community clinics and other partners-sorry if i leave people out-that are coming together to solve the neighborhood issue throughout san francisco. i think we are getting good leverage and that is a good thing and i'm smiling about that. >> thank you. commissioner >> is there money dedicated or available for a educational program that would get a lot of community education out on this? >> part of the plan is to be a road map and the money that we receive from hellmen is targeting for the [inaudible] billing consultant to figure out the money flow so we can get the sealant programs and get the location of services. the promotion and educational programs, that is something we hope this plan can be. i hold

a imaginary plan can we use today leverage more funds and already it has this great promise of doing that, but education is key >> that would be a great benefit >> it has to be hand in hand with that. >> commissioner [inaudible] >> thank you for this, i didn't hear it before so it is quite telling. there is woman who would have benefited from this and a mother who did benefit from this prevention i think is great we ryeing to expand across the city. you don't call out sealant in it and i wonder if there is a reason for that? you call out the varnishx but not the sealant and you make a dif in the prezidation >> the sealant-we are hoping to increase the sealant is getting the billing so we can

pay more people to place it. the fluoride varnish is at all most no cost. [inaudible] >> i know there isn't money for it at this point, but to build point into the notion that this is a road map for sustainability and securing money and that is a important way to secure money >> can fix that and i'm happy to work with coleen perhaps. >> i just want to con gratiate all the efforts and collaboration going on for this key problem. it is great to see the participants involved in this and the fact that you defined the problem and know where the impact problems are and the agency and services being provided. a number of

years ago when we opened up the fill 15o receiving soneter and south market by saint pats many years ago one of the dental schools was a participant because we had issues effecting dental care within this community and [inaudible] some other parts of latin america where there is a multitude of challenges. the school becomes a important vehicle in this collaboration model it is more important. my only thought would be-a number of the kids from different communities still are bused to other parts oof the city. you get many kids from [inaudible] on the other side. in some of the prekindergarten and kiden garten programs there may be more sceneing and assistance in

their home neighborhood when they attend school in a different part of the city. we are talking about where the school sits or where the kids are actually attending and i want to make sure that is clear when we talked about how we do the intervention because my own personal comment would be i think when the crids are in school it gives you a unique [inaudible] if you can get the parents-it could be a much more wide spread situation rather than going back after the school bus or late or missing the bus and getting back and there the other variables that go on. it is a great step here and i endorse the amendments before us and we wish you well and i know there are a number of years ago the rwj fund had a number of programs where the school of denttries did work in the valley and at the border

but there wasn't muchmany being put in the city and county. [inaudible] it is a real god sent foundation for a number of these issues. i'm sure there is a lot more today that would impact our unique populations of kids and families. more power to you, job well done >> i'll share that with the evaluation team. >> thank you for this wonderful report. i do have several questions. one is technical. first, i'm astonished that and upset that the asian population has such a very poor record here. it is a population that has wanted to treat kids, their children well, often to the detriment

their own health and your data seems to say that they are not really caring for the teeth of their children. one of the question may be whether or not messages have gone out to them in the same fashion that we do in terms of get them imue nizeed and allow them to have the advantage of whatever preventive services and is that part your findings at all [inaudible] this is conttrary to all the other data we get on asian health >> [inaudible] said bf it is a multifactorial disease and why there is a lot of reasons with access to dental. cultural habits and feeding

practices, economic, prioritizing baby teeth. that is a the educational push. i do not thinking having worked with parents of 0-5 year olds it isn't wanting to care for their children or connecting the dots and part of the reason we are pushing the primary care clinics to place the fluoride varnish early and give the message is because that is a key way to get the babies before they get the decay and get the parents in a quick way. it is a complicated issue. >> you are adding it is a complicated issue and this brings to mind the problem of deal wg the culture issue. has there been efforts made by the department or the others or even community organizations. it isn't one i'm aware of that

we have a dental [inaudible] on a bill board >> we had a bus campaign in the late summer in chinese script to get baby to dental by age one [inaudible] leading the working with the promotion team and because the china town area is so impacted, it is one of our high risk areas and one of our targets so haepfully we can report good news to you >> this is a small point, you talking about disparity and oral health shows you measured asians. your chart on the children of color having untreated decay states chinese. is that correct that you

called out chinese for these studies? >> yes. one of our readers also questioned that. why is it asian and not chinese. [inaudible] pulled out because of the asian population, the greatest majority is chinese and have the highest decay. just to show that discrepeacy that is why. >> my last question is directed to doctor [inaudible] in regards to one of the points here, which is integrate oral health messaging into the existing programs. i call on you perhaps to really lend some light as you were at china town health center, is dental health one of the priorities or if it were are you looking within the san francisco helt network to

really work this as a subject if infact we pass this as a priority? if you want to pass it to [inaudible] that was fine too. >> i can comment. about 3 months ago a committee-a small group that includes margaret, steve [inaudible] susan fisher own we said how do we make this a operation like this in the clinic flow much like we do intake for diabetic patients. we are trying to build this into the model leverages out pcp staffing because a lot of it can be done by non pcp staff. [inaudible] roll from site to site targeting the higher prevalent sites like in china town. we are still

working throthe plans, but that is our effort going forward >> i think i'm only using this as a example-in the sense that we are trying to integrate the public health messages and issues and the delivery system that we have. i'm ask if that is the overall plan and this is how this is going to be working-we have public health messages andcome pains and we run a delivery system >> absolutely. that is the beauty of the new format, the population health division and san francisco health network and within the network and child health and all the wuntderful things we do and partnering with the population hlth in terms of equity and disease prevention qu bringing all those into one coordinateed nexus where we harness all the

resources from both divisions to drive improvement and outcome for our citizens. we are seeing more and more and hope you are seeing how the different part of the department are intersecting in the various work we are doing. >> yes and i think we then will have a measure, right? here is the base. >> one more point under doctor fish er owens leadership [inaudible] we have built structured data that will capture the information from the primary care clinics so we can see how well we are doing. with time we'll measure that and move upwards >> would like to follow up because it is a-i want to make sure i understand. i thought

the nob nawas a example in the kindergarten screening. we are talking not only in the san francisco school district. isn't that our target? >> that is update >> what i'm trying to say, i know many families do not go to public schools anymore in san francisco. many go to private schools whether it is catholic or whatever. i can think of many latinos and [inaudible] live in the city and don't send their children to public schools. not that they are not good because public schools-if we are only looking at public schools, public schools nationally are known as the schools of the poor and that is wie we-we are fortunate in san

francisco where public sool is a pritorty but we have to reaform or commitment and use our resources that it is the [inaudible] democracy and critical thinking and good citizenship. the fact of the matter is, i thought we were troching about a specific group whether it be in mission or hunters point. that is why i ask if we look that school of where the kids go or where they live. there are all sorts of variables but i assumed the majority of focus is the san francisco unified school district and this is a collaboration with us as we move. does that make sense? >> just to clarify this plan applies to all children in san francisco. the reason why we refer to the school district is because a great majority of the children is in that system and

importantly with the kindergarten screening annual project we have a nice way to measure and get the baseline data because we screen nearly 90-95 percent of children all year. that is part of the san francisco unified school district >> [inaudible] issue that will [inaudible] maybe think more what will help to answer the question. the question is the collects ive impact projects that are large whether it is the [inaudible] or mission or dentistry and the cavity issue in china town is how we know we are having a impact. let's look at the red dot on the map which is china town, but it could be bayview and other areas, it isn't just the health network. when i looked at this with the

[inaudible] we said why caebt we do this in the clinics, but it is also people not in the clinics and it isn't just kids it is also adults, so there were all these sus temic things with in network and out of network and schools and staffing and apparently there are only dentists in china town that [inaudible] the number is limited. how do we dpet professionals in the community and show we have a collective impact? this is what i think we should look at what wie ask the data. going from the 38 percent cavity rate to 27 percent for the whole city is great. maybe we can show in the particular community we had a impact and short term [inaudible] i think we are

looking for language to show we are moving along. we are struggling with this because we want to know something good happened. what i volunteered is ask you and me go on the china town [inaudible] parade and carry a big tooth brush for a educational campaign, but i was told that would have to go to the full commission. the idea is-i think when i heard this they have come a long way in a year and we are [inaudible] in some ways are broad and some ways are specific and i think-how do we know we are satisfied? it is a larger issue. that doesn't mean we don't want to hold the department accountable for cavities in china town and

diabetes in mission and heart disease in bay pch view >> i believe if we pass this resolution i would ask that public health committee actually tried to evaluate and answer those questions for us periodically with reports. we can do work within that segment. if you want to talk to me in the parade the following year we probably need to speak to the orgers, but the department of public health has in the past participated. when the emergency services [inaudible] there are many thoughts. i suggest that we would first place that into the hands of the committee that first heard this. are you recommending this resolution? >> i think the resolution has

a [inaudible] than the first. i think in terms of the varnish i may ask [inaudible] i don't know if we added in the whereas or if you want to add it in resolve. the issue of varnish is-not varnish, the sealant is a dental procedure probably requiring reembursement, where the varnish you can apply and care professionals can be trained and volunteers if they certified right in the way. that is why the varnish is on there. you want to resolve that? >> i ask coleen >> i may suggest incorporating it with the sustainable funding in the 2nd to the last bullet with the resolve >> where would it go? >> in that last bullet. >> [inaudible] fluoride, varnish and sealant

>> assess [inaudible] i think the expansion to sealants as i understand it in part on dent ical funding and finding the proper method for funding >> we can link it to that >> that is a appropriate place for it because it is a preventive dental treatment >> you are moving the resolution with that amendment? >> yes i do want to do that rkss is there a second to that? >> furter discussion? all in favor of the resolution please say aye. opposed? the resolution is passed. thank you very much and thank you for your great interest and we look forward in this topic and

periodic updates >> item 9 is the dph cucommuneicable disease update. >> thank you and was there a hand on this one? >> there is a presentation. >> thank you, doctor horfber >> [inaudible] the director-doctor cora hoover and director of disease control and prevention within population health. i just want to ask mark, do i need to >> it floated here. >> okay, sorry, i'm not finding it. i'm going to present to you a update on some

current communeicable disease issues that may be of interest to you. spirfckly we'll talk about ebola monitoring of returning travellers and update on ourtia gela outbreak. some information about the measles outbreak occurring state wide and seasonal influenza. i will try to be brief and concise and if you need more details we can go into detail on the topics. we are starting with eboma. ebola. as you may have heard in the media the ebola epidemic in west africa seems to be improving in most areas, but there are still a fair number

of personal eltraveling from the united states to west africa as part of relief efforts and also in capacities as journalism and economic development and we continue to comply monitoring these travelers when they return to our communities. the travelers are identified through cdc airport screening process and there is a process to notify us. we screen them, interview them and issue health officer orders and monitor them for a 21 day period after their return, which essentially is the inksbation period for ebola virus. the purpose of this monitoring is make sure we have that relationship and channel of communication open so if a returning traveller begins to

development systems consistent with ebola there is a way for them to receive the needed medical evaluation in a very controlled and system attic fashion without just showing up in a clinic or emergency room. in a way that is very appropriate and safe for everyone. we have nurses do the monitoring and it is going smoothly. we monitored approximately 30 individuals over the last few month squz it is a successful process. that's all will say about the ebola monitoring, but i'm happy to answer questions about that as we go on. i'm also going to talk about an illness calledtia bella. it is a bacterial infection that causes gast row interitis. the spread is fecal, oral. it is fairly common in the united states rks but much less common here than

in developing countries. san francisco normally has about 100 cases a year of what is called shilla loses. there was a large outbreak in the gay community about 15 years ago that went on for over a year and sinss then the levels are fairly stable undill november to december when we saw a increase in cases. so, generally under normal circumstances we have between 5-and 10 shig loses cases a month. they are positive stool cultures a month. it is reported to us which is mandatory. we intervus each case and the main goal of the interview is identify anyone that is in a sentative occupation or setting mainly food handlers. they are not able foowork until they are cleared of dh disease. we look for patterns, outbreak jz

generally we don't find anything that is not unique to us. in general shigela outbreaks are not common. however, we have been experiencing a out break of shigela that started slowly in november. most cases we had were in december, things seemed to probably be tape aing off. there are 181 cases associated with this outbreak and also the bacterium happen tooz be resist tonight one of the more commonly used antibiotics to treat the infection. we had nearly tw years worth of cases in a few months. one of the unique things about the outbreak is it effected the homeless population. half the caseerize homeless or live in residential hotels or single

room occupancy hotels with shared bathroom jz perhaps disease transmission is associate would that. we have been sharing information with the medical community and also worked with our patners at the start department and cdc because this outbreak seems to be connect would a larger nation wide outbreak. we have been working with homeless service providers of sharing information with them and also distributing hygiene materials in the form of hand sanitizer towel ets. we distributed twnt thousand of those and they are very well received by the service oceans and by the clients. environmental branch has worked doing a lot of inspections of facilities providing food to the homeless and also doing inspections

of-and sharing information with the residential hotels. again it looks as if the outbreak is slowing down and we'll continue to keep you posted. no single source for the outbreak has been found and we looked for it very very carefully and we haven't found it. i'm moving on to museals to just talk with you a little bit about the current outbreak in california. just background on mesealatize is one of the most contagious infection known. it spreads through the air. it can even remain in a room after the person with meseal leaves and continues infect people even after the person with meseals has left. it also individuals are infexs for up to 4 days before the measles rash appears

which is a reason why it tends to spread very easily. the good news is there a excellent vaccine against measles that is available and it is extremely effective. we think about 97 percent effectfb if 2 dose are received. most in the united states and san francisco are expected to be immune to measles because they are vaccinated. there is a outbreak in cam that began in laest december 2014 and continues. this also seems to be slowing down. last week there were 110 cases state wide and at this time there are 113. most of the bay area counties have had cases in their residence, so we haven't had a

san francisco resident associate would thes outbreak, but it wouldn't surprise me if we do have one. we have done a lot of testing and fielding inquirys from local providers so we have been looking for measles. i'm going to go back for a second here. basically we are one of the only bay area counties that hasn't had a measle case. [inaudible] what about san francisco schools? we have data on imueization dates among school children in all schools in san francisco and if you look at the total population of school children and specifically cichbder gartners you receive the second dose of