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MEETING PACKET FEBRUARY 2017 �FEBRUARY 2017 . �� �" 4 u CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH � Lv 120 WASHINGTON STREET,4�'FLOOR ,.rrere� Promote,Protect. TEL. (978) 741-1800 FAx(978)745-0343 KIMBERLEY DRiscOLL lramdin@salem.com LARRY RAMDIN,RS/REVS,CHO,CP-F; MAYOR HEALTI-I AGENT NOTICE OF MEETING You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting Tuesday February 14, 2017 at 7:00 PM City Hall Annex 120 Washington Street Room 313 MEETING AGENDA 1. Call to order 2. Approval of Minutes 3. Reorganization of the Board te ' 4. Chairperson Communications � 5. Public Health Announcements/Reports/Updates a. PHN Report - b. Health Agent , C. Administrative c - . > d. Council Liaison Updates 6. Syringe exchange program—Board will discuss approval of Syringe exchange programs in keeping with MGL Chap l s 215. 7. Continue discussion on banning smoking-in public parks and beaches 8. New Business/Scheduling of future agenda items • Items that could not be anticipated prior to the posting of the agenda Larry Ramdin Health Agent cc: Mayor Kimberley Driscoll, Board of Health, City Councilors Next regularly scheduled meeting is March 14, 2017 at 7:00pm at City Hall Annex, 120 Washington Street 3'd Floor Room 313. Know your fights under the open meeting law MGL chapter 30A ss 18-25 and City Ordinance section 2-2028 through 2-2033 This notice posted on ,Office I Bulleti ard" City Hall, Salem, Mass. on . 0o�� at 1, ;-!in accordance with MGL Chap. 30A, Sections 18-25. CITY OF SALEM BOARD OF HEALTH MEETING MINUTES January 17, 2017 • DRAFT MEMBERS PRESENT: Paul Kirby, Chair, Nancy Crowder, Mary Lauby, Jeremy Schiller &Janet Greene OTHERS PRESENT: Larry Ramdin, Health Agent, Suzanne Doty, Public Health Nurse, Heather Lyons-Paul Clerk of the Board, &Beth Gerard Council Liaison EXCUSED: TOPIC DISCUSSION/ACTION 1. Call to Order 7:05pm 2. Minutes of Last Meeting M. Lauby motioned to accept the draft minutes with (December 13, 2016) corrections. Dr Schiller 2"d by All in Favor. Motion passed. 3. Chairperson Announcements The Mayor will be stopping by to discuss temporary food permit cost. Dr. Schiller motioned to take the agenda out of order M. Lauby 2"d All in favor motion passed 4. Monthly Reports-Updates A. Public Health Nurse's Working on wellness - Employee wellness activities will Report hopefully start to include presentations by dietitians or nutritionists, offering exercise classes, and health food options into City Hall offices. Copy available at the BOH office B. Health Agent's Report Working on wellness—L Ramdin added he would like to tie in the wellness program with pop ups throughout the city. In discussions with a few establishments that could feature a chef that will make healthy food options. Copy available at the BOH office C. Administrative Report Breakdown the food permit section of the Administrative Report. Copy available at the BOH office Dr Schiller motioned to accept the reports. 2"d by J Greene All in favor. Motion passed. D. City Council Liaison Changes to Subcommittees. Heather Famico is now the Chair of Updates Public Health subcommittee and Beth Gerard is now the Chair of finance. Continuation of discussion The Board is in agreement to reduce the fee. J. Greene posed on temporary food permitting some topics: What is the purpose of fee structure?Is it to process and fee schedule encourage or discourage business?How will public health be impacted by this change. Input from the public and city representative will be helping us to make this final decision. *Opened meeting for public input* Mayor Driscoll The Mayor address the Board. She would like the Board to look at balancing the fee of the temporary food permit application with the surrounding cities and towns' current • fee structures. The fee reduction should be looked at as an investment in city. The current fee is a financial obstacle. With current trends, like pop up events, lowering the fee would make it more financially manageable to hold more events year-round and bring more people to our local establishments. The Mayor would like Salem to remain open to these trends and flexible by not limiting the number of temporary permits an establishment can pull within a year. By working collaboratively on this and being flexible we will be encouraging more economic growth. M. Laubv talked about the fee the Mayor suggested in her letter to the Board and looking at other cities' rates. Those fees would not cover the full cost of inspection according to the breakdown they received in their packets. Mayor Driscoll responded, the number of inspectors that we have are not going to rise and fall based on the number of fees we are collecting. She would like this cost to be affordable rather than trying to cover the overhead cost of the inspection process. Dr. Schiller added that the money that these permits generate does not go to the department's budget it goes into a general fund. P. Kirby asked if the department is not covering its own cost • what is the impact on the department? Mayor Driscoll responded that we value public health and she understands that the department has many facets outside this type of inspection that need to be addressed as well. There is another inspector's position in the building department that will be a shared position and she hopes this will help take off some of the burden of additional inspections that lowering the fee would bring. She would like to talk more about this at a later date or even in a working group. M. Laubv added that in a prior meeting there was a suggestion of a task force to look at emerging trends in the food industry. Asked the Mayor if she would like the Board to put together a group of people in the industry and from the community. Mayor Driscoll would appreciate it if the Board looked into starting a group, formal or informally, to look at these trends. Bill Legault responded to Janet Greene's question about encouraging or discouraging business in Salem. Feels that the Board doesn't have any responsibility towards encouraging or discouraging business in Salem. There are other Boards that have this responsibility. Feels as though this topic doesn't need to be looked at by this board. P. Kirby thanked Mr. Legault for his input. Dr. Schiller In response to Mr. Legault, that this topic was in regards to the public input of the fee being a discouraging factor. Feels the board should look at the positive or negative impact of any fee we have control over. J. Greene—Yes, we should be focusing on risks to public health. We are being asked by the public to use our fee structures to encourage more activity, where before it was being used to discourage because at the time it was helping local business. innovation in the market think about this when setting fees. Chris Lohring�Notch Brewing - Concern about restrictions on • number of permits per year. 1/20 of his businesses is done in bar service and the rest is around the world. By restricting the amount of permits he can pull it restricts the amount of business he can bring into his brewery. Would the Board be restricting private events and public events? Is the restriction going to be based on the location or the vendor? For example, if he has 5 vendors for the Road Race coming up, does that count to the number of permits he'll be able to pull. He is asking the Board to allow them to be competitive with the other breweries around the North Shore. Heather Famico Ward 2 Councilor—thanked the Board for reevaluating the fee. Having a restriction can limit the amount of events businesses would like to have. We need to keep businesses informed about how to handle these events by going through the proper channels Mary Lohring—Talked about the "fear" of bringing outsiders in. She would like to see the fees down for out of town establishments as well because it shows that Salem is welcoming to all. The Board discussed with Larry Ramdin the difference in permitting between catering (closed events) verses pop up events (open to the public). • M. Lauby asked if anyone is looking at the current change in food trends. L. Ramdin said there are some proposals, at the DPH level, for the new Food Code that can permit pop up events without any additional fees however there has to be some discussion with the health department before these events happen. Dr. Schiller asked if the department is being more taxed with food permits. L Ramdin said that this will increase the amount of work that the department will be doing and it will tax an over taxed department. M. Lauby motioned to conceder a $50 temporary food permit fee. Dr. Schiller 2nd Discussion Dr. Schiller would like to acknowledge the Mayor's proposal of $35. Dr. Schiller motioned to amend the original motion to reduce the fee to $35. J. Greene 2nd Discussion on the financial impact of having a reasonable rate. The Board has the ability to change the fee again if this overwhelms the department staff. At this time, the Board and L. Ramdin are in agreement that there should not be a difference in cost for non-potentially hazardous food(NPHF) and potentially hazardous food(PHF). The Board will revisit intown and out of town fees at a later date. The Board would also like to continue discussion of starting a task force or working group at the next meeting. Mary Lauby motioned to amend her original motion that the M fee structure set 1-3 days $35 and the formula that's currently being used will remain the same for additional days. All in favor. Motion passed At this time, there are no limits on temporary food permits per • establishments. The Board will revisit this at a later date. M. Lauby asked if the Board can have a more detailed administrative report that breaks down the amount of money each permit brought in to the department for each month. 6. Discussion on banning Dr Schiller will be contacting someone from SSU campus on smoking in public parks and how they implemented their smoking ban. beaches Heather Famico —residents have reached out to her about banning smoking in public parks near playgrounds and on beaches. She supports doing this and would like to start working on gathering information on how we get started on enforcing this. She would like the police to get involved in enforcing this to if possible. L. Ramdin discussed this with Park and Rec Director about this as well. Would like to start a joint committee discussion on this. If the Board decides to create a regulation, we can permit other departments to enforce this regulation. The Board agrees that a ban is a good idea and going forward will continue discussions on enforcement of this. 7. New Business/ Scheduling of future Continue discussion on banning smoking in public parks and agenda items beaches Board reorganization. • Establishing working group/task force on emerging food trends. 8. MEETING ADJOURNED: Dr Schiller motioned to adjourn the meeting. 2"d M Lauby by All in favor. Motion passed. 9:45pm Respectfully submitted, Heather Lyons-Paul Clerk of the Board Next regularly scheduled meeting is February 14, 2017 at 7pm At City Hall Annex, 120 Washington Street,Room 313 Salem. • Suzanne Doty RN BSN Salem Board of Health Public Health Nurse Public Health Nurse Report Reporting on January 12th, 2017 through February 8th, 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 inputting flu doses and clinic mfonnahon into the Massachusetts Immunization Information System (MIIS) for up to date vaccine records and better continuity of care between clinics and providers. • Added post to the Board of Health Facebook page including information on peak flu season,Norovirus and recent data from Healthy Streets, also posted on our Twitter account as well. Meetings/Trainings • Continued modules and Working on Wellness webinars, the beginning steps of creating a program on wellness for city employees. Submitting on going assignments as plans become more finalized and planning next committee meeting. First round of seed funding of$2,000 awarded on December 15th and is expected to arrive mid-January. Second round of seed funding for$7,000 has also been awarded and is expected to arrive mid- February. • Attended the Salem Overdose and Substance Abuse Awareness Coalition on January 10"' for ongoing efforts to increase prevention and awareness of substance abuse. • Attended the Northeast Public Health Nurses meeting on January 13th for collaboration with nurses in the northeast region as well as an update and information session from the information technologists from the Massachusetts Virtual Epidemiological Network. • Attended the Emergency Preparedness meeting on January 25th for continued collaboration for emergency preparedness with our region. • Met with Larry Ramdin,Mary Wheeler from Healthy Streets and Denny Desrosiers, a peer support specialist,regarding current overdose prevention outreach and discussion on needle exchange programs within the state. • Attended a meeting with the North Shore public health nurses on January 3 1"to collaborate on issues we are seeing within our communities such as food borne illnesses reported and Tuberculosis education and treatment,as well upcoming joint flu press release and diaper drive. • Monthly Report of Communicable Diseases: January 2017 • Disease New Carry Over Discharged/ Total#Of Running Total for Total for ty Reported Cases this Total for 20162015, Closed ) Month 2017 Tuberculosis 0 0 0 0 0 4 (Active) 0.11 Latent 2 0 2 2 2 31 47 Tuberculosis* k Arbovirus* 0 0 0 0 0 0 t 3�y. Babesiosis 0 0 0 0 0 0 -1 n Calicivirus/No 0 0 0 0 0 0 i rovirus Campylobacte 0 0 0 0 0 15 riosis Chikungunya 0 0 0 0 0 0 0 Dengue* 0 0 0 0 0 00 Ehrlichiosis 0 0 0 0 0 0 Enterovirus 0 0 0 0 0 0 � 1 Giardiasis 1 0 1 1 1 6 2 Group A 0 0 0 0 0 0 R Streptococcus ° Group B* 0 0 0 0 0 27 r Streptococcus � ti Human 0 0 0 0 0 1 1 Granulocytic Anaplasmosis Haemophilus 0 0 0 0 0 2 1 hifluenzae Hansen's 0 0 0 0 0 0 0 • Disease epatitis A 0 0 0 0 0 0 Hepatitis B* 1 0 1 1 1 8 0 Hepatitis C* 6 0 6 6 6 30 29 hifluenza* 11 0 11 11 11 19 29 Legionellosis 0 0 0 0 0 2 1 Lyme 1 0 1 1 1 0 2: Disease* (27**) (Probable) Malaria 0 0 0 0 0 2 0 Measles 0 0 0 0 0 1 0 Meningitis 0 0 0 0 0 0 0 Mumps 0 0 0 0 0 1 0 ' Pertussis 0 0 0 0 0 1 1 Rocky 0 0 0 0 0 0 Mountain Spotted Fever Salmonellosis 0 1 1 1 1 11 6 Shigatoxin 0 0 0 0 0 0 0 Producing Organism Shigellosis 0 0 0 0 0 3 0 Streptococcus 0 0 0 0 0 8 3 Pneumoniae* Varicella* 0 0 0 0 0 1 0 Vibrio 0 0 0 0 0 1 0, 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 22 1 23 23 23 204 -'440 January 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 Salmonella(carry over): Case 1: This patient presented with minimal symptoms, they are currently being followed by an Infectious Disease specialist. They were hospitalized and have been treated and since recovered. They are not a food handler or attending/employed in a care setting. Follow up investigation • completed and reported to DPH, case is closed. Giardia: Case 1: This patient was diagnosed by their primary care, follow up with primary care physician, patient treated and recovered. They are not a food handler or working in a supervised care setting. No further follow up required,case is closed. Acute Hepatitis B: Case 1: Per primary care physician, this is likely an acute case.Appropriate follow up and prevention with sexual contacts completed.Data collected for DPH and education done with patient.No further cases have been reported. Zika Virus Infection: 31 cases of Zika Virus Infection previously listed as cases have been revoked after lab tests. In the month of January, there were no new cases of testing and 4 revoked cases. Confirmed Case(June 2016): Case not pregnant at time of diagnosis. Case traveled to Dominican Republic and reported symptoms of fever and rash. r Morbidity and Mortality Weekly Report Notes from the Field Multistate Outbreak of Escherichia coli 0157:1­17 Eighty-eight samples of dry dough mix from five restaurant Infections Linked to Dough Mix— locations where patients reported eating were collected by United States,2016 public health officials in five states(Illinois,Iowa,Minnesota, Laura Gieraltowski,PhD';Colin Schwensohn,MPH';Stephanie Nebraska, and Wisconsin). The Minnesota Department of Meyer,MPH2;Dana Eikmeier,MPH2;Carlota Medus,PhD2;Alida Agriculture identified non-0157 STEC in seven of 17 col- Sorenson,MPH3;Matthew Forstner3;Asma Madad,MS,MPH4;Joseph lected samples, including one Shiga toxin-1—producing non- Blankenship,MPH4;Peter Feng,PhD4;Ian Williams,PhD' 0157 STEC isolate and six Shiga toxin-2 (stx2)—producing On January 4,2016,CDC PulseNet,the molecular subtyp- non-0157 STEC isolates. FDA collected six samples of dry ing network for foodborne disease surveillance, identified a dough mix from manufacturer A.All six samples tested negative cluster of 10 Shiga toxin-producing Escherichia coli (STEC) for STEC 0157:H7,but one yielded an stx2-producing STEC 0157:H7 infections with indistinguishable pulsed-field 08:H28.All identified strains lacked known a'dherence factors gel electrophoresis (PFGE) pattern combinations. STEC and were therefore considered to present a low health risk. infections with the identified outbreak PFGE pattern are Flour is a raw agricultural product and does not undergo pro- commonly reported to PulseNet, with an average of 40-50 cessing to kill bacteria and other pathogens,so it is not sterile. illnesses reported annually. Because this was a relatively com- Generic E. coli and coliforms have been found previously in mon strain of STEC,multiple locus variable-number tandem flour (1,2). Flour and flour-based mixes have been suspected repeat analysis(MLVA),another subtyping technique used to or implicated as the source of other foodborne Salmonella and characterize the genetic relatedness of bacteria, was used to STEC 0157 outbreaks (1,3-6). Of note, this PFGE pattern help define cases in the cluster. CDC collaborated with state was previously isolated from a sample of bulk flour collected and local health and agricultural agencies and the Food and during a 2009 outbreak investigation (5).Although no labo- Drug Administration (FDA) to investigate the outbreak. A ratory evidence identified contaminated flour as the ultimate case was defined as STEC 0157:H7 infection with an isolate source of this STEC 0157:H7 outbreak, the identification having PFGE and MLVA patterns indistinguishable from the of other enteric pathogens in multiple samples of dry dough outbreak strain in a person with diarrheal illness onset during mix consumed by patients associated with the outbreak impli- December 6,2015—February 9,2016. cates contaminated flour as the possible source of pathogen Thirteen STEC 0157:H7 outbreak-associated cases were introduction for this outbreak.The small number of cases and identified in nine states:Iowa(one case),Illinois(one),Kansas the lack of additional restaurant clusters suggest that this was (one),Minnesota(five),North Carolina(one),Nebraska(one), a low level contamination event or that contamination only New Jersey(one),South Dakota(one),and Wisconsin(one). affected a limited amount of product. Evidence obtained at The median age of patients was 17 years(range=7-71 years); one restaurant A location showed that dessert pizzas were made 53%were female.Among 12 patients with available informa- With the same dough mix used in traditional pizzas,but used tion, eight were hospitalized, including two who developed thicker dough and might have been undercooked at some loca- hemolytic uremic syndrome;no deaths were reported. tions.Flour is usually not thought to be a food safety risk,but Among the 12 interviewed patients, nine reported eating at flour-based mixes are ubiquitous in restaurants and are often one of nine locations of restaurant A,a national restaurant chain, used for dusting of surfaces for transfer of pizzas.This outbreak during the week preceding illness onset, including eight who serves as a reminder that consumers,industry,and government ate a specific dessert pizza made with a proprietary dough mix should consider that flour, a raw agricultural product, might provided by manufacturer A.The ninth patient consumed bread be contaminated with pathogens and,when consumed raw or sticks made from the same dough mix.At one Minnesota loca- undercooked,might pose a risk to human health. tion,six of 21 (28%)non-ill patrons reported eating the impli- Acknowledgments cated dessert pizza.Assuming this was representative of patrons of restaurant A,the proportion of cases who consumed dessert Kirk Smith, Kim Carlton, Nicole Hedeen, Samantha Olson, pizza was significantly higher than what would be expected by Vaishnavi Pattabiraman, Carrie Rigdon; Minnesota Department of Agriculture Microbiology Unit; Iowa Department of Public chance using the binomial distribution model(p<0.001).As an Health;Iowa Department of Inspection and Appeals;University of intervention in this outbreak, restaurant A locations stopped Iowa Hygienic Laboratory; Illinois Department of Public Health using dough mix from manufacturer A on February 4,2016. (IDPH); IDPH Springfield Environmental Micro Laboratory; • 88 MMWR / January 27,2017 / Vol.66 / No.3 US Department of Healt�and Human Services/Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report Tazewell County Health Department,Illinois;Kansas Department References of Health&Environment;North Carolina Department of Health 1.New Zealand Food and Safety Authority.Flour batch believed linked to • and Human Services;Nebraska Department of Health and Human Salmonella outbreak.Wellington, NZ: New Zealand Food and Safety Services;Ohio Department of Health;Pennsylvania Department of Authority;2008.http://foodsaferygovt.nz/elibrary/industry/Flour—Batch- Health;South Dakota Department of Health;Tennessee Department Investigations—Into.htm of Human Services;Wisconsin Division of Public Health;Wisconsin 2.Sperber WH; North American Millers' Association Microbiology Working Group. Role of microbiological guidelines in the production Department of Agriculture,Trade and Consumer Protection Bureau and commercial use of milled cereal grains: a practical approach of Laboratory Services;Food and Drug Administration,Kansas City for the 21st century. J Food Prot 2007;70:1041-53. littp://dx.doi. District Office,Missouri. org/10.4315/0362-028X-70.4.1041 3.Zhang G,Ma L,Patel N,Swaminathan B,Wedel S,Doyle MP.Isolation tNational Center for Emerging and Zoonotic Infectious Diseases, CDC; of Salmonella typhimurium from outbreak-associated cake mix.J Food Prot 2Minnesota Department of Health;3Minnesota Department of Agriculture; 2007;70:997-1001.http://dx.doi.org/10.4315/0362-028X-70.4.997 4Food and Drug Administration. 4.Richter KS,Dorneanu E,Eskridge KM,Rao C.Microbiological quality Corresponding author: Laura Gieraltowski, LGieraltowski0a cdc.gov, of flours.Cereal Foods World 1993;38:367-9. 404-639-3868. 5.Neil K,BiggerstaffG,MacDonald K,et al.A novel vehicle for transmission of Fscherichia coli 0157:H7 to humans: multistate outbreak of E. coli 0157:H7 infections associated with consumption of ready-to-bake commercial prepackaged cookie dough—United States,2009.Chn Infect Dis 2012;54:511-8.http://dx.doi.org/10.1093/cid/cir831 6.CDC. Multistate outbreak of Shiga toxin-producing Escherichia coli infections linked to flour.Atlanta,GA: US Department of Health and Human Services, CDC; 2016. https://www.cdc.gov/ecoli/2016/ol2l- 06-16/index.htm] iI I i I I • A I i 1 • US Department of Health and Human Services/Centers for Disease Control and Prevention TWR / January 27,2017./ Vol.66 / No.3 89 Health Dept. Clerical Report FY617 Burial Permits Certificate of $25 Permits Plan Reviews Copies / Fines : Revenue Permit Fees Fitness $50 J u I -16 $475.00 $2,210.00 $1,950.00 $4,635.00 Food Ser'v►ce'Est." , : <25 seats August $700.00 $985.00 $1,500.00 $3,185.00 � 25'99seats s 8o = >ggseats .s42o September $1,475.00 $2,165.00 $4,300.00 $300.00 " $8,240.00 Retail Food <i000sq' $70 October $475.00 $3,415.00 $2,150.00 $6,040.00 100010,000 s28o >1o,000 s42o November $500.00 $7,785.00 $2,150.00 $150.00 fal $10,585.00 Temp'`Food � ,�13days December $700.00 $36,265.00 $700.00 $37,665.00 �� 4 7;gc�a s�►'S600, >j y � ' y 4 x da s :s January-17Exampleof>7daytempfood Perm ►t.: $750.00 $12,220.00 $90.00 $600.00 $13,660.00 ii�(ddys)d►vrdedbY7';'az"shoo $1200 February March $0.00 Frozen Desserts $25 A $0.00 Mobile Food $210 May $0.00 Plan Reviews k News $0.00 Remodel.:'sgo' June Catering $25 per eventls2oo $0 00 catering kitchen Body Art Est. $315 Total $5,075.001 $65,045.001 $90.00 $13,350.001 $450.00 $84,010.00 Body Art Practitioner 135 Review Plans s18o Fiscal Year Budget 2017 Suntan Est. $140 Rec.Day Camp $10 Sala Starting Endina EX enses Ext.Paint Removal s35 Full Time $362,039.00 $156,142.11 Starting Endina Transport Off.Subst. S1o5 Part Time $28,306.00 $13,075.03 $16,500.00 $7,494.03 Tobacco Vendors $135 Overtime $2,000.00 $315.18 Swimm►r►gPools'`c ;Seasonal $140 " Balance $392,345.00 $169,532.32 Health Clinic Revolving Account Annud!-siio,,' Nonprofit $10,726.38 Title V Review s18o Well Application s18o Disposal works $225118o Food Permit Breakdown Jan 2017 Temporary Food $0.00 Food $8,640.00 Tobacco 675.00 Body Art 2,65 .00 Pool $250.00 Total $12,220.00