Public Health

Beware L.A. County’s rabid bat boom

They’ve shown up in homes in Malibu and Topanga, in a Burbank restroom, on a Van Nuys sidewalk and a closet in Hollywood. In a Santa Clarita barn. In a flower bed in Palmdale. In a cat’s mouth in Glendale.  In the front door entrance to a Pasadena building and a Northridge home where five people were sleeping. In a Los Angeles school.

A record 45 rabid bats have been captured so far this year in the county—four and a half times the normal average for the area. Health officials say that so far, the reasons are unclear; last year’s count also was much higher than normal. But for safety reasons, members of the public are being urged to steer clear of the critters—and all wild animals—and to make sure that pets have up-to-date vaccinations for rabies.

“It is important that everyone understand the potential dangers posed to themselves and their pets, as most of these rabid bats have been found in and around homes,” Director of Public Health Dr. Jonathan E. Fielding said in a statement.  “Children and teens especially should avoid handling bats or other wildlife, even if their intentions are to nurse an injured or ill animal back to health.”

Karen Ehnert, acting director of the county’s veterinary public health program, says she has been talking to local wildlife biologists, but so far hasn’t received any information on what might be causing the outbreak.  “Whether there are more bats in the area and therefore more crowding, or some sick bats migrated in and started spreading it, we don’t know,” she says.

But she knew early this year that the incidence of bat rabies was going to be a problem.

“Usually if I start seeing cases in April and May, there’s more transmission going on,” she says. “Well, this year, I saw the first case in January.”

Typically, Ehnert says, she sees about ten rabid bats in an entire year in L.A. County, and by April, she had already counted nine cases.  Moreover, she says, the percentage of captured bats testing positive for rabies has been rising.

“Usually only about 13% test positive,” says Ehnert. “But last year, it was up to 17% positive. And this year it was 20%.”

Only about 1% of bats are typically infected with rabies in nature, but they are the most common carriers in Los Angeles County, according to public health officials. Healthy bats eat insects, pollinate plants and typically fly only at night and avoid humans. However, the public health department warns that bats flying in daylight, or found on the ground or indoors near a sleeping person should be captured and tested for rabies.

Never pick up a bat with bare hands. Public Health recommends calling a local animal control agency (click here for a list of local animal control numbers), or, in urgent situations, putting on gloves and protective clothing and trapping the animal in a box or a bucket without touching it. Bats are protected by federal law and can only be removed via humane release; it is illegal to try to exterminate them.

If you are exposed to a bat, seek immediate medical attention; bats have very small, sharp teeth and their bites can be hard to detect. And don’t panic. Ehnert says that if you’re bitten, you can recover as long as you receive treatment before you start to develop symptoms. Los Angeles County hasn’t had a case of full-blown human rabies in more than 50 years.

Posted 9/12/12

Understanding the heat of the moment

You don’t need a meteorologist to tell you it’s hot out there. But when planning how to cope, it helps to know what some of the weather jargon means.

When the Los Angeles County Department of Public Health declares a “Heat Advisory,” that means that the heat index—a number combining temperature and humidity to approximate what it feels like—has reached 95 or above. A “Heat Alert,” on the other hand, is issued when a heat index of 95 or above is forecast for two or more days. When a Heat Alert is issued, people are advised to take extra precautions and county cooling centers are opened to the public.

The current Heat Alert started Wednesday, August 8, and runs through Sunday, August 12. Affected areas include the San Fernando, San Gabriel, Santa Clarita and Antelope valleys, and Pomona.

The numbers behind the alerts explain a lot about how we feel.

For example, if it is 90 degrees outside with zero humidity, it will feel like 90 degrees. However, at 60 percent humidity, 90 degrees feels like 100 degrees, according to the heat index—and it also comes with the health risks of a 100-degree day. If the humidity were to reach as high as 90 percent during a 90 degree day, it would feel like a blistering 122 degrees.

According to the National Weather Service, we’re currently experiencing unusual humidity because of monsoonal moisture that is being pushed into the region by a complex of thunderstorms in Mexico and a tilted high pressure system over Nevada and New Mexico. In addition to the humidity, this moisture might also bring thunderstorms to L.A. County starting Friday and continuing through Sunday.

The heat itself, even without the humidity, has been historic. On Wednesday, a daily record high of 107 degrees was recorded in Woodland Hills, where today’s forecast calls for 106 degrees. That’s nine degrees above the monthly average, but still well below 119, the record temperature for all of L.A. County, recorded in Woodland Hills in July, 2006.

Coastal areas won’t be feeling the burn nearly as much. Thursday’s highs predicted for Malibu and Santa Monica are just 78 and 83 degrees, respectively—a relative day at the beach. In downtown L.A., the temperature is expected to approach 95 degrees.

Early August’s blazing temperatures come on heels of the hottest month ever recorded in the United States.

From a health and safety perspective, extreme heat should be handled with extreme caution. According to the Red Cross, high temperatures cause more annual fatalities in the U.S. than any other type of weather event. Children, the elderly, the disabled and pets are particularly vulnerable. Heat-related illnesses include heat rash, heat cramps, heat exhaustion and heatstroke—a life-threatening illness that requires immediate medical attention.

The L.A. County Department of Community and Senior Services maintains countywide cooling centers, including three in the San Fernando Valley, at ONEgeneration Senior Enrichment Center, San Fernando Recreation Park and San Fernando Valley Service Center. The department recommends calling ahead to ensure seating is available. The city of L.A. also manages cooling centers at various libraries, recreation centers and senior centers.

The Department of Public Health has a list of “healthy summer” tips for help staying safe in the heat, and additional advice is available online from the Centers for Disease Control and the Red Cross.

Posted 8/9/12

Taking baby fat off the menu in L.A.

Say bye-bye to those tater tots and juice drinks, baby. Day care workers all over Los Angeles County are about to get an education on how kids ought to eat.

Thanks to a recent initiative to release of hundreds of millions of dollars in funds for early childhood development programs, the Los Angeles County Department of Public Health got the go-ahead this week on a sweeping plan to school babysitters and childcare facilities in preventing childhood obesity.

The $6 million project initially will offer workshops, coaching and follow-up assistance to about 8,000 providers on age-appropriate nutrition, portion control and exercise. However, the service, underwritten by First 5 LA, is expected to eventually expand to all of the 20,000 or so licensed and exempt caretakers operating in the county, from big Head Start programs to family day care homes to neighborhood sitters.

The outreach is considered critical because obese children have a higher likelihood of obesity in adulthood, and childhood obesity is strongly associated with grave and costly health risks such as type 2 diabetes and, over time, heart disease.

More than 16% of preschoolers between the ages of 2 and 5 are overweight in the U.S., and more than 14% are obese, according to the Centers for Disease Control. This is especially true among low-income children; in Los Angeles County, the obesity rate among 3- and 4-year-olds in the federally funded Women, Infants and Children nutrition program is more than 20%.

Those rates tend to worsen as children get older. In California, 38% of fifth- seventh- and ninth- graders were obese or overweight in 2010; in Los Angeles County, that figure stood at about 42%.

More than 350,000 infants, toddlers and pre-schoolers here spend at least part of their day in child care, where the meals they get “leave a lot to be desired,” says Dr. Robert Gilchick, DPH medical director of child and adolescent health programs and policy.

A 2008 study sponsored in part by First 5 LA found that nutrition in Los Angeles County childcare centers was generally too light on lean meat, fresh fruit and vegetables and whole-grain carbohydrates. “There were a lot of fried fish sticks and Tater Tots, and a lot of the portions were much too large for children 3 and 4 years old,” Gilchick says.

Water, in particular, was rarely on the menu. Nearly half the sites regularly served fatty meats such as fried chicken and hot dogs; four offered fried potatoes and at least one was dishing up Doritos.

And lest parents feel smug, meals were even less nutritious when children brought their own lunches.

“One child brought [four] packaged foods—chips, Cheez-Its, candy and cookies—in addition to fried potatoes, an English muffin, 20 ounces of 100% fruit juice, string cheese and yogurt,” the report found; another child’s brown bag featured a McDonald’s McGriddles sandwich with sausage and flavored milk.

Recent state legislation has begun to improve the picture. A new state law, for instance, establishes guidelines that will discourage sweetened milk, sugary “juice” drinks, sodas and other caloric junk drinks in day care facilities.  Another bill, AB 1872, would mandate more milk, fruit and vegetables in the meals served in day care homes, which now are not legally obligated to follow any nutritional standards.

But a little county intervention will go a long way, says Gilchick.

In fact, he says, a pilot project conducted in about 120 South Los Angeles day care centers has already paid off. “Just a 4-hour training course actually made a difference in average nutrition scores.”

Under the new program, DPH will disburse $4.5 million for training and workshops through the Child Care Resource Center and Child Care Alliance, a consortium of 11 childcare service agencies. The rest of the $6 million will remain with the department for follow-up and oversight. “We expect to have the curricula ready for trainers by year-end,” says Gilchick. The workshops should begin in 2013.

The day care project is among many being funded under an aggressive plan to turn some of the hundreds of millions of dollars on reserve at First 5 LA in to much-needed services for children. Dedicated to programs for children age 5 and younger, the money comes from a special 1998 tobacco tax.

Last year, the surplus became a source of controversy after the governor attempted to divert unused First 5 money to help ease the state’s budget problems—an unsuccessful gambit that focused attention on First 5 LA and led to an independent audit. The audit found no malfeasance, but accused the agency of sitting on some $800 million and led to the resignation of its chief executive, Evelyn Martinez.

First 5 LA’s new spending strategy will fund programs ranging from parenting therapy to health insurance outreach to dental and vision care for small children. But it is not without critics. Some of the new and expanded programs will be carried out or overseen by the county, and an original plan, already approved by the First 5 LA Commission, would have fast-tracked several years’ worth of money into a special account to be drawn down by the departments involved as the programs develop. Some $29.1 million would have been added to the account to continue longstanding programs already being supported with First 5 LA funds, and another $58.2 million would have provided long-term funding for new projects.

The account was intended to speed services by eliminating the need to return to First 5 every year for ongoing funding, a step that had contributed to the agency’s slowness in disbursing money. But it required four votes for approval, and was blocked on Tuesday when Supervisor Mark Ridley-Thomas abstained and Supervisor Gloria Molina voted against it.

“Shame on you,” said Molina, who had been an advocate of Martinez, and who charged that the county, like the state, was merely trying to loot the First 5 surplus. “They’re just trying to make up stuff . . . to rip off the money.”

But Supervisor Zev Yaroslavsky noted that the agreements with county agencies dated back years to when Molina herself was chairing the First 5 LA Commission. “Somebody has to stand up when you castigate an entire group of bureaucrats as rip-off artists,” said Yaroslavsky. “It’s not fair.”

As a compromise, the Board approved only the multi-year contracts between First 5 LA and the county’s public health and mental health departments, which will launch the new and expanded programs but still require First 5 to renew the funding annually. The contracts, which required only three votes and passed over Molina’s no vote and Ridley-Thomas’ abstention, will pay for parent-child therapy, substance abuse treatment for at-risk parents and caregivers, outreach for the county’s Healthy Kids health insurance program and the initiative to reduce childhood obesity.

Posted 8/2/12

Show of hands for the new CPR

Want to be a hero? It’s easier than you might think. With recent research showing that lives are saved when bystanders get involved, L.A. County and the American Heart Association have launched a campaign to train 10,000 Angelenos in a simple, “hands-only” form of CPR that anyone can perform.

It turns out that you don’t have to give mouth-to-mouth resuscitation, sit through a lengthy class or hold an official certificate to play a crucial role when an adult has a sudden cardiac arrest. All you have to do is call 911 and begin performing rapid, deep compressions to the victim’s chest until the paramedics arrive.

“It’s so much easier now to teach, and for people to do,” said Cathy Chidester, director of the county’s Emergency Medical Services agency.

You can even learn the easy technique at your local park, grocery store, Costco or Wal-Mart. County fire officials will be fanning out on Thursday, June 7, in a massive educational effort intended to reach people in every part of the community. A list of locations where county fire personnel will be teaching the technique is here; a comprehensive list of other places where the training is being offered Thursday is here.

It’s hard to overstate the importance of learning to perform this simple intervention: “It increases the number of potential lifesavers on the street in our community,” said Kristine Kelly, communications director for the American Heart Association in Los Angeles. “It just empowers people.”

And empowered people can make a huge difference.

“Approximately 80% of cardiac arrests happen at home,” Supervisor Zev Yaroslavsky said in a motion to declare Thursday “Sidewalk CPR Day” in the county. “Put very simply: The life you save with CPR is most likely to be someone you love.”

Posted 6/6/12

Condom contest winner takes a bow

Los Angeles County has an official flag, an official seal, an official web site and even an official song (“Seventy-Six Cities”). On Wednesday, it got an official condom.

Officials from the county’s Public Health Department announced the winner of its “Show Us Your Package” contest, which drew more than 500 entries and was aimed at raising awareness about the importance of condom use. The winner: a white, black and red wrapper with a black bow tie and the admonition “Suit Up.” Nine runners up also were selected, depicting, among other things, a cartoon map of L.A., a Hollywood Boulevard star with the word “SAFE” on it and the Hollywood sign spelling out the word “CONDOM.”

The Top 10 entries came from Santa Clarita, Glendale, Panorama City, West Hollywood, Van Nuys and other parts of the county. The grand prize winner, Adam Lyons, 32, of Hollywood, is the proprietor of Pop the Pixel, a West Hollywood design studio.

“I feel fantastic,” said Lyons, who moved to Los Angeles five years ago from San Francisco and said he entered the contest after seeing an ad on Facebook. “This is honestly the first design award for me, so it’s really exciting.” Three of his designs made it into the semi-finals.

Lyons explained that many of his clients are small local businesses with a strong sense of public spiritedness about Los Angeles, and he felt that participating in a public service campaign would let him share that enthusiasm.

“Being part of the community is something I really want to uphold and maintain,” he said. “I’m incredibly happy to be part of L.A.”

Prizes for the top 10 winners were donated to the contest. Adams will receive $750 in gift cards and a Toshiba 19” LED television with a built-in DVD. The runners-up each get $200 in gift cards. But all will receive invaluable exposure for their public-spirited artwork when the winning wrappers hit the streets in a few months. (Because each new condom wrapper requires FDA approval, there will be some lag time, says True Beck, project manager for the contest.)

All of the top 10 will appear for the next year on the wrappers of a million free condoms that will be handed out throughout the county by the Department of Public Health.

The design contest had a lively tone—its web site was LASexSymbol.com—but sexually transmitted disease is a serious issue here. Some 2,000 new HIV infections occur each year in Los Angeles County, and last year the department reported more than 47,500 new cases of chlamydia, more than 9,500 new cases of gonorrhea and nearly 1,800 new cases of syphilis.

The county distributes grant money each year to local health care providers to purchase and distribute free condoms, which help prevent such diseases. The contest—facilitated by a marketing firm and Boston-based ONE Condoms, which is the county’s wholesaler—was a small part of a larger centralization of STD prevention, in which three county programs already have been merged.

The contest rules stipulated that designs could not be obscene and that designers had to be residents of Los Angeles County. However, entries came from as far away as New York and Florida, as well as from surrounding counties. Last week, a panel of judges including gossip blogger Perez Hilton winnowed the submissions down to 50 semifinalists, which were then voted on by 185,000 members of the public on the contest web site.

Posted 6/28/12

Vote for L.A.’s official condom

One entry has the Hollywood sign spelling out the word CONDOM. One depicts a prophylactic stretched over Los Angeles’ iconic City Hall.  Some have palm trees. Some have movie themes. Some are in Spanish. One features the Capitol Records building with the caption, “Let’s Get It On.”

The contest to select an Official L.A. Condom—or at least its wrapper—is off and running. A panel of judges is winnowing the entries, and, starting this week, the public will be able to vote online.

“We had more than 300 entries the last time I checked,” says Department of Public Health Project Manager True Beck. “On June 21, the semifinalists will be posted, and then the public will pick the top 10.”

Winners will be announced on June 26.

The contest, entitled “L.A.’s Next Sex Symbol,” is intended to promote safer sex and discourage the spread of HIV, syphilis, gonorrhea and other sexually transmitted diseases. A similar contest several years ago in New York generated widespread publicity.

The issue is serious—some 2,000 new HIV infections alone occur annually in Los Angeles County—but the contest’s tone has been anything but somber. The tag line is “Show Us Your Package,” and judges include the colorful gossip blogger Perez Hilton. Earlier this month, buff men in muscle shirts were on hand at the Downtown Art Walk to do condom demonstrations on popsicles and bananas.

Beck says the idea is to keep the conversation “light and sexy and fun”, and engage the public. The number one vote getter will win a television and $750 in gift cards, and the nine runners-up will receive $200 in gift cards.

The real prize, however, will be bragging rights:  The 10 top designs will appear for the next year on the wrappers of a million and one free condoms handed out all over the county by the Department of Public Health.

Click here to see the entries and vote from June 21-26 for your favorite semifinalist, or go to LASexSymbol.com.

Posted 6/20/11

Calling all condom designers

There are a million free condoms in the naked city, and the Los Angeles County Department of Public Health sees a branding opportunity in that.

In an effort to help curb sexually transmitted diseases, the department’s Division of HIV and STD Programs this month will announce a contest to design an official L.A. condom wrapper to help brand the free prophylactics the county distributes to local businesses, social services and healthcare providers. Ads will invite county residents to come up with “L.A.’s Next Sex Symbol.”

“Our tagline is going to be ‘Show Me Your Package’,” says Project Manager True Ann Beck.

The lighthearted derby is part of a serious push in Los Angeles County to consolidate public health outreach on sexually transmitted diseases. An estimated 2,000 new HIV infections occur annually in L.A. County.  Last year, the department reported more than 47,500 new cases of chlamydia, more than 9,500 new cases of gonorrhea and nearly 1,800 new cases of syphilis.

Each year, grant money is distributed by the county to local health care providers to purchase and distribute free condoms, which help prevent sexually transmitted diseases. (About 250,000 have been handed out so far this year, at a wholesale price of about six cents apiece, Beck says.) The contest is a small part of a larger centralization of STD prevention that has already merged three county programs.

The design contest, which will run from May 21 to June 17, will be facilitated by KCBS Marketing with help from the county’s condom wholesaler, Boston-based One Condoms, Beck says. Entrants must be Los Angeles County residents over the age of 18.

Rules will be posted on the contest web site (LASexSymbol.com), but generally, entries cannot be trademarked, copyrighted or sexually explicit. The winner and nine runners-up will receive prizes and gift cards, plus bragging rights to a package design that will be distributed countywide and featured in future condom promotions.  All ten will be produced and distributed.

“We want to circulate more than one design so people can collect them all,” Beck says, adding that the initial plan is “to start with a million and one condoms.”

Updated 6/14/12: Learn more about the contest at the Downtown L.A. Art Walk tonight. Check out the 40-foot RV parked at 24 Main Street.

Public health officials note that contests are only one way among many to raise awareness and improve Southern California’s health. Still, New York’s 2010 contest attracted nearly 600 entries, persuaded New Yorkers to cast more than 15,000 online ballots and conferred momentary celebrity on the graphic artist who submitted the winning wrapper design—a graphic representation of a high-tech power button.

Beck says the hope is that the entries will be so smart and lively that the public won’t think of the free condoms as a government program.

“It’s going to be very light and sexy and fun. We’ll probably get all sorts of comments, but the point is to get people talking, and to get them to practice safer sex,” she says.

Posted 5/17/12

Putting the squeeze on Lap-Band ads

County supervisors squared off Tuesday with promoters of the Lap-Band, featured on billboards all over Southern California but drawing increasing attention from officials concerned that the publicity blitz is obscuring a wide range of medical dangers.

After a series of sharp exchanges with representatives of 1-800 GET THIN, supervisors approved a motion by Supervisors Mark Ridley-Thomas and Zev Yaroslavsky to bring greater scrutiny to Lap-Band marketing and procedures. They directed county staff to, among other things, “develop a plan to identify medical products and services that are being marketed in a dangerously misleading manner.”

The supervisors’ action comes after the U.S. Food and Drug Administration recently sent letters to eight Southern California weight loss clinics and the 1-800 GET THIN marketing firm, warning that the company’s ubiquitous advertisements do not provide enough information about the risks of gastric bypass surgery or about the need to change eating behavior to lose weight over the long term.

“The FDA’s warnings raise significant concerns about the vulnerability of all County residents to these advertisements, particularly those who suffer from morbid obesity and wish to find a cure,” the motion said. “Medical experts and the FDA agree that the Lap-Band procedure is an aggressive treatment for obesity and should only be considered in clinically severe obesity cases.”

Robert Silverman, the president of 1-800 GET THIN, told supervisors that his firm is taking steps to bring its billboards and radio and TV spots into compliance with the FDA requirements. An attorney for the company said its surgery centers “have a better track record than just about anybody else.”

But supervisors were openly frustrated as they tried to find out more about how 1-800 GET THIN operates, in terms of referrals to clinics and responsibility for disclosing risks to potential clients.

“It’s been a long time since a witness or member of the public has come to that table and has obfuscated as consistently and persistently as you have today,” Yaroslavsky told the 1-800 GET THIN representatives. “I did not come here as a person who had any fundamental suspicion one way or the other about what you were doing. I leave here now thinking you are hiding something.”

The FDA’s action was prompted by Dr. Jonathan E. Fielding, the county’s top public health official, who last year asked the agency to investigate whether widespread Lap-Band promotion by 1-800 GET THIN was misleading.

The motion approved by supervisors Tuesday directed the Public Health Department to report back on what it is doing to get the word out about “safe and effective alternative methods to achieve and maintain a healthier weight.”

“There is no panacea for obesity, including the Lap-Band weight loss procedure,” the motion said. “However, there are proven strategies, when sustained over time, which can help people achieve a healthier weight, and decrease the risk for diabetes, heart disease and other chronic diseases.”

The motion also directed the County Counsel to provide legal options on steps the county could take to “ensure truthful advertising of aggressive obesity treatment procedures in unincorporated areas.”  And it instructed the Chief Executive Office to pursue legislation to increase supervision and oversight of clinics that perform “aggressive and invasive obesity treatment cosmetic procedures.”

Posted 12/20/11

 

Backpack? Pencils? Pertussis vaccine?

As September approaches, health officials are reminding parents that a new state law requires proof of a pertussis, or whooping cough, booster for students entering the 7^th through the 12^th grades.

The law was passed last year after a dramatic increase in pertussis cases sent the incidence of the disease soaring in California to the highest levels since 1958. More than 9,000 cases were reported, including 10 deaths, most of which were among infants who had not yet been vaccinated.

According to the Los Angeles County Department of Public Health, four of those babies were in Los Angeles County, where the number of reported pertussis cases quintupled to nearly 900. In normal years, no one dies of the disease.

More commonly called whooping cough, pertussis is a serious and highly contagious respiratory infection that causes violent, uncontrollable fits of coughing and can lead to pneumonia and brain hemorrhages, among other complications.  Although most children receive a vaccination, known as Tdap, before kindergarten, the immunization can wear off, and children can remain susceptible into adulthood without booster shots in adolescence.

The incidence of pertussis has risen nationally in recent years along with measles, mumps and a number of other potentially lethal childhood illnesses. To complicate matters, unfounded fears about vaccine safety have been fueled by internet rumors, leading some states to make it easier for parents to opt out of vaccinations that used to be an iron-clad requirement for school enrollment. This, in turn, decreases resistance in the general population, as the proportion of the community immunized against these dangerous, but preventable, diseases falls below the required critical mass.

The new law does allow very limited exemptions, and includes a 30-day grace period allowing schools to let students attend classes if they don’t have their paperwork in order by the first day of class.  But the school district still has to work with the family to get the child vaccinated before the final deadline because even if an unvaccinated child survives an infection, he or she can pass it to more vulnerable people, such as infants, the elderly and the ill.

Although 2011 rates have dropped and no deaths have been reported so far this year, the California Department of Public Health reports that whooping cough remains at higher-than-average levels in the state—and higher than the last record year, in 2005.

Parents whose middle- and high-school children have not yet been vaccinated should contact their health care provider. The Los Angeles Unified School District has been offering free vaccines this month, along with a number of community groups. For a list of places to go in Los Angeles County for free and low-cost immunizations, click here and here. For more information from the county Department of Public Health, click here. For information in Spanish, click here.

Posted 8/16/11

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