Vector Control for Public Health in North Carolina

In the 1970s the North Carolina Department of Environment and Natural Resources (NCDENR) formed the NC Public Health Pest Management (NCPHPM) division to assist community vector control programs. The NCPHPM in its leadership role has been actively involved in training and support for vector control programs across NC. However, NCPHPM was disbanded in July 2011 due to state budget cuts. Many local agencies that rely on state funds to carry out their vector control programs may also experience budget cutbacks. The impact of these budget shortfalls on services provided by vector control programs is still largely unknown. The objectives of this study are to: 1) assess the current status of vector control programs in NC, 2) evaluate the extent to which the status of local programs may be related to vector borne disease incidence and public health, 3) determine the impacts of losing the NCPHPM division to vector control programs in NC. The results of this study are expected to assess the current status of vector borne disease surveillance in NC that will inform the legislature about the implications of budget cuts to public health. The implications of our findings to public health risk assessment strategies will be discussed.

Bed Bugs, A Re-emerging Public Health Challenge

As with other major cities in North America, Toronto continues to experience an increase in bed bug infestations and the most vulnerable populations in Toronto continue to be the most seriously impacted by these infestations. Divisions within the City and community agencies in Toronto have responded to this re-emerging pest by developing partnerships, maximizing existing programs, and diverting resources from other funded programs. Bed bug control strategies can include both chemical and non-chemical approaches, but non-chemical techniques alone cannot effectively control or eliminate established infestations. The integrated pest management (IPM) approach is viewed as the best practice for most bed bug infestations today. This involves the application of both non-chemical and chemical techniques with an emphasis on those methods and products that will have the least impact on human health and the environment. Non-chemical controls include the use of vacuuming, steam cleaning, controlling indoor temperatures and exclusion strategies. Chemical approaches in Canada are restricted to synthetic pyrethroids which are available in liquid or powder forms.

Toronto Public Health continues to respond to request for service regarding bed bugs. The response includes amongst others, providing advice , bed bug identification services, providing inspection services in problematic cases, conducting education/ outreach sessions, liaising with landlords and coordinating extreme clean events and future case management for vulnerable clients.

Improving the Predictive Value of Air Sampling for Fungal Aerosols with Aggressive Sampling

The presence and activity of humans, in building spaces, that aerosolize deposited reservoirs of fungal particles seem to constitute the single most important cause of the significant variability observed for indoor air sampling for fungal aerosols. This study investigates whether the use of an aggressive sampling technique instead of the usual passive sampling technique, can reduce this variability. The measurements were made in rooms, with and without human activity. With passive sampling technique, the fungal aerosol concentration in rooms without human activity was on average only 9 % of that found with human activity. When aggressive sampling technique was used, this average was 103 %. Use of aggressive sampling, therefore, eliminates to a large extent the variability caused by differences in human activity and thereby improves the predictability of indoor air sampling for fungal aerosols. The level of fungal aerosols was determined by measurements of the activity of the fungal related enzyme β-N-acetylhexosaminidase(NAHA).

An Sanitarian's Overview of Green Certification

Green certifications are encountered daily in our practice. These certifications are for products, performance, people, processes and buildings. Knowing the scope and limitations of the various environmentally preferable certifications will aid us in our health and safety activities.

Geospatial Evaluation of Major Public Safety-related Infrastructure in the Event of an Accidental Radionuclide Release in South Carolina

Geospatial Evaluation of Major Public Safety-related Infrastructure in the event of an Accidental Radionuclide Release in South Carolina Isoken T Aighewi and Helen Tamboue Benedict College, Department of Biology, Chemistry and Environmental Health Sciences, 1600 Harden Street, Columbia, SC 29204 ABSTRACT Recent nuclear incidents in the U.S and elsewhere such as the 2010 Yankee nuclear reactor leakage in Vermont, the recent wild fire that threatened the Los Alamos National laboratory in New Mexico in 2011 and the Japan’s Fukushima Daiichi nuclear disaster in 2011 have brought about new concerns and discussion about how safe and prepared Americans living near nuclear installations are.

The United States have 65 operating nuclear plants with 104 commercial reactors, of which four operating plants are in South Carolina. Although site-specific emergency response plans for nuclear plant accident exist for communities in the immediate vicinity of nuclear plants, the ever-changing demography could render those plans ineffective overt time. This study was initiated to evaluate the present state of vulnerability of populations residing near one of the four nuclear installations in South Carolina-The Savanna River Site (SRS). Using Geospatial techniques, we evaluated populations at risk living within 25km and 50km radius of the installation, number of health facilities, major highways for evacuation during emergency-including their respective 2010 vehicle traffic loads (AADT).


The result shows that in the event of a nuclear emergency resulting in mass release of radionuclide, 12, 780 people in six towns in the immediate vicinity of the SRS will be at risk. However, 295,545 people will be affected if up to 50km radius is considered-based on the latest U.S 2010 census. Only one health facility is located within the immediate vicinity for emergency treatment and 15 within 50km radius of the site. For Emergency evacuation, Northeast bound U.S highway 278 to Georgia state line in Aiken county, SC has a higher traffic load compared to the Southwest bound alternative of the same limited access highway (AADT of 15,200 compared to 13, 800) leading to highway S-68. For the 50 km scenario however, several more evacuation routes are available. A comprehensive comparison of the different evacuation routes for the towns will be presented.

Reducing agricultural food contamination risk and increasing farm worker health and safety opportunities through implementation of an Agricultural Field Toilet Inspection Program

Unsanitary or improperly equipped field toilets are one of many sources that can contribute to Escherichia coli contamination of agricultural products. This public health risk can lead to unsafe field worker conditions, food borne illness, and substantial economic impacts to the agricultural industry. In 2005 and 2006, United States Food and Drug Administration investigations of food-borne illnesses linked outbreaks to fresh-cut lettuce and spinach grown in the Salinas Valley, California. Monterey County Health Department’s Environmental Health Bureau (MCEH) launched an array of potential source mitigations, one of which was an Agricultural Field Toilet Inspection Program (AFTIP) to register, monitor, and enforce sanitary practices. From project launch in late 2007 to the December 31 2009, MCEH inspectors permitted more than 7,500 field toilet units, estimated to likely be nearly all of the units that existed in Monterey County. From the first fully-operational program year (2008) to the second program year (2009), total violations decreased from 1,502 to 315 and of those, the number of violations requiring immediate correction decreased from 244 to 8. These results suggest a decreased probability of crop contamination, food-borne illness, and economic loss for Monterey County agricultural products due to field toilet sources. The study describes MCEH’s rigorously-maintained process to adhere to public health egulations and standards with relatively minor impact on resources, and provides a local health policy, procedures, and materials (forms, tools) to assist other counties in enacting similar policies and cost effective programs. Adoptions of similar practices by other local health departments throughout the U.S. are expected to provide similar results and benefits within those counties. However, because agricultural workers and farming equipment (machinery, trucks, tools, toilet units, etc.) are seasonally transported across county and state boundaries, possibilities of contamination will exist due to differentials in inspections and regulations between counties. Yet implementing AFTIP in California counties would give researchers the opportunity to compare findings, thereby providing further recommendations for greater protections.

Assessing Wastewater Infrastructure Needs – Using Trends to Establish Priorities in Environmental Programs

The most common approach in the United States for dealing with wastewater is the centralized sewer. Environmental laws and public funding largely promote and support the construction, operation and maintenance of large wastewater treatment facilities. Contrast that with historic population declines in many small communities in rural areas of the Upper Midwest and other rural areas of the United States of America, a trend that continues. For example, according to figures provided by the U.S. Census Bureau the median population of communities in Nebraska was 342 in 2000 which declined to 318 by 2010.

Regulatory requirements and demands on wastewater treatment systems continue to increase. The blanket application of environmental regulations and resources to all communities, especially small communities with declining populations on limited incomes, can result in costly upgrades or new construction, and onerous sampling, record keeping and reporting requirements. There may be better ways of assessing needs and maintaining or obtaining regulatory compliance.

Some basic questions are worth asking:

• What is and what will be the overall or comparative watershed impact from
• these small sources (or how can resources best be applied to meet environmental goals and achieve compliance with regulatory requirements)?
• Are all wastewater treatment options or combinations considered equally, or do funding source limitations restrict these choices?
• Can a risk-based approach to wastewater treatment be developed that would
• optimize available resources and still result in adequate and acceptable levels of environmental protection?
• How can wastewater treatment systems, centralized and decentralized, best be
• selected, funded and used consistently and appropriately in each situation?

No single method of wastewater treatment is the answer for all situations and this presentation is not intended to determine the most appropriate wastewater treatment method for any particular situation. However, the intent of the AWIN (Assessing Wastewater Infrastructure Needs) effort is to help develop, enhance and continue the discussion, look at a possible approach to provide a qualified assessment of infrastructure needs, and work towards solving the problem of how best to use available resources to meet wastewater infrastructure needs while providing adequate and appropriate environmental protection.

CSI: Twin Falls, Idaho

On September 15, 2009, elemental mercury was discovered splashed around a small area within a parking lot of an apartment complex in Twin Falls, Idaho. Local and state fire and hazmat teams responded immediately, as did the Idaho Department of Environmental Quality (DEQ), the South Central Public Health District (SCPHD), and the U.S. Environmental Protection Agency (EPA). These agencies joined together in Unified Command and combined resources to assess, stabilize, and mitigate the incident while calmly dealing with the close attention from the local media. A public health concern quickly surfaced due to several factors: the source and quantity of the mercury were unknown, the timing of the incident was vague, school-aged children were involved. The concern was heightened due to the potential dangers of mercury exposure, the possible spread of contamination in homes and school, and the intense media coverage.  That concern was confirmed by data gathered by EPA and hazmat entry teams showing high levels of mercury vapors on the parking lot and inside one family’s apartment unit. Ultimately, the agencies were able to determine the mercury contamination was limited to the apartment and parking lot, and did not affect other homes, the school bus, or school. The apartment has since been remediated and family returned (after being evacuated from their residence).  Some of the “lessons learned” of the response were the importance of incident command leadership, each partner doing their jobs well and staying in their lanes, and open communication between the partners. While EPA provided equipment and technical assistance to the incident response and DEQ handled media inquiries, SCPHD worked smoothly with the school district and children to ascertain the exact number of children involved, to locate the source and amount of mercury spilled, and to provide valuable outreach to the affected families and larger community. This emergency response was a huge success as a result of close cooperation between local, state, and federal agencies. Awards were given to all partners involved by EPA in recognition of their exemplary performance and interagency cooperation during the mercury emergency response.

Lead guidelines for children’s play areas: The need for clean soil policies to protect children

Children’s empirical response to lead (Pb) in soil and revised policy needs are discussed. The median US background soil Pb is 16.5 mg/kg (range 10.3 to 30.1 ppm), and soils of urbanized areas (UAs) are often 500-1000 ppm or more. Two Pb products, Pb-based paint and additives in gasoline contaminated UAs, and 1950 through 1982 fuel sales by state accounts for ~1.4 million metric tons (MT) Pb of the US total of 4.6 million MT in the same years. Aerosol inputs into the 90 UAs from gasoline Pb additives range from 100’s to more than 100,000 MT of Pb depending on traffic flows. Soils are a sink and a source of urban Pb dust.

The response of children to urban soil Pb contamination in New Orleans serves as a case example. The maximum of ~1811 MT lead (Pb) in exterior paint on 86,000 New Orleans houses, compares with ~12,000 MT from vehicle exhaust yielding ~ 9100 MT Pb; ~4850 MT were particles >10 µm and ~4200 MT were <0.25 µm. Brick public properties in the inner city had significantly more Pb contamination and higher prevalence of elevated children’s blood Pb than same-aged brick public properties in the outlying urban areas. The median Pb dust in the inner-city soil was 438 mg/kg or 3.7 times larger than median soil Pb of 117 mg/kg (p-value <0.0001). The prevalence of children’s blood Pb ≥ 10µg/dL was 22.9% within the inner-city and 9.1% in the outlying areas of New Orleans (p-value <0.0001). Lead dust from gasoline additives explains the discrepancy of soil Pb and children’s blood Pb in the traffic congested inner-city core compared with the lower traffic outer areas of New Orleans. Similar patterns of environmental Pb dust contamination and childhood Pb exposure are expected in all US cities. To meet the goal of primary childhood Pb prevention, the findings underscore the need for revised soil policies that act to eliminate the impact on children of Pb dust that has accumulated in urban soils.

Sanitation in Classroom and Food Preparation Areas in Child Care Facilities in North Carolina and South Carolina [POSTER]

Introduction:  Approximately 60% of U.S. children age 5 and younger spend time in child care settings.  Such environments increase risk of enteric disease, including foodborne illness.

 

Purpose: To describe adherence to sanitation standards in classrooms and food preparation areas in child care facilities in the southeastern United States.  

Methods:  Site visits were conducted at 35 licensed child care facilities: 27 centers (77%) and 8 homes (23%). Data were collected in two classrooms at 16 facilities; thus, the sample size for classroom-level data was 51 (43 rooms for centers and 8 homes). Data collection methods included questionnaires, audits, observations, and environmental samples. Audits in up to two classrooms (an infant, toddler, and/or combined infant/toddler classroom) at each facility and the food preparation area were performed using a form similar to a regulatory inspection form. Audit data were used to calculate indices to describe adherence to sanitation standards based on the 2009 FDA Food Code and guidance from food safety experts.

Results:  The mean classroom sanitation index (0-8) was 7.7 (SD=0.7) and the mean food preparation area sanitation index (0-10) was 7.2 (SD=1.4). Items with low compliance included availability of a sanitizer test kit and use of hair restraints by food handlers. For classrooms with a refrigerator used to store food and beverages for children, 40% of centers and 75% of homes had refrigerators with ambient temperatures > 39°F. For facilities with a separate food preparation area, 48% of centers and 63% of homes had refrigerators with ambient temperatures > 39°F. 

Significance: Most facilities participating in this study adhered to sanitation standards within the classroom; however, improvements with regard to sanitation in food preparation areas and refrigerator operating temperature are needed.  These results, in conjunction with observational data and microbiological analysis of environmental samples, provide insight into risk factors for enteric disease transmission in child care facilities. 

Cross Community Collaborations for Environmental Health

Environmental health problems typically cross boundaries of race, gender, class, and geography, especially problems that impact those who are disproportionately at risk from harmful chemical exposures. Developing successful collaborations among the diverse stakeholders seeking to resolve such problems is a major challenge for environmental health professionals. The Oakland-based Center for Environmental Health (CEH) has successfully facilitated collaborations among environmental justice community-based groups, government agencies, non-profits, labor unions, and business leaders to eliminate health threats and create more sustainable communities. In this session CEH Executive Director Michael Green will discuss with participants the strategies for facilitating successful collaborations across diverse communities, the methods for developing successful relationships, and practices that professionals can use in their work with diverse constituencies.

Rocky Mountain Spotted Fever - Dog Population Survey and Prevention Efforts

A dog population survey was conducted on two southwestern reservations to determine the number of dogs and identify how specific factors among the dog population are contributing to the spread of Rocky Mountain spotted fever (RMSF).  The tick responsible for transmission of RMSF in the southwest is the brown dog tick, which is found on dogs and around homes.  A large population of free-roaming dogs combined with a widespread infestation of ticks on reservation lands has adversely impacted the health status of tribal members.  Dogs bring ticks in close contact with people, and free roaming and stray dogs are contributing to the extensive distribution of ticks in homes and yards.  The survey found that the number of dogs per household was comparable to the national average, however results revealed there was a greater percentage of free roaming dogs on the reservations.  The presentation will describe how information gathered from the dog population survey is assisting health officials to improve control measures and reduce the risk of RMSF.

Specific job-exposure records to assess in routine carcinogenic risks [POSTER]

The aim is to present a simplified job-exposure records to identify occupational exposure to carcinogens with minimum formative experience Methodology.  We built 105 forms corresponding to specific jobs, including the main risks. Results: a specific job-exposure record was filled for each of 2017 workers.  Nine hundred and fifty three workers corresponding to 47% of the studied population were exposed during their work to one carcinogen or more.Main occupational carcinogens were hepatitis B virus, environmental tobacco smoke ,and inorganic acids... Discussion /the workers are exposed to a large variety of occupational carcinogens, although most of them are not belonging to industrial, but to tertiary sector

Pediatrician's Perceptions on Child Lead Poisoning

Despite national reductions in reported cases of child lead poisoning, the illness still disproportionately affects many socially disadvantaged communities. No previous research has identified the extent to which pediatricians consider and utilize environmental interventions within treatment protocols.  Quantitative and qualitative methods were used to analyze pediatricians' perceptions on environmental contributors and interventions related to the issue of child lead poisoning. Within an assessment study, more than 100 pediatricians revealed their perceptions about environmental causes and interventions for child lead poisoning. Logistic regression and split data anaylsis were used to quantify pediatrician perceptions. The study revealed that pediatricians with more than half of their patients receiving Medicaid assistance were  approximately twice as likely to emphasize the importance of environmental issues in matters relating to child lead poisoning (OR 2.62, 95%CI 1.15-5.96).

Pets in Retail Food Outlets: A Literature Review

The presence of service animals in restaurants as allowed under the 1990 Americans with Disabilities Act, coupled with the resurging popularity of tea cup dogs and portable exotic pets, raises questions about the environmental health and safety implications of animals in patronage areas within retail food outlets. To provide the evidence base for informed policy and practice, the authors conducted a search of public health journals and medical publications with the aim to aggregate and summarize literature germane to this issue. A range of potential zoonotic diseases was identified among common household pets, including those that are parasitic, bacterial, and viral in origin.  At the same time, the relative risk associated with specific pet-human interactions has yet to be established in a clear and consistent manner. The U.S. Centers for Disease Control and Prevention reported approximately 100 disease outbreaks involving animals in public settings for the time period of 1996-2008, though most were rooted in petting zoos. Existing literature largely failed to recognize the potential significance of aeroallergens, which the authors believe may present the single most significant animal-related risk to the dining public.  Public policy developers should consider vulnerable populations such as children, pregnant women and their fetuses, asthmatics, and the immune-compromised.  Preventive measures and best practices include signage, installation and maintenance of suitable building materials, adherence to applicable ventilation standards, staff training and hygiene, and aggressive animal management systems.  There is a paucity of published scientific literature directly related to risk factors associated with animals in restaurant seating areas. Environmental health professionals are encouraged to stay abreast of emerging literature related to the hospitality industry.

Where Have All The Vector Programs Gone?

For decades, state and local public health agencies throughout the United States have experienced a steady loss of vector and pest control programs and capacity.  The ongoing economic crisis that began in 2008 has greatly expedited these losses with several states and many local public health agencies eliminating their vector control programs in entirety.  However, even when vector control programs or activities have been reduced or eliminated, environmental health programs are usually expected to respond to and mitigate vector or public health pest problems within the local community.

This presentation will discuss potential health impacts from the loss of vector and pest control programs and capacity throughout the country.  The presentation will also present activities that have been implemented by the CDC National Center for Environmental Health to provide the environmental health workforce with the knowledge and skills needed to effectively reduce health threats from disease vectors and public health pests.

Control of Methane Emissions from Anaerobic Digestion

Anaerobic digestion from septic tanks or other sources give off gases, a large part of which is methane that is a greenhouse gas (GHG) 21 times more damaging than carbon dioxide.  Municipal systems can trap and reuse the methane but this is not practical for smaller systems.  Injection of the gases into the soil through a subsurface drip system will convert the methane to carbon dioxide thereby reducing the GHG damage by 95%; and furthermore, if there is vegetation on the surface the carbon dioxide will be taken up by this vegetation resulting in increased growth.  Studies by U.C. Davis (funded by WERF) and the California State University at Fresno will be referenced.

Prevalence, Knowledge, and Concern about Bed Bugs [POSTER]

Recent research suggests that the United States and the world are on the verge of a bed bug pandemic. Physical and psychological injuries result from not only the infestation but also from the misuse of pesticides to treat the bed bugs. Assumptions have been made that socioeconomic status (SES) is not an indicator of bed bug infestations. However, little information is available at the local level about the prevalence of bed bugs in private homes in areas of higher SES. This study aimed to identify prevalence, knowledge, and concern about bed bugs in one village in Ohio. Responses from 96 individuals who completed the Prevalence, Knowledge, and Concern about Bed Bugs (PK CABB) survey were utilized for data analysis. The majority of the sample was white non-Hispanic and about 95% of the respondents in the survey reported that they owned their residence.  Only about 6% of the respondents knew someone with bed bugs. Additionally, 50 people (52.1%) reported they were somewhat concerned about bed bugs, despite recent media attention. About 43% of people reported that they had changed their behavior. There were no differences in the responses based on data collection method. For this higher income area the prevalence was dissimilar to the rate reported in the general public (about 20%).  This suggests that bed bugs may be an environmental issue effecting low income disproportionately. Confounding issues, such as reluctance to report infestations could have resulted in inaccurately low results. Further research is needed in areas of differing socioeconomic levels. Education is needed for all in the general public related to bed bug prevention and elimination. 

Radon Activities in Comprehensive Cancer Control Programs – Finding the Gaps to Connect Existing Resources.

Introduction

Radon is a radioactive gas and the second leading cause of lung cancer. Most states have federally-funded radon programs. Radon testing and remediation is relatively inexpensive. Comprehensive Cancer Control (CCC) programs may be aware of this existing resource. 

Methods

All currently-available CCC plans (65) and interim progress reports were reviewed for the terms “radon,” “radiation,” or “lung.” Actions to address radon exposure were categorized into: education, testing, remediation, or policy development/evaluation.

Results

62% (n=40) of all plans had terminology that could be associated with radon yet only 38% (n=25) explicitly addressed it. Radon education was the most common action (25 plans) followed by: home testing (20), remediation (10), policy development/revision (10), and policy evaluation (1). 

Conclusion

CCC programs may not be aware of the link between radon exposure and lung cancer. CCC programs and radon programs should consider collaborative efforts to leverage scarce resources to address radon exposure.

Environmental Health Perception Among College Students [POSTER]

An individual’s knowledge, perception, and attitude are fundamental in determining how a person behaves regarding environmental hazards.  While science has made great strides in promoting environmental health, threats still exist, largely due to individual actions in response to potential health hazards.  Undergraduate students (n=395) enrolled in an introductory Health Education course participated in an environmental health awareness survey examining knowledge, attitudes, and behaviors.  Results indicated that there was a general lack of knowledge among participants about environmental health-related issues.  In addition, it was determined that males were more likely to have positive attitudes towards issues relating to air quality and the green environment.  Further analyses revealed that there was a significant relationship between age and attitudes toward issues dealing with sustainability.  In addition, race/ethnicity predicted attitudes toward water quality and recycling behaviors.  While students typically possessed positive attitudes toward environmental health, they engaged in non-eco-friendly behaviors.  Because knowledge influences a person’s attitude, and ultimately behavior, continued efforts in environmental health education should be refined.