as at least one “consumer” who is either eligible to receive or has
received services. Their purpose is to advise the Agency on professional issues, participate in the evaluation of Agency programs and assist the
Agency in maintaining liaisons with other health care providers.

Philip Gara, MD, Medical Director
Patricia Hunt, Director WC Public Health
Kathy McIntyre, Asst. Directory WC Public Health
Amy Baulsir, Community Representative
Marion Jessen, Community Representative
Michele Miller, WC Public Health Office Manager
Claire Murphy, Director, Economic Opportunity Council
Beth Bruno, RN, Dir. of Home & Community Services, Fort Hudson Nursing Home
Marie Capezzuti, Infection Control Nurse, Bioterrorism Coordinator
Courtney Shaler, Adirondack Rural Health Network
Patricia Godnick, Case Manager, Glens Falls Hospital
Theresa Roberts, Supervising Public Health Nurse
Kathy Grant, Community Representative

Suzanne Smith, Interim Health Care
Tammy Whitty, RN CFSS, HCR

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These services are based on the 10 Essential “Key” Public Health Functions:
1) Monitor the health status to identify community health problems.
2) Diagnose and investigate health problems and health hazards in the community.
3) Inform, educate, and empower people about health issues.
4) Mobilize community partnerships to identify and solve health problems.
5) Develop policies and plans that support individual and community health efforts.
6) Enforce laws and regulations that protect health and ensure safety.
7) Link people to needed health services and assure the provision of health care when otherwise unavailable.
8) Assure a competent public health and personal health care workforce.
9) Evaluate effectiveness, accessibility, and quality of personal and population based health services.
10) Research for new insight and innovative solutions to health problems.

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Health Services Unit Summary 1,161

2017 17
3
Lead Screening Program – Children Screened
Lead Screening Program – Home Visits / Case 163
Follow-up
Flu Clinics 5
Flu Vaccines Administered 0
117
Pneumococcal Vaccinations Administered 251
Tuberculosis – Active TB Cases 26
Maternal Child Health Patients 54
Maternal Child Health Home Visits 326
MOMS Participants 14
MOMS Clinic Visits 913
Animal Bite Investigations 3
People Receiving Post-Exposure Rabies 58
Rabies Inoculations – Dogs & Cats & Ferrets 11
Animals Positive For Rabies 1
Animals Submitted For Testing
Rabies Clinics
Blood Titers Drawn for Human Rabies Titers

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Argyle 5
Cambridge 5
Dresden/Clemons 4
Easton 0
Fort Ann 16
Fort Edward 48
Granville 26
Greenwich 23
Hampton 16
Hartford 5
Hebron 0
Jackson 0
Kingsbury 84
Putnam 0
Salem/Shushan 54
White Creek 2
Whitehall 19
Schaghticoke/South Glens 12
Falls
319
TOTAL
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State Aid Funding Analysis 2017

Basic Services: 2017
Health Administration
Family Health $339,583
Disease Control/Chronic Disease $117,699
Environmental Health $245,825
Community Health Assessment
Emergency Preparedness & $48,725
Response $9,231
Total Basic Services $17,810

$769,873

Base Grant $500,000
Amount Exceeding Base Grant $269,873
36% Funding Above Base
Total Basic Services Funding $97,155
$597,155

State Funding is broken down into the following categories:

Family Health Disease Control/Chronic Disease

Child Health Arthropod
Maternal and Infant Health General Communicable Disease

Reproductive Health Immunization

Environmental Health Rabies
STD/HIV
Injury Prevention and Control Outpatient Tuberculosis
Lead Poisoning Prevention

State Aid Funding from 2016 to 2017 remained fairly consistent with a 4% decrease in total Article 6 funding. Based upon
statewide claims, this did not represent a budget cut. Health Education and Laboratory Services are no longer distinct categories, but
are distributed throughout other categories.

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Washington County Public Health
Expenditures

$346,611 $907,332 Public Health
Family Health
$9,764 Disease Control
$5,000 Community Health Assessment
Health Education
$59,476 Fringe Benefits
$29,590

Washington County Public Health
Revenue

Home Care

$720,153 Immunization Clinic

$2,755 State Aid and
$13,312 Grants

Other

$14,498

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Immunization Action Plan - IAP

Each year Washington County participates in an Immunization Action Plan Grant. A new five year funding cycle began in 2013. As with
previous grant years, there are specific goals delineated. New accountability standards were established including the utilization of immunization
rates as a performance measure. The five year plan, from 2013-2018, is designed to move LHDs to a performance-based reimbursement structure.

The overall mission is to promote and improve vaccination status of all residents through meeting the following goals.

Goal 1: Childhood Immunizations
NYS Objective: In accordance with Healthy People 2020, the New York State Bureau of Immunization seeks to meet or exceed an 80%

statewide immunization coverage level for 19-35 month old children; with 4 doses DTP or DTaP, 3 Polio, 1 MMR, 3 HIB, and 3 Hep B and 1
Varicella, and 4 doses pneumococcal vaccine (4:3:1:3:3:1:4) and series as a whole.

Physician practice site visits were conducted for an Assessment Feedback Incentives Exchange (AFIX) visit. (An Office’s immunization
rates and standards of practice for child and adolescent immunizations are reviewed and a quality improvement plan is developed where
needed.)
All antepartum MOMS admitted were provided with immunization brochure and CDC Pertussis Flyer.
Immunization reminders and messages were mailed in conjunction with lead mailings.
Provided admissions packets which include immunization schedule and reminders throughout Baby’s First Year Calendar to obtain
immunizations.
All newborn referrals receive information regarding immunizations.
Delivered packets of immunization flyers to Family Health Care Centers located all around Washington County.
Immunization information was supplied to Enrollment Assistance Service Specialist, providing her with the Recommended Immunizations
for Children from Birth through six years old. The VFC program and promotion of medical home was discussed.

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Flyers have been posted at high traffic sites throughout the County that notes Vaccine information.
Presented at the Local Early Intervention Coordinating Council (LEICC), regarding immunizations and services available at WCPH.
During National Infant Immunization Awareness, WCPH distributed backpacks containing immunization information to a variety of sites
including; health centers, WIC, Pediatrics, Food Pantries, outreach centers and Churches.
Washington County Public Health partnered with Warren County Public Health during National Infant Immunization Week to provide
signage on Greater Glens Falls Transit buses.
Head Start Family Worker Meeting handed out Flu vaccine information and IAC prevent whooping cough flyer was provided.
Halloween bags were provided to Pre-K programs. Each bag contains a Childhood Immunization schedule and Flu vaccine flyers.
Supplied the Early Childhood Development and Health Services Advisory Meeting with CDC flyers to disperse.

Goal 2: Adult Immunizations
NYS Objective: Conduct activities to increase county specific influenza and Tdap immunization rates among pregnant women, their partners,

and other adult (19+) caregivers of infants.
Distributed Adult Immunization updates and educational materials at the Annual School Nurse meeting.

https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule-easy-read.pdf

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Presented at Home Town vs Heroin Coalition Meeting CDC’s “2017 Recommended Immunization Schedule for Adults “.
Presented Certified Home Health Agencies with Adult Immunization information for their admission packets.
Created and supplied SUNY Adirondack with handouts about immunizations, to be placed in resident’s dorm mailboxes.
Immunization information and display were set up at the Economic Opportunity Council Winter Coat Boutique and Family Info. Fair.
Held an immunization clinic at Ideal Dairy Farm.
Flu clinics were held for: WCPH, WIC, Sheriff/Jail Employees, and Washington County Employee Building B.
Provided the Office for Aging with CDC recommendations for vaccinations (flu, pneumococcal, shingles, and tetanus), to be distributed at
Senior Meal Sites.
Distributed adult immunization educational materials at The Senior Picnic, sponsored by Office ADRC
Mailed letters to local employers of migrant and seasonal workers regarding availability of immunizations through WCPH.
Provided Food Pantries with CDC immunization materials for distribution.
Adult Immunization (flu & pneumococcal) information was provided at the Whitehall American Legion COPD presentation and at Tai Chi
Classes.

Goal 3: Immunization Information System
NYS Objective: Ensure that all vaccination records are completely and accurately entered in NYSIIS, in a timely manner. “Increase the

number of health care providers including; family medicine, adult medicine, OB/GYNs, pharmacists, who are registered with NYSIIS and maintain
immunization records through the system by 2% annually”.

All adults who receive immunizations at WCPH are encouraged to consent to have immunizations entered into NYSIIS.
At all AFIX visits and educational visits, nurses review NYSIIS and encourage offices to utilize NYSIIS.
NYSIIS flyers were distributed at the Senior Picnic and Senior Fair.
Attended NYSIIS training in Clifton Park.
Monitor HCS for updates to ensure proper data input.
Attend webinars and user meetings to remain current in NYSIIS.
Support given to our Provider community and encourage the use of NYSIIS.
VFC providers in Washington County are utilizing NYSIIS.
Provided Family Health Centers with NYSIIS Reminder/Recall Quick Reference Guide for Users.

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Goal 4: Education, Information, Training and Partnerships
NYS Objective: Provide information, education and training for local health department (LHD) staff and health care providers who provide

immunizations. Promote immunizations and provide up-to-date, relevant educational materials to the public, consumer groups, employee health
services, long term care facilities, hospitals, schools, colleges, and providers in your jurisdiction on an ongoing basis. Meaningfully engage
special/underserved populations specific to your jurisdiction, such as but not limited to American Indian tribes, in immunization activities. Increase
compliance with Public Health Law Section 2164 (PHL2164) and 2165 by ensuring completion of annual school and post-secondary institution
surveys.

Provided WIC representatives with a variety of immunization materials.
Updated social media monthly which included immunization and clinic schedule.
Met with newly opened Pharmacy. Vaccination information was discussed and Pharmacist can act as a resource to encourage vaccination.
Laminated 2017 Infant and Teen Immunization Schedules were supplied.
Attended several Coalition meetings; Northeast New York Immunization Coalition, NYSACHO 2017 Statewide and In Person Immunization
Consortia Meeting, Home Town vs Heroin, Early Childhood Development and Health Services Advisory Meeting, Bioterrorism Partners
Meeting.
Collaborated with Warren County Public Health in running two Public Service Announcements. A 30 second PSA was held at the Aviation
Mall Cinema. Two thirty day Ads ran. One was during National Immunization Awareness Week and the other Ad ran during National
Influenza Vaccination Week.
Provided Immunization handouts to attendees of the conference, held at the Queensbury Hotel for Health Care Providers.
Attendees of the Local Early Intervention Council were informed about WCPH Immunization clinics, Immunization recommendations, VFC
Program, and reminded to get flu vaccine.
Attended Head Start Family Worker/Advocate meeting. Educated on the flu vaccine, Pertussis outbreak, and VFA. CDC Immunization and
VFA flyers were distributed.
Supervising nurse attended the Regional Preventative Supervisors Meetings. Agenda items included updates regarding Immunizations/ IAP
work plan.
Displayed educational immunization board and an electronic match game at the Washington County Fair. WCPH Nurses and Educator were
on hand to answer questions.
Created and sent a new outreach letter to local employers with uninsured employees.
Distributed CDC Immunization materials for the Adirondack Health Institute’s Program held at the Great Escape Lodge.
Provided education and outreach to the Hope and Recovery Center.
Provided National Immunization Awareness Toolkit to medical practices throughout Washington County.

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Supplied Health Care Providers with the CDC Pamphlet “6 Reasons to Get HPV Vaccine for Your Child”.
Provided packets to attendees of the School Nurse Meeting, 4 Things A Parent Needs to Know about HPV.
Flyers were sent to nine schools (Meningococcal Vaccine Requirement and HPV vaccine)

Goal 5: Eliminate Perinatal Hepatitis B
NYS Objective: Facilitate and coordinate local perinatal hepatitis B initiatives and activities mandated by Public Health Law 2500-e and

Title 10 NYCRR, subpart 69-3.
All newborn referrals are mailed immunization and Hepatitis B information.
At the Annual MOMS meeting, each attendee received CDC materials including: Maternal Vaccination, Pregnancy and Vaccination,
Hepatitis B and the Vaccine to prevent it and more.
Distributed Hepatitis B materials to the Neonatal Abstinence Subcommittee and Hope and Recovery Center.
Accompanied the NYSDOH Immunization Bureau while performing school audit.
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Who What
Adults and Children need -Answer Immunization
Questions
immunizations
throughout their lives. -Assess the
Immunizations needed
-Provide Guidance and
Education

Washington County When
Public Health At every stage of life
Vaccine schedule is based
Wednesdays 2-4 on: age, health conditions,
415 Lower Main Street travel and other factors.
Hudson Falls, NY 12839 Yearly Flu for 6 months and
up

Why Where
Provide protection Health Care

for children and Provider
adults from 14 WCPH
Deadly Diseases. Pharmacies

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Vaccine Charges 2017

ActHIB $51.00 Hepatitis B (Pediatric) $91.00 Prevnar 13 $133.00
Adacel (Tdap) $69.00 Ipol $57.00 Rotarix $130.00
Boostrix $59.00 Menactra $139.00 Tetanus
$44.00
DTap $50.00 Menomune $139.00 Tubersol $34.00
$141.00
Gardasil $161.00 MMR $108.00 Twinrix $164.00
$88.00 Varivax
Hepatitis A (Adult) Pediarix $43.00
$92.00 $106.00 Flu

Hepatitis A (Pediatric) Pentacel $133.00
$105.00

Hepatitis B (Adult) Pneumovax 23
$ 98.00

Clinic Data 2017

2017 Number of Clinics Number of IZ Given Flu IZ Given Attendance
Office Clinics 44 105 122 134
Off Site Clinics 5 31 13 113
12 45 28` 48
Jail Clinics
61 181 163 295
Total

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The mission of the Lead Poisoning Prevention Program is to reduce the prevalence of childhood lead poisoning.

Environmental lead exposure is a recognized health hazard. Children are particularly susceptible to its affects and pose lifelong health and
learning consequences. These affects include learning disabilities, kidney damage, hearing loss, growth problems, anemia, and behavior
problems. Symptoms of lead poisoning may not be apparent or may be mistaken for other illnesses. The symptoms may include fatigue,
crankiness and stomachaches. However, there are usually no signs. Lead poisoning in its most severe form can be fatal.

Lead Poisoning is Preventable!

Washington County’s Lead Poisoning Prevention Program is funded via a grant from the New York State Department of Health.

NYSDOH Lead Poisoning Prevention Program Grant has key components ( ) to be addressed:

Local Health Departments (LHD) will effectively administer a Lead Poisoning Prevention Program (LPPP).

(In order to meet these goals several objectives have been met by Washington County Public Health.)

Maintained standard operating manual for management of blood lead levels.
Distributed to Family Health Care Centers, Pediatric Offices, WIC, and Head Start Newsletter (Be Lead Free News!)
WCPH hosted Quarterly Professional Administration Committee meetings. (Policy and Procedures are presented and approved by this
committee.)
Demonstrated that the LHD has the capability to identify and assess high-risk populations annually.
Followed up on a case by case basis, informing parents and physicians when to obtain venous BLL as indicated (venous BLL is obtained for
any capillary result of > 5mcg/dl.)
Consulted with Dr. Shottler-Thal at the Regional Lead Poisoning Center. Recommendations are forwarded to the child’s primary care
physician.
Maintain a current LHD LPPP Policy and Procedure Manual based on the NYS Public Health Law.
Updated and maintained Recall Resource Binders

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-

Increase knowledge and awareness of the public, healthcare providers, other professionals, and local policy makers regarding
lead poisoning and lead poisoning prevention in children and pregnant women. Education is based on the needs of the county,
including the specific impact on the local community.

Washington County Public Health Nurses displayed a (Lead Poisoning Doll House).

 Each room contains a LPP message.

 Display was utilized at different locations including libraries, Head Starts and Schools.

Numerous Presentations were given to educate an array of entities that promote lead awareness. Presentations were held at:

Southern Adirondack Child Care Network  Head Start Early Childhood Development and Health Services
Glens Falls Hospital  Head Start Early Head Start Health Advisory Committee
 Head Start Family Worker Meeting Salem Family Health Center
 Greenwich Family Health Center

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Collaborate with WIC to generate awareness about our LPPP.
 Children who receive WIC services are screened for low hemoglobin levels. (Low hemoglobin levels are referred for lead testing either to
their HCP (Health Care Providers) or WCPH.)
Supplied WIC with a variety of educational materials for distribution to its clients.
At this year’s School Nurse Meeting, Washington County Public Health Nurses distributed 15 packets with LPPP materials for distribution.
During National Lead Poisoning Prevention Week-October 22-28th, Washington County Public Health distributed a total of Halloween
Bags to various entities.
 Each bag contains an array of educational LPP materials and promotional items.
 Police Departments, Libraries, WIC, Health Centers, Head Starts, and Pre K programs are some of the organizations that were given the
Halloween bags to distribute.

Distribution of 242 Back Packs with LPP materials to EOC and the following food pantries to distribute: Whitehall, Granville, Greenwich,
Salem, Hartford, Argyle.

Building Permits obtained at Washington County Code Enforcement office receive “Become Lead Aware” brochure.
Information is shared using innovative messaging via Facebook, Twitter accounts, and LPP Messaging.

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Advertising Campaign on Greater Glens Falls
Transit Buses

Billboard Signage

Sent mailings, including LPP materials, to newborn referrals.
Mailed Educational pamphlets to MOMs and antepartum referrals.
These pamphlets contain LPP educational information.
All MOMs referrals receive mailings regarding “Pregnancy and Lead Poisoning, What Every Woman Should Know”

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–
All children and pregnant women are tested for lead poisoning consistent with NYS Public Health Law

A blood lead test is the only way to determine exposure to lead. Exposure usually occurs when children lick, swallow, or breathe in dust from
old lead paint. NYS requires physicians to test all children at age one and again at age two with a blood lead test. This is noted to be a time
when children are at highest risk for hand to mouth ingestion. Physician practices should also screen children up to age six at every well child
visit, through questioning about possible exposure risks. Children who have any possible exposure should have a blood lead level obtained. In
order to enhance compliance with testing for 1 and 2 year olds, proof of lead testing is recommended but not required for preschool entry.
Children are not excluded for lack of testing as they may be for lack of immunization. There has been steady improvement demonstrated in
children being tested at ages one and two. Most health care providers now have the ability to provide on-site capillary testing. The results from
the blood sample are obtained within three minutes. This is less stressful and convenient because families do not have to go to a lab for venous
testing.

Testing compliance has been enhanced with the use of the Lead Care II testing device in the County’s pediatric and family health practices.
A calendar, “Your Baby’s First Year” is provided to all new moms receiving a home visit.

The calendar is a that will provide reminders on recommended lead testing dates and lead poisoning prevention throughout the child’s
first year.

The WCPH Nurse informs the new mom at the home visit regarding our LPPP.

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Distributed letters to families as a reminder to have their two year old screened.
Screened women for lead poisoning risk in pregnancy.

Several were referred for further testing through their OB/GYN.
All children referred for Early Intervention and Child Find will have their lead levels checked through NYSIIS or Lead Web. (Information
will be supplied to parents regarding testing for lead if the child is between the age of one and two years old and have not been tested for
lead.)
Provided six lead screening clinics in different areas of Washington County.

–

Follow-up for children with elevated BLLs < 18 years of age. All children with elevated blood levels receive timely and appropriated
follow-up services, consistent with the Public Health Law, Administrative Rules and Regulations, and CDC guidelines.

Provided education, guidance, and follow up to physician practices when a false blood level elevation occurred with the use of Lead Care II
device.
Mailings sent to parents/guardians for all blood Lead levels results ≥5 and ≤10 mcg/dL.
 Recommend venous blood level obtained to confirm results.
 Mailed letters explaining the function of the Lead Poisoning Prevention Program, resources, and contact information.
 Emphasis is placed on prevention measures.
 Included NYSDOH educational Form #2526, “What Your Child’s Blood Lead Test Means”, and “Lead Poisoning Know the Facts”
Provided case management for all children in the county with a blood Lead level of >10 mcg/dL.
 For levels 10-14 mcg/dl a letter and educational packet of information is sent to the family.
 Follow-up telephone call is made to take a lead risk assessment and exposure history and offer a home visit.
 Follow child until they meet criteria for discharge.
Reminder letters are sent when repeat blood lead levels are due.
Education is provided and a plan established on how to reduce the child’s lead exposure.
 Referrals are made to other programs based on the nurse’s assessment.
Works closely with New York State Department of Health District Office in Glens Falls for environmental management of cases with a BLL
> 15mcg/dL.

For children with a blood lead level > 15mcg/dL, a home visit is made.
NYSDOH Sanitarian assesses the home to identify the source of lead exposure.

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NYSDOH criteria for medical discharge is two consecutive venous levels < 15 mcg/dL, taken at least six months apart OR one venous blood
lead level < 10 mcg/dL. (All required follow-up activities, including environmental management, have been completed consistent with the
child’s blood lead level.)

There were 17 cases managed in 2017. Six new cases were opened. Seven cases were discharged in 2017.
–

Lead hazards in the community are identified and controlled before children become lead poisoned.
Advocate Assistance Programs utilizes client checklist “Was home built before 1978?”
 The checklist is a guide for clients to assist them in having lead exposure conversations with prospective landlords.
 LPP materials made available for distribution to those applying/receiving DSS assistance.
Education is provided at initial newborn home visits. “Your Baby’s First Year” calendar is presented and lead poisoning prevention is
highlighted throughout child’s first year.
Engaged with providers and community agencies to educate our communities through site visits, meetings, and educational materials.
A wide variety of educational materials were distributed by Maternal Child Health staff at health fairs, well child visits, to the physician
provider community, on all referrals and via the MOMS Program.
 Hardware stores, code enforcement, and building inspectors, have assisted the Washington County Public Health LPP in distributing these
educational materials.
Provided the Economic Opportunity Council with brochures and packets of literature to distribute at their annual Coat Boutique and Family
Information Fair.

EOC Annual Coat Boutique and Family Information Fair

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Washington County Public Health identified the potential risks for exposure to lead during home renovations.
Washington County Public Health took the initiative to facilitate a free training (EPA Certified Renovator Initial (RRPI) for
contractors, homeowners and landlords. The course was funded through our LPPP Grant.

This was a unique opportunity to obtain EPA Certification.
Renovate, Repair, and Paint programs Trainings on EPA Renovate, Repair and Paint provided at three sites in Washington County
3/7/17 Whitehall
3/21/17 Cambridge
3/31/17 Kingsbury
As of April 2010 Federal law requires contractors to become EPA Lead Certified Renovators.
The Lead Renovation, Repair and Painting Rule (RRP) will affect anyone who is paid to perform work that disturbs paint in housing and
child-occupied facilities built before 1978.
This training has been required for any renovation, repair and painting that disturb lead-based paint in homes, child care facilities, and
schools built before 1978.

Keep children away from peeling or chipped paint.
Make home repairs safely by following the “EPA Lead Hazard Pamphlet” and EPA Repair, Renovation, and Painting Rule (Effective
April 2010).
Hire contractors with Lead-Safe certification and training.
 Children and pregnant women should stay away until the area is properly cleaned with wet cleaning and HEPA vacuuming.
Wash dust off hands, toys, bottles, windows and floors.
Check toys for recall at www.cpsc.gov/cpsclist.aspx
Avoid exposure to costume jewelry.
Remove clothing prior to coming home, whenever possible or have a designated changing room, and wash thoroughly if you have a hobby or
occupation that involve contact with lead (painting, plumbing, construction, car and computer repair, firearms, pottery, stained glass).

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 Prenatal visits are arranged with the expecting mom. (Can occur at the Washington County Public Health office or at another site.)
 Postpartum visits occur in the home through the agency’s Licensed Home Care Service Agency (LHCSA).

 Our Registered Nurses assess the mother and newborn. (Referral to community resources is a key focus.)
 The nurse provides support, reassurance, guidance and collaboration with the family’s health care provider.

 Standardized teaching is provided utilizing evidence-based best practice materials.

 Key areas taught include: SIDs prevention newborn care growth/development
nutrition community resources
maternal depression exercise healthy lifestyle choices immunizations
emergency preparedness
safety (lead poisoning prevention, car seat)

All referrals receive a phone call from a registered nurse and are mailed a newborn information packet.

Outreach to our community partners is crucial

 Emphasize the referral process Promote service availability Seamless Transition across service providers

Destigmatize any misconceptions about MCH services

 Head Start  Glens Falls Hospital  South Western Vermont Medical Center  Albany Medical Center

 WIC  Wait House  Open Arms  School Nurses  Community Maternity Services  DSS

 NAS Subcommittee  Pediatric and OB/GYN offices  EOC

Page | 27

Washington County’s Prenatal Programs are designed to work in collaboration with a woman’s health care

provider, by establishing a plan of treatment. Washington County Maternal Child Health nurses provide
prenatal services. Services focus on the assessment of the woman’s health and risk factors. By utilizing
evidenced based standardized assessment and education, the goal is “Healthy Mothers, Healthy Babies!”

Women can be referred by:

Self
Health Care Provider
Community Partners (WIC, Head Start, Community Maternity Services, etc.)

Education is provided regarding: Prenatal Care
 Infant Growth and Development
Child Birth  Parenting Skills
Labor and Delivery  STD and HIV Counseling and Testing
Postpartum Care Family Planning Options
Infant Care
Reducing Health Risks

Assistance is provided in obtaining services: Transportation to MD Appointments
Health Insurance coverage
 WIC (food assistance)
 Birthing and Breastfeeding Classes

Women can use the Presumptive Eligibility Form to verify insurance coverage to a Health Care Provider.
The completed Presumptive Eligibility Form supports the eligibility requirements for WIC.
If the insurance provider changes from traditional Medicaid to a Managed Medicaid Care provider, our WCPH Nurse can
work with the insurance provider in obtaining authorization for visits.

Page | 28

The majority of women enrolling in the MOMS program during 2017 were younger than twenty-five.

Typically the women enrolled in the MOMS program have more psychosocial needs.
There is a higher risk for complications.
The majority are first time mothers.
Many have a history of domestic violence.
Almost a third scored at risk for Lead exposure and were referred to their physician for lead testing.
Due to the complexity of these cases, WCPH Nurses noted that most women are accepting revisits and
postpartum services.

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Postpartum Depression

Approximately one third of women seen in the MOMS Program had a history of a Mental Health diagnosis. Depression during pregnancy may
not be as well-known as postpartum depression however, it is estimated that a significant percentage of women experience a depressive disorder
during pregnancy. (Depression during pregnancy has been associated with poor prenatal care.) The American College of Obstetricians and
Gynecologists (ACOG) encourages screening patients for depression during and after pregnancy.

Depression affects women of all backgrounds

Depression affects women at a rate of one in five women.
Over one-third of women of childbearing years have depressive symptoms.
Mothers living in poverty are over three times more likely to have depression.
The NYS Community Action Association reported that the poverty rate in Washington County, with women as head of households with children, is 42%.
Maternal Depression impacts the family.
Children of parents with depression are at increased risk of behavior, attention, anxiety, and depression disorders.
The earlier a woman is identified with maternal depression, the earlier she can receive treatment.

Cognitive and interpersonal therapies, medication, peer to peer support programs and support groups are some of the treatments
that currently exist. Prior to 2017, the tri-county region was lacking in support groups for moms affected by depression.

Washington County Public Health Nurses identified a need to support these moms. WCPH Nurses applied for and
were awarded an Adirondack Health Institute Grant. The grant made it possible for our Nurses to complete a
Support Group Training Course, offered through Postpartum Support International.

“Washington Counties inaugural social support group, ” was held in October 2017. Through an established
partnership with Head Start, the Hudson Falls River Street, location was chosen due to its accessibility.

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NAS is a condition in which a baby has withdrawal symptoms after being exposed to certain substances. Many
times the baby is exposed when the mother uses substances such as medications or illicit drugs during pregnancy. Opioid
use is the most common cause of NAS.

Data compiled from the CDC shows that among 28 states with publicly available data in HCUP during 1999–2013, the
overall NAS incidence increased 300%, from 1.5 per 1,000 hospital births in 1999, to 6.0 per 1,000 hospital births in
2013.

Page | 31

Our NAS Subcommittee focused on the following goals:

Develop a collaborative care team with our community partners by establishing a subcommittee of the
specific to Neonatal Abstinence Syndrome.

Share information and collaborate with clinical and human service partners to develop policies, procedures, and educational
messages to improve the delivery of services to pregnant and parenting women with a substance abuse disorder.
Provide an evidence based standard of care for infants withdrawing from opiates and narcotics.
Improve screening of pregnant women and make it a standard of practice that they are screened throughout pregnancy.
Provide standardized patient education in relation to prescription and recreational drug use to all women during preconception
counselling and/or receiving substance abuse treatment.
Provide an evidence based standard of care for drug-addicted mothers during pregnancy.
Reduce barriers to treatment through a fast track available to assist women into a treatment program that works for them.
Empower women to self-disclose an addiction and to enter treatment.
Help women to navigate through services that are available.
Improve the transitions through care services with “warm" handoffs and better communication across disciplines and services.
Provide anticipatory education and guidance to women regarding withdrawal symptoms and how to support their newborn.
Improve acceptance of Maternal Child Health Nurse referrals and home visits.
Promote family-centered care during treatment and recovery.

Educational materials and programs were redesigned to focus on the positive impact of bonding a mother has on her substance exposed infant.
(Through knowledge and support, a mother with substance use disorder can change the trajectory of her infant’s risk for NAS.)
Warren County hosted training utilizing the NeoAdvances Program.
This program trains nurses on the Finnegan NAS scoring tool.
Maternal Child Health Nurses from Warren, Washington, Saratoga, and Essex were certified.
NAS Educational committee obtained sponsorship for National speaker Dr. Mara Coyle, Brown University and Women & Infant’s Hospital,
Providence RI Boston University. “Collaborative and Compassionate Care for Maternal Substance Use and Substance Exposed Newborns.”
Members of the committee continue to provide education about Substance Use Disorder and outreach to our community partners.
MCH SPHN attended NYSDOH AIDS Institute’s Office of Drug User Health presentation, by Dr. Miska Turplan. “Responses to the Opioid
Epidemic: Improving the Health of Women Who Use Drugs”

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MCH Nurses provided education and support to pregnant and parenting women regarding non-pharmacologic intervention for the
management of NAS infants. (The focus is on promoting mother infant bond.)

The Office of Alcoholism and Substance Abuse Services invited our participation with the National Center for
Substance Abuse and Child Welfare initiative on In Depth Technical Assistance (IDTA). This initiative has
representation on the national, state and local levels.

Increase universal screening for pregnant women
Increase identification and engagement in treatment of women and infants, including outreach to women in marginalized
populations
Develop a scope of practice for the use of parent family/care giver peer services when infants are affected by prenatal substance
exposure
Identify and implement policy and practice changes as needed to comply with CAPTA (Child Abuse Prevention and Treatment Act)
and promote child well-being.

“Pain Management for
Pregnant and Laboring
Women who are taking
Prescribed Opioids or On

Medicated Assisted
treatment”
(MAT)

Page | 33

Baywood, Conifer Park Subcommittee members Hudson Headwaters
and Center for Recovery share information Health Network initiated a
Substance Abuse Service
prioritize pregnant regarding access to MAT
women and all provide and the providers who Expansion Project.
will accept referrals for Individuals completing
walk in services. pregnant women with
substance use disorder. treatment can be
maintained through
primary care provider.

Case management and Center for Recovery has Dr. Lefner (Saratoga
Health Care Providers offered to make substance Hospital) and Michelle
encourage acceptance abuse consults for moms Eastman (GFH) both offer
of MCH Nurse referrals while they are inpatient consultation for women
during pregnancy and following delivery. Began receiving MAT during
home visits following
dialogue for a family pregnancy.
hospital discharge. centered approach at GFH

with the hospital
redesign/Medical Village

model.

Page | 34

MCH Supervisor attended American Congress of Obstetricians and Gynecologists (ACOG) District II statewide educational summit.
This was a multidisciplinary opportunity to share and learn about key approaches to improve the care of women with substance
use disorder during pregnancy. The goal was to release recommendations summarizing strategies to manage opioid use disorder
in pregnancy thereby improving outcomes of women and infants. The Summary of Key Recommendations was reflective of the
goals initially established by the NAS subcommittee in 2015.

Four key recommendations were:
1. Change perceptions of opioid use disorder through the use of a common language
2. Develop and offer multifaceted education and implementation tools to better assist women’s health care providers in caring for

pregnant women with opioid use disorder.
3. Create better engagement and communication among providers within the continuum of care and across service areas, including

the justice system
4. Enhance patient and family engagement

Source: Opioid Use Disorder In Pregnancy Actionable Strategies to Improve Management & Outcomes in New York State
November 2017

Five Local County Health Departments: 1) Washington, 2) Warren, 3) Saratoga, 4) Essex, 5) Franklin
Hudson Headwaters Health Network case managers Drug User Health and Administration AIDS Institute.

Washington County WIC Warren and Washington County DSS
Glens Falls Hospital Saratoga Hospital
Physicians (Pediatric & OB/GYN) Nurses from GFH Snuggery and Pediatrics
Neonatal Nurse Practitioner Council for Prevention
The Baywood Center NAS Center for Recovery

Harm Reduction Coalition NYS Division of Family Health

Rural Health Network and NYS Surveillance Members

Page | 35

OASAS The Children and Family Futures/National Center on Substance Abuse and Child Welfare (NCSACW) Harm
Reduction Coalition NYDOH Division of Family Health Rural Health Network Surveillance Prevention Drug
User Health and Administration AIDS Institute
Many of these members are involved in activities throughout NYS and Nationally. Their participation keeps the
group informed of any new initiatives as we continue to tackle the complexity of the issues presented.

Page | 36

Child Find Program

Child Find is a part of the Early Intervention Program. It is designed to locate and identify infants and toddlers (0-3)
who are at risk of developmental delay. Identifying children at risk can be facilitated in a number of ways:

Hospitals and NICUs
Physicians
Social Services
WIC
Maternal Child Health RN
Head Start
Parents

The Child Find Program presents a tremendous opportunity for parent education regarding age appropriate
developmental milestones. Public Health offers resources and guidance to parents for referral to care and follow-up.
Child Find is voluntary and there is no charge to families for the program. Once Child Find is open and if it is determined
that further evaluation is needed then referral can be made to Early Intervention or CPSE. If developmental concerns
are identified the Child Find program works closely with Early Intervention program to assure appropriate transition.

Page | 37

EARLY INTERVENTION

Early social, emotional development, and physical health provide the foundation upon which cognitive and language skills develop. High
quality early intervention services can change a child's developmental trajectory and improve outcomes for children, families, and ultimately our
communities. There is an urgent and substantial need to identify as early as possible those infants and toddlers in need of services to ensure that
intervention is provided when the developing brain is most capable of change.

Proven benefits of Early Childhood Intervention Programs:

Early childhood intervention programs have been shown to yield benefits in academic achievement, behavior, educational progression
and attainment, delinquency and crime, and labor market success.
High quality early intervention programs for vulnerable infants and toddlers can reduce the incidence of future problems in their learning,
behavior and health status.
Intervention is likely to be more effective and less costly when it is provided earlier in life rather than later.
Positive early experiences are essential prerequisites for later success in school, the workplace, and the community.
The brain is strengthened by positive early experiences, especially stable relationships with caring and responsive adults, safe and supportive
environments, and appropriate nutrition.
Early social/ emotional development and physical health provide the foundation upon which cognitive and language skills develop.
Minimize potential developmental delay, and reduce educational costs to our society by minimizing the need for special education services as
children with disabilities reach school age.
Families benefit from early intervention by being able to better meet their children’s special needs from an early age and throughout their
lives.
Benefits to society include reducing economic burden through a decreased need for special education.

The Early Intervention Program for infants and toddlers ages birth up to age three and their families was established in 1994
conforming NYS law to Federal Individuals with Disabilities Act (IDEA), Part C. The New York State Department of Health
(NYSDOH) is the lead agency for statewide administration and oversight of this program. The program is implemented at the local
level under the direction of the Early Intervention Official (EIO) and the Washington County Public Health Department (WCPH).

Page | 38

Eligibility Requirements for the Early Intervention Program

Children less than 3 years of age with a developmental delay or diagnosed physical or mental condition with a high probability of a delay in
any of the following areas:

Physical development (vision and hearing included)
Cognitive development (thinking)
Communication (understanding or expressing language)
Social/Emotional (relating to others)
Adaptive development (self-help skills)

A developmental delay for the purposes of the Early Intervention Program is a developmental delay that
has been documented as:

A twelve month delay in one functional area as described; or
A 33% delay in a functional area or a 25% delay in each of two areas; or
If appropriate, standardized testing tools are individually administered in the evaluation process, a score at least 2.0 standard deviations below
the mean in one functional area or a score at least 1.5 standard deviation below the mean in each of two functional areas; or
Due to the child’s age, condition, or the type of diagnostic instruments available in the specific domain, a standardized score is either
inappropriate or cannot be determined, a child may be deemed eligible by the documented informed clinical opinion of the multi-disciplinary
team.
For Speech only children, 2 standard deviations below the mean are required for the evaluation team to determine a child is eligible for Early
Intervention Program Services, or the evaluation team must use other qualitative criteria included in regulation/clinical practice guidelines on
communication disorders.

Page | 39

A child must qualify according to the written standards, to be eligible for services under the Early Intervention Program. If a child

does not meet the degree of delay required, parents may pursue services via their primary care physician and primary health

insurance.

Early Intervention Services Include:

Early identification, screening and assessment Service coordination

Special instruction Speech pathology and audiology

Occupational Therapy Physical Therapy

Nutritional Services Vision Services

Respite services if qualified Assistance with transportation

Assistive technology devices and services Hearing Services

Family Training, counseling, home visits, parent support groups
Early intervention services are provided at no cost to families. Washington County is reimbursed by New York State at a rate of 49%
of total costs. Private insurance (licensed and regulated by New York State) and Medicaid are billed for Early Intervention Services paid by the
county. All attempts are made to maximize reimbursement and defray Washington County expenses. Providers enter into agreements with New
York State directly for services and providers bill insurance companies and Medicaid directly for services first. Any services not covered are
then paid for by the county.

Number of Children Referred
to EI, Evaluated, and Qualified

Number of Children
served Early
77 Intervention (birth -
3 yrs old)

Number of children
176 Evaluated

126 Number of children
qualified for services

Page | 40

Preschool Program For Children With Disabilities/
Committee on Preschool Special Education (CPSE)

The Preschool Special Education Program is a Federal and State mandated program for children from three years old until they become
age eligible for kindergarten. Each school district has a Committee on Preschool Education (CPSE) who determines if a child qualifies for
services as a preschooler with a disability. Eligibility is determined by evaluation, based on criteria established in regulation, and a meeting of
the CPSE. New York State Education Department (SED) is the lead agency for statewide administration and oversight.

Services are provided at no cost to families. The use of third party payment (using Medicaid or private insurance) is at the discretion of parents.

Children potentially eligible are referred directly to the Committee on Preschool Special Education (CPSE) either by parents, providers or through the transition

process from the Early Intervention Program. The child is referred to their home school district. Parents are provided with a list of approved evaluators for

Washington County. Parents then select the agency they wish to evaluate their child. All appropriate consents and documentation are secured by the school

district CPSE office. Following the child’s evaluation the committee is convened to review the evaluation, determine qualification and eligibility, and discuss the

child’s needs. Recommendations for services are made at this time if the child qualifies for services. A representative from Washington County Public Health
attends all CPSE meetings. These services are voluntary and the parents may withdraw the child from any program at any time. The county is reimbursed for
its costs at a rate of 59.5% by New York State Education Department. Medicaid is billed for related services such as speech therapy, occupational
therapy, physical therapy, nursing, and counseling for all Medicaid eligible children.

All attempts are made to maximize reimbursement and defray Washington County’s expenses.

Number of CPSE Children Served

300 Number of children
250 served CPSE (3-5 yrs old)
200
150 2016 2015 2014
100

50
0
2017

Page | 41

Early Intervention Cash Receipts
By Revenue Source

$180,000 $24,037 2017
$160,000 $10,491 2016
$140,000 $12,454 2015
$120,000 $97,972
$100,000 $92,953 2017
$133,964 2016
$80,000 $1,742 2015
$60,000 $6,929
$40,000 $16,302
$20,000 $123,751
$110,373
$0 $162,720

$1,600,000 Medicaid NYSDOH Escrow Total
$1,400,000
$1,200,000 3-5 Program Cash Receipts
$1,000,000 By Revenue Source

$800,000 $313,977
$600,000 $332,027
$400,000 $250,319
$200,000 $552,166
$1,015,441
$0 $1,198,543
$866,143
$1,347,468
$1,448,862

Medicaid NYS Ed Dept (59 1/2%) Total

Page | 42

Expenditures for Early Intervention and CPSE

$3,000,000

$2,500,000

Expenditures$2,000,000

$198,437$1,500,000 2017
$171,513 2016
$250,382$1,000,000 2015
$2,236,214
$1,873,603 2017
$2,143,111 2016
$2,434,651 2015
$2,045,117
$2,393,493
$500,000

$0 Total
Early Intervention 3-5 Year Program

Expenditures Minus Revenue For EI/CPSE

$3,000,000 Combined

$2,500,000

$2,000,000Expenditures

$1,500,000 $2,434,651
$2,045,117
$1,000,000 $2,393,493
$989,894
$1,457,841
$1,611,582
$1,444,757
$587,276
$781,911
$500,000

$0 Difference Page | 43
EI/CPSE Expenditures EI/CPSE Revenue

The mission of this program is to prevent the spread of reportable communicable diseases to residents of
Washington County through timely reporting, investigation, and containment.

Washington County Public Health is responsible for the prevention, investigation, reporting, and treatment of reportable communicable
diseases in Washington County. Programs within Public Health include Communicable Disease; Sexually Transmitted Disease (STD); HIV referrals
for Counseling and Testing; and Tuberculosis Control. Disease surveillance is monitored closely. The staff create new and diverse ways to develop
education, outreach, testing, and treatment strategies to minimize the impact of communicable disease in the community.

In order to meet the program’s mission, the WCPH provides:

Surveillance and reporting of communicable diseases as mandated under Public Health Law.
Investigation and follow-up of all reportable diseases in Washington County residents, including coordination of efforts with other
health related entities (laboratories, hospitals, infection control practitioners, physicians, etc.)
Recommendations for preventative treatment when indicated
Screening and exclusion of persons who are suspected/confirmed to have certain communicable diseases and who are in sensitive
areas (such as food handlers, infants or toddlers in child care, child care providers, health care providers)
Education to community and health care providers
Reporting of disease to NYSDOH
Information to the public in a timely manner to protect and improve the health of our community
Serving as a resource to area schools and businesses in matters of infection control, disease mitigations and prevention.

. The number of investigations of communicable disease cases in 2017 totaled 646 cases of confirmed reportable diseases.
This was a 4.8% decrease overall in confirmed cases of reportable disease over 2016.

Food Borne Illnesses

A total of 26 food-borne illnesses were investigated in 2017. Food-borne illnesses were noted with Salmonella,
Campylobacter and Yersiniosis. Campylobacter case (n=22) again was the most reported food-borne illness in 2017, same as
the previous year. (Campylobacter is a common gastric illness usually caused from ingestion of raw milk or by handling raw
poultry products or animal exposure.)

Page | 44

The best defenses to prevent food borne illness.

Proper hand hygiene
Prevention of cross-contamination
Proper washing and storage of food

*Education regarding measures to prevent food-borne illness occurrences is provided to
community residents*

In addition to the increase in Campylobacter, there was one case of Yersiniosis. No cases of this disease had been reported since 2013.
This is an illnesses usually associated with pork.
Legionella cases decreased (n=4). Several of these cases were associated with long term care facilities. Overall in the U.S. Legionella cases reported
are increasing. Etiology for this is unknown.

Washington County’s Response to Communicable Diseases is Swift and Thorough

Washington County Public Health Communicable Disease nurse continues to respond rapidly in collaboration with the Regional New
York State Department of Health Epidemiology staff and the NYSDOH District Office, in the event of any outbreak or incidents of concern.
Washington County Public Health Communicable Disease staff monitors surveillance locally, regionally, and nationally on a daily basis. The
Washington County Public Health infection control nurse continues to work closely with other area facilities and school districts in regard to issues
of concern related to infection control.

Page | 45

Tuberculosis Control

The Tuberculosis (TB) Control program provides comprehensive testing, diagnosis, and treatment of latent and active tuberculosis cases in Washington
County. The TB Control program decreases the public health threat of TB by evaluating and treating positive cases of TB, while promoting preventative
therapy as indicated for contact cases.

Washington County Provides for TB Control:

Tuberculin skin testing
Client assessment
Case management for active and latent TB cases
TB surveillance in Washington county
Community and provider education about tuberculosis

Mosquito Virus Surveillance

There have not been any human cases of West Nile Virus to date diagnosed in Washington County. This is a reportable disease and any suspect
or confirmed case would be investigated by the infection control nurse. In late 2015, Washington County Public Health began training for
surveillance of the Zika virus. Washington County did not have any cases of Zika in 2017. The mosquito responsible for transmission of the Zika
virus is not present to date in the Capital Region of NYS. Surveillance and planning is still being undertaken. The Zika plan is updated annually.

Lyme and other Tick Borne Diseases

In an attempt to increase community awareness regarding Lyme Disease, Senator Kristen Gillabrand and Assembly Woman Carrie
Warner met with representatives from WCPH in Juckett Park, July 2017. Public Health Director Patricia Hunt spoke to attendees regarding
current funding and research being undertaken by an area research group for improved testing and diagnosis of tick related diseases. Senator
Gillabrand and Assembly Woman Carrie Woerner demonstrated their support for the Tickborne Disease Prevention, Education, and
Research Act which was passed as part of the 21st Century Cares Act.

Reported cases of Lyme disease again dropped in 2017 (n=37) confirmed cases that met case definition. A total of approximately over 100
additional suspected cases of Lyme disease were also investigated, but did not meet the current case definition.

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(There is no human vaccine on the market for the prevention of Lyme Disease or any other tick borne illnesses at this time.)
Another arthropod disease specifically, Anaplasmosis, is still prevalent within this region. Anaplasmosis, Babesiosis and Ehrlichiosis are all

reportable to local health departments in NYS. These diseases are also caused from tick bites. Washington County had 150 confirmed cases
Anaplasmosis in 2017 (a 76% increase over 2016), Ehrlichiosis cases numbered 3, and Babesiosis 2.

Washington County is Proactive in preventing Tick Borne Diseases

Lyme disease awareness as well as other vector-borne education is distributed to area health providers.
Washington County Public Health provides an educational display for the public yearly at the Washington County Fair.
Phone inquiries from county residents serve as an opportunity to educate regarding ways to reduce the risk of arthropod exposures.
Washington County Public Health places innovative social media posts on Facebook, Twitter, and our Public Health website.

Prevention is an Important Factor in Contracting Tick Borne Diseases

Dressing to repel by wearing light colored clothing and using Permethian on clothing.
Tuck pants into socks when outside.
The use of a DEET based insecticide helps to reduce the incidence of these exposures. (minimum of 20% DEET)
In addition, animals and humans should be checked for ticks after every outdoor activity especially in wooded areas.

For more information on tick illnesses visit: http://www.cdc.gov/ticks/

Page | 47

Washington County Communicable/Infectious Disease Data

Disease 2017 2016 2015 2014
Anaplasmosis** 150 48 61 26
Babesiosis** 2 5 1 0
Brucellosis** 0 1 1
Campylobacteriosis** 22 21 18 17
Cryptosporidiosis** 0 2 2 3
E.Coli 0157:H7 0 4 2 0
Ehrlichiosis (Chafeensis)** 2 1 0 0
Ehrlichiosis (Undetermined) 1 0 0 2
Giardiasis 6 5 2 4
Haemophilus Influenzae, Not Type B 1 1 0 0
Hemolytic Uremic Syndrome** 0 1 0
Hepatitis A 0 0 0 0
Hepatitis B, Chronic 0 1 0 2
Hepatitis C, Acute 1 1 2 1
Hepatitis C, Chronic 29 27 22 36
Influenza A, Lab Confirmed 125 95 195 98
Influenza B, Lab Confirmed 37 23 46 21
Influenza Unspecified, Lab Confirmed 2 4 7
Legionellosis 4 11 4 1
Listeriosis 0 0 0 0
Lyme Disease** **** 37 51 68 59
Meningitis, Other Bacterial 1 0 1 0
Meningococcal** 0 0 1 0
Mumps 2 0 0 0
Pertussis** 4 0 0 2
Q Fever** 1 0 0 0
Rocky Mtn Spot Fever** 0 0 0 0
Salmonellosis 4 10 8 5
Shigellosis 0 0 0 0
Strep, Group A Invasive 3 2 2 1
Strep , Group B Invasive 10 5 6 3
Strep Pneumoniae Invasive 6 11 9 4
Toxic Shock Syndrome, Streptococcal** 0 0 0 0
Tuberculosis 0 0 0 1
West Nile Virus** 0 0 0 0
Yersiniosis 1 2 0 1
Syphilis Total 0 0 1 0
--Late Latent 2 0 0 0
--P & S Syphilis 0 0 1 0
--Congenital Syphilis 0 0 0 0
--Early Latent 0 0 0 0
Gonorrhea Total 20 23 11 4
--Gonorrhea 20 23 11 4
--Pelvic Inflammatory Disease 0 0 0 0
Chlamydia 151 148 143 135
Chlamydia P.I.D. 2 0 2 2

Total NYS Reportable 646 679 617 426

Page | 48

Sexually Transmitted Diseases
The Sexually Transmitted Disease program is responsible for the investigation, follow-up surveillance and reporting of
chlamydia, gonorrhea, syphilis, and HIV.

In 2017, throughout Washington County, the number of chlamydia (n=151) rose slightly over the previous year, however, gonorrhea (n=20)
cases dropped by five. Outreach education through schools and public posters regarding awareness is ongoing. Washington County continues to
sponsor a weekly STD clinic along with Warren County. They are held every Tuesday evening from 6-7pm at the Warren County Health Services on
Rt. 9 in Lake George. Weekly reminders for the clinic are posted via social media. A social media campaign was also pushed out over several weeks
to increase STD awareness, reminding people to get tested and use protection.

Washington/Warren County’s STD Clinic Report
Washington County Public Health works in collaboration with Warren County to provide an STD Clinic. The clinic is held
every Tuesday Evening 6PM-7PM at Warren County Public Health.

The clinic is staffed by two nurses, one support staff and one physician.
Prevention is stressed at the clinic.
Condoms are supplied by NYS and are available at no charge to the patient.
STD clinic routinely tests for gonorrhea, chlamydia, and syphilis on all clients.
HIV testing is performed at the clinic (The HIV clinic counselors are from the HIV/Ryan White Program under the
sponsorship of Hudson Headwaters.)
The ages of the participation at the clinic ranges from 17yrs. – 60 yrs. (teenagers-elderly)
The clinic remains a valuable resource to the community and to those in need of services.

Page | 49