MEETING PACKET DECEMBER 2017 DECEMBER 2017
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"t FLOOR Pub&Hean
Prevent.Promote.Protect.
(978) 741-1800 FAX(978) 745-0343
KIMBERLEY D2011 DECI.I -6 � Iramdin&salem.com
LARRY RAMDIN,RS/REHS,CHO,CP-rS
MAYOR CITY CLERK HEALTH AGENT
SALEM.11ASSNOTICE OF MEETING
You are hereby notified that the Salem Board of Health will hold its regularly scheduled
meeting Tuesday,December 12, 2017 at 7.00 PM
City Hall Annex 120 Washington Street Room 313
MEETING AGENDA
1. Call to order
2. Approval of Minutes Q
0
3. Chairperson Communications
4. Public Health Announcements/Reports/Updates pop co
a. PHN Report c �_j
b.. Health Agent m
c. Administrative m
d. Council Liaison Updates �j 3
en
5. Discussion of the Health Department's budget request for next year- Board to discuss 4 = c
budget priorities for FYI O O 10
Ui
C O O
G. Board of Health program planning &city health status discussion
a. Larry Ramdin- Role, function, authority and scope of the Board of Health
b. Kimberly Waller- Salem-specific data presentation o Sri
00
7. New Business/Scheduling of future agenda items U `-
• Items that could not be anticipated prior to the posting of the agenda O W) _
C = O
y 60++
V
!- L) ev tq
Larry Ramdin, Health Agent
cc: Mayor Kimberley Driscoll, Board of Health, City Councilors
Next regularly scheduled meeting is January 9, 2018 at 7:00pm at City Hall Annex,
120 Washington Street Yd Floor Room 313.
Know your rights under the open meeting law MGL chapter 30A ss 18-25 and City
Ordinance section 2-2028 through 2-2033
CITY OF SALEM
• BOARD OF HEALTH
MEETING MINUTES
November 14, 2017
MEMBERS PRESENT: Paul Kirby, Chair, Dr. Jeremy Schiller, Mary Lauby,Nancy Crowder, Kerry Murphy
EXCUSED: Beth Gerard, Council Liaison
OTHERS PRESENT: Larry Ramdin, Health Agent, Suzanne Darmody, Public Health Nurse, Maureen Davis,
Clerk of the Board, Kimberly Waller, Salem State University
TOPIC DISCUSSION/ACTION f
1. Call to Order 7:01pm
2. Approval of Minutes K. Murphy motioned to approve minutes with correction on
(October 10, 2017) page 3 of typo of:"tics" corrected. N. Crowder 2"d. All in favor.
k
Motion passed
1
df•
3. Chairperson Communications P. Kirby'sliar_ed an emaW'from Mary Wheeler regarding the syringe
exchange program. There are currently no new funds available,but
Healthy Streets will--"still go forward with the program for us using
existing services.
• T`Ramdm said police department approval is a matter of courtesy and
he does not anticipate=any objections to the program.
J. Schiller said he would like Narcan administration data, including
the number of overdoses and deaths.
W `used towet t ehat'data because of the opioid coalition meetings,but
`there.has been a shift in`strategy now. There was a Town Hall
meeting with mayors from a few communities. Report just came out
last week _,.Still needs to meet with the directors of Peabody and Lynn
to discuss the outcomes. Changing the whole focus from a reporting
meeting to break up into interest groups to focus on destigmatization,
awareness and treatment.
L'` .Tamdin will send a letter to Chief Butler requesting data on Narcan
f146drninistration and deaths.
4. Monthly Reports-Updates
a. Public Health S. Darmody reported lots of flu clinics. She went out with Denny
Nurse's Report from Healthy Streets and Officer Vaillancourt to give flu shots to the
homeless.
The reported suspected mumps case was negative.
P. Kirby asked how contagious are mumps.
S. Darmody said it is spread by droplets of saliva and mucous
membranes, much like a cold.
K. Murphy asked if the mumps vaccination wears off.
S. Darmody said it can - every person is different.
M. Lauby asked what is discussed at the Emergency Preparedness
meetings.
S. Darmody said they discuss many things, like funding, planning flu
clinics, trainings, programs, i.e. Mary Wheeler has come to one of the
meetings.
L. Ramdin added they discuss common responses to how we are
going to support each other in emergencies such as hurricanes,
emergency dispensing, etc. We do site set up drills. Prepare for food
and shelter response to winter storms, etc. Each different type of
emergency requires a different response.
Lyme season never stops.
M. Lauby asked what is the flu-season prediction.
S. Darmody said there is a higher incidence than in the past couple of
years. Tracking up a little:;faster'tfian last year at this point.
K. Murphy asked if theylknow if the'vaccine matches whatever strain
is out there.
S. Darmody said she just saw that they were seeing A-strains. There
are two A-strains". `the vaccine,but they don't>know exactly which
ones. H1N1 is an A*strain. Encouraging everyone to get the flu shot.
Cop:`available at the BOH office
b. Health Agent's L. Ramdm reported on his sit
e visit to Northwestern University on
Report October 29, 31 as,part_of their reaccreditation.
In Orange C¢unty, California he moderated two sessions and
• presented on Elie.use of_tfi`e food code'for non-environmental health
T` professionals on�tle prevention ofoodborne illness. It was both well
attended and well received. It was a room full of epidemiologists and
.,they now understaid'what we do on our side.
The new hotel on Essex;Street is not ready. We will issue a food
f permit for tli&first Aoor,but the roof and the basement are not ready.
They"wanted an inspectionto get advice. No major issues.
=M. Lauby,;asked how we can begin to assess Councilor Famico's
noise complaint possibilities.
L. Ramdin said we must first look at the surroundings— is it business
or re§idential, wind direction, etc. For example, the hotel built
housing around their evaporator units to buffer the noise.
r1V1 Lauby asked for an update on the Washington Street/Mill Hill
hotel project- Hampton Inn.
L. Ramdin reported the project is on hold for now due to design
issues.
Construction will begin soon on the old district court building. There
will be residences on top, shops on street level and parking
underground.
Former Jimmy John's on Lafayette Street will be a bakery. Still has
some work to do.
Mr. Crepe(former Melita Fiore) on Washington Street near main City
Hall should be up and running in a couple of months.
Village Tavern remodel—we had to make sure his kitchen could
support the additional seats he added. It did.
Problem trash areas, such as dumping behind the Moose along the
tracks and a few other places. We have a few cameras set up around
town. Janet Mancini downloads the pictures and reviews them. We
need to go over 1,500 pictures per location. We will ticket violators.
The departments at the Annex are moving up the street across from
City Hall in March. We are being taxed for time and resources right
now. We have a week to get most of our files ready for digitizing.
We are also getting trained on a new phone system. Asked the IT
department to retain the direct lines for the inspectors and the entire
office because we need to have those for contact. It is a great phone
system.
L. Ramdin has to write a letter_to;the building inspector because the
Red Lion Smoke Shop downstairg`from our new location across from
City Hall has a smoking roomwhich can put people in the offices
upstairs at risk for health-issues-Vch as asthma and other respiratory
issues related to secondhand smoke;aincluding predisposition to
cancer. They should have a better ventilation system.
The Public Health:Committee proposed sliding scales for certificates
of fitness fees for,first; second and third inspections done on the same
w
day. That would not work because each inspection is unique, so he
asked,to.have that section-stripped and they did. Another section was
about the director of inspectional services deeming someplace a
problem.property;and he had them add in "or the Board of Health
agent"because the certificate of fitness ordinance is a Board of Health
}.ordinance `-We are the ones.empowered to enforce it.
k-Copy available at the BOH office
c. Administrative Reports were distributed showing the number of temporary permits
Report issued vs,cost of overtime for fiscal years 2016, 2017 and 2018 (thus
T.-Schiller stated it is a very strong bargaining chip for the budget for
next year.
L. Ramdin,asked for an additional $2,000.00 from free cash for
overtime:.It's on the council agenda for Thursday and he has no
reason to doubt that it won't be granted.
N Crowder wondered if that will be enough to get us through June.
r,Schiller said we lowered the fee dramatically, anticipating the
number of food permits would go up and they went up 600%, which
Ti
:.really is a boom for the City. That was the whole point of doing it.
It's more exciting because there's more stuff going on. We should be
requesting the budget increase based on these numbers.
P. Kirby suggested at the next meeting we consider a draft letter to the
Mayor.
M. Lauby said the letter will also serve as an update for the Mayor on
the status of the permits since lowering the fees.
Copy available at the BOH office
• d. City Council Beth Gerard not present.
Liaison Updates
N. Crowder motioned to accept the reports. M. Lauby 2"d•
All in favor. Motion passed.
•5. Board of Health Program
Planning& city health status
discussion
a. Continue discussions with Dr. Kimberly Waller suggested, with regard to budget talks, we think
Kimberly Waller, Salem about cost-effective ways to utilize all departments to accomplish
State University, on how common goals.
best to approach She looked up data about health and social issues in Salem. It was a
health/social issues lot of work,but she now has sorre'sense of what's out there and
would like to help us prioritizessues.
She sent P. Kirby the new.N verPoint document about data review
she showed at the meeting: .,
She proposes a 3 to 5_year strategy with both short and long-term
goals to give the city;a' compass to better health.
We should compare`what other cities have-done or are doing.
It was a lot more challenging to find data online specifically for
Salem.
M. Lauby stated that L-Ramdin'had sent the Board some data.
L. Rarndin;said there is data:out there.
K. Waller said rt would be gre�t;to pool data on our website so it
would beFeasierf for people to find"
• She found that m Essex County, mental illness and substance abuse
f `mortality is greater than 1ri both,MA and nationally.
Thereis data for gateway cities:;Cities apply to be a gateway city—
state funding is available to those cities. Salem is one of 28 gateway
cities ';Compared to the other gateway cities, Salem did not do well
'with ob6ity yasthma, cardiovascular disease and high school
education attainment.
K Waller did some"interviews with Clark University, North Shore
di enter and City Connects.
There is lots;of data on the opioid crisis.
Homelessness is an issue. Transient homeless a bigger issue.
N. Crowder spoke of scattered sites for homeless families too large
for other shelters. Landlords rent apartments to agencies for larger
families to be able to stay together. Homeless data is skewed because
some homeless families were housed in shelters in Peabody.
We need cross sector collaboration with schools, North Shore
Medical Center, Salem State University, etc.
P. Kirby suggested as a next step, each member can take a close look
and pick out an area they could each individually pursue and maybe
get a grant to do. Without funding it is hard to do anything.
L. Ramdin said that is why he has requested a public health programs
specialist to look at how we address these things and what is our role
• as a Board of Health and what projects we can work around this.
M. Lauby feels health disparities are not included in the data, so she is
not ready to decide her priority.
K. Murphy is meeting with K. Waller and will share that data with her
as far as health disparities.
J. Schiller said this is a great start to help us with the vision of the
• Board.
N. Crowder feels we are months away from being able to decide. She
would like the staff to be part of deciding the priorities.
K. Waller suggested next steps to have interviews with councilors,
etc., to see what they feel are top issues.
She also feels we need to find out if other gateway cities were using
grants or existing budgets to get things done.
She thinks by May, June or July we should be able to decide priorities
and plans.
K. Murphy said Mass in Motion's-'Community health assessment must
be done by December.
L. Ramdin said he provided;a:foundation with the Salem-specific
community health assessment a couple of months ago.
N. Crowder would love to have the newly elected Latino councilor-at-
large and school committee members,bepart of the data gathering
process.
L. Ramdin said it ere..are a lot of unsaid thirigsAhat we do and we are
aware of the consequences of tho;'se. For example, residents of rental
housing,are afraid to c6ffiplaid and lose their housing or have
problemsiWith immigration, so they live in sub-standard conditions.
He feel's the eoinmittee's new;certificate of fitness policy for a three-
year cycle of inspections will address these issues.
--N. Crowderz aid homeless.program'system is working, but not great.
• M Lauby feels we would be better prepared to handle other issues.
K tWaller said what is the cntera`for prioritizing issues—perceptions
and high visibility'?:She can help coordinate, dig deeper into issues.
She.teaches at SalemState University and will be able to utilize
interns'from`-her health-policy class in the fall to help compile data.
M. Lauby requestedanother data dive. She will email our data to K.
Waller-to compile
6. New Business/Scheduling of future - K. Waller to return in December.
agenda items Draft a budget letter to the Mayor. L. Ramdin asked to
include the need for a program specialist who could also help
and work with K. Waller.
7. MEETING ADJOURNED: M. Lauby motioned to adjourn the meeting. K. Murphy 2"d.
All in favor. Motion passed.
9:20pm
Respectfully submitted,
Maureen Davis
Clerk of the Board -
• Next regularly scheduled meeting is Tuesday,December 12, 2017 at 7:00Pm
At City Hall Annex, 120 Washington Street,Room 313, Salem,MA
iASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH I BUREAU OF ENVIRONMENTAL HEALTH
CHANGES TO THE LEAD REGULATIONS FOR
PROPERTY OWNERS AND CONTRACTORS
The Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention
Program (CLPPP) has amended its Lead Poisoning Prevention and Control Regulation.
Notably, the new regulation amends the definition of"Accessible, Mouthable Surfaces" and
creates a new type of lead hazard, both of which impact the number and type of surfaces
which must be de-leaded. Details of these and other policy changes are found below.
Please refer to our website or contact CLPPP at 800-532-9571 with any questions.
When Do the Changes Go into Effect?
• All changes go into Effect December 1, 2017
• Deleading work that began before December 1, 2017 can be completed to the
abatement standards in place,at the time of the deleading notification if:
1. The submitted deleading notification includes the "start work date" prior to
12/1/17; and
2. The work is completed and passes a final deleading re-inspection on or
before January 1, 2018.
What are the Changes to Deleading Requirements?
• Accessible, Mouthable Surfaces
o The following must be deleaded:
■ Window sills that are 5 feet or less from a floor, stair tread, or ground
■ Hand rails and railing caps
o Surfaces like baseboards, door and window casings, and outside corners of
walls that are in good condition no longer require deleading:
• Friction Surfaces
o Doors (edges), door jambs, and stair treads are lead hazards. They must be
deleaded at all points of potential friction where the components meet. Stair
treads need to be abated in their entirety from the balusters to the wall — or
• they can be covered.
• What are the Changes to Acceptable Deleading Methods and Re-
inspection Requirements?
• Encapsulation: Can now be used for Exterior Accessible, Mouthable Surfaces if:
1) The existing paint or coating is well adhered and
2) The surfaces assessment requirements are met.
• Repainting/Sealing: Floors where loose lead paint was made intact for compliance
must be repainted and pass a dust wipe sample (alternatively, these surfaces can be
covered).
• Coating Removal Using Chemicals: All doors and woodwork where chemical
stripping, including off-site dipping, was utilized, will now be subject to re-inspection
to ensure that the components are repainted prior to occupancy.
Oureau of Environmental Health Updated October 20,2017
Massachusetts Department of Public Health
250 Washington Street, 7th Floor
Boston, MA 02108
Phone:617-624-5757 l Fax:617-624-5183 1 TTY:617-624-5286
www.mass.gov/di)h/environmental health �F"'"�9c�
OF.
•
MASSACHUSETTS DEPARTMENT OF OF - •
CHANGES TO THE LEAD REGULATION FOR
PEDIATRIC HEALTHCARE PROVIDERS
The Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention Program CLPPP
P 9 9 (CLPPP)
has amended its Lead Poisoning Prevention and Control Regulation which will go into effect December 1,
2017. Notably, it lowers the blood lead level in the regulatory definition of Lead Poisoning, establishes a new
Blood Lead Level of Concern category, and institutes additional screening guidelines for these blood lead
levels. Details of these and other changes are found below. Please refer to our website or contact CLPPP at
800-532-9571 with any questions.
How Will this Affect your Practice?
• Mandatory Screening Schedule Remains the Same
o Screen all children at 9-12 months and again at ages 2 & 3
o Continue to screen children 4 and over if High Risk
■ Lives in a High Risk Community: A list of these communities can be found at:
mass.gov/dph/clppp: "Lead Research and Statistics"
■ Lives in a High Risk Environment: Other poisoned children in the same home or pre-
Chan homes under renovation
• Changes to Regulatory Blood Lead Level Categories
o . Lead Poisoning: Venous Blood Levels>_ 10 pg/dL (reduced from 25 Pg/dQ
o Blood Lead Level of Concern: Venous Blood Levels 5 to <10 pg/dL (new regulatory category)
• Changes to Screeninq and Reporting Thresholds
o Capillary tests z 5 pg/dL now require venous confirmatory re-screening (recommended within 2
months)
o Continue to report all Blood Levels to CLPPP
■ BLL 10 pg/dL or greater(reduced from 25 Ng/dQ: Report within 3 business days of
testing
■ BLL < 10 pg/dL: Report within 7 business days of testing
o Provide parents/guardians with proof of screening for entry into daycare and pre-K programs in
addition to kindergarten.
Bureau of Environmental Health Updated October 20,2017
Massachusetts Department of Public Health
250 Washington Street, 7th Floor
�oston, MA 02108
hone:617-624-5757 1 Fax:617-624-5183 1 TTY:617-624-5286 ten,OF
www.mass.gov/dph/environmental health
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• From: Mary Wheeler [mwheeler@healthinnovationsinc.com]
Sent: Tuesday, December 12, 2017 11:22 AM
To: Mary Butler; Larry Ramdin; Suzanne Darmody; Paul Kirby; Kim Driscoll; Susana Medeiros
Subject: Syringe Services
Hello everyone!
Wanted to pass along a quick SSP update and a question about next steps. We have done one
home visit so far and one walking route but we didn't see anyone. I am thinking that this is the
best practice for the city,just walking and home visits as people call us. I don't feel the van is
necessary, I don't think we would see folks and I think keeping the services as quiet as possible
will be best for the clients and community. Thoughts on that?As for testing we can bring our
supplies right into homes and do it that way. At this point we are only planning to do the SSP
outreach 2 days a week and if people call us for a home delivery one of the staff will try to
accommodate.
Do we want to set up a meeting to talk further or would you like to set a date a few months out
for us to present at the BOH meeting? I know other providers have mentioned the service to
me but at this point I have just let people know that BOH approved it, MDPH approved us and
we are going to start up. I am trying to just keep it within this group for now and when we are
all comfortable we can spread the word among providers who have clients that may benefit
• from the service.
Thanks all!
Mary
Mary Wheeler
Program Director
Healthy Streets Outreach Program
A program of Health Innovations Inc.
100 Willow Street 2nd Floor
Lynn, MA
01902
Cell: 339-987-2388
Office: 339-440-5633
Fax: 339-440-5653
• Salem Board of Health
120 Washington Street,41h Floor
Salem, MA 01970
December 12,2017
Mayor Kimberley Driscoll
Salem City Hall
93 Washington Street
Salem, MA 01970
Dear Mayor Driscoll,
We are writing to you as a Board to discuss the upcoming FY 19 budget request for the Salem Health
Department. As you know,the Board has taken steps to modernize the fee structure for temporary
food permits, in response to the increasing popularity of"pop-up" food events within Salem's vibrant
culinary scene. The Board reduced the fee from $300 to$35. One major effect of the fee reduction,
which we anticipated and discussed with you,was that it would lead to increased pop-up activity, and
therefore to an increased workload for the Department's staff.
We were pleased to hear recently that the City Council approved an emergency supplemental budget
request in the amount of$2,000 to the Department's overtime account, to help defray the costs
associated with the increased pop-up activity(much of which takes outside of normal Department office
• hours). We very much appreciate the Council's willingness to take this step. However,we would also
request that, during the upcoming budget process, consideration be given to permanently increasing the
annual allocation to the Department's overtime account,so that future emergency supplemental budget
requests can be avoided.
In addition,we ask that funding be added for two other positions within the Department.The first is a
Public Health Program Specialist position.This position would coordinate grant-funded programs,which
are an increasingly important source of funding for innovative,forward-thinking programs and initiatives
in public health.As a Board,we have begun a planning process,working with an outside expert(Dr.
Kimberly Waller of Salem State University)to identify areas of concern within the city's public health
profile and strategize ways that the Board and the Department can meaningfully impact these areas.
Given the existing budget constraints,we anticipate that the Department would need to seek
extramural funding in order to pursue-any new initiatives. A Public Health Program Specialist would be
tasked with developing new funding proposals as well as managing existing grant-funded programs. The
second position we recommend being added to the Department's budget is an additional Health
Inspector,to deal with the additional workload created by the recent changes made by Council to the
Certificate of Fitness program. (NOTE—need additional details here)
Thank you for your consideration of these requests.We would like to formally invite you to attend a
Board meeting in the near future to discuss further, and will coordinate with your office to check your
availability. Finally,we appreciate the strong support you have given to the Department and the Board
as we work to promote public health in Salem.
• Sincerely,
Suzanne Doty RN BSN
Salem Board of Health
Public Health Nurse
Public Health Nurse Report
Reporting on November 2, 2017 through December 1, 2017
Disease Prevention and Health Promotion
• Investigated reportable diseases and reported case information to MDPH.
• Coordinating follow up with North Shore Pulmonary Clinic on tuberculosis cases.
• Continually recording and submitting refrigerator temperature logs, flu doses and clinic
information into the Massachusetts Immunization Information System(MIIS) for up to
date vaccine records and better continuity of care between clinics and providers.
• Posted Facebook, Twitter and Instagram posts regarding the third annual Walk for
Opiate Awareness and preventing blood clots during travel during holiday travel. Flu
vaccine week is 12/3-12/9 which will be reflected on social media.
• On site clinics dates scheduled for
Police on November 8th(2 sessions)- 21 vaccines given
Fire on November 8,9,15 and 20th-23 vaccines given
DPS November 281h—6 vaccines given
School staff clinic to be held December 19th
Meetings/Trainings
• Next session with Diane Dube, nutritionist, is being held on December 6t" for helpful tips
and recipes for the holidays.
• The final seed money of$1000 from Working on Wellness was received.
• Attended the NSPHN meeting on November 71h where we all provided update on flu
clinics, discussed the new Shingles vaccine and arranging for a representative to come to
a meeting, questions we have received regarding Narcan and purchasing it in bulk, the
cancer registry in response to a call received by the Hamilton nurse, and on-going
questions and issues faced with communicable diseases and guidance with
MDPH/schools.
• Met with owners of a prospective permanent make up establishment in Salem on
November 14th, provided guidance on the regulations and requirements to obtain the
necessary permits.
• Attended the Northshore Cape Ann Emergency Preparedness meeting on November 29t"
for collaborations with health agents and nurses from surrounding towns for emergency
preparedness and current events. Each town is currently working on 4 documents to be
submitted to meet required deliverables. These include documentation forms for the
Emergency Dispensing Site set up drill, site activation and staff notification which were
drilled during our large flu clinic. An After-Action Report and Improvement plan is being
submitted as well.
• Marliyatou Diallo, A Salem State University RN to BSN student is continuing her
clinical hours, she will complete 70 clinical hours by mid-December.
Monthly Report of Communicable Diseases: November 2017
Disease New Carry Over Discharged/ Total# Of Running Total for Total for
Reported Cases this Total for 2016 2015
Closed Month 2017
Tuberculosis 0 1 0 1 2 4 4°
(Active)
Latent 1 0 1 1 37 31 47
Tuberculosis*
Arbovirus* 0 0 0 0 0 0 0
abesiosis 0 0 0 0 0 0 1
Calicivirus/No 0 0 0 0 1 0 1
rovirus
Campylobacte 1 0 1 1 2 15 11
riosis
Chikungunya 0 0 0 0 0 0 0
Dengue* 0 0 0 0 0 0 0
Ehrlichiosis 0 0 0 0 0 0 0
Enterovirus 0 0 0 0 0 0 l
Group A 0 0 0 0 3 0 4`
Streptococcus.
Group B* 0 0 0 0 4 2 7
Streptococcus
! ,
Disease New Carry Over Discharged/ Total# Of Running Total for Total for
Weported Cases this Total for 2016 2015
Closed Month 2017
Human 0 0 0 0 0 1 1
Granulocytic
Anaplasmosis
Haemophilus 0 0 0 0 3 2 1
Influenzae
Hansen's 0 0 0 0 0 0 0
Disease
Hepatitis A 0 0 0 0 0 0 0
Hepatitis B* 0 0 ' 0 0 4 8 0
Hepatitis C* 3 0 3 3 28 30 29
Influenza* 2 0 2 2 67 19 29
Legionellosis 0 0 0 0 0 2 1
* Lyme 0 0 0 0 0 0 2
Disease*
(0) (0) (0) (24) (27**)
(Probable)
Malaria 0 0 0 0 0 2 0
Measles 0 0 0 0 0 1 0
Meningitis 1 0 1 1 1 0 0
Mumps 0 0 0 0 0 1 0
Pertussis 0 0 0 0 0 1 1
Salmonellosis 0 0 0 0 8 11 6
Shigellosis 0 0 0 .0 0 3 0
Streptococcus 2 0 2 2 5 8 3
Pneumoniae*
Varicella* 0 0 0 0 0 1 0
Vibrio 0 0 0 0 0 1 0
Disease New Carry Over Discharged/ Total# Of Running Total for Total for
eported Cases this Total for 2016 2015
Closed Month 2017
West Nile 0 0 0 0 0 0 0
Yersoniosis 0 0 0 0 0 0 1
Zika Virus 0 0 0 0 0 1 0
Infection
Total 10 1 10 11 165 204 140
November 2017
*Notifications only, LBOH not required to follow up or investigation per DPH.
**Total reflects cases that have also been reported as suspect cases.
All Communicable disease totals above are subject to change in the event that the follow-up investigation
results in the revocation of the diagnosis.
• Yearly totals for 2016 have been updated for year end with the number of CONFIRMED cases.
Summary of Current Communicable Diseases
Tuberculosis:
Active Case 1:
I was contacted on August 24"'regarding an active case of Tuberculosis infection in a Salem resident.
This resident has started the appropriate antibiotics and discharged home. Direct Observed Therapy
(D.O.T.)has begun and consists of home visits 5 days per week during the course of treatment which is
typically 9 to 12 months.
In the meantime, 20 close and household contacts have been identified. I have been completed
Tuberculosis testing on all of these contacts and placed referrals to the North Shore Pulmonary Clinic.
However, on October 11"'those case moved to another town and no longer is a resident of Salem. I
notified the MDPH Tuberculosis nurse overseeing our region who was able to have D.O.T. continued at
the new residence. I reported off to the new case manager and this case is now closed in Salem.
•
• Active Case 2:
As part of the follow up contact investigation, all patients with positive PPDs (tuberculosis skin tests)
were referred to the NSMC pulmonary clinic for chest x-rays. This case had an x-ray suggestive of
Tuberculosis in conjunction with a large positive skin test. Medications and D.O.T. has been started 5
days per week. Sputum samples are pending final results for 60 days. However, the patient is smear
negative for acid fast bacilli and is not considered contagious. This patient will continue to be treated by
NSMC. D.O.T. and medication management has been continued until treatment in completed. A follow-
up chest x-ray showed improvement while on the Tuberculosis treatment. A second round of contact
testing is currently being completed.
Suspect Mumps:
Case 1: This case presented with facial swelling and was withheld from work and isolated at home for 5
days with a suspicion of possible Mumps. They were vaccinated in the past and had no known contact
with any persons with Mumps or any high-risk groups. Information was provided to their work place and
follow up with their family was done to prevent further spread. A buccal swab test result was negative
however the accuracy of these tests is no high enough to rule out the diagnosis. The patient has since
recovered and returned to work.No further cases have resulted.
Campylobacteriosis:
Case 1: This came became ill while they were traveling outside of the country. Their Primary Care
Physician treated them when they returned home. They have an administrative occupation and are not
• involved in supervised care or food handling. The patient has since recovered and this case is now closed.
Meningitis:
Case 1: This case became ill with flu like symptoms and required EMS to transport to the hospital when
they developed neurological symptoms. They have been treated and stabilized at a hospital in Boston.
They have no known contact with any ill persons and all close contacts, medical personal and first
responders were treated prophylactically. The Nisseria Meningitis strain was identified as a C-strain,
which is covered in the Menactra vaccine. There are no further cases in Salem. Per MDPH this case is
completed and closed.
•
• Health Agent report November 2017
Announcements/Update
• New Childhood Lead Poisoning Regulations will take effect on Friday December 1. The
regulations lead poisoning is categorized as Venous Blood Levels> 10 µg/dL (reduced
from 25,ug/dL) and Blood Lead Level of Concern: Venous Blood Levels 5 to <10
µg/dL (new regulatory category). I have included in the packet a summary of the
changes.
• The City Council passed the amended Certificate of Regulations on November 16 and
second passage is expected to be approved at their meeting on December 7, 2017.
• City Council approved an increase of$2000.00 in the Department's overtime budget.
• I will be proceeding on vacation out of the country from December 15- January 8. In my
absence Jeff Vaughan, Health Director Swampscott, and other local Public Health
Directors will be available to provide advice in the event of an emergency. Lisa
Cammarata, Human Resources Director, will provide personnel issue support.
Community Outreach
• I did an interview with an MPH student who was working on a paper that discussed
• climate change and Public Health impact.
• A Salem State University Healthcare Studies student shadowed me for a few hours on
November 30 shadowed for a class assignment.
Meetings and Trainings
• Larry Ramdin and Elizabeth Gagakis attended Lead Determinator Refresher Training that
discussed the new Lead Regulations and included a refresher on Lead Determination
processes.
• The Environmental Health Team and the Health Agent attended the Food Sanitation,
Food Inspection Tools and Regulating Cannabis Foods MEHA Seminar. They discussed
Marijuana in Food products and how it is regulated in Denver Co, Health inspection
processes and inspection equipment.
• 1 attended the 2017 Integrated Foodbome Outbreak Response and Management
Conference. I presented at one of the sessions on Food Code for non-environmental
health professionals and moderated 2 sessions. The conference focused on Foodborne
illness outbreaks, investigation and prevention strategies.
• Staff Attended Civility and Inclusion training sponsored by the HR Department
•
• Environmental Health Activities
Inspections
Item Monthly Total YTD 2016 Total
Certificate of Fitness 26 365 506
Inspection
Certificate of Fitness 0 46 42
re-inspection
Food Inspection 13 232 241
Food Re-inspections 10 81 , 31
Retail Food 1 32 17
Inspections
Retail Food 1 13 12
• re-inspection
Temporary Food 7 232 48
General Nuisance 0 32 26
Inspections
Food— 0 0 2
Administrative
Hearings
Housing Inspections 7 86 94
Housing re- 1 43 25
inspections
Rodent Complaints 2 45 24
Court 1 3 3
Hearings/filings
•
• Item YTD 2016
Trash Inspections 42 857 574
Orders served by 2 3 3
Constable
Tanning Inspections 0 0 0
Body Art 0 0 0
Swimming pools 0 22 9
Bathing Beach 0 123 108
Inspection/testing
.Recreational Camps 0 6 6
•
Lead Determination 0 1 2
Septic Abandonment 0 2 0
Septic System Plan 0 0 0
Review
Soil Evaluation 0 0 0
Percolation tests 0 0 0
Total 108 2210 1699
•
Health Dept. Clerical Report FY 8
BurIal Permits CertPermits Plan Reviews Fitness
$5icate o Copies / Fines Revenue Permit Fees
July-1 7 $900.00 $4,350.00 $630.0.0 $1,800.00 $300.00 $7,980.00 Food Service Est. <25 seats $140
August $700.00 $1,670.00 $270.00 $1,500.00 $4,140.00 25-99 seats s28o >99 seats $420
September $900.00 $4,530.10 $270.00 $2,350.00 $200.00 $8,250.10 Retail Food <l000sq' s7o
October $100.00 $2,910.80 $540.00 $1,550.00 $5,100.80 1000-10,000 $28o >io,000 $420
November $1,075.00 $10,620.00 $90.00 $1,450.00 $50.00 $13,285.00 Temp.Food 1-3 days s3s
December $0.00 4-7 days s70 >7days s
January-18 Example of>7 day temp food permit:
$0.00 14(days)divided bY7=2 x s70=$140
February $0.00 Frozen Desserts $25
March $0.00 Mobile Food $210
April $0.00 Plan Reviews New s18o
Ma $0.00 Remodel $go.
June Catering $25 pereventl$200
$0.00 catering kitchen
Body Art Est. $31s
Total $3,675.00 $24,080.90 $1,800.00 $8,650.00 $550.00' $38,755.90 Body Art Practitioner si35
Review Plans s18o
Fiscal Year Budget 2018 Suntan Est. $140
Rec.Day Camp $10
Salary $tartinq Ending Expenses Ext.Paint Removal $35
Full Time $412,115.00 $265,160.27 Starting Ending Transport Off.Subst. slo5
Part Time $43,354.00 $31,267.31 $32,500.00 $18,041.60 Tobacco Vendors $135
Overtime $2,000.00 $1,555.75 Swimming Pools Seasonal $140
Balance $457,469.00 $297,983.33 Health Clinic Revolving Account Annual$210 Nonprofit$40
S9,437.73 Title V Review s18o
Well Application $180
Disposal works $225118o
• •
Breakdown of Permits and Fines
November 2017
Permit Description Total Permits Issued Permit Cost Total
Annual Food - Non-Profit 6 $25.00 $150.00
Annual Food - Hotel 1 $100.00 $100.00
Annual Food - <25 seats 6 $140.00 $840.00
Annual Food - 25-99 seats 13 $280.00 $3,640.00
Annual Food - >99 seats 6 $420.00 $2,520.00
Annual Food - Retail <1,000sq' 2 $70.00 $140.00
Body Art Establishment 1 $315.00 $315.00
Body Art Practitioner 2 $135.00 $270.00
Burial Permit 43 $25.00 $1,075.00
Catering 2 $25.00 $50.00
Certificate of Fitness 29 $50.00 $1,450.00
Exterior Paint Removal 3 $35.00 $105.00
Frozen Dessert 2 $25.00 $50.00
Hotel/Motel 1 $200.00 $200.00
Plan Review- Remodel 1 $90.00 $90.00
Pool 1 $210.00 $210.00
Temporary Food - Pop Up (1-3 days) 11 $35.00 $385.00
Temporary Food - Pop Up (1-3 days)- Non-Profit 1 $25.00 $25.00
Ticket Violation 1 $50.00 .$50.00
Tobacco 12 $135.00 $1,620.00
Total $13,285.00