The best defense against communicable diseases can be boiled down to one thing, says the manager of the program at the Wayne County Health Department — wash your hands.
That has long been the rule of thumb for preventing spread of the flu and the common cold, but it is also true for most contagious issues.
At the recent Board of Health meeting, Josa Raynor-Vaughn, supervisor of the communicable disease department, gave an overview of the reporting system and handling of conditions, which can range from anthrax and foodborne illnesses to yellow fever and the Zika virus.
“Communicable disease control is a core public health function and public health provides necessary education, prevention, surveillance and outbreak investigation,” she said. “Our main goal is to keep the public safe by preventing the spread of communicable disease and reports.”
Sources for receiving notification can include physicians’ offices, laboratories, schools, day cares, food establishments, hospitals and long-term facilities.
The state has a procedure for reporting, as well as a timeliness to notify the Health Department about the disease or condition.
The department’s main service areas, in addition to what they call general communicable diseases, are immunizations, sexually transmitted diseases and tuberculosis, Raynor-Vaughn said.
“In some instances, (the Health Department) does provide disease treatment,” she said. “We promptly implement control measures to keep these diseases from spreading. We investigate and report and we do surveillance.”
The STD clinic provides free and confidential HIV testing and referral, as well as exams, treatment, partner notification, preventive counseling and condom distribution. In 2018, the department saw 2,491 clients and performed 1,560 HIV tests, she said.
“We had 85 positive for gonorrhea, 299 positive for chlamydia, 14 positive for syphilis, four new HIV cases and 21 positive for herpes,” she said.
Tuberculosis has been another area of concern, be it providing treatment, testing or case management for people with the active form or a latent TB infection, which requires medication to prevent it from becoming active.
“We also do screening and evaluation for people at high risk, community outreach and education,” Raynor-Vaughn said. “We also do targeted investigation to identify what we call context for those people that have been exposed to active TB.
“And I want to give Wayne County a hand because in 2018 we had zero, I mean zero, cases of tuberculosis.”
That is not to say the concern is gone. Her department currently has 26 clients that are on preventive treatment. The medication is offered for nine months. Clients do not have to take it but those testing positive are encouraged to take it.
There were likewise no flu deaths or pertussis cases for 2018, she added.
Hepatitis, however, is an issue both nationally and locally.
“Hepatitis A outbreak has occurred in California, Utah, Kentucky and West Virginia and now it is here in North Carolina, and it is here in Wayne County,” she said. “North Carolina has had a total of 72 confirmed cases — 52 of those were hospitalized and there has been one death since June 2018.
“The N.C. counties with the most cases included Mecklenburg with 29, Wake with 12 and Wayne with six cases since September of 2018.”
A highly contagious liver infection spread from person to person — from not washing hands after using the bathroom, changing diapers or having sexual contact with someone infected or eating or drinking after a person with Hepatitis A — not all who are infected will come down with the illness, Raynor-Vaughn said.
The Centers for Disease Control and Prevention has focused on vaccinating the homeless, men having sex with men and injection-drug users, she said.
“All of our cases here in Wayne County have been injection drug users, using meth and heroin,” she told the board. “Three of those cases were transients. All of our cases have been hospitalized and one had been incarcerated.”
The Health Department’s response has been providing hepatitis A vaccines at the Wayne County jail, the detention center, the Community Soup Kitchen and the Community Crisis Center. The efforts are ongoing, she added.
“We have given a total of 153 hepatitis A vaccines and we’re doing a focus in the future with the Salvation Army to get some of these high-risk areas, like the Serena Hotel and Irish Inns, to get some of these people to come out and get vaccinated, also,” she said.
Even though the outbreak numbers were small, Wayne County Health Director Davin Madden said he was proud of his staff for responding at the “hot spots” for at-risk people.
“They did a good job — they went out, they went to the jails, they coordinated with the sheriff’s department and vaccinated people there, at the soup kitchen and other places,” he said. “This measure is really the best we can do because it’s really a consent-driven approach.
“Even though you educate them on their potential exposure and their risk factors, (and try to encourage vaccination) some did opt not to receive the vaccine.”
The public health response was followed, Madden added, but there are still constraints and limitations.
“You have only so much limited control when it comes to this category, especially in places like jails,” he said.
The bottom line, in the case of hepatitis as well as other contagions, is that there are basic precautions within the grasp of everyone, said Raynor-Vaughn.
“If you want to stop the spread of any kind of communicable disease, you need to wash your hands, preferably with soap and water, for about 20 seconds,” she said. “Make sure you get your vaccinations, that’s very important — now that we’ve had this hepatitis A outbreak, people are coming in here wanting to get a hepatitis A shot.
“And if you’re sick, you need to stay home, stay away from people so you can get better and you won’t infect anybody else.”