Delinquent mortgages, neglected swimming pools, and West Nile virus, California

Adjustable rate mortgages and the downturn in the California housing market caused a 300% increase in notices of delinquency in Bakersfield, Kern County. This led to large numbers of neglected swimming pools, which were associated with a 276% increase in the number of human West Nile virus cases during the summer of 2007.     

Relationships among weather, mosquito abundance, and encephalitis virus activity in California: Kern County 1990-98

The summer abundance of Culex tarsalis in Kern County, California, during 1990-98 was related quantitatively to rainfall, snow depth and water content, and runoff of the Kern River. Total monthly rain that fell during winter, lagged by 4-6 months, explained only 13% of the variability in the number of host-seeking females collected per trap night per month during summer. In contrast, regression analysis showed that river runoff 1 month earlier explained 67% of the variability in mosquito abundance. The water content of snowpack measured within the Kern River watershed during winter explained 70% of the variation in average mosquito abundance during the following summer. After being absent from Kern County since 1983, western equine encephalomyelitis virus (WEE) returned during the wet years of 1996-98 after the flow of the Kern River exceeded 150,000 acre-ft (450 hectare-meters) per month. Water content of snow in the Sierra Nevada during winter provided an excellent early warning of vernal river runoff, mosquito abundance, and enzootic WEE activity levels on the floor of the San Joaquin Valley.     

Monitoring mental health contract services: A management approach

Conclusion Kern County Mental Health Department's managerial approach to contract monitoring has contributed in large part to its successful utilization of contracts. The monitor's linking role as coordinator, consultant and communicator has provided a comprehensive system designed to maintain program integrity in a positive, non-punitive fashion. Agencies are given opportunity through a Contractor Satisfaction Survey to relate their perception of the contracting relationship. A definitive policy of management of contractual non-compliance objectively outlines progressive steps to be taken which reduces subjective judgments by the monitor. Through this mechanism, Kern County has maintained long term contracts with a multiplicity of mental health, alcohol and drug abuse providers and provided quality care to its residents. He received his M.S. from the University of Southern California and has served as adjunct lecturer in Community Mental Health at California State College, Bakersfield.     

Inhalation of Phosphine Gas Following a Fire Associated with Fumigation of Processed Pistachio Nuts

ABSTRACT

On December 10, 2009, a fumigation stack containing aluminum phosphide became soaked with rain water and caught fire at a pistachio processing plant in Kern County, California. Untrained plant personnel responding to the fire had exposure to pyrolysis by-products, particulates, and extinguisher ingredients. Ten workers taken for medical evaluation had respiratory and nonspecific systemic symptoms consistent with exposure to phosphine gas. Six of the 10 workers had respiratory distress, indicated by chest pain, shortness of breath, elevated respiratory rate, or decreased oxygen saturation. Recommendations are made for the management of similar illnesses and prevention of similar exposures.     

Community Exposure Following a Drip-Application of Chloropicrin

ABSTRACT

Objectives. To evaluate illnesses resulting from community exposure to chloropicrin on October 5, 2005, in the agricultural community of Salinas, California. Methods. A cross-sectional interview survey was conducted of 142 households downwind from the application site in neighborhoods that were sources of emergency calls. A total of 439 residents of the 142 households in affected neighborhoods and 1 emergency responder were interviewed. The authors assessed exposure to chloropicrin resulting from the application using a public domain air pollution dispersion model, the Industrial Source Complex 3 (ISC3). Results. A total of 440 subjects were represented in the interviews, including 324 (73.6%) who reported symptoms possibly or probably related to chloropicrin exposure. Ocular symptoms were present in 302 (93.2%) of the symptomatic cases. Nonocular (usually systemic or respiratory) symptoms occurred in 170 cases (52.5%), but occurred significantly more frequently in residents who lived within 0.46 miles of the application site. Air-modeling showed a plume of chloropicrin in the affected neighborhoods, with estimated 1-h TWA (time-weighted average) air concentrations between 0.15 and 0.025 ppm. Conclusions. Ocular, respiratory, and systemic symptoms on the evening of October 5, 2005, corresponded to a plume of chloropicrin, with estimated concentrations as high as 0.15 ppm, in the community of Salinas, California. Cases occurred between 0.36 and 2.89 miles from the application site. Use of irritant agricultural fumigants near residential neighborhoods can produce a risk of illness for distances more than 2 miles from the site of application. Air modeling is useful for evaluating the relationship between possible exposures and community symptoms.     

Worker illness related to ground application of pesticide--Kern County, California, 2005

In California, suspected pesticide and work-related illnesses and injuries are reportable conditions. The Occupational Health Branch (OHB) of the California Department of Health Services (CDHS) conducts surveillance of work-related pesticide illness with support from the National Institute for Occupational Safety and Health (NIOSH) and the U.S. Environmental Protection Agency (EPA). On May 12, 2005, CDHS received a report from the California Department of Pesticide Regulation (CDPR) of a suspected pesticide incident in Kern County involving 27 farmworkers (age range: 21-61 years; median: 32.5 years) and six emergency responders (age range: 28-51 years; median: 33.5 years). CDHS investigated this incident by conducting a site visit; reviewing medical and meteorologic records; and interviewing affected workers, pesticide applicators, and the farmworker employer. Findings indicated that workers became ill from drift of a pyrethroid pesticide (cyfluthrin) that was being applied in a neighboring field. Pyrethroid pesticide applicators should always operate in a manner that ensures workers are not exposed.     

A point-source outbreak of Coccidioidomycosis among a highway construction crew

Coccidioidomycosis is an infection caused by inhaling spores of the soil fungus Coccidioides immitis (hereafter termed Cocci). Cocci is endemic in certain areas of California. When soil containing the fungus is disturbed, as during earth-moving activities, respirable Cocci spores can become airborne and be inhaled by persons in the vicinity. This article describes a cluster of seven Cocciodioidomycosis cases among a highway construction crew that occurred in June/July 2008 in Kern County, CA, which is among the most highly endemic regions for Cocci in California. The exposures spanned no more than seven work days, and illness developed within two to three weeks of the exposures. Given the common source of exposure (soil dust generated at the work site) and the multiple cases occurring close in time, the cluster can also be termed a “point-source outbreak.” The contractor was not informed of the infection risk and did not take adequate precautions against dust exposure. Appropriate engineering/administrative controls and respiratory protection are discussed.     

Zero-sum politics,the Herbert thesis,and the Ryan White CARE Act: lessons learned from the local side of AIDS

This study examines the dynamics of grass-roots decision-making processes involved in the implementation of the Ryan White CARE Act. Providing social services to persons with HIV/AIDS, the CARE act requires participation of all relevant groups, including representatives of the HIV/AIDS and gay communities. Decision-making behavior is explored by applying a political (zero-sum) model and a bureaucratic (the Herbert Thesis) model. Using qualitative research techniques, the Kern County (California) Consortium is used as a case study. Findings shed light on the decision-making behavior of social service organizations characterized by intense advocacy and structured on the basis of volunteerism and non-hierarchical relationships. Findings affirm bureaucratic behavior predicted by the Herbert Thesis and also discern factors which seem to trigger more conflictual zero-sum behavior.     

Health effects associated with recreational coastal water use: urban versus rural California

We compared rates of reported health symptoms among surfers in urban North Orange County (NOC) and rural Santa Cruz County (SCC), California, during 2 winters (1998 and 1999) to determine whether symptoms were associated with exposure to urban runoff. NOC participants reported almost twice as many symptoms as SCC participants during the 1998 winter. In both study years, risk increased across symptom categories by an average of 10% for each 2.5 hours of weekly water exposure. Our findings suggest that discharging untreated urban runoff onto public beaches can pose health risks.     

Human rabies--California, 2002

On March 31, 2002, a man aged 28 years residing in Glenn County, California, died from rabies encephalitis caused by a rabies virus variant associated with the Mexican free-tailed bat (Tadarida brasiliensis) (Figure). This report summarizes the investigation by the Glenn County Health Department (GCHD) and the California Department of Health Services (CDHS). Persons who observe abnormal behavior in any wildlife species should contact animal control or animal rescue agencies immediately and should avoid approaching or handling these animals.     

Coccidioidomycosis: a reemerging infectious disease.

Coccidioides immitis, the primary pathogenic fungus that causes coccidioidomycosis, is most commonly found in the deserts of the southwestern United States and Central and South America. During the early 1990s, the incidence of coccidioidomycosis in California increased dramatically. Even though most infections are subclinical or self-limited, the outbreak is estimated to have cost more than $66 million in direct medical expenses and time lost from work in Kern County, California, alone. In addition to the financial loss, this pathogen causes serious and life-threatening disseminated infections, especially among the immunosuppressed, including AIDS patients. This article discusses factors that may be responsible for the increased incidence of coccidioidomycosis (e.g., climatic and demographic changes and the clinical problems of coccidioidomycosis in the immunocompromised) and new approaches to therapy and prevention.     

Studies on autogeny in Culex tarsalis: 1. Selection and genetic experiments

Autogenous and anautogenous strains were selected from a laboratory colony of Culex tarsalis established from a foothill environment in Kern County, California. An autogenous strain also was selected from immatures collected at the Kern River. Autogenous and anautogenous strains remained heterogeneous and did not consistently exhibit 100 or 0% autogeny, respectively, despite continual selection pressure and inbreeding. Autogeny rates did not increase when sublines selected from the anautogenous strains were outcrossed within single female lines; however, autogeny rates increased when crosses were made between single female lines. Crosses and backcrosses between the autogenous and anautogenous strains indicated that autogeny was controlled by a dominant, autosomal gene(s). The persistence of heterogeneity during selection and the decrease in autogeny rates among the female progeny of crosses where autogeny was inherited through the male indicated that the genetics of autogeny may be polyfactorial and/or phenotypic expression compromised by sex.     

Farm worker illness following exposure to carbofuran and other pesticides--Fresno County California, 1998

In California, suspected pesticide-related illnesses and suspected work-related illnesses and injuries are reportable conditions. On July 31, 1998, the Occupational Health Branch of the California Department of Health Services (CDHS) received a report from the California Department of Pesticide Regulation (CDPR) of a pesticide exposure incident in Fresno County involving 34 farm workers. CDHS investigated this incident by reviewing medical records of the 34 workers and interviewing 29. The findings indicated that the workers became ill after early reentry into a cotton field that had been sprayed with a cholinesterase-inhibiting carbamate pesticides     

Influence of host genetics on the severity of coccidioidomycosis.

Coccidioidomycosis, a mild flulike illness in approximately 40% of infected persons, progresses to severe pulmonary or disseminated disease in 1% to 10% of symptomatic cases. We examined host genetic influences on disease severity among class II HLA loci and the ABO blood group. Participants included African-American, Caucasian, and Hispanic persons with mild or severe disseminated coccidioidomycosis from Kern County, California. Among Hispanics, predisposition to symptomatic disease and severe disseminated disease is associated with blood types A and B, respectively. The HLA class II DRB1*1301 allele marks a pre-disposition to severe disseminated disease in each of the three groups. Reduced risk for severe disease is associated with DRB1*0301-DQB1*0201 among Caucasians and Hispanics and with DRB1*1501-DQB1*0602 among African-Americans. These data support the hypothesis that host genes, in particular HLA class II and the ABO blood group, influence susceptibility to severe coccidioidomycosis.     

Human death associated with bat rabies--California, 2003

Rabies is a rapidly progressive, incurable viral encephalitis that is, with rare exception, transmitted by the bite of an infected mammal. On September 14, 2003, a previously healthy man aged 66 years who resided in Trinity County, California, died from rabies approximately 6 weeks after being bitten by a bat. This report summarizes the investigation by the Trinity and Shasta County Health Departments and the California Department of Health Services (CDHS). Persons should avoid direct contact with bats; however, if such contact occurs, the exposed person should visit a health-care provider immediately, and the exposure should be reported to local public health officials.     

Coccidioidomycosis among Workers Constructing Solar Power Farms,California, USA, 2011–2014

Coccidioidomycosis is associated with soil-disruptive work in Coccidioides-endemic areas of the southwestern United States. Among 3,572 workers constructing 2 solar power–generating facilities in San Luis Obispo County, California, USA, we identified 44 patients with symptom onset during October 2011–April 2014 (attack rate 1.2 cases/100 workers). Of these 44 patients, 20 resided in California outside San Luis Obispo County and 10 resided in another state; 9 were hospitalized (median 3 days), 34 missed work (median 22 days), and 2 had disseminated disease. Of the 25 patients who frequently performed soil-disruptive work, 6 reported frequent use of respiratory protection. As solar farm construction in Coccidioides-endemic areas increases, additional workers will probably be exposed and infected unless awareness is emphasized and effective exposure reduction measures implemented, including limiting dust generation and providing respiratory protection. Medical providers, including those in non–Coccidioides-endemic areas, should suspect coccidioidomycosis in workers with compatible illness and report cases to their local health department.     

HIV transmission in the adult film industry--Los Angeles, California, 2004

In April 2004, the Los Angeles County Department of Health Services (LACDHS) received reports of work-related exposure to human immunodeficiency virus (HIV) in the heterosexual segment of the adult film industry in California. This report summarizes an investigation by LACDHS into four work-related HIV-transmission cases among adult film industry workers. The investigation was initiated April 20, 2004, and joined by the California Department of Industrial Relations, Division of Occupational Safety and Health (Cal/OSHA) on April 21, 2004, and by CDC on May 18, 2004. This investigation identified important and remediable gaps in the prevention of HIV and other sexually transmitted diseases (STDs) in the adult film industry.     

Studies on the seasonality of Culiseta inornata in Kern County, California

The seasonal abundance of adult Culiseta inornata was markedly bimodal in the San Joaquin Valley of Kern County, California, with minima observed during both summer and midwinter. Larvae were abundant in most surface water habitats during winter, but could not be found during summer. The occasional collection of females during summer indicated the persistence of an adult population. The midwinter decrease in adult abundance was attributed to the progressive mortality of the autumnal cohort and delayed emergence due to cold water temperature. Reproductive diapause was not induced experimentally when field or laboratory populations were exposed as larvae, pupae or adults to simulated summer or winter photoperiod and temperature regimens. In comparison, Culex tarsalis readily entered a winter diapause when concurrently exposed to simulated winter conditions. The aestivation, and perhaps hibernation, of reproductively quiescent females makes Cs. inornata theoretically attractive as a maintenance host of encephalitis viruses, while the bimodal seasonality of host-seeking activity defines periods when Jamestown Canyon virus may be transmitted horizontally.     

Compliance with childhood immunizations in Kern County, California

A rapid survey was conducted to describe the immunization status of the 0- to 2-year-old population in selected communities of Kern County, California, and identify reasons for noncompliance with immunization recommendations. Households were selected by two-stage cluster sampling. Among 860 children, 38% had received immunizations on schedule, while 44% had not received the recommended doses for their age. Compliance with the immunization schedule worsened dramatically after the first year of life. Among 2 year olds, the proportion that had the recommended number of vaccine doses was 81% for MMR, 82% for polio, 65% for DTP, and 47% for Hib. Parents' main reasons for noncompliance included child's illness, procrastination, and limited access to information and services. The low levels of compliance reflect lack of active follow-up in preventive health care across socioeconomic levels. The results show the importance of aiming immunization messages at parents and physicians of 12- to 18-month-old children. The rapid survey approach offers public health agencies an efficient means of assessing community health problems and targeting programs according to need.     

A Preliminary Survey of Vietnamese Nail Salon Workers in Alameda County, California

In recent decades, the nail salon industry has been one of the fastest growing in the U.S. California has over 300,000 workers licensed to perform nail care services. Though little is known about their health, these workers routinely handle cosmetic products containing carcinogens and endocrine disruptors that may increase a woman's breast cancer risk. Additionally, an estimated 59-80% of California nail salons are run by Vietnamese women who face socio-cultural barriers that may compromise their workplace safety and health care access. In a pilot project designed to characterize Vietnamese nail salon workers in Alameda County, California in order to inform future health interventions and reduce occupational exposures, we conducted face-to-face surveys with a convenience sample of 201 Vietnamese nail salon workers at 74 salons. Of the workers surveyed, a majority reported that they are concerned about their health from exposure to workplace chemicals. Additionally, a sizeable proportion reported having experienced some health problem after they began working in the industry, particularly acute health problems that may be associated with solvent exposure (e.g. skin and eye irritation, breathing difficulties and headaches). Our findings highlight a critical need for further investigation into the breast cancer risk of nail salon workers, underscored by the workers' routine use of carcinogenic and endocrine-disrupting chemicals, their prevalent health concerns about such chemicals, and their high level of acute health problems. Moreover, the predominance of Vietnamese immigrant women in this workforce makes it an important target group for further research and health interventions.