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Q&A With Public Health
updated: Dec 28, 2013, 4:00 PM

By Erin Lennon

Paige Batson leans back in her chair parked behind her modest desk in her closet-sized office at the Santa Maria Health Center. Her leather jacket, high heels and the strategies she lays out for combating serious contagious diseases in Santa Barbara County conjure images of a glamorous superhero. It doesn't hurt that she spends her days combating disease, and due to the recent outbreak of bacterial meningococcal near the UC Santa Barbara campus, many of her nights are spent the same way.

Batson, manager of Disease Control & Prevention for the Santa Barbara County Public Health Department, beams as she tosses out diagnoses for hypothetical cases of chlamydia, tuberculosis and HIV, and explains what the county would do if there were any such outbreaks.

The list of possible public health crises and responses to them continues, but it's the current outbreak of meningitis around UCSB caused by the Neisseria meningitides bacteria that occupies her thoughts these days.

And if it's not the meningococcal outbreak, it's flu season or there's a tuberculosis case in a hospital or a long-term care facility full of nauseous seniors. Batson has little time to dally, but she managed to sit still long enough for Mission and State to ask how the county fights back when public health problems threaten to run rampant.

Fighting the good fight: Santa Barbara County Public Health Department's Paige Batson. (Erin Lennon)

Mission and State: Could you describe what your position is and what you do?

Paige Batson: Basically I direct all of the activities for programs like tuberculosis control, sexually transmitted disease control, HIV/AIDS programs, and I oversee the immunization programs, which mostly focus on immunization practices, recommendations for what immunizations to get, [advertising] campaigns and so forth. This is why we're called the disease control and prevention subdivision within the public health department structure. In my subdivision, we deal mostly with acute communicable diseases, which are severe diseases that can be spread to others. HIV, sexually transmitted diseases, tuberculosis, pertussis or whooping cough, the H1N1 influenza strain, meningococcal disease-those are all acute diseases that we deal with.

That sounds like a lot of public outreach. How does that help you control and prevent the spread of disease?

Our primary prevention effort is education. With immunizations, which protect people from diseases by building immunity against them, we have certain campaigns that we're charged with and expected to do annually. During Toddler Immunization Month we really get out there and talk about the importance of immunizations for toddlers or for infants and do something similar for Teen Immunization Week.

And with this whole meningococcal outbreak, for example, we're giving information. Now, you might ask, how is that prevention? Well, it's preventing further cases. Even though primary prevention is a goal for us, the reality is that oftentimes we're learning of a disease and intervening after a person has acquired it. You're going to expect people to get sick, no matter how much educating you do. You're going to see cases of tuberculosis, despite our very active campaign for TB prevention.

How many cases is an outbreak?

That depends on the diseases. With bacterial meningitis, which is what we're seeing in this current outbreak, it's three cases. But each disease has its own threshold before we can determine that it's an outbreak. But an outbreak always starts with one case. This time we got a second case. I've been here 13 years, and I've never seen two related cases of meningococcal. The general rule to define an outbreak is two cases from a common source. Anytime I see two cases from a common source as a disease control manager… my suspicion grows, especially for a high-priority referral such as a meningococcal.

These thresholds depend on the organism but also the setting. For example, a food-borne outbreak means two or more cases came from a common source. However, if you and I live in the same household, and we both got sick, that wouldn't be an outbreak. One case of influenza in a long-term care facility is considered an outbreak. "X" number of Varicella, or chickenpox, cases in a school setting is an outbreak. So, the setting plays a big role.

What does the Public Health Department do when a severe, spreadable disease is detected?

Well, first of all, we have a list of reportable diseases that providers are required to report under Title 17 of the California Code of Regulations. It mandates that every healthcare provider-dentist, nurse, lab, etc.- reports a suspected or confirmed communicable diseases. For example, healthcare providers are required to immediately report somebody who is suspected of having meningococcal disease.

So, providers report a case based on that list, and the reports come through a real-time, web-based reporting system that the state launched in 2010 called CalREDIE [California Reportable Disease Information Exchange]. Back in the day, before electronic records and electronic everything, people would have to write out what we call confidential morbidity reports that are used to report communicable diseases, and labs would be mailed in. You would have a whole series of reporting that wasn't really timely, especially for these severe and rapid diseases.

Since CalREDIE began, the reports come into the central office electronically and they're immediately assigned to a public-health nurse. Right now, a report is going to be coming in on a TB case in a hospital. I already know that because the infection-control nurse at the hospital alerted me. A public-health nurse will get that report, and the system alerts him or her of the case's priority. If I have a high-priority referral like a meningococcal case, it will take precedence over a lower-priority case like chlamydia. I'm not going to run after a chlamydia, but I'm surely going to respond to that meningococcal. CalREDIE helps us prioritize. Oftentimes you do not know there's an outbreak until you know there's an outbreak.

Let's look at this meningococcal case. We got one case. That's not unusual. We see them. Sometimes we see one every year and a half. Sometimes you'll see two a year. We had four cases in 2010. This doesn't mean that these are the same kind of meningococcal disease that we have with the current outbreak. When reports were coming into the central office in November, we got our first case of meningococcal, we always look at those immediately. So, if you walked into the emergency room with this particular rash, with a stiff neck and headache and saying you're college student, for example, having photosensitivity, and they're thinking you have meningococcal disease, they're going to report that to us. And we're not going to sit here. We need to get out there very quickly to provide prophylaxis, or preventative treatment, to your close contacts. Your provider is going to treat you anyway, so you're going to be taken care of. What about your contacts? So, that's where we come in.

When the second meningococcal case came in, we had to find what was in common. Immediately I learned, it was UCSB. But we had to dig deeper. We hadn't called it an outbreak yet because it didn't meet the threshold or the definition of an outbreak. Then we got a third case. We were in outbreak mode anyway. UCSB is not enough of a connection, though. Where do they live? What commonalities do they all have? Do they attend the same classroom? Do they have the same sport? Are they all in the same fraternity, sorority? We're doing that, and we're finding out whom we need to treat to stop the disease from spreading, especially with this group because they're kissing, sharing cigarettes, drinks, etc. So, that's how we approach it.

Excerpt provided by Mission & State. Read the full article at www.MissionAndState.org


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