The Waco-McLennan County Public Health District (Health District) is pleased to provide you with a summary of the many activities we perform on a daily basis to honor our commitment to a safe, healthy, and vibrant community. As you will note, we are focused on prevention. Our programs seek to increase healthy births, promote healthy lifestyles, prevent the spread of infectious diseases, protect the environment, and prepare for emergencies.

The past year has been a year of change and of achievement. I was formally selected as Health Director and am so excited to work with this amazing team who comes to work every day to silently promote, protect and improve the health and lives of all residents of McLennan County. The Health District also embraced new opportunities to address the issues of infant mortality and preterm births, and to help transform our community by reducing death and disability due to cardiovascular disease, smoking and physical inactivity.

Effective public health is one of the characteristics of an industrialized society. Many of the major improvements in the health status of our country have been realized because of public health measures. These include programs to assure that our food is safe to consume, immunizations to prevent illness, and surveillance to monitor and control the spread of disease. Public health needs to be considered as an investment for the well-being of the community. Without the investment in those basic services the overall health of the community will begin to decline.

As public health servants, the employees of this department will work with our stakeholders towards planning a better and healthier community. It is with great pride that I present the highlights of the past year and an overview of the organization’s many programs showcasing the services, performance and impact we provide as “Gatekeepers of Our Community’s Health.”

Sincerely,

Sherry Williams, RNC, WHNP

The Health Education program works to provide education to county residents regarding a variety of health topics. In fiscal year 2011-12 over 15,000 people were served through various health education methods including presentations, health fairs, and other community activities. Staff continues active community involvement while working with area coalitions, committees and councils to impact local health issues.

This year the program continued its service to local School Health Advisory Councils (SHACS). Acting as community advisors, educators provide advice on school health programming and its impact on student health and learning. As SHAC members and Partners in Education stewards, staff contributed to the installation and/or maintenance of school gardens as well as community gardens serving area neighborhoods. Such projects aid in our endeavor to increase access to healthier foods and promote healthy eating.

Alongside other committed community partners, the Health Education program helped launch the Live Well Waco project, a collaborative effort of the Power of Prevention Coalition to address disease burden in Waco and surrounding cities within McLennan County. The project includes five categories: Eat Well Waco (Healthy Dining Options Program), Play Well (Increasing Access to Physical Activity), Be Well (Chronic Disease Management), Think Well (Mental Health Support), and Work Well (Worksite Wellness Initiative). The project was officially unveiled in September 2012 with a launch party provided for residents to take part in free health activities promoting wellness and increasing knowledge regarding important health matters. As part of the group’s work to transform Texas communities, the program offered outreach including health discussion panels in which area physicians gathered in Q & A sessions with residents to discuss health issues impacting county residents. A tobacco prevention tour visited area schools as a well renowned speaker spoke out against tobacco initiation in youth. Additionally, the Community Play Day at Indian Springs Park offered free access to activities including biking and kayaking, as well as food and fitness demonstrations. The group will continue to offer activities and events to assist county residents in achieving healthier lifestyles. More information can be found at livewellwaco.com.

Diabetes Self Management Education In an effort to better serve residents needing diabetes education, the Diabetes program instituted a Spanish language diabetes self management series in addition to the regularly scheduled English Do Well, Be Well series. Cooking classes were also held in a variety of venues throughout the county. Cooking Well with Diabetes was provided for diabetics and their families or those at risk for the disease. A total of 1,531 residents were served through these diabetes programs this year.

Physical Activity ProgramsProviding physical activity opportunities is also an important focus of the program. By offering various adult and family physical activity programs, the program was able to increase physical activity and healthy eating among residents, in particular those with diabetes and pre-diabetes. Two sessions of the Family Physical Activity program were offered during summer months to provide additional options for exercise.

In order to serve youth at risk for diabetes, the program offered the BOUNCE summer camp which led teenage girls through nutrition, exercise and self image education. Lessons were further supplemented by fun field trips allowing the girls exposure to factors affecting healthier living.

In partnership with Texas AgriLife Extension Service, the diabetes program implemented the Walk Across Texas program, offered at no cost to area residents. This wellness initiative was used by several area worksites to encourage walking for greater health benefits. This year a total of 27,880 miles were walked by over 250 participants.

To learn more about upcoming diabetes programming, please call 750-5631 or find more information at mclennanpublichealth.org under the Diabetes tab.

The Health Education program also assisted with projects of the new Healthy Babies Coalition which works ‘to change a community’s knowledge, attitudes, and behavior regarding preterm births, its risk factors and strategies to prevent it.’ The coalition introduced the Healthy Babies are Worth the Wait ® initiative to McLennan County in an effort to improve awareness regarding the increased cases of preterm births and infant deaths in the county. The Health District, in partnership with several area agencies and both hospitals, are working to educate and provide resources for families and medical providers in order to combat this issue affecting our youngest residents and their families. You can find out more about this project at mclennanpublichealth.org under the Health Education tab.

In an effort to educate and immunize the community, several immunization clinics were offered throughout McLennan County. This year, the Health District and the McLennan County Immunization Coalition collaborated with Voice Inc. and Family Health Center to organize a very successful back-to-school event, Hip Hop 2 Health, which attracted over 2500 individuals. In addition, the clinic staff worked diligently during the summer to vaccinate students to meet the immunization requirements mandated by the Texas Department of State Health Services for school admission. The immunization outreach staff participated in numerous area health fairs in collaboration with county agencies and schools districts in effort to educate the community by offering vaccine information. An annual Immunization Workshop was held to offer providers and school nurses updates and information on the current immunization recommendations.

ImmunizationsTo serve all clients more efficiently, staff continues to be available daily for administration of immunizations and TB skin tests (not related to cases) on a scheduled basis. Over 1,000 TB skin tests were given this year. The clinic is open outside of normal business hours to accommodate county residents. During this fiscal year, 19,462 vaccines were administered to 10,125 individuals.

Foreign TravelAn annual total of 813 foreign travel vaccinations were administered including Yellow Fever and Typhoid vaccines. Nurses are able to provide information as to what vaccines may be necessary for a geographic area. For more information about foreign travel call the clinic at 254-750-5410.

Texas Vaccines for Children/Adult Safety Net ProgramsThe Texas Vaccines for Children (TVFC) and Adult Safety Net programs help get vaccines to uninsured, Medicaid and CHIP-elgible children and uninsured adults at low or no cost. All immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) are available through this program. The Health District’s Immunization Clinic is enrolled in the TVFC /Adult Safety programs. Through these federally funded programs, the clinic administered over 12,411 immunizations to more than 8,051 clients during FY 2011-12.

ImmTracImmTrac is the immunization registry for Texas. The system allows information access and retrieval from any ImmTrac enrolled provider. Many area doctors use and update the registry to ensure proper recording of vaccines administered to children. Our Immunization Outreach staff monitors this system to ensure children are current on all recommended vaccinations.

Waco-McLennan County Public Health District’s (WMCPHD) HIV/STD Services staff works on a daily basis to educate the public on the risks of HIV/AIDS as well as other STDs, offers educational information to reduce individual risks for HIV and STDs, and tests for HIV and STDs. WMCPHD also offers a HIV Case Management program that provides support to HIV positive individuals. This support includes: medical care referrals, assistance obtaining necessary HIV medications, and referrals/assistance with dental care, housing issues, mental health needs, eye care, and other personal health concerns. WMCPHD also provides laboratory services for the STD and Tuberculosis Control (TB) programs.

During Fiscal Year 2011-2012, Waco-McLennan County Public Health District’s HIV/STD staff tested 2,840 individuals for HIV and Syphilis and 1,740 individuals for Gonorrhea and Chlamydia. The attached graphs reflect positive cases of HIV/AIDS and STDs from 2004-2011 for all of McLennan County, including tests conducted by WMCPHD and other health care providers. McLennan County has seen a significant decrease in the number of newly diagnosed HIV and AIDS cases since 2009 however no reason for this decline has been identified.

There has been a decrease in Gonorrhea and Syphilis cases since 2007, which is most likely attributed to an increase in the number of partners treated. The increase in Chlamydia cases is most likely due to more sensitive testing (identifying more positive cases) rather than an actual increase in disease.

The Center for Disease Control (CDC) recommends screening for HIV infection be performed routinely for all individuals aged 13-64 years. The WMCPHD’s HIV/STD program offers confidential HIV testing and counseling at no cost, as well as a low cost STD clinic 4 days a week (Monday through Thursday). Call 254-750-5499 for more information or to make an appointment.

The Preparedness Program of the Waco-McLennan County Public Health District focuses its efforts on planning for, and responding to public health emergencies such as infectious disease outbreaks, bioterrorism and natural disasters. Throughout the year, Preparedness staff members collaborate with emergency response partners through planning meetings, as well as drills and exercises that allow us to evaluate our plans and revise them as needed.

In December of 2011, we partnered with Walgreens Pharmacy to hold a free flu shot clinic for the general public. Due to the clinic being held in December, it was not a drive-through shot clinic as the Health District had done in years’ past. The 2011 flu shot clinic was a walk-in clinic held at the Extraco Events Center Fine Arts Building. The Preparedness team, with the help of other Health District staff members, was able to organize the event, secure a location and recruit volunteers in a short time period.

During the summer of 2012, the Preparedness team worked closely with our Epidemiology staff to respond to cases of West Nile Virus in McLennan County. Preparedness team members focused their efforts on getting information out to the public regarding prevention of West Nile Virus by preventing mosquito bites. The campaign was titled “Fight the Bite.” Public Service Announcements (PSA’s) were made, and flyers and postcards were distributed through a variety of venues.

On a yearly basis, the Preparedness program undergoes a Technical Assistance Review of our Strategic National Stockpile program. This year the program received a score of 92, which is above the benchmark set by the Department of State Health Services.

Medical Reserve CorpsThe Central Texas Medical Reserve Corps (CTMRC) has 88 members with a variety of skill sets that have been utilized during the past year, including participation in the December 2011 flu shot clinic.

Annual training for the Psychosocial Intervention Teams, a key component of the CTMRC, was held on January 20-21st, 2012. Psychosocial Intervention Teams work to alleviate anxiety of clients and may refer individuals with psychosocial needs to professionals. Psychosocial Intervention Teams can be activated during real incidents or exercises.

Fiscal Year (FY) 2011-12 was an eventful year for the Waco-McLennan County Public Health District’s Epidemiology division. A total of 314 notifiable disease reports were investigated from October 2011 through September 2012. Two major investigations were conducted relating to Pertussis and West Nile Virus.

Below is a graph (Figure 1) depicting diseases that were reported and investigated by Health District staff during this fiscal year. The graph shows the total number of disease reports received by the Health District (confirmed, probable or not a case)

PERTUSSISWaco McLennan County Public Health District (WMCPHD) staff investigated a Pertussis (whooping cough) outbreak in the county. The first case was reported to the Health District on March 26, 2012. Since then the Health District has investigated 53 confirmed cases (52% Male, 48% Female). All cases were investigated and case status was defined according to the Center for Disease Control’s (CDC) case classification criteria “Acute cough illness of any duration, with isolation of B. Pertussis from a clinical specimen; or cough illness lasting ≥2 weeks, with at least one of the following symptoms: paroxysms of coughing; inspiratory “whoop”; or post-tussive vomiting and polymerase chain reaction (PCR) positive for Pertussis; or illness lasting ≥2 weeks, with at least one of the following symptoms: paroxysms of coughing; inspiratory “whoop”; or post-tussive vomiting; and, contact with a laboratory-confirmed case of Pertussis”. Forty-four (44) percent of cases were between 2-10 years of age. The second highest age category with confirmed cases status was 11-15 years (38%). (Figure 2)

The Health District sent out Pertussis reporting and prevention information to 457 local contacts (health providers, nursing homes, day cares, schools). Enhanced surveillance methods and follow-up was implemented at the school districts with higher numbers of Pertussis cases. The Pertussis activity dropped significantly at the end of the school year in May.

WEST NILE VIRUSThere was a significant increase in West Nile Virus (WNV) cases in the United States this year. The WMCPHD received the first case report of WNV in July 2012, and since that time investigated 45 cases with two associated deaths during FY 2011-12. The majority of cases were in older age groups with twenty-nine (29) individuals 50 years of age or more. (Figure 3) The Health District staff distributed educational information at various community sites and disseminated updates to the local providers. Insect repellent was also provided to residents in targeted high risk neighborhoods.

SURVIELLANCEOn a routine basis, the quarterly reports and annual statistics were sent to 111 health care providers. The report included the updates and topics on enteric diseases, vaccine preventable illnesses, flu and preparedness.

The Waco-McLennan County Public Health District implements year round surveillance of influenza and influenza-like illness (ILI). During FY2011-2012, WMCPHD staff participated in the Council of State and Territorial Epidemiologists (CSTE) / Centers for Disease Control and Prevention (CDC) sponsored Influenza Incidence Surveillance Project (IISP). IISP was an enhancement of influenza surveillance activities in the county. Two health care providers participated in the project. The WMCPHD is continuing participation in 2012-2013 Influenza Incidence Surveillance Project.

Figure 4 shows the weekly regular flu like symptoms activity and influenza incidence surveillance project activity.

INTERNSHIP OPPORTUNITIESIn summer of 2012 the Health District participated in the Maternal Child Health Information Resource Center’s Graduate Student Internship Program. The Health District’s epidemiology department developed a 38 question “Maternal Child Health Needs Assessment” survey tool which was executed by a graduate intern at local maternal child health service locations. Although the goal was to target all child bearing aged women of McLennan County within various socio-economic status groups, women who utilized WIC services completed the majority of the surveys. 71% of the participants had an annual income of less than $40,000. The results showed that the participants were inclined to have greater gaps in services, and challenges with health care. Their major concerns were lack of employment, lack of transportation, and lack of medical insurance.

The mission of the Environmental Health Division is to identify and correct conditions in the environment that may cause disease or disease outbreaks. To be as effective as possible in accomplishing this mission, comprehensive approaches are utilized which may be regulatory, advisory, consultative, academic, investigative and punitive in nature.

Environmental Health focuses on the natural and built environment that may affect human health. The term Environmental Health is broad in nature encompassing many topics including the permitting and inspecting of food establishments, childcare facilities, swimming pools/spas, and on-site sewage facilities (OSSF). Investigating and correcting general sanitation nuisances such as fly, rat and mosquito breeding conditions, and requiring proper disposal of trash, garbage, wastewater and sewage are part of the Environmental Health component to help assure quality living standards in the community.

The efficiencies in operations, personnel and delivery of services established in the current and previous fiscal years proved effective to provide stability and sustainability for the Division during the current depressed economy. No services or responses to the public were eliminated. Inspections were not reduced since inspections are the primary method to identify and correct conditions in the environment that may cause disease or disease outbreaks.

2011/2012 Year - Effective activities of the division to accomplish its mission:• Informed food industry employees how applying food safety knowledge in their duties, reduces the possibility of food borne illnesses or outbreaks. All food safety classes received reviews and subsequent updates to improve content, provide relevant information, and provide a classroom environment conducive to active learning. Class schedules were revised to improve efficiency in providing the content. • The location for the food manager certification course was moved from Texas State Technological College (TSTC) to McLennan Community College (MCC). The new location at MCC provides a location that is convenient and centrally located for students. • The OSSF program actively administered and enforced the maintenance requirement for aerobic treatment units to ensure that all units have a maintenance contract, periodic inspections and necessary maintenance. Approximately 4,000 units installed throughout McLennan County require periodic inspection and maintenance to ensure the units are functioning properly to avoid health nuisances, water pollution, and property nuisances. After receiving approved training, homeowners may chose the option to maintain their system rather than hiring a maintenance provider. • Working behind the scenes to ensure healthy venues and an enviable quality of life for the Waco area, sanitarians and inspectors provided information, consultation, and inspection activities to new businesses such as the Waco Downtown Farmers Market and the Hawaiian Falls Water Park. • Reported cases of West Nile Virus disease transmitted by infected mosquitoes significantly increased this year. In response, efforts to educate and inform the public were coordinated with other divisions of the Health District and Waco City departments. Inspections and enforcement of the mosquito control ordinance were increased to reduce mosquito breeding locations.

Statistically the Environmental Health Division protected citizens by:

• Inspecting approximately • 1,137 food establishments • 96 mobile food vendors • 210 temporary food booths at special events • 135 childcare facilities, foster homes, and adoptive homes • 246 public and semi-public swimming pools and spas • 330 on-site sewage facilities for installation, repair, and proper disposal of wastewater, plus numerous physical checks for aerobic treatment units

• Investigating approximately 398 citizen complaints concerning health nuisance conditions 99% of all complaints received were investigated in less than 24 hours

• Providing additional enforcement and protection by • temporarily closing 47 food establishments until corrections were provided • temporarily closing 11 pools and spas until corrections were provided • filing 288 cases with the Justice of the Peace Courts for unresolved violations regarding on-site sewage facilities

• Educating the public by • Teaching approximately 3,592 individuals about food safety and the proper handling of food • Providing 22 presentations to groups and organizations on health and safety topics

The Tuberculosis Control (TB) Program of the Waco-McLennan County Public Health District primary purpose is to identify, educate, and treat persons suspected or known to have tuberculosis. Services provided include skin testing, contact investigation, limited medical evaluation by a physician, appropriate referrals, and monthly follow up. Staff is also available for presentations to community organizations and health care agencies since awareness is very important in halting the spread of this disease. People with active disease are placed on Directly Observed Therapy (DOT) as required by the Texas Department of State Health Services as a method of TB control. During Fiscal Year 2011-2012, the TB staff provided approximately 4,683 services, including 1,842 services to 123 clients, 11 of which were active cases of TB.

Active Tuberculosis Cases 11Suspects/Non-Mycobacterium Tuberculosis 6 / 7Latent Tuberculosis Infection 106Services 4,683

The WIC program is a health and nutrition program with a successful record for improving the diet of infants, children, and pregnant, postpartum, and breastfeeding women who are at risk for nutrition-related illness. The main focus of the WIC program is to educate mothers on the proper nutrition for babies and young children.

In 2012, the WIC program provided services to more than 7700 clients per month through our 6 clinics county-wide. We were one of the few WIC programs in the state that had a consistent caseload increase throughout the year.

Nutrition Education, one of WIC’s primary focuses, was expanded and offered through a variety of options: On-line, Classroom, DVD, Book, Shopping Tour, “Fun-in the Kitchen” cooking class, Health Carnival, and/or One-on-One counseling. Our clients choose what interested them most and/or was most convenient.

This year WIC received a generous gift from the McLennan County Hunger Coalition to increase our book selections for children for their Nutrition Education option at home. This option provides the parent/guardian a basic lesson on both the importance of reading to their child as well as good nutrition – both of which are critical to brain growth and development in young children. The child selects an age-appropriate book to take home – so their parent/guardian can read it to them.

Our “Fun in the Kitchen” cooking class continues to be a favorite. This class involves both the parent/guardian and child. Children get hands-on experience, which contributes to other learning opportunities, making simple recipes involving WIC approved foods while the parent/guardian receives basic nutrition education on the selected food group and how to promote healthy lifestyles with their children at home.

Two additional very popular nutrition education settings implemented include our Health Carnival and On-line classes. These options have enabled us to increase our services to more eligible individuals throughout Waco and McLennan County. www.TexasWIC.org is the website where clients go to complete online lessons at home or on their smartphone. Many helpful resources are available to eligible and current WIC clients about the Texas WIC Program at www.TexasWIC.org.

Waco-McLennan County WIC increased our outreach efforts and collaborations substantially this past year and will continue. Helping potential clients as well as area organizations and agencies understand the benefits of WIC will help promote early healthy lifestyles throughout Waco and McLennan County. Our collaborations efforts with both the Healthy Babies Initiative and the Smart Babies Initiative will provide opportunities for increased participation and for reaching WIC eligible clients.

In the past year, our WIC clinics have undergone renovations to become more kid-friendly with vibrant paint colors, fun decorations and new toys. Also, our clinics have worked to become more family-friendly with room for strollers, privacy for breastfeeding and convenient diaper-changing stations. New machines have been purchased for “ouch-free” iron testing! These machines are available at all of our clinics and approximately 75% of our WIC clients are able to get their iron checked with the new equipment.

Every year, Texas WIC joins a worldwide campaign during the month of August to increase public awareness of the many benefits of breastfeeding. When it comes to breastfeeding, every single ounce counts towards the health of mom and baby. This year’s Texas WIC World Breastfeeding Month (WBM) theme was Connecting communities: Strengthening support for breastfeeding moms.. This campaign was designed to educate on the importance of nursing, especially during the first year. A new study published in Pediatrics (April 2010) says if 90% of US families could comply with medical recommendations to breastfeed exclusively for six months, the United States would save $13 billion per year and prevent an excess of 911 deaths, nearly all of which would be infants. WIC offers breastfeeding classes and the peer counselor program provides support to educate women about the immense importance of breastfeeding their babies and to provide resources to help moms continue breastfeeding when they encounter obstacles. This past August, the Waco-McLennan County Public Health District – WIC program delivered approximately 500 informational packets on the importance and benefits of breastfeeding to area health care providers to both inform them of our services as well as their patients. WIC knows when it comes to health and well being of mom and baby, breastfeeding is the best choice!

To learn more about the WIC program call 254-750-5474, 254-750-8623 or visit www.TexasWIC.org