Health director addresses disease outbreaks

In reference to an outbreak of pertussis (whooping cough) in Ravalli County and the general resurgence of this disease throughout Montana and the U.S. and cases in Flathead County last year and earlier this year, we will continue with active surveillance in our community and do everything possible to minimize the potential of multiple cases arising here.

In addition, a long-term care facility in Flathead County has suffered an influenza outbreak resulting in three deaths. Many influenza illnesses and deaths can be prevented. The Centers for Disease Control and Prevention estimate that 35,000 people die in the U.S. every year from seasonal influenza disease, and a very large proportion of the deaths occur in our elderly population.

The death rate due to influenza has not changed much over the past several years. As the health officer of Flathead County, I want to emphasize the seriousness of this problem and to inform the citizens of our county how to prevent sickness and death due to influenza disease and vaccine-preventable communicable diseases in general, including whooping cough. I will use influenza or flu as my model.

There are a few ways of reducing the burden of influenza disease in the community — the judicious use of hygienic controls, social distancing and immunization.

Hygienic controls include proper hand washing and covering a sneeze or cough — preferably in one’s sleeve. Droplets containing the infectious virus or bacterial are not spread from a shirtsleeve as they would from a hand used for the same purpose. Children are very good at this, frequently to the dismay of their mothers.

Social distancing is the concept of sick people staying away from well people and vice versa.

Providing immunity through vaccination is a powerful tool to reduce the burden of disease in a community. Vaccines contain a mild or dead form of the infectious agent your body recognizes as foreign, which stimulates your body to make antibodies to fight the organism. These antibodies remain in your body for months to years ready to mobilize should the individual be exposed to the same organism. The result of this exposure is immunity. Immunity from an agent will result in either no obvious infection or a much less severe version of the disease if exposed.

As good as vaccination is, vaccines are not 100 percent effective, and as is the case with influenza vaccine, the effectiveness generally diminishes with a person’s increasing age.

Vaccination not only protects the individual but also the community through so-called herd immunity. If most people in a community are vaccinated against a disease such as influenza, not only is it unlikely to spread widely because most people are immune, but it may disappear completely, as polio has disappeared in North America thanks to widely accepted polio vaccination.

The resurgence of pertussis in the past few years could similarly be curtailed with higher vaccination rates. Unfortunately, many influenza and pertussis victims are the very young who have not been able to benefit from vaccination.

We all understand the importance of vaccinating our long-term care facility residents to provide immunity to influenza, and vaccination rates of residents in most of our facilities is quite high, hovering around 90 percent.

Unfortunately, vaccination rates for the staff of long-term care facilities are reported to be as low as 20 percent, and these are the people, because they are much more mobile in the community, who are most likely to introduce influenza to these facilities. These low vaccination rates are very disappointing for those to whom we entrust the care of our elderly. Health-care providers in these settings are given the opportunity to be vaccinated but too often they refuse.

The disappointingly low influenza vaccination rates in our long-term care facilities are in stark contrast to those in our hospitals. Under the leadership of Velinda Stevens and Jason Spring, CEOs of Kalispell Regional Medical Center and North Valley Hospital, our hospitals and their affiliated services have taken an aggressive approach to reducing influenza transmission in the hospital setting. Staff of the hospitals must immunize or mask when there is a potential to transmit influenza disease. As smart and effective as these simple procedures are, why are they are not required in all health-care environments?  

We at the health department will be taking a much more aggressive approach with regards to vaccination rates of staff in long-term care facilities. Though workers at these facilities cannot be forced to be vaccinated, the residents and their families deserve to know which facilities provide a safer environment for their loved ones. We plan to consider publishing the vaccination rates of these institutions so their clients can make an informed choice.

Joe Russell is the Flathead City-County Health Officer.