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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
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Health Department
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DATE:
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December 10, 2007
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BOARD MEETING DATE:
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December 18, 2007
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SPECIAL NOTICE/HEARING:
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None
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VOTE REQUIRED:
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Majority
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TO:
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Honorable Board of Supervisors
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FROM:
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Charlene A. Silva, Director, Health Department
Brian J. Zamora, Director, Public Health and Environmental Protection Division
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SUBJECT:
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Grant Award from the State Department of Public Health for the Tuberculosis Prevention and Control Program
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RECOMMENDATION
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Adopt a Resolution authorizing acceptance of a Grant Award from the State Department of Public Health for Tuberculosis (TB) prevention and control activities for the term of July 1, 2007 through June 30, 2008, in the amount of $281,028.
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VISION ALIGNMENT
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Commitment: Ensure basic health and safety for all.
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Goal 5: Residents have access to health care and preventive care.
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The TB Grant Award contributes to this commitment and goal by providing funds to identify patients with TB and appropriately treat them to prevent spread of the disease.
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Performance Measure:
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Measure
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FY 2006-07
Actual
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FY 2007-08
Projected
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Number of TB investigations conducted to ensure that secondary cases are identified.
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310*
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250
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* Several large-scale worksite investigations involving multiple contacts occurred in FY 2006-07. These were unexpected and unusual circumstances.
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BACKGROUND
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According to the Healthy San Mateo 2010 Report and like most other urban and suburban regions in the United States, San Mateo County experienced a resurgence of TB in the early 1990s. Nationally, this increase was attributable to several factors: increased immigration from regions where TB is highly endemic, association with HIV transmission, increased transmission among homeless populations, increased transmission in congregate settings such as prisons and jails, and a general reduction in the national public health infrastructure supporting TB control activities.
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In 2006 the local rate in San Mateo County was 10.7 per 100,000, which is similar to that of California (7.4 per 100,000), but greater than the national rate of 4.8. This rate is higher than the Healthy People 2010 target of 3.5.
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DISCUSSION
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The State Department of Public Health provides funding for TB control activities including the investigation of potential cases and administration of the directly-observed therapy program (DOT). One of the major concerns with TB cases is the rise in multi-drug resistant strains of the disease. This occurs when treatment is started but is not completed. If patients are noncompliant with their treatment, staff will work with the patients to directly observe their medication usage. If this fails, the Health Officer has the authority to detain patients in facilities to ensure treatment compliance and to protect the health of the community.
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Many patients diagnosed with TB may also have challenges, such as stable housing or appropriate nutrition, which can interfere with treatment. The State recognizes these obstacles and provides funding for these needs. These funds are used to enhance adherence of treatment protocols, prevent homelessness, and allow the use of less restrictive alternatives that decrease or prevent the need for detention. Examples of incentives include vouchers for transportation, food and rent assistance.
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The TB Program operates in compliance with both the requirements of the Policies and Procedures Manual as well as conditions stipulated by the State TB Control Branch, as noted in the Base Award. This Award notice was received from the State in late September, and staffing changes within Public Health resulted in a longer processing time.
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County Counsel has reviewed and approved the Resolution and Grant Award.
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FISCAL IMPACT
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The term of the Award is July 1, 2007 through June 30, 2008. The total amount is $281,028; $251,584 for the Base Award and $29,444 for food and shelter incentives. There are no required matching funds included in this award, resulting in no Net County Cost. The revenue and expenditures associated with this Award are included in the Public Health FY 2007-08 Adopted Budget.
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