Bed Bug Medicolegal

Bed bugs, Cimex lectularius, have become one of the most prominent structurally infesting public health nuisance pests in the United States.  Combined rapid re-emergence and insecticide resistant population strains have made bed bugs a formidable pest foe with considerable medical and legal significance. Requirements for new and innovative bed bug elimination methods demands priority action by both pest management and environmental health professionals. In this session, you will discover the unique biology and behavior that allows bed bugs to be incredibly successful within the human environment. In addition, you will learn the medical and legal issues of bed bugs as well as an update on best practices in bed bug elimination.

An Evaluation of Dual Bacteria Indicators for Urban Stormwater Control

Surface water quality standards for recreational waters were developed by EPA in the mid 1980’s based on epidemiological data gathered and published in August 1984 in an EPA report “Health Effects Criteria for Fresh Recreational Waters”.  In this report, the relationship between gastrointestinal illness and levels of E. coli and Enterococcus were observed and risk levels estimated.  Subsequent studies by EPA have found relationships between Enterococcus exposure levels and gastrointestinal illness rates.

In Texas, fresh water recreational standards are established in the Texas Surface Water Quality Standards.  E. coli is used to evaluate the risk associated with primary contact recreation and the standard established is set to achieve a risk of no more than eight illnesses per 1,000 swimmers, based on the risks established in the EPA report.  In urban watersheds in the Houston area, the E. coli water quality standard is not being achieved.  The levels of E. coli are quite often up to several magnitudes of order greater than the current standard of 126/100ml.  Many of these watersheds are greatly influenced by urban storm water run-off as well as discharges from wastewater treatment plants.  These discharges not only provide a continuous source of fecal bacteria, but also nutrients which may provide for continued survival and replication of E. coli.

To set priorities for management practices as well as to judge the success of those practices, the TMDL Bacteria Implementation Plan contains suggested provisions for the monitoring program to look at both E. coli and Enterococcus. Because of the potential for replication of E. coli in the waterways, a supplemental indicator is necessary to validate BMPs and their success. This presentation will look at the relationship of E. coli and Enterococcus in the data presented in the EPA studies, historical data from a non-urban watershed and the urban watersheds in the Houston area.

The Inspector’s Guide to Indoor Pool Air Quality

The indoor air quality associated with swimming pools in hotels, water parks and other recreational facilities can pose a variety of health risks to swimmers, lifeguards and building occupants. Additionally, the high humidity environments of indoor pools combined with the off-gassing of disinfection by-products can interact to damage building interiors and impact building use.  These problems can be mitigated through a combination of proper water feature management and well designed indoor ventilation systems. This presentation will provide an overview of the health threats and occupant comfort issues commonly associated with indoor water feature air and how this indoor environment can impact building structure and use. It will discuss the critical components for managing indoor water feature air, including environmental quality and occupant comfort maintenance. The above information will then be used to provide a background and basis for a discussion of the Center for Disease Control’s draft Ventilation and Air Quality Module of the Model Aquatic Health Code and how pool operators, building managers and inspectors can use this proposed code as a guide to resolving indoor air quality complaints.       

The Fungus Among Us: Blasto Isolated in the Home Environment

During 2010 a large outbreak of Blastomycosis, a potentially life-threatening fungal infection caused by Blastomyces dermatitidis, occurred in Marathon County, Wisconsin. A disease investigation was conducted by the local health department in conjunction with the Center for Disease Control and Prevention (CDC), the State of WI Dept of Health and Marshfield Clinic.  The investigation included environmental sampling within recognized cluster areas of soil, air and rodents.  Blastomyces has only been successfully identified in the environment twice in relation to human illness.  Sampling in this outbreak led to the discovery of a Blastomycosis isolate from the basement of a home where unrelated tenants who lived in the home in succession were diagnosed with Blastomycosis.  Recommendations were developed to reasonably remediate the basement in response to the positive air sample result. The presence of the CDC heightened the concerns of the community.  Policies were challenged by both the media and the community creating a controversy over the disclosure of locations and the confidentiality of diagnosed individuals. This presentation will discuss the benefits and disadvantages of environmental sampling for Blastomyces.  In addition, the importance of public communication through the press and how it can impact various aspects of a community will be examined.

LEED Versus Human Health

US Green Building Council (USGBC) certifies buildings through their Leadership in Energy and Environmental Design (LEED) standards which are based on the idea that LEED-certification implies “sustainability.” Since there are no universally accepted definitions or measurements for sustainability as it relates to their inhabitants, how do we know if LEED certification produces a healthy building? These buildings are human habitats. It is important to establish criteria for sustainability based on empirical evidence and measures which are public health- related. Human health must be incorporated into these standards and measures to assure that the buildings are not only environmentally sustainable, but protective of public health. This presentation will look at various aspects of LEED certification in terms of the ten essential services; particularly as it pertains to the three core functions of public health and suggest a beginning point for measures and standards.