05/03/2000
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NEW HANOVER COUNTY BOARD OF HEALTH
Carl Thomas Durham Auditorium
New Hanover County Health Department
AGENDA
Date:
May 3,2000
Time:
8:00 A.M.
Place:
Carl Thomas Durham Auditorium
New Hanover County Health Department
Presiding:
Mr. William T Steuer, Chairman
Invocation:
W Edwin Link, Jr., RPH
Minutes:
AprilS, 2000
Recognitions:
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Personnel
New Emolovees
Carolyn H. Allen, Physician Extender, Community Health
Kristen E. Keenan, Public HealthNurse I, Child Health'
Leslie W Yusko P~blic Health Nurse I, Comm~nity Health
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Department Focal:
Ocean Fish and Mercury
10 - t! Monthly Financial Report: March 2000
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Committee Reports:
Executive Committee (listed under New Business)
- Mr William T Steuer
Chairman
Dr. Ltianne Williams
State Toxicologist
Ms. Cindy Hewett
Business Officer
- Mr William T Steuer
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NHCBH Agenda
May 3, 2000 - Page 2
p ~ Unfinished Business:
- Mr William T Steuer
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Generators/Hookups at Emergency Shelters /5'l/lftJeJ
New Business:
- Mr. William T Steuer
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Revision to Fee Policy - Personal Health 4-(.
New Hanover County Budget Calendar for FY2000-0l
~roject ASSIST - Legacy Grant Application ~
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Comments:
Board of Health Members
Health Director
1. AEIOU Update reM~I) ~)
2. Staff Appreciation Luncheon - Thank You ()Jofe"5)(I*P
3 Azalea Festival Parade - Health Department Float( PhoflJ5J.
~ NHC Certificate of Safety Achievement - 6 years ( itlltuJ) . ,1 J1"", "
(Y N.C. Institute for Public Health Update Of~ 10 - Pr 9'W1t1 <F PI (31 I, 1ft. :e-~)
6. Eastern District N. C. Public Health Association - May 3-5, 2000
7 Management Academy for Public Health - May 10-12, 2000
8. P3'P5'fef'4., /I?~,"~ (fItOKer)
9-, ':l t ~ at. p~, ~ l:r w..::U)()0
Other Business: 0
- Mr. David E. Rice
Mr. William T Steuer
Adjourn:
Mr. William T Steuer
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Mr. William T. Steuer, Chairman, called the regular business meeting of the New Hanover County Board
of Health to order at 8:00 a.m. on Wednesday, May 3,2000.
Members Present:
William T. Steuer, Chairman
Wilson O'Kelly Jewell, DDS, Vice-Chairman
Henry V. Estep, RHU
Michael E. Goins, OD
Robert G. Greer, Vice-Chair, County Commissioners
Gela N. Hunter, RN, Nurse Practitioner
W. Edwin Link, Jr., RPH
Anne Braswell Rowe
Philip P. Smith, Sr., MD
Melody C. Speck, DVM
Estelle G. Whitted, RN
Members Absent:
Others Present:
Mr. David E. Rice
Lynda F. Smith, Assistant Health Director
Frances De Vane, Recording Secretary
Invocation:
Mr. W. Edwin Link gave the invocation.
I Minutes:
Mr. Steuer asked for corrections to the minutes of the April 5, 2000 New Hanover County Board of
Health meeting. The Board of Health approved the minutes of the April 5, 2000 Board of Health
meeting.
Recognitions:
Mr. Rice introduced health department new employees
Personnel
New Emolovees
Carolyn H. Allen, Physician Extender, Community Health
Kristen E. Keenan, Public Health Nurse I, Child Health
Leslie W. Yusko, Public Health Nurse, Community Health
Other Guests
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Mr. Rice introduced Mayor Ray Rothrock, Town of Carolina Beach, and Mr. Don Y ousey, Health
Director, Brunswick County.
Mr. Steuer welcomed the new health department employees and guests attending the Board of Health
meeting.
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Department Focal:
Ocean Fish and Mercury - Dr. Luanne Williams. State Toxicolo!!ist
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Mr. Rice introduced Dr. Luanne Williams, Toxicologist, N. C. Department of Health and Human
Services, who presented a department focal on Ocean Fish and Mercury. Mr. Rice stated the Board of
Health is concerned about the issue of mercury in ocean fish and requested more information on the
health advisory regarding the higher than normal levels of mercury in large king mackerel caught off the
coasts of North Carolina, South Carolina, Georgia, and Florida. Dr. Williams reported from August 1998
through October 1999, the Division of Marine Fisheries collected samples of 181 king mackerel for
mercury testing. She presented the findings of a risk assessment on the consumption of king mackerel
based on these samples.
Dr. Williams explained on March 23, 2000, health officials from the above four southeastern states issued
a joint health advisory regarding the high mercury levels found in large king mackerel. The health
advisory was issued to protect the public's health since high levels of mercury can damage unborn babies,
young children, and women of childbearing age. The advisory stated king mackerel less than 33 inches
fork-length (from nose to where the tail forks) are safe to eat; however, king mackerel over 39 inches
should not be eaten. People should limit their consumption of 33 to 39 inch fish. Childbearing age
women and children age 0-12 should eat no more than one 8-ounce portion a month, and other adults
should eat no more than four 8-ounce portions a month. The advisory alerted fish processors not to
accept king mackerel over 39 inches long.
Dr. Williams advised industrial sources spread mercury through the air. The Environmental Protection I
Agency (EPA) is working to control the level of mercury in the environment and trying to get legislators
to support the efforts to identify the risks of environmental mercury. Dr. Williams reported after
Hurricane Floyd tests were performed on a variety of finfish and shellfish taken from North Carolina
coastal waters and none of these samples contained mercury. Large king mackerel, as well as, large
tunas, sharks, and swordfish contain high levels of mercury. Large fish eat smaller fish and live longer
accumulating more mercury in their tissues. The Food and Drug Administration (FDA) samples large
fish other than mackerel.
A discussion followed on the validity of the mackerel consumption advisory, health problems, and
economical effects related to mercury levels in our ocean water and environment. Mr. Steuer inquired if
there is a long history of high mercury levels in king mackerel. Dr. Williams informed this is North
Carolina's first fish consumption advisory for ocean waters and fresh water sampling began in 1980.
There have been no fish advisories west of Interstate 95. The Division of Marine Fisheries recommends
and plans to collect samples of ocean fish to test the mercury level in five years. The N. C. Department
of Environment and Natural Resources routinely monitors water quality and fish tissue for potential
problems. Dr. Williams advised Ms. Linda Rymer is the liaison between the EPA and the Division of
Marine Fisheries, N. C. Department of Environment and Natural Resources. Dr. Williams stated the issue
of mercury in our environment is a global problem. She advised the Marine Fisheries has are limited
resources to collect samples of fish to test mercury levels.
Mayor Ray Rothrock, Town of Carolina Beach, asked if the four states will continue to issue food
consumption advisories and continue samplings. He stated it is easier to sample king mackerel during
tournaments. Dr. Williams reiterated mercury is a global issue. The four bordering states have high I
levels of mercury and problems areas will be targeted; however, it will be five years before the Marine
Fisheries plans to test king mackerel for mercury. Mr. Greer stated the advisory was based upon testing
king mackerel once. Ms. Hunter expressed due to health concerns samplings need to continue more
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frequently. Mayor Rothrock reiterated concern regarding targeting recreational fishing for testing. He
requested samplings sooner than five years. Dr. Goins stated commercial fishing is a multimillion
industry. He expressed concern about the frequency of adequate fish samplings, health and economical
issues, and about the possibility of addressing the environmental issue with the EPA and legislators. Mr.
Greer advised environmental standards are being raised and these issues regarding regulations need to be
addressed with the EPA. Mr. Steuer concluded it is a major public health, recreational, and economical
problem that needs addressing and needs to be better coordinated among governmental agencies. Ms.
Whitted stressed the public health issue related to mercury levels especially in women of child-bearing
age and young children.
It was the consensus of the Board of Health to prepare a letter to coastal legislators addressing the
concerns of the Board of Health regarding obtaining better controls, more research, and more frequent
monitoring of mercury levels in our environment and in ocean fish. The letter is to request the Division
of Marine Fisheries to collect samples for the detection of mercury levels in ocean fish within the next
two years instead ofthe scheduled five-year samplings.
MOTION: Dr. Goins moved and Ms. Hunter seconded to prepare a letter to the Division of Fisheries
requesting obtaining better controls, more research, and more frequent monitoring and testing of mercury
levels in our environment and in ocean fish.. Upon vote, the MOTION CARRIED UNAMIOUSLY.
Mr. Steuer thanked Dr. Williams for her presentation.
Monthly Financial Report:
March 2000 Monthlv Financial Reoort:
Mr. Steuer reported the Executive Committee reviewed the March Health Department Financial Summary
Monthly Revenue and Expenditure Report. It reflects expenditure remaining balance of $3,128,447
(67.56%), an earned revenue remaining balance $1,221,533 (71.40%), and a cumulative percent of
74.97%.
Committee Reports:
Executive Committee
Mr. Steuer reported the Executive Committee met at 6:00 p.m. on Tuesday, April 25, 2000. Items are
listed under New Business on the Board of Health Agenda.
Unfinished Business:
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Generator Hookups at Emer!!encv Shelters
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Mr. Steuer, Chairman, gave an update on the generator hookups for emergency shelters. He reported the
contractor plans to install manual electrical transfer switches at Dorothy B. Johnson, Trask, and Eaton
Schools by the middle of June and to install transfer switches at Noble and Codington Schools, the
central school office, and the Cape Fear Museum by June 30.
Mr. Rice, Health Director, announced the School Retrofit Projects Steering Group plans to meet on May
15, 2000, to address emergency shelter issues.
New Business:
Revision to Fee Policv - Personal Health
Mr. Steuer recommended from the Executive Committee for the Board of Health to accept and approve
the revisions to the New Hanover County Health Department Fee Policy.
Mr. Rice reminded the Board that the Health Department Fee Policy is a fluid document that will change.
He presented three proposed revisions to New Hanover County Health Department Fee Policy, Section
IV, Personal Health - Women's Preventive Health (WPH). They are as follows:
1. Delete the following statement based on N. C. Department of Health and Human Services, I
Women's and Children's Health Section guidance. . . . .Patients who are certified for WPH services
under Title XX will not be charged for reimbursable WP H visits. Claims will be submitted to Title XX for
reimbursable visit.
2. Approved by the State with following recommended changes. .. Full charges will be assessed if
patient income falls at or above 250% of the Federal non-farm poverty level. (Pending state approval)
3. Delete the following Title XX* reference. . . Unemancipated minors seeking confidential services
are "a family of one" and are to be considered on the basis of their own resources. In such cases, the
minor's income must still be reported through the patient date system. Third party sources (e.g.
Insurance, Title XIX, * [Title XX] remove) should be billed if eligibility criteria are met.
Mr. Rice explained the above first and third (#'s 1 and 3) policy deletions are based upon state guidance
to remove the above references to Title XX in the existing policy. The second policy change (#2)
addresses charges assessed according to the N. C. Division of Public Health Women's and Children's
Health Section Annual Gross Family Income Sliding Fee Scale - 100% to 250% of Poverty.
Dr. Speck inquired about how the fee changes would effect our clients. Mr. Rice stated the revisions are
more for clarification and would not impact the patients.
MOTION: Mr. Steuer moved from the Executive Committee for the Board of Health to accept and
approve the above revisions to the New Hanover County Health Department Fee Policy and to submit the I
fee policy revisions to the New Hanover County Commissioners for their consideration. Upon vote, the
MOTION CARRIED UNAMIOUSL Y.
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New Hanover County Bud!!et Calendar for Fiscal Year 2000-01
Mr. Rice referred and presented the New Hanover County Budget Calendar for FYB2000-01 to the Board
of Health. It is as follows:
May 19
May 22
Meeting
May 22-June 5
June 5
June 19
- Budget to Board of Commissioners
- County Manager Presents Recommended Budget at Board of Commissioners
- Board of Commissioners Work Sessions
- Budget Public Hearing
- Adoption of County Budget
Mr. Rice noted the Budget Public Hearing is on Monday evening, June 5. He will receive the County
Manager's Recommended Budget on May 22.
Mr. Steuer advised the Board of Health would not have an opportunity to review the County Manager's
Recommended Budget prior to the June 6 Budget Public Hearing. He invited the Board of Health
members to attend the May 30 Board of Health to review the changes to the County Manager's
Recommended Budget since the next Board of Health meeting is on June 7, 2000.
The Board of Health voted to attend the May 30th Executiv~ Committee meeting to review the
recommended changes to the health department budget. Mr. Rice advised a public notice of the full
Board of Health meeting with the Executive Committee will be prepared. Mr. Rice informed the Board
he will not be present at the Executive Committee meeting on May 30 but will be available via telephone
conference call.
Mr. Steuer reminded the Board members that the Budget Public Hearing at 6:30 p.m. on June 5 will be
held in the new conference room of the New Hanover County Board of Commissioners.
Proiect ASSIST - American Le!!acv Foundation Grant Application $57.500
Mr. Steuer recommended from the Executive Committee for the Board of Health to accept and approve a
Project ASSIST American Legacy Foundation Grant in the amount of $57,500 annually for three years
beginning in September 2000 (FY200 1) continuing Fiscal Years 2002 and 2003.
The purpose of the grant is for the New Hanover/Brunswick County ASSIST Coalition to expand youth
outreach efforts to reduce tobacco usage and to promote tobacco free generations. The grant funding
($57,500) is to begin in September 2000 (FY 2001) and is to continue at $57,500 for Fiscal Years 2002
and 2003. The budget request is for one (1) Health Educator position, a computer, youth incentives,
training and travel, program-training retreats for youth, and departmental supplies.
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MOTION: Mr. Steuer moved from the Executive Committee for the Board of Health to accept and I
approve a Project ASSIST American Legacy Foundation Grant in the amount of $57,500 annually f~r
three years beginning in September 2000 (FY200 I) continuing Fiscal Years 2002 and 2003 and to submit
the fee policy revisions to the New Hanover County Commissioners for their consideration. Upon vote,
the MOTION CARRIED UNAMIOUSL Y.
Comments:
Board of Health Members
Staff Appreciation Luncheon
Ms. Hunter reported she has received positive comments regarding the Board of Health preparing the
hamburgers for the luncheon and cleaning following the Staff Appreciation Luncheon on Thursday, April
13, 2000.
Expiration of Billboard Moratorium
Ms. Rowe reminded Board members of the expiration of the billboard moratorium and those wishing to I
should contact their legislative representatives. This issue will be voted on during this session of the
North Carolina General Assembly.
Health Director
AEIOU (Accessing. Evaluatin!!. Improvin!!. our Opportunities are Unlimited) Committee Update
Mr. Rice gave an update on the activities of the AEIOU Team. He referred the Board to a Chart of
Organizational Capacity Survey Priorities for 2000. The first three priorities are (1) the health department
has clear authority act as a law enforcement officer for public health problems, (2) the health department
is regularly consulted by the local elected officials about aspects of local policy relating to health issues,
and (3) the health department has established a process for community health assessment and the
development of a community health plan.
Mr. Rice reported in 1998, 67 strengths were recorded, and the strengths increased to 75 in 2000. The AEIOU
Team compared the indicators that were strengths for 1998 and 2000. The AEIOU Team is using 1998 as a
reference starting point in reviewing, revising, identifying, and analyzing strengths and opportunities to improve.
Staff Appreciation Luncheon - Thank You
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On behalf of the health department staff, Mr. Rice expressed his appreciation to the Board of Health for
sponsoring the Staff Appreciation Luncheon held from 12 Noon - 1 :30 p.m. on Thursday, April 13, 2000.
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He distributed photographs of the event and employee thank-you notes to the Board of Health and Mr.
John Coble, Past Board Chair, for providing the Staff Appreciation Luncheon.
Azalea Festival Float - Health Department Float
In celebration of Public Health Month, the Health Department sponsored a float in the North Carolina
Azalea Festival Parade held on Saturday, April 7,2000, in Wilmington, North Carolina. The float is an
employee project to market Public Health to the community. No county tax dollars are spent for the float.
NHC Safety Award
The New Hanover County Safety Committee presented a Certificate of Safety Achievement in
Recognition of Six Years of Outstanding accident Prevention Efforts to the Health Department on April
19,2000. Mr. Rice commended the health department staff for their safety record.
North Carolina Institute for Public Health Update
Mr. Rice reported as a result of a March 29th meeting with Dr. Rachael Stevens, Deputy Director of the
North Carolina Institute of Public Health, UNC at Chapel Hill, Mr. Steuer, Dr. Jewell, Mr. Estep, Dr.
Goins, Health Department Division Directors, and Mr. Rice on developing Strategic Planning for the
Health Department; the Health Department will be the first to join and consult with the N. C. Institute for
Public Health on Strategic Planning. The Institute of Public Health will fund and provide the facilitators
for strategic planning. Mr. Rice and Ms. Smith plan to meet with Dr. Stevens and Dr. Bill Hertzog on
May 5 to address this issue.
Mana!!ement Academv for Public Health - Mav 10-12.2000
Ms. Smith, Ms. Hewett, and Mr. Rice plan to attend the 1999-2000 UNC Management Academy for
Public Health from May 10-12, 2000 for graduation activities. Other staff members plan to attend the
next Management Academy, a training program for public health managers from North Carolina, South
Carolina, and Virginia.
Eastern District North Carolina Public Health Association - Mav 3-5. 2000
Ms. Smith, Ms. Susan O'Brien, Laboratory Director, and Mr. Rice attended the Eastern District N. C.
Public Health Association Annual Meeting from May 3-5, 2000, held at the Sheraton on Emerald Isle,
North Carolina.
Information for Board of Health
Mr. Rice referred the Board to supplementary information in their folders on Pfiesteria and to a
Dangerous Dog Report.
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Other Business:
57th Case of Positive Rabies in New Hanover County - 1st Case in 2000
Mr. Rice announced on April 25th, the 57th case of Rabies was reported in New Hanover County. This is
the first case in Year 2000. Animal Control Services caught and killed the rabid raccoon identified in the
Crosswinds subdivision in Wilmington, N. C. The state laboratory in Raleigh determined the positive
rabies.
Adjournment:
Mr. Steuer adjourned the regular meeting of the New Hanover County Board of Health at 10:00 a.m.
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William T. Steuer, PE/RLS, Chairman
New Hanover County Board of Health
David E. Rice, M.P.H.,M.A., Health Director
New Hanover County Health Department
Approved: June 7, 2000
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Dr Wilson 0 Jewell, Vice-Chairman, called the regular business meeting of the New Hanover County
Board of Health to order at 8:00 a.m. on Wednesday, April 5,2000.
Members Present:
William T. Steuer, Chairman
Wilson O'Kelly Jewell, DDS, Vice-Chairman
Henry V Estep, RHU
Michael E. Goins, OD
Robert G. Greer, Vice-Chair, County Commissioners
Gela N. Hunter, RN, Nurse Practitioner
W Edwin Link, Jr., RPH
Anne Braswell Rowe
Philip P Smith, Sr., MD
Melody C. Speck, DVM
Estelle G. Whitted, RN
Members Absent:
Others Present:
Mr. David E. Rice
Lynda F Smith, Assistant Health Director
Frances De Vane, Recording Secretary
Invocation:
Mr. Hank Estep gave the invocation.
Minutes:
Dr Jewell asked for corrections to the minutes of the March I, 2000 New Hanover County Board of
Health meeting. The minutes of the March 1,2000 Board of Health meeting were approved by the Board
of Health.
Recognitions:
Service Awards
Mr David E. Rice, Health Director, recognized employees receiving Service Awards.
Years of Service
F ive Years
Vivian Mears, Public Health Nurse, Communicable Disease
Ten Years
Mary Piner, Pubic Health Nurse, Women's Health Care
Ken Sholar, Vector Control Manager, Vector Control/Environmental Health
Fifteen Years
Sylvia E. Brown, Social Worker, Women's Health Care
A round of applause followed in recognition ofthe Service Awards recipients and for the years of public
health service to the community
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Personnel
New EmDlovees
DeAnne A. Chryst, Health Educator I, Women's Health Care
David G. Howard, Health Educator II, Women's Health Care
Doris B. Sanders, Animal Control Officer, Animal Control Services
Mr Rice welcomed the new employees. Ms. Saunders is a former health department employee who
worked with Animal Control Services for two years.
Student Intern
Mr. Rice introduced Ms. Susan Hannah, MPH Intern from UNC @ Chapel Hill.
Department Focal:
The Women's Health Care Division
Ms. Betty Jo McCorkle presented a department focal on the Women's Health Care Division of the New
Hanover County Health Department. The programs of the division are Women's Preventive Health,
Maternal Health, and Health Promotion.
Ms. McCorkle explained the Women's Preventive Health activities include Family Planning Clinics for
adults and teens, pregnancy testing, Temporary Aid to Needy Families (T AN F), cancer screening
(breast/cervical), sterilization (vasectomy, tubal ligation, and male station), health education, community
outreach, and marketing. Maternal Health activities are Maternity Clinics, Maternity Care Coordination
services support pregnant women, and health education (Baby Talk, Prenatal Classes). Health Promotion
activities include staff training (OSHA, CPR, First Response, Hazardous Communications), Community
Assessment, Healthy Carolinians, Injury Prevention (Traffic Safety), Residential Injuries, Recreational
Injuries, Firearm Safety, Violence/Intentional Injuries, and Tobacco Prevention (Project Assist). Tobacco
Awareness Week is this week.
Ms. McCorkle stated the Women's Health Care Division consults and works with other Health
Department Divisions, Coastal OB/GYN Center, Carolina and Cape Fear OB/GYN, New Hanover
Community Health Center, New Hanover Network, Coastal Family Medicine, and the Department of
Social Services. She invited the Board to visit the Button Chair displayed at the entrance of the Health
Department.
Dr Jewell thanked Ms. McCorkle for her presentation.
Monthly Financial Report - February 2000:
Ms. Cindy Hewett, Business Officer, presented the February Health Department Financial Summary
Monthly Revenue and Expenditure Report that reflects an expenditure remaining balance of $3,992,927
(58.42%), an earned revenue remaining balance $1,451,418 (65.43%), and a cumulative percent of
66.67%. She stated this year is a baseline year
Ms. Hewett advised the $174,590 Medicaid Cost Settlement (October 1997-1998) funding is reflected in
the report and is being spent. Thirty (30) personal computers and computer equipment have been ordered.
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Committee Reports:
Executive Committee
Dr Jewell reported the Executive Committee at 6:00 p.m. on Tuesday, March 28, 2000. Items are listed
under New Business on the Board of Health Agenda.
Environmental Health Committee
Mr. Link, Chairman, Environmental Health Committee reported the Environmental Health Committee
met on Wednesday, March 8, 2000.
Unfinished Business:
Generator Hookuos at Emerl!encv Shelters
Mr Steuer, Chairman, asked Mr Rice to give an update on the generator hookups for emergency
shelters. Mr. Rice reported the Board of Commissioners approved the contract for the School Retrofit
Project. Plans are to install manual electrical transfer switches at Dorothy B. Johnson, Trask, Eaton,
Noble, and Codington Schools, the central office, and the museum. The project should be completed 90
days from the Notice to Proceed. Mr. Steuer suggested the contractor attempt to expedite the project and
possibly complete the project by the end of June. He informed a 15k generator is available for the Animal
Control Services Shelter
New Business:
Mr Steuer asked Dr Jewell to present the New Business items on the Board of Health Agenda.
New Hanover County Plan to Establish A Drainal!e Prol!ram
Dr Jewell recommended from the Executive Committee for the Board of Health to approve for the
Health Department to continue to partner by sharing equipment with other agencies as much as possible
but would like for the County to establish a Drainage Program.
Mr Link, Chairman, Environmental Committee, reported at the request of the Board of Commissioners,
Mr Weaver, Assistant County Manager, addressed the Environmental Health Committee to determine the
feasibility of the Health Department Mosquito Control Program expanding to include a county drainage
program. Two scenarios were presented to the Environmental Health Committee requiring Health
Department involvement in the drainage projects. Dr Speck referred to and inquired about the two
scenarios regarding the establishment of a Drainage Program. She expressed as complicated as the
drainage issue is; it would appear the county should establish its own drainage department. Mr Rice
advised the County Commissioners have decided not to establish a separate county drainage program at
this time.
Mr. Greer stated New Hanover County has many drainage issues and problems. He understands the
county could spend $1,500,000, and it would not assure a solution to the flooding and drainage problems.
He informed the County Commissioners are addressing and are trying to make a decision regarding the
drainage. The present drainage options are to provide funding and to join with the Health Department,
to contract with a private company, or to establish a separate district or department for the drainage work.
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Mr. Link stated the Health Department equipment is used most of the time by its mosquito control
program. Mr. Steuer added the Vector Control equipment generates revenues from the Core of Engineers
to eliminate mosquito-breeding areas on Eagle's Island. Mr Rice informed the Health Department can
assist and share equipment during the winter months.
Mr Steuer concurred drainage throughout the county is an extensive, complex problem that requires
expertise. Mr Link expressed Vector Control is currently assisting with drainage. Dr Goins added the
Environmental Health Committee had reservations about more Health Department involvement in
drainage. He stated Vector Control's main mission is mosquito control. It would be difficult to know
how to establish priorities to remove staff from mosquito control to drainage problems. Dr Goins
emphasized the drainage program is a tremendous undertaking. He expressed during hurricanes Vector
Control needs to perform mosquito control duties and not drainage issues.
Mr Link advised the county has requested Vector Control share mosquito control equipment for
drainage based upon availability He clarified the Vector Control Program does not have enough
equipment or staff for the county drainage project. Mr Ken Scholar, Vector Control Manager, advised
the mosquito control equipment is currently shared with other agencies and is also used to run the Beaver
Control Program. The Health Department plans to continue to partner by sharing equipment with other
agencies based upon availability
MOTION: Dr Jewell moved from the Executive Committee for the Board of Health to approve for the
Health Department to continue to partner by sharing equipment with other agencies as much as possible
but wishes the County would establish a Drainage Program. Upon vote, the MOTION CARRIED
UNAMIOUSLY.
Post Hnrricane Flovd Water SamDlinl! Proiect ($65.250)
Dr Jewell recommended from the Executive Committee for the Board of Health to accept and approve a
Grant Application for the Health Department to pursue the Water Sampling Project Funding ($65,250)
and to hire two new positions in Fiscal Year Budget 2000-0 I with a request for the county continuing
funding those positions in future years because of growth and need of services to provide a high level of
service.
Ms. Harvell informed the Health Department has an opportunity to participate in the Water Sampling and
Well Inspection Survey Program and make $65,250 through the Environmental Health Division, N. C.
Department of Environment and Natural Resources. The purpose of the project is to resample 380
positive water samples @ $57,000 and 55 samples for retesting @ $8,250 for a total revenue of $65,250.
She stated the budget request includes the establishment of two new Environmental Health positions (I
Environmental Health Specialist and I Clerical Specialist). It will be budgeted in the FY 2001 Revenue
Budget for Environmental Health. Ms. Harvell advised the water sampling project must be completed by
May 31, 2000 and will take the time of one Environmental Health Specialist. She explained until the
project is completed, the annual inspections of existing Type IV and V water systems could be delayed
without a hardship to customers. A plan for catch-up will be activated after May 31 "
Mr Rice reported the county provides more than 95% funding for the Environmental Health Division.
Ms. Harvell reiterated this is an educational opportunity to follow-up on positive private water samples
and water quality following Hurricane Floyd and to obtain two additional staff members needed due to
increased workload and population growth in our county She emphasized if New Hanover County does
not participate in the post-hurricane water sampling project; other surrounding counties will accept the
one-time grant funding.
MOTION: Dr Jewell moved from the Executive Committee for the Board of Health to accept and
approve a Grant Application for the Health Department to pursue the Water Sampling Project Funding
($65,250), to hire two new positions in Fiscal Year Budget 2000-0 I with a request for the county
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continuing funding those positions in future years because of growth and need of services to provide a
high level of service, and to submit the grant application to the New Hanover County Commissioners for
their consideration. Upon vote, the MOTION CARRIED UNAMIOUSL Y.
ADDointments to Animal Control Services Advisorv Board
Dr Jewell recommended from the Executive Committee the appointment the following applicants to the
vacant positions on the Animal Control Services Advisory Board:
Ms. Timmi Evans, Friends of Felines
Ms. Sylvia Cowan Hall, Kennel Operator
Ms. Jeannie M. Leonard, Cat Interest
Dr Jean McNeil, Animal Control Services, stated the Board of Health approved the appointment of Ms.
Jewell Ann Diehn for Member at Large at their March meeting. She again advertised and recruited for
applicants for the above vacant positions.
MOTION Dr Jewell moved from the Executive Committee for the Board of Health to accept and
approve the appointment of Ms. Timmi Evans, Friends of Felines; Ms. Sylvia Cowan Hall, Kennel
Operator; and Ms. Jeannie M. Leonard, Cat Interest, to the Animal Control Services Advisory
Committee. Upon vote, the MOTION CARRIED UNAMIOUSLY.
Skin Cancer Screeninl!: Grant ADDIication ($.1500)
Dr Jewell recommended from the Executive Committee for the Board of Health to accept and approve a
Skin Cancer Screening Grant Application from The North Carolina Advisory Committee on Cancer
Coordination and Control in the amount of $1 ,500.
Dr. Jewell advised this grant is identical to the skin care grant that the Health Department participated in
last year. The purpose of the grant is to conduct skin cancer screenings and to promote public awareness
activities.
MOTION: Dr Jewell recommended from the Executive Committee for the Board of Health to accept
and approve of a Skin Cancer Grant Application from the N. C. Advisory Committee on Cancer
Coordination and Control in the amount of $1,500 and to submit the grant application to the New
Hanover County Commissioners for their consideration. Upon vote, the MOTION CARRIED
UNAMIOUSLY.
N. Co HeaIthv Start Foundation Grant Application
Dr Jewell recommended from the Executive Committee for the Board of Health to accept and approve a
North Carolina Healthy State Foundation Community Grant Application in the amount of $128,845 over
a two-year period.
Ms. McCorkle referred the Board to an Application for The North Carolina Healthy State Foundation
Community Grants Program in the amount of $85,000 for FY200 I and for $43,845 to be included in the
FY2002 Budget. The purpose of the grant is to reduce infant mortality in the state. The priority area is
improved timing and spacing of pregnancies. The grant proposal includes funding for two (2) Maternal
Outreach Workers to be reimbursed by Medicaid. Ms. McCorkle stated the original projected budget
request was $150,000, and the revised total budget request is $128,845
MOTION: Dr Jewell recommended from the Executive Committee for the Board of Health to accept
and approve a North Carolina Healthy State Foundation Community Grant Application in the amount of
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$128,845 over a two-year period and to submit the grant application to the New Hanover County
Commissioners for their consideration. Upon vote, the MOTION CARRIED UNAMI0USL Y.
Fiscal Year 2000-2001 Budl!et Update
Mr Rice reported he met with Mr Allen O'Neal, County Manager, and Ms. Cam Griffin, Budget
Director, and Budget Office staff members to review the Health Department Fiscal Year 2000-200 I
Budget Request. Division Directors are to prioritize budget items for Capital Outlay, new positions, and
programs. These priorities will be presented to the County Budget Office.
Mr. Rice referred the Board to reports on the FY99-00 Amended Health Department Budget Request
($9,435,033) and to the original FYOO-OI Budget Request ($10,193,749) reflecting a 13.95% increase.
The tentative date for the Budget Public Hearing before the County Commissioners is June 5, 2000, at
6:30 p.m.
UNC Institute for Public Health
Mr Rice reported on March 29, 2000, Dr Rachael Stevens, Deputy Director of the North Carolina
Institute of Public Health, UNC at Chapel Hill, facilitated a brainstorming session on developing Strategic
Planning for the Health Department. Mr Steuer, Dr Jewell, Mr Estep, Dr Goins, Health Department
Division Directors, and Mr. Rice attended the luncheon meeting held in the Wood Conference Room.
Mr Rice advised Dr Stevens will assist the Health Department address and identify health issues and
proceed with a strategic planning process. He informed the Health Department will be the first to join
and consult with the N. C. Institute for Public Health on Strategic Planning. Dr Jewell expressed the
meeting was most productive and that the Institute for Public Health is a tremendous resource.
Dr Speck thanked Mr Rice for contacting and securing Dr. Stevens and the Institute of Government as strategic
planning resources. Dr Jewell and Dr. Smith commended Mr. Rice for assuring the Board of future planing with
Dr. Stevens and the UNC Institute for Public Health. Mr. Estep emphasized the Health Department will save
potential tax dollars and should advise the County Commissioners of the potential.
Comments:
Board ofHeaIth Members
Staff Appreciation Luncheon
Ms. Rowe reminded the Board members to attend the Staff Appreciation Luncheon on Thursday, April
13, 2000, and to plan to stay and clean-up following the employee luncheon.
Permanent Dates for Staff Appreciation Luncheon and Health Department Christmas Party
Mr Rice reported that the Management Team recommended the establishment permanent dates for the
following activities:
Staff Appreciation Luncheon - 2"d Thursday in April
Annual Health Department Christmas Party - 2"d Thursday in December
MOTION: Mr Link moved seconded by Dr Goins for the Board of Health to approve and adopt the
permanent dates of the second Thursday in April for the Staff Appreciation Luncheon and the second
Thursday in December for the Annual Health Department Christmas Party Upon vote, the MOTION
CARRIED UNAMIOUSL Y.
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Health Director
Kin!! Mackerel - Mercurv
Mr Rice reported a press conference was held on Thursday, March 23, for public awareness ofthe higher
than normal levels of mercury in large king mackerel caught off the coasts of North Carolina, South
Carolina, Georgia, and Florida. Dr. Luanne Williams, Toxicologist, and state health officials issued a
state consumption advisory regarding the mercury found in large mackerel. It alerted fish processors not
to accept king mackerel over 39 inches long. Mr Rice stated this will affect fishing and the economy It
is a public health problem that needs addressing.
Dr Speck and Mr Steuer inquired about the mercury level and safety of consumption of other species of
ocean fish i.e. tuna, wahoo, swordfish, etc. Ms. Harvell responded the South Atlantic Fishery
Management Council is responsible for the management of king mackerel from North Carolina through
Florida while the North Carolina Marine Fisheries Commission is responsible for king mackerel in our
state waters. These management groups plan to discuss this issue in the near future to determine if
additional fisheries regulations are needed. Ms. Harvell advised the Environmental Protection Agency
(EPA) is working to control the level of mercury in the environment and trying to get legislators to
support the efforts to identify the risks of environmental mercury The N. C. Department of Human
Resources is getting information for the public regarding the safety of consumption and mercury levels.
Ms. Harvell informed the processing plants are under the Department of Agriculture.
Dr Speck suggested sending a letter to legislators addressing the concerns of the Board of Health
regarding obtaining better controls, more research, and more monitoring of mercury levels in the
environment and in fish. She stated this is a global problem. Mr Steuer emphasized this issue needs to
be better coordinated among governmental agencies.
The Board of Health concurred more information on the mercury levels in fish is needed. Mr Rice
suggested inviting Dr Luanne Williams, Toxicologist, N C. Department of Health and Human Services,
to speak to the Board on mercury levels in ocean fish to the Board of Health. The Board requested Mr
Rice contact Dr Williams to address this issue.
West Nile Virus Press Release
Mr Rice advised the Centers for Disease Control (COC) Morbidity and Mortality Week Report
(MMWR) featured an article on West Nile Encephalitis. Mosquitoes collected in New York tested
positive for the West Nile Encephalitis Virus. Health officials are concerned about the possible
introduction of West Nile Encephalitis into North Carolina. Surveillance, prevention, and response
efforts are being addressed locally and by the state. The virus is introduced by birds and transmitted by
mosquito bites.
Mr Ken Sholar stated the Health Department Vector Control Program plans to focus on crows and
seagulls especially the seagulls at the county landfill. New Hanover County has checked for eastern
equine encephalitis for years and will get two more flocks of sentinel chickens in May to be tested for the
West Nile virus. He explained that sentinel chickens provide an excellent warning system for detecting
the virus, and the state plans to test blood samples from the flocks every two weeks.
Mr Sholar informed many counties in the state do not have mosquito control programs; in fact, New
York City does not have a mosquito program. The state is seeking CDC funds to expand and enhance its
West Nile detection and surveillance activities of the West Nile Virus.
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Oreanizatioual Capacity Assessment Update
Mr Rice thanked the Board for completing their abbreviated Organizational Capacity Assessment
surveys. He reported 130 (77%) of 169 employee questionnaires were completed and returned. It was a
volunteer effort. The Accessing, Evaluating, Improving, our Opportunities are Unlimited (AEIOU) Team
will process the infonnation from a summary report being prepared by Coastal Area Health Education
Center The AEIOU Team is to identify and to analyze strengths and opportunities to improve.
NHN/NHCHD Senior Mana!!ement Meetin!!
The New Hanover Network and the Health Department Management Teams met on March 6, 2000. The
group addressed health care issues, exchanged ideas, and identified common areas the agencies could
work together on.
UNCW Adult Scholars Presentation - March 9. 2000
On March 9, 2000, Mr Rice gave a presentation on Public Health Issues to UNCW Adult Scholars at the
UNCW campus.
Healthv Carolinians Task Force - March 22. 2000
Mr Rice attended the Healthy Carolinians Task Force meeting on March 24,2000. emphasized the New
Hanover County Healthy Carolinians Task Force has been a force since the early 1900's and was
instrumental in the establishment of Wilmington Health Access to Teens (WHAT). The Task Force
plans to request a one-year extension before applying for recertification.
Information for Board ofHeaIth
Mr Rice referred the Board to supplementary information in their folders on the following King
Mackerel and Mercury, West Nile Virus, AEIOU, Serving Safe Food, and a County Commissioner/Board
of Health Directory, a Dangerous Dog Report, EPllnfonnation Newsletter, an article from Commissioner
Buzz Birzenicks, and a copy of the Animal Control Services Advisory Committee Meeting.
Other Business:
Pnblic Health Month
April is Public Health Month. Mr. Rice reminded the Board members to get their Public Health Month Calendars
and Public Health Buttons. He again reminded Board members of the Staff Appreciation Luncheon on Thursday,
April 13, 2000. Lunch will be served from 12 Noon - 1.30 p.m. Cooks were asked to arrive by 11.30 a.m.
Animal Control Services Citations
Dr Jean McNeil, Animal Control Services Director, reported approximately 1,300 citation letters were
mailed. Follow-up of the citations will be through a collection agency if the violators do not appeal. The
appeal process will start on April 19 with Attorney Andrew Olsen serving as the Appeals Officer
Dr McNeil emphasized the public was given ample time to get their pet immunizations and to get pet
licenses. A brochure entitled "Rabies Protecting Your Family and Your Pets" was included in the Val-
Pak coupon mailer and public service announcements were prepared for the media. Pet owners may get
their pets immunized for a $6.00 fee at a Rabies Clinic on April 161h at the Animal Control Services
Shelter
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Rubella in Nortb Carolina
Mr Rice reported he received a letter from Ms. Beth-Rowe West. Head of Immunization Branch, N. C.
Department of Health and Human Services, stating since the first week of March, 14 cases of Rubella
have been confirmed in North Carolina. He advised the cases of Rubella occur primarily in the
Latino/Hispanic population that has not received their Measles, Mumps, Rubella (MMR) vaccination.
Mr. Rice stated the Health Department will be proactive in outreach efforts to increase community
awareness and to provide immunizations targeting the LatinofHispanic population.
Shi!!ella Update
Ms. Gela Hunter inquired about the status on Shigella in New Hanover County Mr Robert Keenan,
Environmental Health Specialist on the Epidemiology Team, reported II cases were reported this past
month. He advised the Health Department sent letters to day care centers and is visiting the day care
centers to collect samples and make sure precautions and guidelines are being followed. He stated the
disease seems to be under control.
Adjournment:
Mr. Steuer adjourned the regular meeting of the New Hanover County Board of Health at 10:05 a.m.
William T Steuer, PE/RLS, Chairman
New Hanover County Board of Health
David E. Rice, M.P.H.,M.A., Health Director
New Hanover County Health Department
Approved:
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New Hanover County Health Department
FY99-00
MONTHLY EXPENDITURE REPORT
As of March 31, 2000
Sunmary for lhe New Hanover County Health Department
Cumulative % 74.97%
Month Reported Month 9 of 12: Mar-OO
Current Yea,
Budgeted Expe_ Balance
Amount Amount Remalnln
PrIor Vea'
Bu~ Expe_ Balance %
Amount Amount Remalnl
5,087,500
Expenditure Summary
For Month of March 2000
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Type of
Revenue
F_&~
ACFees
MedIcaid
Medicaid MaJC
EHFees
Health Fees
other
New Hanover County Health Department
FY99-00
MONTHLY REVENUE REPORT
As of March 31, 2000
Sunmary for the New Hanover County Health Department
Cumulative %
74.97%
Month Reported
Month 9 of 12 Mar-OO
Current Year
Budgeted Revenue
Amount Earned
ro h Jan 2000
Balance
Remalnl
Prlor Year hro
Budgeted Revenue
Amount Earned
%
%
1,3tf7 ,878 976,565 411,313 70.36% $ 1,377,269 970,995 406,274 7O.5O'Ilo
518,453 281,890 234,563 54.58% $ 493,100 273,118 219,982 55.39'110
801,504 500,340 301,164 82.43% $ 824,754 473,924 350,830 57_
388,891 388,891 100.00% $ 401,789 401,788 1 100.00%
312,900 228,947 73.17% $ 243,100 207,838 35,264 85._
109,515 105,807 96.61% $ 98,085 78,378 21,889 77.88%
778,172 589,340 75.93% $ 572,457 433,837 138,820 75.79%
Note: County Appropriation Ie not calculated above. The County appropriation 18 the dlfferenC8 beIween the total amounts on the
program 8llpIlI1dllure reporland the totale on the program revenue report.
The ~ amount for County ApproprIation for FY 99 - 00 Ie ($9,644,380 - 54,271,313) = $5,373,087
The __ amount for County Appropriation IOrthle FY (year-to-dale) is ($8,515,933 - $3,049,780) = $3,408,153.
Revenue Summary
For Month of March 2000
11
REVISIOlIIS ro FEE POLICY - PERSOI!lAL HEALTH
e
Donations may be accepted from any patient regardless of income status
as long as they are truly voluntary There should be no "schedule of
donations", bills for donations, or implied or overt coercion.
W
n. Program Specific Information
A Environmental Charges - Water Bacteriology
1. Samples collected by the Environmental Health division will be
charged and the fee collected in the Environmental Health section.
2. The Environmental Health clerk will submit a monthly report to
the Laboratory Director listing total water sample revenues for the
month.
3 Fees, for water samples, not collected by the Environmental Health
Division will be billed monthly by the Laboratory Director.
4. Checks will be received by the Administration Division and
deposited to the appropriate account.
e
B
Women's Preventive Health
Delete based on 3
State guidance.
Approved by the State 4.
nth recOIDIIlended chaDges.
Delete Title :xx reference 5.
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04119/00
1. The WPH Program has established a method of directly assessing
patient charges and collecting payments for clinical services in
accordance with Title X regulations and the fee policy as
established by New Hanover County Board of Health.
2. There will be no minimum fee requirement or surcharge that is
indiscriminately applied to all patients.
Patients who are certified for WPH services under Tide XX
will not be charged for reimbursable WPH visits. Oaims will
be submitted to Tide XX for reimbursable visit. *
Full charges will be assessed if patient income falls at or above
250% of the Federal non-farm poverty level. (pending state
approval)
Unemancipated minors seeking confidential services are "a family
of one" and are to be considered on the basis of their own
resources. In such cases, the minor's income must still be
reported through the patient data system. Third-party sources ( e.g.
Insurance, Title XIX, Tide XX) should be billed if eligibility
10
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A revised 2000-2001 Budget Calendar follows. As shown in the schedule, the
Recommended Budget will be presented to the County Commissioners on May
22, 2000.
2000
May 19
May 22
BUDGET CALENDAR FOR FISCAL YEAR 2000-2001
(Revised 4/10/00)
Budget to Board of Commissioners (informally)
County Manager presents Recommended Budget at Board of
Commissioners' Meeting
May 22-June 5
Board of Commissioners to establish budget work session(s)
June 5
JUDe 19
Public Hearing on budget (night meeting)
Adopt budget
14
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HfAl..TH
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
REQUEST FOR BOARD ACTION
Meeting Date: 05/-:22,U()
03
Department: Health Presenter: Betty Jo McCorkle, Director Women's Health
Contact: Betty Jo McCorkle 343-6660
SUBJECT:
Project ASSIST (American Stop Smoking Intervention Study) application for the
American Legacy Foundation Grant for $57,500 (this amount of $57,500 to be
continued each year for 3 years)
BRIEF SUMMARY:
We are requesting a grant from the American Legacy Foundation for $57,500. Program level
grants are offered to communities with existing local ASSIST coalitions to expand diverse youth
led school and community initiatives. This money can only be used towards youth advocacy and
involvement initiatives. Each coalition can apply for up to $57,500 The New Hanover and
Brunswick County ASSIST Coalition is applying for this amount to expand our outreach efforts to
the youth.
In November, 1998, Americans won an unprecedented victory in our nation's century long fight
against tobacco use and abuse. A coalition of 46 state Attorneys General successfully settled
their case with the tobacco companies amounting to $206 billion over the first 25 years. The
American Legacy Foundation, established to reduce tobacco usage in the United States as
outlined in the Master Settlement Agreement, will set in motion a new legacy through a public
education campaign driven by a single premise: Promoting Tobacco Free Generations.
Our proposal includes hiring one full-time Health Educator who will be involved in training for
school personnel and youth. We will partner with the Boards of Education (Alternatives to
Suspension Program)-New Hanover and Brunswick Counties, Wilmington Health Access for Teens
(WHAT) Youth Advisory Board, and the University of North Carolina at Wilmington Crossroads
Co-op Program. Funding will also be used to purchase a computer, youth incentives, training
and travel, program training retreats for youth, and for departmental supplies.
This funding is to be recurring at $57,500 each year for 3 years. At the end of the grant period,
the programs at the Board Of Education (New Hanover and Brunswick Counties), WHAT and
UNC-W Crossroads Co-op should be prepared to absorb the programs.
RECOMMENDED MOTION AND REOUESTED ACTIONS:
Approve Grant Application and associated budget amendment for $57,500 if grant awarded (the
budget amendment would be for FY2001 since this grant would be awarded for September
2000). (The amount of $57,500 will be included in the budget request for the following fiscal
yea rs: FY2002 and FY 2003.)
FUNDING SOURCE:
American Legacy Foundation
ATTACHMENTS:
5 pa ges
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New Hanover! Brunswick County ASSIST
American Legacy Grant Application
April 19, 2000
The New Hanover and Brunswick County ASSIST coalition is applying for
$57,500 to be funded by the American Legacy Grant in September 2000. This money
will be used expand our outreach efforts to the youth. A Public Health Educator I
position will be added to the New Hanover County Health Department staff whose focus
would be to strengthen the local infrastructure in the schools for New Hanover and
Brunswick Counties. At a local level this position would be the point person to provide
all fmancial, training and technical assistance resources to the youth in these counties.
HeI she will work on expanding the coalition's already existing "Tobacco Awareness
Week" to one month per county in order to reach more students as well as involve more
peer educators. This would include presentations in all possible schools as well as
providing information booths for students. The booths will provide a variety of tobacco
free incentives as well as cessation materials for those who smoke. Media involvement
would be encouraged during these months as the coalition seeks support from the
mayor's office as well as county commissioners. An annual wreath lying would take
place at the tree that has been planted in honor of the victims oftobacco.
Brunswick County has successfully implemented Alternative to Suspension in their
county. Brunswick County has been unable to assist these students with cessation due to
a lack of funding, a trained program and a facilitator. The N-O-T (Not On Tobacco)
program wouldbe.an excellent fit for the students who complete the Saturday School and
wish to quit smoking. This need for cessation has been identified by the youth that
attended the Governor's Youth Summit on Tobacco. He!she would work closely with the
Student Support Services Director for the county to continue the Alternative to
Suspension and to fill in the gap that Brunswick County desperately needs to fill.
Brunswick County has approximately 30 students who are T ATU (Teens Against
Tobacco Use) trained. These students need the leadership of a health educator to focus
their ideas and programs and assist them with reaching out to the elementary schools,
church groups, and day care centers in their area. Until another N-O- T facilitator's
training is offered, helshe will have access to contract out a local prevention specialist
who is trained to facilitate the meetings. Tobacco Free Teens is another youth cessation
program that can be implemented if the N-O- T program does not offer another training.
Hislher role will still be essential for organizing and coordinating the trainings.
A close partnership will be continued as helshe teams up with Wilmington Health Access
For Teens and University of North Carolina at Wilmington's Crossroads Co-op's already
established peer health educators. The majority of the 30 teens that are trained in TATU
for New Hanover County are also a part of one of the two above organizations. These
organizations are pursuing the N-O- T facilitator's training for both their stafflfacilitators
as well as a select group of peer educators. New Hanover County school board has yet
to iniate Alternative to Suspension or any youth cessation programs. This position would
16
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be able to work closely with Coordinator of Safe and Drug Free Schools, to implement
these programs throughout the county. There is defmitely a need in both counties to
reach out to middle school students. He/she will need to work with the middle school
health teachers to pursue a relationship that will build consistency in their tobacco
prevention education. While working with these teachers, he/she will research and/or
develop programs that are geared towards middle school students. He/she will have
access to work with UNC-W's peer wellness group. These are college students that can
be trained in T ATU and then brought to the middle schools to make presentations.
New Hanover and Brunswick County both have the interest in developing the SWAT
(Students Warning Against Tobacco) club. This is an after school club geared towards
high schoolers. Brunswick County has a tremendous need for an outlet for teens. Being
a very rural area, many teens resort to smoking for something to do. The SWAT club
would also be another resource for ex-smokers to gain support and encouragement on a
consistent hasis. This position would also do what is possible to include and/or adjust
this club to reach middle school students
He/she would have the responsibility of creating flyers, advertisements, calendars, and
press releases, etc. concerning all of the events they are involved in. He/she would be the
contact person for all of the schools in New Hanover and Brunswick County concerning
requests for presentations and health fairs. He/she would be responsible for maintaining
contacts with area organizations to ensure that duplicate work is not being done. Media
coverage and advocacy would be an important goal for this position. He/she would also
train and encourage media advocacy with the peer educators, TATU trained teens and the
SWAT club members. He/she would be involved in recruiting teens for the different
available programs. Other possible programs he/she would be involved are The Great
American Smoke Out, The Smoke Scream, World Asthma Day, and Kick Butt's Day.
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Budget Outline
I. Salary - $26,562
II. Fringe Package - $7970
III. Training & Travel - $2400
IV. Local Mileage - $1200
V. Computer and Software- $3500
. This would include a lap top computer and al1 relevant software.
VI. Educational Programs - $10800
A Tobacco Cessation Programs - $3300
. This would include 6 sessions at $550 each, 3 in New Hanover and 3 in
Brunswick County. Each session consist of one one-hour meeting for 10
weeks along with I booster session. The recommended number of
participants is 10- 12 students
. The money would go towards the purchase of: Healthy fruit snacks, printing
(duplication from master copy is recquired for each participant, postage
weekly mailings include tips, encouraging notes and reminders), certifIcates,
incentives, bus vouchers or taxi cab fares for students with transportation
needs.
B. SWAT Club- $2000
. This would cover $1000 per county start-up and one- time expenses (Mr.
Gross Mouth, Human lung set, CO Monitors and props used in presentations).
This also includes youth training retreats, transportation for youth and quality
start-up incentives ie. embroidered windbreaker jackets. Fol1owing the fIrst
year, the SWAT clubs should be self-supporting tbrough fundraisers and
should then only need $250 per club. The later expense would cover the cost
or replacement pamphlets, brochures, recruitment and training of new
members.
C. Teens Against Tobacco Use- TATU -$1100
. This would include expenses for three youth training retreats (training facility
rental, transportation for students, food, incentives, art supplies). He/she will
be encouraged to apply for any potential T A TU mini-grants that are available.
D. Tohacco Awareness Month- $4400
. This would include $2200 per county cost of pamphlets, incentives, and
brochures for all of the students in both counties. This would involve
approximately 20,000 or more students.
VII. Advertising- $868
. This will cover the cost of newspaper advertisements for upcoming events.
Project ASSIST has an established earned media relationship with the main
media channels in our local area. We have a fairly balanced relationship
between our earned and paid media.
VIII. Contract Services - $1000
. This money would include having to bring in people to facilitate trainings for
mediaadvocacy,N-O-T, TATUandSWAT.
VIV. Postage -$200
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. This will cover mailing expenses outside of educational programs ie.
newspapers, correspondences.
Supplies - $3000
. This will cover departmental supplies ie. office furniture, office supplies,
telephone, and work station for a workspace in both counties.
Total Budget: $57,500
19
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Legacy vvel'Vlew
~AMERICAN
i<~."....LEGACY
. FOUNDATION
..,. . ~ 10b0cc0 ,,.. c.--abO/U
Legacy Overview Speak Out
Legacy Overview
Adm ini!>tration
Board of Director!>
GlJidin~ Prindple!>
Home
Welcome to the American Legacy Foundation -
Promoting Tobacco Free Generations
Each day, about 6,000 young people try a cigarette. 3,000 more
become daily users.
When does it stop?
In November, 1998, Americans won an unprecedented victory in our
nation's century long fight against tobacco use and abuse. A coalition
of 46 state Attorneys General successfully settled their cases with the
tobacco companies amounting to $206 billion over the first 25 years.
Now the real work is about to begin as the funds from this settlement
will be channeled towards tobacco prevention - not tobacco
promotion.
The American Legacy Foundation, established to reduce tobacco
usage in the United States as outlined in the Master Settlement
Agreement, will set in motion a new legacy through a public
education campaign driven by a single premise: Promoting Tobacco
Free Generations.
Legacy Goals
. Reduce youth tobacco use
. Reduce exposure to second-hand smoke among all ages
and populations
. Increase successful quit rate among all ages and
populations
. Decrease tobacco consumption among all ages and
populations
American Legacy Foundation
1001 G Street, NW, Suite 800
Washington, DC 20001
202-454-5555 phone
202-454-5599 fax
infotWamericanleoacv.ora
http://www.american1egacy.org/overview/index.html
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NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Prepared By the Occupational and Envirollmental Epidemiology Branch
Medical Evaluation and Risk Assessment Unit
MERCURY IN THE ENVIRONMENT
WHAT IS MERCURY AND HOW IS IT RELEASED INTO THE ENVIRONMENT?
Mercury is a naturally occurring metal and is present at very low levels in rock, soil, and water
throughout North Carolina. Man can introduce mercury into the environment through fossil fuel
combustion (i.e., coal, oil, and natural gas), municipal solid waste and medial waste incineration,
chlorine manufacturing, and lead and copper smelting.
WHAT HAPPF.NS TO MERCURY WHF.N IT IS RELEASED INTO THE
ENVIRONMENT'!
Mercury is not broken down in the environment, but is recycled between air, land, and water
Once mercury gets into water, it may be converted to another substance called methylmercury
which is consumed by tiny aquatic organisms as well as fresh water and ocean fish. The most
significant impact from release of mercury into the environment is the accumulation in fish.
Methylmercury builds up in the aquatic food chain, accumulating in larger and larger amounts as
small invertebrates arc eaten by small fish, which in turn arc eaten by large fish (sometimes
called predators). Methylmercury builds up to potentially high levels in predatory fish that arc at
the top of the aquatic food chain by becoming attached to the protein of the fish which cannot be
removed by cooking or cleaning.
HOW CAN MF.T1IYLMERCURY AFFF.CT YOUR HEALTH'!
Methylmercury primarily affects the nerve cells within the brain and spinal cord. The
complexity and severity of the symptoms of toxicity is dependent upon the amount of
methylmercury taken into the hody and the duration of exposure.
The earliest obvious signs of methylmercury poisoning in adult humans are abnormal sensations
of the lips, tongue, lingers, or toes; fatigue; and blurred vision. [n more severe cases, a person
may develop a hearing and speech impairment, and loss of coordination in the worst cases; tbe
patient may go into a coma and ultimately die. These effects have been reported in individuals
who have consumed fish for several years containing extremely high levels of methylmercury
(20 milligrams of mercury per kilogram [mg/kg] offish tissue and greater) in the 1950s and
I %Os in Japan. Similar effects were also reported in the 1970s in Iraq following I to 2 months
of consumption of contaminated bread made from methylmercury treated wheat.
The developing brain of fetuses and young children may be more sensitive to the toxic effects of
methylmercury I-ligh levels of methylmercury exposure interfere with the way nerve cells move
into position as the brain develops resulting in abnornlal brain development. Delayed walking
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and talking, mental disturbances, speech retardation, cerebral palsy, blindness, inability to walk,
and inability to crawl have been reported in children whose mothers consumed the contaminated
bread in Iraq in the 1970s and in Japan in children whose mothers consumed highly
contaminated fish.
WHAT LEVELS OF METHYLMERCURY ARE FOUND IN FRESHWATER FISH?
The methylmercury levels in freshwater fish vary markedly depending on the species, metabolic
rate, age, weight, geographical location, and position in the food chain. In general,
methylmercury levels for most fish range from less than 0.0 I mglkg to 0.5 mg/kg. It's only in a
few species of fish in a few locations that methylmercury levels reach the North Carolina's
action level of I mg/kg for issuing a fish consumption advisory In some North Carolina fresh
water locations, this occurs in older predatory fish such as largemouth bass and bowfin (or
blackfish).
WHAT LF.VELS OF MF.T1IYLMF.RCURY IN FISH ARF. CONSIDERED SAFE TO
EAT'!
In North Carolina, a Iish consumption advisory is issued when the average mercury level for a
(ish species is equal to or greater than 1 mgikg. Elevated mercury levels are most often seen in
largemouth bass and bowfin. If the average mercury level for a particular species is I to less
than 2 mgikg, than a limited consumption advisory of no more than two meals per person per
month is issued for the general public. Children and women of childbearing age arc advised not
to consume these Iish species. A no consumption advisory is issued for the general public,
children, and women of childbearing age when the average mercury level for a particular species
is equal to or greater than 2 mg/kg.
Fish consumption advisories, due to elevated levels of mercury, have been issued for several
locations in North Carolina. ^ list of locations can be obtained from the internet web address
hllll://www.schs.state.ne.us/eni/lish or by contacting Dr Luanne Williams within the North
Carolina Department of Health and Human Services, Occupational and Environmental
Epidemiology Branch, 11)12 Mail Service Center, Raleigh, NC 27699-1912, or by calling (919)
715-6429
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RISK ASSESSMENT OF CONSUMPTION OF KING MACKEREL*
Prepared by Dr. Luanne K. Williams, Pharm.D., Toxicologist
North Carolina Department of Health and Human Services
Medical Evaluation and Risk Assessment Unit
March 22, 2000
King Mackerel less than 33 inches
Women of Child Bearing Age and Children (0-12 years)
The average mercury level found for king mackerel just under 33 inches was
approximately 0.5 mglkg (see enclosure).) When the mercury fish tissue levels from all
fish consumed are 0.5 mglkg, the recommended number of fish meals per month for
women of child bearing age and children (0-12 years) is approximately four meals per
month (based on review of Seychelles Islands fishing village data from Indian Ocean in
Davidson PW et al. 1998, Effects of Prenatal and Postnatal Methylmercury Exposure
From Fish Consumption on Neurodevelopment. JAMA, Vol. 280 (8),pp. 701-707).
It is estimated that North Carolina citizens may consume both
freshwater/estuarine and marine fish. For the purposes ofthis risk assessment, the
average total fish intake for a North Carolina citizen is estimated to be 2.5 meals per
month (0.75 meals/month-freshwater/estuarine fish, 0.875 meals/month marine finfish,
0.875 meals/month shellfish) (U.S. EP A Exposure Factors Handbook Volume I August
1997). This was calculated as shown:
. 6 grams/day avg. freshwater/estuarine fish consumption rate x 30
days/month x I oz/30 grams x I meal/8 oz = 0.75 meals per month expected
from freshwater/estuarine fish
. 7 grams/day avg. marine finfish consumption rate x 30 days/month x I oz/30
grams x I meal/8 oz = 0.875 meals/month expected from marine finfish
. 7 grams/day avg. shellfish consumption rate x 30 days/month x I oz/30 grams
x 1 meal/8 oz = 0.875 meals/month expected from shellfish
For the purposes of assessing exposure to king mackerel, it is assumed that a
North Carolina citizen may eat 0.75 meals per month _of freshwater/estuarine fish at 0.5
mglkg (average'mercury levels found across the state are 0:5 mglkg or less), 0.875 meals
per month of king mackerel as the marine fish at 0.5 mglkg (average mercury level found
just under 33 inches), and 0.875 meals per month of shellfish at 0.5 mglkg and less
(average mercury levels in shellfish are 0.5 mglkg or less). Ifi! is assumed that four
meals per month is the acceptable number of meals per month when mercury tissue levels
from all fish consumed are close to 0.5 mglkg, then one can calculate the recommended
number of meals per month for king mackerel as follows:
*(based on mercury sampling results of 181 king mackerel collected off the coast of
North Carolina, South Carolina, Georgia, and Florida between 1998 to 1999)
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. A total of 4 recommended fish meals per month - (0.75 meals per month
expected from freshwater/estuarine fish) - (0.875 meals per month expected
from shellfish) = 2.375 meals per month recommended for King Mackerel.
A North Carolina citizen is not expected to consume more than 0.875 meals
per month of king mackerel. Therefore, king mackerel just under 33 inches
would be considered safe.
Adult Males and Women not of Child Bearing Age
~
The average mercury level found for king mackerel just under 33 inches was
approximately 0.5 mglkg When mercury fish tissue levels from all fish consumed are
0.5 mglkg, the recommended number of fish meals per month for adult males and women
not of child bearing age is approximately ten meals per month (based on review of 1965
methyl mercury fish poisoning incident in Niigata, Japan in Tsubaki T et al. 1978,
Clinical, Epidemiological, and Toxicological Studies of Methylmercury Poisoning, Proe
First Intl Congress Toxieol, pp. 339-357).
North Carolina citizens are expected to consume both freshwater/estuarine and
marine fish. For the purposes of this risk assessment, the average total fish intake for a
North Carolina citizen is 2.5 meals per month (0.75 meals/month-freshwater/estuarine
fish, 0.875 meals/month marine finfish, 0.875 meals/month shellfish) (U.S. EPA
Exposure Factors Handbook Volume I August 1997). This was calculated as shown:
. 6 grams/day avg. freshwater/estuarine fish consumption rate x 30
days/month x I oz/30 grams x I mea1l8 oz = 0.75 meals per month expected
from freshwater estuarine fish
· 7 grams/day avg. marine finfish consumption rate x 30 days/month x I oz/30
grams x 1 mea1l8 oz = 0.875 meals/month expected from marine fmfish
. 7 grams/day avg. shellfish consumption rate x 30 days/month x I oz/30 grams
x I mea1l8 oz = 0.875 meals/month expected from shellfish
For the purposes of assessing exposure to king mackerel, it is assumed that a
North Carolina citizen may eat 0.75 meals per month of freshwater/estuarine fish at 0.5
mglkg (average mercury levels found across the state are 0.5 mglkg or'le~s), 0.875meals
per month of king mackerel as the marine fish at 0.5 inglkg (average mercury level found
just under 33 inches), and 0.875 meals per month of shellfish at 0.5 mglkg and less
(average mercury levels in shellfish are 0.5 mglkg or less).). Ifit is assumed that ten
meals per month is the acceptable number of meals per month when mercury tissue levels
from all fish consumed are close to 0.5 mglkg, then one can calculate the recommended
number of meals per month for king mackerel as follows:
. A total of 10 recommended fish meals per month - (0.75 meals per month
expected from freshwater/estuarine fish) - (0.875 meals per month expected
from shellfish) = 8.375 meals per month recommended for king mackerel.
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North Carolina citizens are not expected to consume more than 0.875 meals
per month of king mackerel. Therefore, king mackerel just under 33 inches
would be considered safe.
Kin!: Mackerel 33 to 39 inches
Women of child bearing age and children (0-12 years)
The average mercury levels found for king mackerel 33 to 39 inches were
approximately 0.6 to 1 mg/kg. When mercury tissue levels from all fish consumed are
- -
close to 0.6 mg/kg to 1 mg/kg, the recommended number of fish meals per month for
women of child bearing age and children (0-12 years) is approximately 2 to 3.3 meals per
month (based on review of Seychelles Islands fishing village data from Indian Ocean in
Davidson PW et al. 1998, Effects of Prenatal and Postnatal Methylmercury Exposure
From Fish Consumption on Neurodevelopment. lAMA, Vol. 280 (8),pp. 701-707).
North Carolina citizens are expected to consume both freshwater/estuarine and
marine fish. For the purposes of this risk assessment, the average total fish intake for a
North Carolina citizen is 2.5 meals per month (0.75 meals/month-freshwater/estuarine
fish, 0.875 meals/month marine finfish, 0.875 meals/month shellfish) (U.S. EPA
Exposure Factors Handbook Volume I August 1997). This was calculated as shown:
. 6 grams/day avg. freshwater/estuarine fish consumption rate x 30 days/month
x I oz/30 grams x I meal/8 oz = 0.75 meals per month expected from
freshwater/estuarine fish
. 7 grams/day avg. marine finfish consumption rate x 30 days/month x 1 oz/30
grams x 1 meal/8 oz = 0.875 meals/month expected from marine finfish
. 7 grams/day avg. shellfish consumption rate x 30 days/month x I oz/30 grams
x 1 meal/8 oz = 0.875 meals/month expected from shellfish
For the purposes of assessing exposure to king mackerel, it is assumed that a
North Carolina citizen may eat 0.75 meals per month of freshwater/estuarine at 0.5 mg/kg
(average mercury levels found across the state are 0.5 mg/kg or less), 0.875 meals per
month of king mackerel as the marine fish at 0.6 to 1 mg/kg (average mercury level 33 to
39 inches), and 0.875 lIleals per month of shellfish at 0.5 mg/kg and less (average
mercury levels in shellfish are 0.5 mg/kg or less). Ifit is assumed that two meals per
month is the acceptable number of meals per month when mercury tissue levels from all
fish consumed are close to 0.6 to 1 mg/kg, then one can calculate the recommended
number of meals per month for king mackerel as follows:
. A total of2 recommended fish meals per month- (0.75 meals per month
expected from freshwater/estuarine fish) - (0.875 meals per month expected
from shellfish) = 0.375 or approximately 1 meal per month is recommended
for king mackerel. Because of the safety factors used in the calculation of the
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recommended number of meals per month, 1 meal per month would be
considered safe for women of child bearing age and children.
Adult Males and Women not of Child Bearing Age
The average mercury levels found for king mackerel 33 to 39 inches were 0.6 to I
mg/kg. When mercury tissue levels from all fish consumed are close to 0.6 mg/kg to 1
mg/kg, the recommended number of fish meals per month for adult males and women not
of child bearing age is approximately 5 to 8 meals per month (based on review of 1965
methyl mercury fish poisoning incident in Niigata, Japan in Tsubaki T et al. 1978,
Clinical, Epidemiological, and Toxicological Studies of Methylmercury Poisoning, Proe
First Int/ Congress Toxieo/, pp. 339-357). -~ -
North Carolina citizens are expected to consume both freshwater/estuarine and
marine fish. For the purposes of this risk assessment, the average total fish intake for a
North Carolina citizen is 2.5 meals per month (0.75 meals/month-freshwater/estuarine
fish, 0.875 meals/month marine finfish, 0.875 meals/month shellfish) (U.S. EPA
Exposure Factors Handbook Volume I August 1997). This was calculated as shown:
. 6 grams/day avg. freshwater/estuarine consumption rate x 30 days/month x I
oz/30 grams x I meaI/8 oz = 0.75 meals per month expected from
freshwater/estuarine fish
. 7 grams/day avg. marine finfish consumption rate x 30 days/month x 1 oz/30
grams x I meal/8 oz = 0.875 meals/month expected from marine finfish
. 7 grams/day avg. shellfish consumption rate x 30 days/month x I oz/30 grams
x I meaI/8 oz = 0.875 meals/month expected from shellfish
For the purposes of assessing exposure to king mackerel, it is assumed that a
North Carolina citizen may eat 0.75 meals per month of freshwater/estuarine at 0.5 mg/kg
(average mercury levels found across the state are 0.5 mg/kg or less), 0.875 meals per
month of king mackerel as the marine fish at 0.6 to Img/kg (average mercury level 33 to
39 inches), and 0.875 meals per month of shellfish at 0.5 mg/kg and less (average
mercury levels in shellfish are 0.5 mg/kg or less). If it is assumed that five meals per
month is the acceptable number of meals per month when mercury tissue levels from all
fish consumed are close to 0.6 to I mg/kg, then one can calculate the recommended
number of meals per month for king mackerel as follows: c_
- -
. A recommended totalS fish meals per month - (0.75 meals per month
expected from freshwater/estuarine fish) - (0.875 meals per month expected
from shellfish) = 3.375 or approximately 4 meals per month would be
recommended for king mackerel.
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Kin~ Mackerel greater than 39 inches
Women of child bearing age and children (0-12 years)
The mercury levels found for king mackerel greater than 39 inches were on
average greater than I to 2 mglkg (maximum 3.50 mglkg). When the mercury tissue
levels from some of the fish consumed are greater than 1 mglkg to 2 mglkg, the
recommended number of fish meals per month for women of child bearing age and
children (0-12 years) is 1 meal per month (based on review of Seychelles Islands fishing
village data from Indian Ocean in Davidson PW et al. 1998, Effects of Prenatal and
Postnatal Methylmercury Exposure From Fish Consumption on Neurodeyelopment.
JAMA, Vol. 280 (8),pp. 701-707).
North Carolina citizens are expected to consume both freshwater/estuarine and
marine fish. For the purposes of this risk assessment, the average total fish intake for a
North Carolina citizen is 2.5 meals per month (0.75 meals/month-freshwater/estuarine
fish, 0.875 meals/month marine finfish, 0.875 meals/month shellfish) (U.S. EPA
Exposure Factors Handbook Volume I August 1997). This was calculated as shown:
· 6 grams/day avg. freshwater/estuarine fish consumption rate x 30 days/month
xl oz/30 grams xl meal/8 oz = 0.75 meals per month expected from
freshwater/estuarine fish
· 7 grams/day avg. marine finfish consumption rate x 30 days/month x 1 oz/30
grams xl meal/8 oz = 0.875 meals/month expected from marine finfish
· 7 grams/day avg. shellfish consumption rate x 30 days/month x 1 oz/30 grams
x I meal/8 oz = 0.875 meals/month expected from shellfish
For the purposes of assessing exposure to king mackerel, it is assumed that a
North Carolina citizen may eat 0.75 meals per month of freshwater/estuarine fish at 0.5
mglkg (average mercury levels found across the state are 0.5 mglkg or less), 0.875 meals
per month of king mackerel as the marine fish are greater than I to 2 mg/kg (average
mercury levels greater than 39 inches), and 0.875 meals per month of shellfish at 0.5
mglkg and less (average mercury levels in shellfish are 0.5 mglkg or less). Ifit is
assumed that I meal per month is the acceptable number of meals per month when
mercury tissue levels from some fish consumed are up to 2 mg/kg, then one can calculate
the recommended number of meals per month for king mackerel as follows: -
· A recommended total 1 meal per month - (0.75 meals per month expected
from freshwater/estuarine fish) - (0.875 meals per month expected from
shellfish) = -.625 meals per month or 0 meals per month would be
recommended for king mackerel.
Adult Males and Women not of Child Bearing Age
The mercury levels found for king mackerel greater than 39 inches were on
average greater than 1 to 2 mglkg (maximum 3.50 mglkg). When mercury tissue levels
e
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from some of the fish consumed are up to 2 mg/kg, the recommended number of fish
meals per month for adult males and women not of child bearing age is 2.5 meals per
month (based on review of 1965 methyl mercury fish poisoning incident in Niigata, Japan
in Tsubaki T et a1.1978, Clinical, Epidemiological, and Toxicological Studies of
Methylmercury Poisoning, Proe First lntl Congress Toxieol, pp. 339-357).
North Carolina citizens are expected to consume both freshwater/estuarine and
marine fish. For the purposes of this risk assessment, the average total fish intake for a
North Carolina citizen is 2.5 meals per month (0.75 meals/month-freshwater/estuarine
fish, 0.875 meals/month marine finfish, 0.875 meals/month shellfish) (U.S. EPA
Exposure Factors Handbook Volume I August 1997). Thiso\Vas ~alculated as_shown: .
· 6 grams/day avg. freshwater/estuarine fish consumption rate x 30 days/month
x I oz/30 grams x I meaV8 oz = 0.75 meals per month expected from
freshwater/estuarine fish
· 7 grams/day avg. marine finfish consumption rate x 30 days/month x I oz/30
grams x I meal/8 oz = 0.875 meals/month expected from marine finfish
· 7 grams/day avg. shellfish consumption rate x 30 days/month x I oz/30 grams
x I meal/8 oz = 0.875 meals/month expected from shellfish
For the purposes of assessing exposure to king mackerel, it is assumed that a
North Carolina citizen may eat 0.75 meals per month of freshwater/estuarine fish at 0.5
mg/kg (average mercury levels found across the state are 0.5 mg/kg or less), 0.875 meals
per month of king mackerel as the marine fish at greater than I to 2 mg/kg (average
mercury levels greater than 39 inches), and 0.875 meals per month ofshellfish at 0.5
mg/kg and less (average mercury levels in shellfish are 0.5 mg/kg or less). If it is
assumed that 2.5 meals per month is the acceptable number of meals per month when
mercury tissue levels from some of the fish consumed are up to 2.0 mg/kg, then one can
calculate the recommended number of meals per month for king mackerel as follows:
· A recommended total 2.5 fish meals per month - (0.75 meals per month
expected from freshwater/estuarine fish) - (0.875 meals per month expected
from shellfish) = 0.875 meals per month of king mackerel.
Because king mackerel greater than 39 inches have consistently been associated
''Nith having the highest mercury levels from all four statesJ>amplt~d and because of the
possibility that a North Carolina citizen may catch a king mackerel in this size class with
levels greater than 2 mg/kg, it is recommended that adult males and women not of child
bearing age not consume king mackerel greater than 39 inches.
Health Effects Observed From Consumption of Bread Contaminated
with Mercury in Iraq in 1970s
A mercury poisoning incident occurred in Iraq in the 1970s where contaminated
bread was fed to men, women, and children. Delayed walking and talking, mental
disturbances, speech retardation, cerebral palsy, blindness, inability to walk, and inability
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7
to crawl were reported in children whose mothers consumed the contaminated bread.
Based on these results, the developing brain of fetuses and young children may be more
sensitive to the toxic effects of methylmercury It is thought that high levels of
methylmercury exposure interfere with the way nerve cells move into position as the
brain develops resulting in abnormal brain development (World Health Organization
Environmental Health Criteria 101 Methylmercury 1990, Geneva). Because of these
health effects, the above recommendations with regard to king mackerel consumption are
recommended for women of child bearing age and children (0-12 years).
Health Effects From Consumption of Fish Containinl: Levels 20 Times
Hil:her than Seen in Kin~ Mackerel in Niil:atta. Japan in 1965
A mercury fish poisoning incident occurred in Niigata, Japan in 1965 where fish
tissue levels were seen as high as 20 mg/kg (based on review of 1965 methyl mercury
fish poisoning incident in Niigata, Japan in Tsubaki T et a1.1978, Clinical,
Epidemiological, and Toxicological Studies of Methylmercury Poisoning, Proe First lnt/
Congress Toxieo/, pp. 339-357). Many of the Japanese adults developed abnormal
sensations of the lips, tongue, fingers, and toes; fatigue; and blurred vision. In more
severe cases, persons developed hearing and speech impairment and loss of coordination.
In worst cases, some patients develped a coma and died. Because of these health effects,
the above recommendations with regard to king mackerel consumption are
recommended.
In Summary
king mackerel less than 33 inches - Safe to eat.
king mackerel 33 to 39 inches - Women of child bearing age and children (0-12 years)
should limit their consumption to one 8-ounce meal per month and all other adults should
limit their consumption to four 8-ounce meals per month.
king mackerel greater than 39 inches - Should not be eaten.
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'MAR 13 '00 03:26PM DNR ATHENS
P.l
Georgja~ent olliatural Resources
Floyd rawer Ilu~ Suite 1152. 205 Bu1Icr St, SIl. Atlanta, Oeorsil 30334
LaIioo C. Bond. Caiilmiai....
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Fax Telecopy Transmittal Form
Environmental Protection Division
Randall O. Manning, Ph.D.( DABT
Environmental Toxicologist
Atlanta Telephone: (404) 656-4713
Athens Tele1phone: (706) 369-6376
Fax: (706) 369-6398
TO; ) u~"'nL Luilliams
J!AX:.....9 J '1 -"133 - q.}S..5-
FROM:3""...rlj HA.n.n...a'j
NUMBER OF PAGES INCLUDING COVEk SHEET TRANSMITTED;_' Lf
SPECIAL MESSAGE OR INSTRUCTIONS:
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9/9 - 7/5 -(, vc;; 9
,
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'Ml<R 13 '00 03'Z7PM Dtfi! ATHENS P.2
Georgia Department of Natural Resources
205 Butler st. S.E. , East Floyd Tower, Atlanta, Georgia 30334
Lonice C. Berrett, Comml88ioner
Harold F Rehela, Director
Environmental Protection DiViSion
4041655-4713
March 13, 2000
George Henderson, FL Fish & Wildlife Conservation Commission
Tom Atkeson, FL Department of Environmental Protection
Tracy Shelley, SC Department of Health & Environmental Control
Luanne Williams, NC Department of Environmental Health & Natural Resources
Mark Hale, NC Department of Environmental Health & Natural Resources
Susan Shipman, GA Coastal Resources Division
Linda Ham, GA Environmental Protection Division
Hello everyone:
Attached ie a summary of the information I have been working on regarding King
Mackerel mercury concentrations In the Atlantic. Thanks to everyone for sharing their
data. I am including a summary table showing lengths of fish relative to predetermined
mercury concentrations for each state and the combined group. The regreuion graphs
and a printout of the data follow. I believe that all the data I have summarized was sent
in fork length (correct /TIe if I am wrong) and I eonverted everything from mm or em to
inches.
As most of you knew this idea grew out of discussions with Luanne Williams, Tracy
Shelley, Tom Atkeson. and Roger Inman (now retired from Florida) more than a year
ago after North Carolina began looking at concentrations of mercury in King Mackerel.
We knew that Florida had some data. and Georgia and South Carolina were also
beginning to collect fish, Our discussions focused on the idea of developing consistent
information if the data warranted, despite the differences In our state fish consumption
advisory programs.
My involvement has been to pull information together. and put the data In a format that
. we could all easily understand and compare. The first and most critical i$$ue Is to .
determine if the KIng Mackerel off of our coasts are similar In mercury concentl1ltion.
and then to try and agree on common language for advisories. The latter issue may be
a bit tricky because of existing approaches that each state has in place for evaluating
fish tissue.
As we begin to discuss this issue in eamest. keep In mind that each state has a
different perspective and track record (i.e., baggage) on how to issue fish consumption
advisories for mercury. In an attempt to bring us all to the same starting point, I will
summarize what I know about each state's program as It relates to mercury. These are
my own recollections from numerous conversations with many of you. If I misstate
somethIng about your state's program, please forgive me. We will straighten the
details out on a future conference call.
A:\MWOl.Wl'D
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'MF!R 13 '00 03' 27PM ON< F1THENS
P.3
Florida already has a gulf advisory for King Mackerel, but it also extends around the tip
of the state, throl.lgh the Keys and north to Cape Canaveral. 50 technically a precident
for issuing an advisory has been set in the Atlantic. That advisory is: less than 33 in. ..
no restrictions, 33 . 39 in. .. limit consumption to 1 meal per week, greater than 39 in. ..
no consumption. These lengths are fork length, and the_~l'\traijons were set to
coincide with concentrations of approximately 0.5 and 1.5 ppm mercury. Florida's
selection of these numbers to protect the public predated the development of most
other state programs in the Southeast, and most of the currently used toxicity values.
However, a recent review of Florida's approach by Harvey Clewell from lCF Kaiser
taking Into account data from ongoing large mercury studies concluded that Florida's
numbers were protective, and about "where they needed to be". -
Georgia and South Carolina use tiered approaches for freshwater consumption
restrictions, but have issued no advisories for saltwater fish. Both states' values on the
low side are slightly more restrictive than Florida's, but less restrictive on the high side.
Georgia's values are based on EPA's RID, and South Carolina's values were state-
derived. Regardless of the difference in the starting to)(iclty value, both states achieve
'similar" tissue concentratons and guidance. That is: less than 0.23 - 0.25 ppm .. no
restriction, 0.23-0.25 to 0,6-0.7 ppm = limit consumption to 1 meal per week, 0.6..0.7 to
2.3-3.0 ppm .. limit consumption to 1 meal per month, and greater than 2.3-3.0 ppm =
no consumption. It should be noted that Tracy and I are In aggreement...... we are not
wed to sticking 10 the very low numbers generated by these approaches for ocean fish
(different populations of consumers and other factors limiting availability, etc.). This
point should help us In coming to an approach more similar to Florida's.
North Carolina has historically used a value of 1 ppm for Issueing fish consumption
advisories for mercury. This number likely originated from or was influenced by FDA's
action level. However, Luanne has reviewed the literature and derived North Carolina's
own toxicity value and exposure values which supported the use of the 1 ppm tissue
concentration (sorry Luanne, I can't remember exactly what those were). More
recently, North Carolina's Scientific Advisory Board has produced a review of the
toxicIty of methylmercury and is recommending toxicity values of 0.2 ug/kglday for
sensitive subpopulations and 0,5 ug/kglday for non-sensitive populations. These
values are likely to lead to the development of some tiered approach in North Carolina,
but they are different than EPA'S RID af 0.1 ug/kg/daY_l.!sed by Georgia, and the values
developed and used by Florida ar'ld South Carolina. -
Also for those of you that are not aware, a couple of news articles were published last
week in North Carolina papers regarding the King Mackerel mercury issue. In speaking
with Luanne last week, I learned that she may not be able to wait until the May Mercury
Task Force Meeting before being required by the state to issue some guidance, 50 It Is
important that we all be prepared to discuss these Issues amongst ourselves, and
pO$sibly on a conference eall within the next few weeks.
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'MAR 13 '00 03:28PM Dffi! ATHENS
P.4
Please talk amongst yourselves end anyone else from your state that needs to be
Involved. Luanne or I will be contacting all of you in the future to set a time for a
conference call. My small Is not working, and likely won't be for another week or more,
so please c;:ontact me by phone (706) 36~376 or fax (706) 369-6398 to discuss these
Issues.
Lastly, recall that most of the data Included In this packett has not been officially
released by the states. Please use discretion in reviewing and sharing this material, so
that no state's credibility will be damaged.
Sincerely,
~
Randy Msnnir
GA Environmental Protection Division
attachments
~--MAR 13 '00
03:28PM DNR F1THENS
P.5
e
Comparison 01 Mercury COncentrations:
Length Relationships 10r Atlantic Coast King Mackerel
South NQrth
State Georgia Florida Carolina C.rolina Combined
N 20 21 28 112 181
LenRth (Inches)
e 'E 0.20 29.8 28,9 33,3 27.8 27.9
0,50 33,0 32.0 37.9 30.3 31.6
g,
a. 0.75 36.1 35.1 40.4 33.1 35.1
-
~ 1.00 39.3 38.3 44.0 35.9 38,7
=
e 1.50 45.5 44,6 51.1 41.4 45.9
CD
:! 2.00 51,6 50,8 58.3 47.0 63.0
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MAR 13 '00 03:28PM DNR ATHENS
P.6
KING MACKEREL DATA
.... SC data, N == 28
Regression
4
Coefficients:
b = -2.08
m!ll:0.07
r 2 = 0.43
3
1_
_
_
~R 13 '00 03'28PM DNR ~THENS
-4
-
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KING MACKEREL DATA
. GA data, N = 20
Regression
Coefficients:
b = -2.14
m = 0.08
r2 = 0.59
3
.
1
o
10 15 20 26 30 35 40 45 60 65
Length (in)
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MRR 13 '00 03'29PM DNR RTHENS
......
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P.9
KING MACKEREL DATA
<) FL data, N = 21
- Regression
4
Coefficients:
b = -2.08
m = o.oa
r l! = 0.82
3
1
0>
,
"'
0
10 15 20 25 30 35 40 45 50 55
Length (In)
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~R 13 '00 03'29PM DNR ~THENS
P.10
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KING MACKEREL DATA
<) FL data, N = 21
o GAdata, N = 20
o NC date, N = 112
o SC data, N = 28
Regression
Coefficients:
b = -1.71
m = 0.07
r 2 = 0.60
o
3
1
o
10 15 20 25 30 35 40 45 50 65
Length (in)
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'MRR 13 '00 03'29PM DNR RTHENS
I:\FISHFILE\FL.SPW
P.ll
-1-
GA size
-3-
-4-
NC ~ize
-6-
-5-
NC cone
-2-
GA cone
1 32.50 0.z8 28.00 0.36
33.00 0.66 27.40 0.38
3 33.30 0.43 30.10 0.38
34.00 0.59 28.50 0.40
34.80 0.6e 28.70 0.43
6 35.50 0.64 29.10 0.47
36.00 0.60 29.90 0.50
8 36.70 1.2( 32.2C 0.54
9 37.80 O. 6~ 36.8( 0.65
39.00 -0 - 1.10 34.3( 0.87 .
0
1 40.70 0.89 31. 5c 1. 00
41. 00 0.95 45.30 1.20 .
3 41.70 1. 90 41.30 1.20
4 43.30 0.71 37.20 1.20 .
45.00 1. 20 42.30 1.30
6 45.20! 1.201 37.40 1. JO
7 46.50 2.60 40.90 1.50.
47.20 1.80 41. 70 1.60 .
9 49.00 1. 70 38.60 1.80 .
0 49.30 1.40 I 45.30 1.80
1 43.30 2.0e .
2 () 38.20 2.10 .
:3 I l'Ln 40.00 2.10 .
4 v 48.80 ;! .20 .
5 39.60 2.20
6 49.6e 2.30 .
7 I 48.90 2.60 .
8 50.40 2.80,
\I 46.9C 3,00 ,
0 48.80 3.00 .
1 23.9C 0.20
2 24.10 0.3!
3 I 24.80 0.24
4 25.60 0.28
5 26.20 0.17
6 27.50 0.24
7 ..- - 27.80 0.35 0
8 27.9C 0.22
9 28.0C 0.23
0 28.3( 0,20
1 28.3( 0.;!3
2 28.90 0.25
3 28.90 0.15
4 29.00 0.32
5 29.10 0.29
6 29.60 0.22
7 29.80 0.32
8 30.10 0.2~
9 30.50 0.4
0 34.30 0.72
2
4
5
7
10
1
12
1
1
15
1
1
18
1
2
2
2
2
2
2
2
2
2
2
3
:;
3
3
3
3
:;
3
3
3
4
4
4
4
4
4
4
4
4
4
5
-pagEl 1-
'MRR 13 '00 03'29PM DNR RTHEN5
"
I:\FtSHFILE\FL.SPW
e
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P.12
-1-
GA ~ize
-3-
-4-
NC size
-5-
He eonc
-6-
-2-
GA cone
1 34.40 0,87
35,00 0.6
35.60 0.5E
4 35.80 1.00 - '"
5 36.40 0.64
6 36.60 0.90
37.00 0.86'
38.00 0.86
9 . . 39.20 1.30
~ .
40.00 1.10 .
1 40.00 1.30 ,
41,50 1.40 .
3 29.10 0.2E
4 29.30 0.28
5 I 30,50 0.34
~ 30.60 0.42
7 30.60 0.35
e 30.70 0.33
9 I 30.80 0.35
0 34.3C 0.78
1 34.6C 0.60
2 28.90 0.31
3 30.00 0,30
4 34.40 0.64
5 35.20 0.3E
e 35.70 0.73
7 36.30 0.8
a 36.90 0,56
9 16,50 0.16
0 18.50 0.2J
1 19.9C 0.1"
2 20,l-C 0.23
3 20.10 0,22
4 20.30 0.22
5 32.10 0.43
6 32.50 . . .. 0.4~ .
.
7 34.30 0.60
8 34,4C 0.66
9 35.4C 0.76
0 36.60 0.73
1 36.60 1.20 .
2 38.20 1.30 .
3 39.20 0.44
4 42.10 1.Se .
5 46.90 3.00 .
6 49.00 2,80 .
7 49.40 2,20 .
8 40.20 1. 80 .
9 40.70 1.70 .
5
52
53
5
5
5
57
58
5
60
6
62
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7
7
e
B
8
8
8
B
n a
8
8
e
g
9
9
9
9
g
9
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DIVISION OF MARINE FISHERIES
INFORMATION PAPER
KING MACKEREL MERCURY SAMPLING
April 13, 2000
Prepared by: Dr. Louis Daniel
ISSUE:
A State Health Advisory has been issued by the North Carolina
Department of Health and Human Services (DHHS) concerning the consumption
of king mackerel. Sampling of king mackerel analyzed for this advisory were
collected at the request of the DHHS by the Division of Marine Fisheries. This
information paper summarizes the sampling protocol, ideas for future sampling,
and provides some basic information pertaining to the fishery.
SAMPLING PROGRAM:
Sampling of king mackerel for mercury testing was conducted from August
1998 through October 1999. Recreational fishing tournaments provide an
excellent source of a variety of size classes of fish taken from a variety of areas
and are relatively inexpensive to sample. The following tournaments were
sampled during the sampling period:
Topsail Beach (August 1998 and 1999)
Atlantic Beach (September 1998)
Wrightsville Beach (September 1998)
Swansboro (May 1999)
Carteret County (October 1999)
In addition to these five tournaments, samples were taken from recreational
catches off Morehead City in June 1999.
King mackerel samples from the commercial fishery were taken off
Wrightsville Beach in January 1999, off Cape Hatteras in February 1999, and off
Morehead City in April 1999. Samples from all fish collected consisted of 1 to 2
pound, edible fillet with skin on that was wrapped in aluminum foil and frozen.
Samples were sent to the Division of Water Quality for analysis.
Overall, 112 samples of king mackerel were collected ranging from 1 to 37
pounds (16 to 51 inches FL). The age of fish collected ranged from 1 to 20 years
old. Results of the tissue analysis indicate that king mackerel regularly exceeded
the North Carolina advisory standard at 8 years old (39 inches FL). King
mackerel live to a maximum age of 26 years old.
FISHERY INFORMATION:
King mackerel are managed by the North Carolina Division of Marine
Fisheries, Marine Fisheries Commission and the South Atlantic Fishery
Management Council by a 24 inch minimum size limit (1-2 year old fish),
recreational bag limit of 3 fish per person per day, and a 3500 pound trip limit
for commercial fishermen.
The North Carolina commercial fishery for king mackerel primarily occurs
from November through March, beginning with the sink gill net fishery off Cape
Hatteras in November jDecember. As the season progresses, the fishery becomes
dominated by hook and line catches, particularly in the southern part of the
state. During the 1998-1999 fishing year, 572 fishermen landed 1,207,374
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pounds of king mackerel. Tournaments (n = 13) sold 24,130 lbs (2% of all
commercially landed king mackerel).
The recreational fishery for king mackerel generally occurs from April
through December and is primarily a small, private and charter boat fishery.
During 1998, recreational anglers landed 1,077,284 pounds. The size of king
mackerel required to receive a North Carolina citation is 30 pounds and 364
citations were issued in 1998. Recreational tournaments for king mackerel
continue to grow in number and popularity across the state and can be
extremely important to local economies and charities.
Data from the North Carolina Trip Ticket Program, Marine Recreational
Fishery Statistics Survey, and fish house samples of commercial catches were
examined to estimate the percentage of king mackerel harvested that exceed the
39 inch (17 pounds) no consumption advisory limit. Based on these data,
approximately 3 to 4% of the recreational harvest exceeds the 39 inch no
consumption limit. The advisory allows those successful anglers to make an
informed decision as to whether to harvest that fish or return it to the water.
The commercial king mackerel fishery targets fish from approximately 6 to
15 pounds, below the 39 inch consumption advisory limit. During the 1999
fishing year, approximately 10% of the commercial harvest was comprised of fish
greater than 39 inches. Consequently, the chance of a consumer routinely
purchasing or encountering large king mackerel in markets or restaurants is
remote. Very few fish at the highest risk levels (e.g., > 30 pounds and 3.0 p.p.m.)
ever reach the market.
FUTURE SAMPLING:
After Hurricane Floyd, a battery of heavy metal and other chemical tests
were performed on a variety of finfish and shellfish samples taken from North
Carohna coastal waters (e.g., red drum, spotted seatrout, white shrimp,
weakfish, blue crab, southern flounder, striped bass, striped mullet, white perch,
and silver perch). None of these samples contained mercury levels that exceeded
North Carolina standards for an advisory. Further, samples of Spanish mackerel
were collected along with king mackerel in the current study and likewise
contained levels less than the North Carolina standard.
Large king mackerel, as well as large tunas, sharks and swordfish contain
high levels of mercury. High mercury levels in fish tissue may be attributed to
the fact that most of these species are fast growing, long lived, coastal ocean
predators. King mackerel eat large quantities of smaller fishes that contain low
levels of mercury Over the course of years, mercury accumulates in the tissues
of the older fish. Other fish species such as dolphin, wahoo and smaller tuna
species are more short lived and less likely to accumulate large quantities of
mercury Other candidiates for high mercury levels might include larger, older
members of the snapper-grouper complex or any other large, old predatory fish.
However, these larger, older fish are relatively rare in the population and
generally do not occur in commercial quantities. Consequently, we do not
recommend sampling of other fishes at this time. Should information become
available that another species may contain high levels of mercury, or any
potentially harmful substance, further testing may be required.
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MarcY Smith
04/24/2000 11 :24 AM
To: Health
cc:
Subject: AEIOU Team Minutes
Enclosed are the April 17, 2000 minutes from the AEIOU Team. Please post for staff who do not
have Lotus Notes. Thank you.
New Hanover County Health Department
AEIOU (Assessing, Evaluating, Improving, Our Opportunities are Unlimited)
Team Minutes
April 17, 2000, 3:00 p.m.
Attendance: Carol Bottoms, Mamie Carlos, Dianne Harvell, Beth Jones, Robert Keenan, Mary
Jo Newton, Susan O'Brien, Dave Rice, Avery Rollinson, Marcy Smith, Bobby Waters
Dave Rice opened the meeting by reviewing several principles described in The Team
Handbook which the team should remain aware of and subscribe to. They are: quality
leadership, freedom through control, and unity of purpose. According to Juran and Deming "at
least 85% of an organization's failures are the fault of management-controlled systems." The
team must focus on improvements to the system and not blame individuals.
Chart handouts compared results between the 1998 and 2000 organizational capacity surveys.
In 1998,60 strengths were recorded; they increased to 75 strengths in 2000.
Because some of the survey responses did not indicate if the survey was being completed for
the first or second time, comparisons between the two could not be reasonably made.
The Board of Health completed a condensed version of the survey responding to 35 indicators
which they rated based on perceived importance.
A flow chart handout showed the steps necessary to follow when assessing organizational
capacity It is important to follow all the steps. Steps one, two, and three have been
completed-conducting the survey, scoring the indicators, and identifying strengths and
weaknesses (opportunities to improve). The team proceeded to step four-analyzing
strengths.
The team compared the indicators that were strengths for 1998 and 2000, discovering that
most of the strengths were the same for 1998 and 2000.
The rest of the meeting was devoted to defining four strengths and describing their related
factors based on what the 2000 survey reported. The team used the information compiled in
1998 as a reference starting point in reviewing and revising strength definitions and related
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factors.
It was suggested that a brief update on AEIOU Team meetings be made at the monthly staff
meetings.
The team will consider the need to schedule more than one meeting per month in order to
complete the organizational capacity assessment process in a timely manner The next
meeting is scheduled for May 15 at 3:00 p.m. in the Thomas Fanning Wood Conference
Room.
The meeting was adjoumed at 4 45 p.m.
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Flowchart of Steps
In Assessing Organizational Capacity
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Part I
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Section A
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Organizational Capacity Assessment
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New Hanover County Board of Health
Organizational Capacity Survev Priorities - 2000
IA1 The health department has clear authority to act as a law enforcement office
for public health problems.
185 The health department is regularly consulted by the local elected officials about
aspects of local policy relating to health issues.
1IIA2 The health department has established a process for community health
assessment and the development of a community health plan.
IVC1 The local government unit collaborates with the policy board and the health
department director in developing public policy which may impact public health.
IVC2 The elected officials at the local level actively solicit the opinions of the
professional staff and/or health department director on scientific issues in
policy development.
181 At least once every two years (biennially), the health department reviews its
joint powers agreements, memoranda of understanding, and other agreements
with units of government within its jurisdiction or in neighboring jurisdictions to
identify problems, propose solutions, and look for areas for further
development.
IC1 The health department has legal counsel sufficient to provide advice as needed
on administrative practices; department powers, duties, policies, and
procedures; relevant laws and ordinances; contracts; and other legal matters.
IIIA1 The health department has a clear and concrete mission statement that all staff
are capable of stating and explaining in relation to their duties.
1VB4 The health department facilitates the formulation of public health policy in the
community.
IV85 The policy board and the health department director monitor and evaluate the
impact of public policy on specific health problems.
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Pfiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
1.
Introduction
The NC HAB Program is working with other states and federal agencies to determine if
Pfiesteria poses a threat to people in the natural environment. The purpose of this
presentation is to provide an update on our current understanding of this organism as it
relates to public health.
2. Pfiesteria History
Pfiesteria piscicida was first discovered during 1988 in fish cultures at the North Carolina
School of Veterinary Medicine. The fish in these cultures had come from many regions of
the world, so the organism was a novel culture contaminant of unknown origin. Dr.
Burkholder, and other members of the NCSU Aquatic Botany Laboratory were called in to
learn more about this small dinoflagellate's activity and life cycle when it was killing
cultured fish. The researchers worked with fish pathologists Drs. E. Noga and S. Smith to
begin to understand the organism's effects on fish health. Dr K. Steidinger and
colleagues (Florida Marine Research Institute) helped these researchers to formally name
the dinoflagellate, which represented a new family, genus and species. Pfiesteria was
named in honor of the late Dr. Lois Pfiester, who contributed much of what we know today
about the complex life cycles of dinoflagellates.
3. What is known about Pfiesteria?
Pfiesteria piscicida is a microscopic organism called a dinoflagellate and is a natural part
of the marine environment. It may be associated with fish lesions and fish kills in
Maryland, Delaware and North Carolina. Most dinoflagellates are not harmful, and
Pfiesteria is harmful only under certain conditions; in fact, some strains never produce
toxins, and even the strains that can produce toxins are benign under most conditions and
during most of the year Pfiesteria and the related un-described species are protists
(single-celled, eucaryotic micro-organisms). They are not strictly plants or algae in that
they do not have their own capacity tor photosynthesis~ They lire not parasites but, rather,
predators capable of feeding on other organisms which, in the case of fish, may be much
larger than themselves. Pfiesteria-like species are also not bacteria, as they have been
called early on in some popular press accounts.
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Pfiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
3.A. Pfiesteria Life Cycle
(as described by Dr. JoAnn Burkholder, NC State University)
Pfiesteria piscicida has a complex life cycle that includes at least 24 flagellated,
amoeboid, and encysted stages or forms. Both flagellated and amoeboid forms are
known to be toxic to fish. The size range of these stages extends from 5 - 450 um along
the major cell dimensions; the cyst (dormant) stages include an array of outer
appearances or coverings (7-60 um in diameter), and they commonly occur among the
bottom sediments of North Carolina's estuaries.
Amoeboid stages can be found in the water column as well as among the bottom
sediments; they feed on other organisms (bacteria, algae, small animals) or on bits of fish
tissues by engulfing their prey Flagellated stages (vegetative or asexual cells, sexual
cells or gametes, and motile sexual products or planozygotes) can also engulf similar
prey, but more often they feed, instead, by attaching to prey cells using a cellular
extension called a peduncle and suctioning the prey contents.
Pfiesteria is often found in the water column in its non-toxic form as a predator of other
algae. Zoospores are induced to become toxic when enough of an ephemeral substance
that live fish excrete or secrete into the surrounding water is detected. When fish (e.g., a
large school of oily fish such as Atlantic menhaden) swim into an area and linger to feed,
their excreta triggers encysted cells to emerge and become toxic. Active amoeboid and
flagellated cells which are present also become toxic in the presence of the fish excreta.
It is thought that the small cells swim toward the fish prey and excrete potent toxins into
the water which make the fish lethargic so that they tend to remain in the area. The toxins
also injure the fish skin so that they lose their ability to maintain internal salt balance. As
the skin is destroyed, open bleeding sores and hemorrhaging often occur. Once fish are
incapacitated, Pfiesteria feeds on the sloughed epidermal tissue, blood, and other
substances that leak from the sores. When the fish are dead, flagellated stages transform
to amoeboid stages and feed on the fish remains or, alternatively, if conditions become
unfavorable (e.g., sudden storm), Pfiesteria cells make protective outer coverings and sink
out of the water column as dormant cyst stages. All of these changes can take place in
_ a matter of hours.
3.B. How do we detect Pfiesteria?
3.B.1 Pfiesteria Identification
There is currently no direct method to determine the presence of Pfiesteria toxin.
However, there are analytical methods that have been developed to screen for the
presence of this organism and there is a Scanning Electron Microscopy (SEM) method
that can visibly identify the particular species and life cycle stage of the Genus Pfiesteria.
However, this method is very expensive and time-consuming. Also, the NC Aquatic
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Pfiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
Botany lab (Dr JoAnn Burkholder) and the Florida Marine Research Institute (Dr Karen
Steidinger) may be the only labs capable of performing this test.
The SEM method involves the preparation of zoospores with the outer membrane stripped
from the cells or with the cell sutures swollen. SEM cannot be done on most field samples
because the abundance of cells are generally too low.
. Molecular Probes are another tool used to identify the presence of Pfiesteria. This
technique is used to detect the DNA that is unique to the TPC species. There are currently
three types of molecular probes in use today These probes have been developed by Dr.
Parke Rublee at UNC-Greensboro and Dr. David Oldach at University of Maryland using
virulent clonal cultures of TPC. None of these techniques can determine whether there is
toxin present (or whether TPC, if found, is actively toxic).
A. Hetero-duplex mobility assay (HMA) amplifies target fragments of genetic material
in polymerase chain reactions (PCR). The HMA method can determine whether
cultures are monoclonal (only one dinoflagellate strain and species present) or
whether there are multiple species and strains of Pfiesteria present.
B. Polymerase Chain Reactions (PCR) assay amplifies target genetic material and
enables the screening of cultures and natural estuarine water samples to
qualitatively detect the presence of Ptiesteria piscicida.
C. Fluorescent in situ hybridization (FISH) ribosomal DNA probe allows visualization
of whole Ptiesteria piscicida cells and quantitative evaluation of Ptiesteria piscicida
cells densities in water samples.
3.C How do we determine that Pfiesteria is toxic?
Not all strains of Pfiesteria are toxic and toxic strains are not always toxic. Identification of
toxicity is tricky since the organism's bio-active material has not been chemically
characterized. Scientists must determine toxicity by observing the behavior of specific
strains of Pfiesteria under controlled laboratory conditions. The toxic forms of Pfiesteria
are referred to as Toxic Pfiesteria Complex (TPC). .These dinoflagellates are thought to-
produce bio-active compounds that cause erratic swimming behavior in fish and may also
be a cause of fish lesions and kills in the natural environment. These effects have been
observed repeatedly in laboratory aquaria.
To be included in the TPC, a species must exhibit all of these characteristics:
. Strong attraction to live fish prey;
. Ability to produce substances that cause erratic behavior, disease, or death in fish;
. Production of toxic substances by some strains within the species that is stimulated by
the presence of excretions or secretions of live fish (usually in large numbers).
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Ptiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
There appears to be two species of Pfiesteria that exhibit toxicity. Pfiesteria piscicida and
species B which has recently been named Pfiesteria shumwayae. An additional species
of Pfiesteria that have the characteristics described, will also be added to the TPC
Within the TPC, there are strains that have different abilities to produce toxins. The three
functional types among strains of TPC are:
· Actively toxic strains which are producing substances which"have caused stress,
disease or death in fish. -- - -
· Nontoxic strains which are potentially toxic, but are not presently producing toxins
and
· Non-inducible ("never-toxic") strains which are incapable of producing toxins in the
presence of live fish or their fresh materials.
Toxin strains of TPC species are difficult to maintain in culture. If denied access to live
fish and fed other prey, they lose their ability to produce toxins within 6-8 months. Even
when they are maintained in an actively toxic mode (given live fish daily), they generally
loose their ability to produce toxins in laboratory cultures within a year or less. Since
these observations are based on artificial lab conditions, the data cannot be used to
extrapolate the ecology and behavior of toxic Pfiesteria in the natural environment.
3.C.2 Determination of Pfiesteria Toxicity
The fish bioassav is the only method currently available to determine whether a sample
contains strains of TPC species that are actively toxic. The fish bioassay involves adding
a cultured amount of the suspected TPC species to an aquarium with live fish (Talapia
species). The lab observes fish behavior and mortality as compared to control fish
populations.
3.C.3 Other Pfiesteria Screening Methods
-
As we've stated before, the presence of dinoflagellates and Pfiesteria species in estuarine
water is common and poses no hazard under most conditions. In the event of a fish kill, it
becomes necessary to sample the water in order to determine if Pfiesteria was involved. It
should be noted that unlike other harmful algae, actively toxic Pfiesteria does not discolor
the water This makes it impossible to visually identify a Pfiesteria bloom. Since the fish
bioassay test is expensive and lengthy, other screening tests can be performed to quickly
rule-out or implicate Pfiesteria.
A presumptive count of dinoflagellates in a water sample tells us the cell count per milliliter
of water Pfiesteria-Iike organisms (called PLOs) describes dinoflagellates that look
similar under light microscopy These organisms all look similar to the Pfiesteria piscicida
zoospores. To discern the presence or absence of TPC, Pfiesteria-like zoospores can be
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Pfiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
eliminated if they have chloroplasts freely distributed in the cytoplasm of both the upper
and lower part of the cell. Dinoflagellates that photosynthesize on their own (with their
own chloroplasts, rather than kleptochloroplasts that may be retained by TPC species)
can be ruled out. Therefore, autotrophic cells are cells that contain chlorophyll. So a
water sample that contains mostly autotrophic cells is unlikely to be Pfiesteria or TPC.
Heterotrophic cells are characterized by little or no chlorophyll. These cells may be a TPC
species; however, a fish bioassay would be necessary to confirm toxicity. The NC Division
of Water Quality, Environmental Sciences Branch concJlJcts presumptive.cell counts using ~
a fluorescence method to detect chlorophyll. There web-site is
http://www.esb.enr.state.nc.us/
During late June 1999, the Environmental Sciences Branch obtained equipment
necessary to view phytoplankton samples under epifluorescence microscopy (FM). This
method excites chlorophyll under 397-563 nanometers wavelength of light. FM is used to
discern photosynthetic dinoflagellates from heterotrophic dinoflagellates, but definitive
identification of Pfiesteria requires the examination of its sub-membrane plate structure
under SEM. The slide in the PowerPoint presentation contains micrographs of "before
and after" pictures of a Pfiesteria-like dinoflagellate examined in a sample collected from a
fish kill on the Albemarle Sound last August, 1999. Since the cell is glowing throughout
and not in one particular location, it is a photosynthetic dinoflagellate
with chloroplasts scattered throughout the cell. If it was Pfiesteria, the chloroplast would
be localized in a food vacuole. This cell is 14xll microns at 63X magnification on a
compound microscope.
References cited:
Burkholder, J.M. and H.B. Glasgow, Jr 1997. Pfiesteria piscicida and other Pfiesteria-
like dinoflagellates: Behavior, impacts, and environmental controls. Limnology and
Oceanography 42:1052-1075.
4. Fish Kills
Nineteen fish kills were reported and investigated in coastal North Carolina through
August, 1999. These fish kills are posted weekly on the DWQ website. None of the fish
kills were attributed to the toxic form of Pfiesteria. Presumptive counts using the epi- ._
fluorescence tests was enabled DWQ to quickly rule out TPC as a causative agent. Even
though presumptive counts for Pfiesteria-like dinoflagellates in the preserved samples
were as high as 2000 cells/mL (7/26/99 fish kill on New River). The combination of quick
field investigation and reliable screening tests are critical to establishing a temporal as
well as spatial link of Pfiesteria outbreaks.
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Pfiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
4.A.
What's Pfiesteria's role in causing fish sores (lesions)?
Fish get sores for a number of reasons and from several potential sources:
· Injury from nets, traps, or encounters with other aquatic life
· Stress due to changes in water chemistry, contaminants, and temperature fluctuations
. Algae, fungi, bacteria, and parasites _ _
It has been observed that fish exposed to TPC that are actively toxic in fish bioassays
appear to develop bloody lesions (JoAnn Burkholder, NC State University and Harold
Marshall, Old Dominion University). These lesions have not been histologically compared
with lesions found on fish in the natural environment. The role of Pfiesteria as a causative
agent of fish lesions is still unknown. Our program has contracted with the NC State
School of Veterinary Medicine to evaluate fish lesions in the natural environment.
Excellent work on the histopathology of Menhaden lesions has been conducted by
Wolfgang Vogelbein at the Virginia Institute of Marine Science, Andrew Kane University of
Maryland and by Renate Reimschuessel, US Food and Drug Administration. The lesions
observed in the natural environment apparently develop over a long period of time
(months and years) and are deep tissue lesions with the presence of parasites (Kudoa
species) and/or fungi in the tissues.
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Ptiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
5.
What are the human health effects of exposure to Pfiesteria?
Although there is not yet agreement on health effects and no specific tests to determine
exposure to Pfiesteria, the CDC and other agencies and researchers have agreed on a
combined set of environmental conditions and clinical signs and symptoms that together
may represent exposure to Pfiesteria, called Possible Estuary-Associated Syndrome
(PEAS). PEAS is currently defined by the following 3 criteria:
1 Individual reports exposure to estuarine water within two weeks of developing
symptoms;
AND
2. Individual subsequently reports either'
a. memory loss or confusion; OR
e
b. 3 or more of the followin s m
. headache
. skin rash at the site of water contact .
. sensation of burnin skin .
. astrointestinal s m toms
Note: These symptoms, with the exception of skin rash at the site of water
contact and sensation of burning skin, need to persist for 2 or more
weeks for a erson to meet the s m tom criteria.
AND
3. The health care provider cannot identify another cause for the symptoms.
If a person's condition meets the criteria for PEAS, the information, without personal
identifiers, is then reported to the CDC The data is analyzed by the CDC along with
PEAS reports from Virginia, South Carolina, Delaware, Maryland and Florida (MMWR
May 14, 1999). - -- -
At present, there have been no reported cases that fit the PEAS case description in North
Carolina since July, 1998. Also, there have been no cases that meet the PEAS
description in any of the participating states to date. The participating states include
Delaware, Florida, Maryland, South Carolina us (NC), and Virginia. The passive
surveillance results from all of the participating states from June 1, 1998- December, 31,
1999 indicates that no one met the PEAS criteria during this time period. Of the nearly
2000 calls received, most people (96%) were calling with questions and the request
information about Pfiesteria, PLOs or PEAS. There have been no human deaths
e attributed to exposure to Pfiesteria.
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Pfiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
6.
Is Pfiesteria a public health problem if there are no PEAS cases identified?
It's too early to draw conclusions regarding the public health significance of Pfiesteria. It
is possible that on-going surveillance is not capturing exposure cases.
Surveillance Limitations
- .- -
. The exposed person may attribute health effect from an encounter with actively toxic
Pfiesteria species to some other disease such influenza.
. PEAS disease state may be self-limiting.
. PEAS criteria may note accurately describe the true nature of the disease.
Another consideration is that the intersect of active Pfiesteria outbreak and human
exposure may be an infrequent event.
Evidence of Exposure
Evidence that Pfiesteria poses a human health hazard has been anecdotal. The lab event
at NC State University has been the best documented exposure from Pfiesteria, and the
reported symptoms have served as the basis for the CDC case description for PEAS. The
circumstances of this accident are discussed in a 1995 journal article by the exposed
researchers at NC State University Reference: Glasgow HB Jr., Burkholder J.,
Schmechel DE et at: Insidious effects of a toxic estuarine dinoflagellate on fish survival
and human health. J Toxicot Environ Health 46(4):501-522.1995.
Weakness of the evidence for Pfiesteria posing a possible human health hazard should
also be considered. Many people recreate and work on coastal waters without apparent
suffering from PEAS symptoms. Other than anecdotal cases, there have been no
reported cases in North Carolina from local health care professionals, county health
departments, or from any of the 5 other states involved in surveillance efforts.
Additional information is needed to determine whether or not there is a potential health -
hazard from exposure to Pfiesteria in the natural environment. Development of methods
for positive identification and quantification of the various species and stages of Pfiesteria-
like dinoflagellates and their toxins, characterizing the toxin, and development of a
biomarker are all necessary elements that must be known to adequately address this
issue. Scientists from federal and state agencies are working together to understand the
delivery of nutrients from the land into estuaries and the relationship of nutrients to
Pfiesteria-like organisms and ultimately fish health.
Scientists suspect a link between high nutrient levels in water and the occurrence of algal
blooms and the occurrence of Pfiesteria-like organisms. Nutrients enter estuarine waters
from 'point' and 'non-point' sources. Point sources of nutrients (phosphorus and
nitrogen)are from wastewater treatment plants or industrial locations. Non-point sources of
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pfiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
nutrients are more difficult to identify; they originate from agricultural, urban, suburban, or
atmospheric sources. Nutrients enter estuaries from water that is washed off the land
surface, chiefly in the aftermath of storms. Nutrients also seep into the ground water from
the land surface and make their way into the rivers and streams that flow into estuaries.
7. How do we communicate risk to the general public?
Presence of a toxin (TPC) alone is not enough to pose a health risk. There needs to be
an opportunity and mechanism for the toxin to enter an individual at a concentration and
form that is harmful. At present, work is currently on-going to identify and characterize the
bioactive material that appears to be associated with Pfiesteria. It will be important to
determine the dose-response effect as well as a reliable biomarker before we can assign
a health risk related to exposure to actively toxic Pfiesteria. This association of risk can
be summarized as Health Risk is a function of both exposure and toxicity.
Health Risk = (Exposure)(Toxicity)
There have been anecdotal instances of exposures that have resulted in PEAS symptoms
reported by the media. The most famous exposures occurred among the researchers that
were involved in culturing actively toxic Pfiesteria. However, this case and as well as
other alleged cases have not been reported to the state health departments either by the
exposed individual or by their treating physician. At a minimum, verification of PEAS must
include the determination of both a spatial and temporal link between exposure and onset
of specified symptoms, and the healthcare professional must be unable to attribute the
symptoms to another cause.
As discussed above, there is still no quick and convenient field test to identify Pfiesteria
species, nor has there been sufficient progress toward characterizing the putative toxin
associated with the TPC. It is our position that the best way to address concerns of the
public is to be proactive and open about the current level of information and what steps
are being taken to address this issue. The limitations of the current level of knowledge
about Pfiesteria makes it impossible to prove that Pfiesteria is, or is not a human health
hazard. It is a mistake to attempt to argue on either side of this debate. Rather, public
health agencies should report preliminary findings from the gDC and.state agencies --
.regarding the results of surveillance efforts. Research findings regarding Pfiesteria's _.c
behavior in lab aquaria or other basic science theories are generally too abstract to draw
any meaningful conclusions for the purposes of establishing public health policy While
the evidence is building that Pfiesteria can prey on fish and other aquatic life, there is
nothing definitive that Pfiesteria is a direct threat to human health.
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Ptiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
The debate about the etiology of fish lesions is an example of a scientifically contentious
issue that should be avoided by public health officials. There are large gaps in the basic
science that prevent us from making sweeping statements of the association of Pfiesteria
and health risk. We need to focus on the issues that are directly related to public health
and where there is a consensus. The purpose of our Spring 2000 HAB presentations
have focused on the current state of knowledge and generally accepted analytical
practices regarding Pfiesteria.
o
8. NC's Response to Pfiesteria: Environmental Assessment of Water Quality
The Environmental Sciences Branch provides DWQ's Water Quality Section with scientific
and technical support required to regulate and manage water quality in the state. There
are four units and two teams of the branch, composed of biologists, environmental
specialists, and technical support staff. These units evaluate the aquatic resources
through a variety of specialized biological, chemical, and physical techniques in order to
provide the bases for sound scientific decisions. The field teams responsible for
investigating fish kills and collecting samples, are located in Wilmington, Washington, and
New Bern, NC.
The Neuse River Rapid Response Team, located in New Bern, N.C., is responsible for
monitoring water quality conditions in the lower Neuse River watershed below Kinston.
The team's primary charge is rapid evaluation of acute water quality related events like
fish kills and algal blooms. During routine operations, the team performs regular
monitoring duties along the river, collecting monthly ambient water quality samples at long
term sites, and working collaboratively with other research agencies in monitoring field
parameters (e.g. dissolved oxygen, pH, temperature, salinity) to track conditions. The
Neuse Team, which began operations in June, 1997 has been involved with field aspects
of Pfiesteria research. Team members frequently interact with the public in an educational
capacity to pass along a better understanding of water quality issues.
Contact
NEUSE RIVER RAPID RESPONSE TEAM
Toll Free (888) 764-7661
New Bern 252 514-4748 Fax 252514-4903
Waters Monitored
Neuse River
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Ptiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
The Pamlico River Rapid Response Team, located in Washington, N.C., is responsible for
monitoring water quality conditions in the lower Pamlico River watershed. The team's
primary charge is rapid evaluation of acute water quality related events like fish kills and
algal blooms. During routine operations, the team performs regular monitoring duties
along the river, collecting monthly ambient water quality monitoring at long term sites and
works collaboratively with other research agencies in monitoring field parameters (e.g.
dissolved oxygen, pH, temperature, salinity) to track conditions. The Pamlico Team, which
began operations in June,'1998 has been involved with field aspects of Pfiesteria
research. Team members frequently interact with the public in an educational capacity to
pass along a better understanding of water quality issues.
Contact
PAMLlCO RIVER RAPID RESPONSE TEAM
Toll Free (877) 337-2383
Washin ton 252 946-6481 Fax 252 946-5276
Primary Waters Monitored
Tar and Pamlico Rivers
Albemarle
A third rapid response team is located in Wilmington, NC. The team is staffed by
Wilmington regional office personnel. They can respond to fish kill and other water quality
concerns
Contact
WILMINGTON REGIONAL OFFICE
(WiRO)
Rick Shiver/Supervisor
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
Tel:91 0/395-3900
FAX: 910/350-2004
Primary Waters Monitored
Cape Fear and New Rivers
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Pfiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epifpfie.html
9.
NC's Public Health Response to Pfiesteria and other harmful algal blooms
HAS):
In North Carolina, the HAB Program is part of a coordinated, cooperative,
interdisciplinary effort that involves other state agencies and universities, state agencies
in several eastern coastal states,and the federal government. We are all working together
to study possible human health effects of exposure to Pfiesteria, to keep the public and
policymakers informed, and to make recommendations for protecting public health.
The HAB Program is part of the Occupational and Environmental Epidemiology Branch in
the NC Division of Public Health. There are 3 main components to our program:
. Surveillance
. Education
. Research
The HAB Program educates the public and health care providers about possible health
risks from exposure to Pfiesteria in a number of ways:
Surveillance
In order to better understand what effects Pfiesteria has on human health, North Carolina
cooperates with several other eastern coastal states and the national Centers for Disease
Control and Prevention (CDC) by examining reports of medical conditions
possibly linked to Pfiesteria, including those reported to the HAB Hotline. To help in this
effort to protect North Carolinians' health, physicians who practice in coastal
communities have been asked to report patient symptoms possibly related to Pfiesteria
or other potentially harmful marine organisms to the state health department. The HAB
Program also asks the public to report fish kills and health issues to the HAB Hotline. This
is the same general number that people can call to get information about Pfiesteria.
Education
The HAB Program established a toll-free hotline number (1-888-823-6915) for
people to call to get information on possible health risks from Pfiesteria exposure,
report health problems they think are linked to the toxic alga, report fish kills, and
get information about waterway closings due to Pfiesteria. The automated system
allows callers to speak to a live attendant during regular business hours (8 a.m. - 5
p.m. weekdays), and to hear recorded messages or leave a message after hours.
Spanish-speaking callers are served through the state's toll-free Care-Line
(1-800-662-7030) .
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Ptiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/pfie.html
To reach communities at the grass-roots level, the HAB staff works in partnership
with local health department staff, providing printed information, training sessions, funding
and resources for direct communication through the Internet, and personal
contact.
Health care providers receive Pfiesteria-related information from HAB staff both by
request and through targeted information campaigns. Staff personally visit providers in
areas of greatest need. The HAB Program posts current information on the Internet about
P'fiesteria and its possible effects on human health, and provides links to other up-to-date
Pfiesteria information sites.
Research
As part of the multi-state/national Centers for Disease Control study, a separate public
health study on the human health effects of Pfiesteria is being conducted in cooperation
with the University of North Carolina's School of Public Health's Department of
Epidemiology in Chapel Hill. This study will look for 150 men and women with exposure
to estuaries and potentially to Pfiesteria, and another 75 persons who have not been
exposed to estuary waters. The two groups will be interviewed, receive baseline and
semiannual physical and neurocognitive examinations, and their exposures and health
effects followed carefully over a period of time to see if there are significant differences
in their health that might be attributable to exposure to estuaries where Pfiesteria has
been identified.
Its important to note that this study will only compare the health and neuro-cognitive status
of people who are exposed to estuary waters to those not exposed to these waters.
Should a statistical significance be observed in the exposed group, we can only infer that
there are factors unique to the exposed cohort that may be responsible. The study alone
cannot specifically implicate or exonerate Pfiesteria as a potential health hazard; however,
this study, along with other research, will begin to answer questions about the public
health risk posed to people who live and work around estuaries. A direct toxicological
human dose response relationship to the Pfiesteria toxin can only be assessed once the
toxin is characterized and a human biomarker identified. The study is projected to last 5
years, and the results of the cohort study are still a couple of years away
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Ptiesteria Update, Spring 2000
Harmful Algal Blooms Program
NC Division of Public Health
Information Hotline: 1-888-823-6915
Web Site: http://www.schs.state.nc.us/epi/ptie.html
Summary
There have been no documented Pfiesteria outbreaks in NC during 1999 season and no
confirmed PEAS cases reported to date in NC or among the other 5 participating states.
Pfiesteria fish bioassay method and toxicity has been validated by Old Dominion
University In these bioassays, fish developed lesions ana clied rapidly. The Pfiesteria
bioactive material appears to be very potent and deadly to fish.
There has been good progress made in Pfiesteria basic science research. Questions that
need to be answered before we can determine the potential threat to human health from
Pfiesteria will need to focus on the following research areas:
. Development of more effective and more rapid means for positive identification and
quantification of the various species and stages of Pfiesteria-like dinoflagellates and
their toxins, including morphological, biochemical, genetic, and immunological
methods.
. Determination of the complete life histories of all the species. Ecology and nutrition of
the benthic (bottom-dwelling) stages of Pfiesteria-Iike dinoflagellates. It is likely that
these organisms spend most of the time living in bottom sediments or near the
sediment-water interface.
. Quantification of the role of organic versus inorganic nutrients in stimulating the growth
of Pfiesteria-Iike dinoflagellates.
. Determination of the role of bacteria in the dinoflagellates' nutrition.
. Determination of the role of nutrients and other factors in expression of toxicity
. Investigation of the potential for direct stimulation of Pfiesteria-Iike dinoflagellates via
organic wastes from animal production and sewage.
. _ Assessment of physical processes that affect Pfiesteria-like dinoflagellates on botn_
-larger scales (distribution within an estuary) and smaller scales (responses to fish and
feeding behavior).
. Determination of the effects of top-down controls (e.g., predation) on these
dinoflagellate populations.
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