Returning to school this fall should look a lot different than last year.

Schools are due to be open and thanks to the variety of COVID-19 vaccines available, including Pfizer’s that has been approved for ages 12 and up, that’s going to be safer than in-person classes were last year.

But parents also should remember that their children need to get other vaccines in order to be healthy, keep their fellow students safe and comply with West Virginia law.

Children still need to be protected against vaccine-preventable diseases such as measles, chickenpox, pertussis and diphtheria. 

August is National Immunization Awareness Month. As has become strikingly clear during the past 17 months, vaccines are a vital tool in the public health toolbox. 

Diseases such as polio and smallpox have been eliminated in the United States, and a resurgence of measles outbreaks a couple of years ago illustrated what can happen when individuals let down their guard when it comes to inoculations.

And, of course, the COVID-19 pandemic is a great example of how cases and deaths lowered dramatically once vaccines ramped up — and also how once a new and dangerous variant popped up, those who remain unvaccinated became the ones suffering the most.

The Centers for Disease Control and Prevention has information on vaccines needed at every stage of life, including children, teens, adults, pregnant women and travelers. 

Because it’s time for students to get their back-to-school vaccines, we’re focusing on kids who are around ages 5 through early adulthood. 

Here are just a couple of examples why vaccines are important. 

It seems like a long time ago, but let’s not forget that in October 2019, there was concern about a case of hepatitis A in a food worker at an area restaurant. Monongalia County Health Department worked to vaccinate individuals who had eaten there during a certain window of time.

And again, there’s the measles. Previously considered eliminated in the United States since 2000, a 2019 outbreak resulted in 1,282 cases in the United States in 2019. The CDC reported 13 cases in 2020 and two so far in 2021. Because of West Virginia’s strict vaccination laws, none of these cases took place in West Virginia. 

The CDC offers an easy-to-read guide on vaccinations that babies should receive from infanthood to the age of 6. These are the mandated vaccines that the state of West Virginia requires students to get in order to attend public school. 
 
For children who have been vaccinated according to the current schedule, here is a list provided by the CDC of recommended vaccines for students between the ages of 7 and 18:

• All preteens and teens need a flu vaccine every year. Some children 6 months through 8 years of age require two doses of flu vaccine. Children 6 months through 8 years getting vaccinated for the first time, and those who have only previously gotten one dose of vaccine, should get two doses of vaccine this season. The first dose should be taken as soon as the flu vaccine is available, and the second dose should be received at least 28 days after the first dose. In following years, only one dose is needed. Flu vaccines are always important, but vitally so now.

In addition to an annual flu vaccine, three vaccines are recommended specifically for preteens: 

• HPV vaccine protects against HPV infections that can cause cancer later in life, including that of the cervix, for which women can be routinely screened, as well as mouth/throat, anus/rectum, penis, vagina or vulva, for which people are not routinely screened. 

• Tdap is a booster shot to help protect preteens from whooping cough, tetanus and diphtheria. Tdap not only protects the child from these diseases, but also keeps them from giving whooping cough to a young baby who does not have immunity yet.

• Meningococcal conjugate vaccine protects against meningitis and bloodstream infections (bacteremia or septicemia). These illnesses can be very serious, even fatal.
MCHD Clinical Services has made some changes in order to be as safe as possible during the pandemic. Forms are sent online the day prior to the appointment, and when you arrive, you can call from your phone to alert us that you’re here. You will be registered and payment will be taken over the phone. Then your temperature will be taken at the entrance. Patients should go to the upper level to the front door. 

If you haven’t gotten your child vaccinated yet, there is still time. Call your health care provider. Or make an appointment at Monongalia County Health Department’s Clinical Services at 304-598-5119. 

Dr. Mark E. Rogers has recently seen two, three or even four cases of Lyme disease daily at WVU Urgent Care at Suncrest Towne Centre, one indication that the tick-borne illness is on the rise in Monongalia County.

“This year, it’s really taken off,” Dr. Rogers said. “We’re seeing multiple cases every day.”

In fact, the entire county is diagnosing an average of one COVID-19 case a day, and he personally hasn’t seen one since about mid-June. So when a patient comes in complaining of a low grade fever, malaise, fatigue and joint pain, his first thought is often Lyme disease — an illness caused by the bite of a blacklegged “deer” tick — rather than COVID-19.

“Some of the people, we still test for COVID, but I’m telling my patients that the big thing to watch out for is Lyme disease right now,” Dr. Rogers said.

Cindy Graham, RN, a Monongalia County Health Department nurse who helps with Lyme disease investigation, said she started seeing bloodwork-confirmed reports of the illness in mid-June. “It really went crazy,” she said. 

Lyme is a reportable disease, so medical practitioners who diagnose it via bloodwork or with a bull’s-eye rash at the site of the tick bite must send the report to the health department. The bull’s-eye rash, also known as erythema migrans (EMs), is a symptom that sets a Lyme disease diagnosis apart from COVID-19 and other illnesses. 

The bull’s-eye rash is left by the tick feasting on the host’s blood, during which disease transmission can occur. The Centers for Disease Control and Prevention estimates that the tick must feed on the host’s blood for between 36 to 48 hours before the tick transmits the disease.

Graham follows up with the reporting practitioner on all cases as well as patients who have  positive bloodwork and/or the rash.

“If the patient has that bull’s-eye rash, I call the patient and ask where they’ve been, does anybody else have it, if they found a tick,” Graham said. “It seems like there have been more people with EMs this time than last year.”

But if a practitioner diagnoses Lyme based solely on symptoms minus the bull’s-eye rash, then that case would not be reported to the health department, which means that confirmed cases figures are actually probably low.

This rise in Lyme disease has received news coverage from WBOY in Clarksburg and WCHS in Charleston. 

The Mountain State is one of 15 states, plus the District of Columbia, listed by the CDC as having a high incidence of Lyme disease. Nearby Pennsylvania topped the 2019 data, with 6,763 confirmed cases and 2,235 probable cases. West Virginia’s numbers were lower, at 703 confirmed and 182 probable, although this data is two years old.

The West Virginia Department of Health and Human Resources’ (DHHR) Zoonotic Disease Group provided updated numbers this week. However, last year’s statewide number of 1,062 Lyme cases compared to 205 so far in 2021 is misleading, according to Michael L. Abshire, a Zoonotic Disease Group research specialist.  

“The 2021 numbers look small, but they also do not show all the cases that have been reported so far, only the ones that have been investigated and are confirmed,” Abshire said.

By comparison, at this same time in 2020, the state had 243 Lyme cases, Abshire said. Dr. Diane K. Gross, MCHD’s regional epidemiologist, added that the number of Lyme cases tends to increase exponentially in late summer, and also that the COVID pandemic has probably led to late reporting of cases, which would be another reason why current confirmed numbers seem low.

Dr. Gross also noted that while the DHHR’s official Lyme number for Monongalia County is 17, she has 26 potential cases that still need to be evaluated. 

The 2020 number of 1,062 also shows an increase in statewide cases since 2017, when 648 cases were reported. The number rose to 671 in 2018 and 898 in 2019.

Both Dr. Rogers and Graham said they have seen Lyme diseases in patients of all ages. Individuals can get it while out hiking or camping, but Graham said she has heard a lot of accounts in which individuals reported getting it just working or playing in their yards.

“Generally, it’s around their home,” Graham added. “They haven’t traveled anywhere.”

Ticks can be found anywhere on the body, but common places include skin folds such as behind the knees, under armpits, around the beltline, in the groin and behind the ears, as well as on the scalp, Dr. Rogers said. 

And even though a mature deer tick has a distinguished look, with black legs and a red and black body, they might not always be so obvious.

“They can be very tiny nymphs, smaller than a poppy seed,” Dr. Rogers said. “People come in and don’t recall having a tick bite. But they have the symptoms or the rash.”

Graham said that many people never actually see the tick. Those who want to remove it, rather than wait for a health care practitioner’s help, should do so with tweezers, making sure to get a firm grip on it in order to get the head out.

“I use the same procedure that the CDC recommends,” Dr. Rogers said. “Get as close down to the skin where the mouth meets the skin and firmly grasp them and pull them up with traction. The skin is going to tent and it will pop off.”

If the head remains embedded, Dr. Rogers uses a tiny needle to flick it out like a splinter. “There are some people who think that you shouldn’t mess with it by monkeying around with it, that you are more likely to get infected,” he said. “If I can get it out, I do.”

But even though many individuals never see a tick, it’s always a good idea to look for them. The CDC (cdc.gov/ticks) provides a lot of information on tick prevention. This includes checking yourself and your pets daily when you return from outdoors.

Prevention actually starts before you step out the door. Clothes and gear can be treated with products that contain 0.5% permethrin and individuals also can use Environmental Protection Agency-registered insect repellents that contain diethyltoluamide, or DEET.

Anyone planning on spending time outdoors should also consider wearing long sleeves and/or long pants. 

In some situations, such as when multiple members of a family have been diagnosed with Lyme disease contracted while spending time in their yard, Dr. Rogers also suggests considering treating the yard with pesticides. 

Chad Carpenter, assistant director of Pesticide Programs at the West Virginia Department of Agriculture, said individuals should read and understand the pesticide label and follow all “use precautions and restrictions” before applying it.

“If there is a section for personal protective equipment, make sure this is followed,” he added.

Lyme disease is treated with the antibiotic doxycycline. Dr. Rogers prescribes a one-time dose as a prophylaxis if the patient is not experiencing any symptoms. Someone who does have symptoms would get a longer course of the medication, he said, maybe 10 to 21 days.

The bacteria that cause Lyme disease will clear up if treated properly, Dr. Rogers added. Problems can occur if Lyme disease gets into a joint or nerve, where permanent damage can result.

“One misconception is that there is this chronic Lyme disease, where people might be on antibiotics for months or years,” he said. “That’s not something we have evidence for.”

Lyme disease is found primarily in the mid-Atlantic and Northeast regions of the United States. CDC surveillance maps (cdc.gov/lyme/datasurveillance/maps-recent.html) show that more of the state’s instances of the illness have been found in northern West Virginia. 

Neither Dr. Rogers nor Ed Abbott, RN, who also investigates Lyme disease for MCHD, know for certain why Lyme disease is on the rise, although both believe weather could be a factor.

“That’s what I would like to know,” Dr. Rogers said. “I know it seems like we’ve had milder winters, but that’s hypothetical. But my guess is that we have more surviving through milder winters.”

Also, Abbott added, the COVID pandemic has prompted individuals to spend more time outdoors.

MCHD’s Threat Preparedness program conducts tick surveillance, and Abbott said that recently, more ticks have been found in shady areas. “So it could be that, because of the heat, ticks are seeking shady areas,” Abbott said, noting that humans also have the tendency to gravitate toward cooler places when they are outdoors. 

Tick surveillance was suspended last summer because of the COVID-19 pandemic, said Jamie Moore, MCHD’s Threat Preparedness program director. 

“However, we’ve resumed dragging for ticks this summer, although efforts have sometimes been hampered by rain,” he said.

Tick surveillance is conducted to learn what ticks are in the area and to send off specimens to the state lab to be tested for disease.

So far, surveillance has been done in Monongalia, Preston and Marion counties, with plans to also move into Harrison, Doddridge and Taylor counties. These are the members of the six-county Preparedness Action Coalition Team (PACT), one of the DHHR’s West Virginia Surveillance Regions.

“We plan to send Threat Preparedness staff to the Vector Biology Boot Camp in upstate New York later this year,” Moore said. “This is an event we’ve attended in the past so we can keep our knowledge of dealing with pests such as ticks and mosquitoes updated.”

It’s been nearly a year and a half since Monongalia County Health Department’s six Women, Infants, & Children’s offices have opened their doors to participants.

Luckily, like many others dealing with the pandemic, technology has come in handy so that the federal food assistance program, officially titled the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), could continue to operate. 

Food supplements funds are loaded onto an Electronic Benefit Transfer (EBT) card, and WIC already had introduced an app called Pacify that provides 24/7 breastfeeding support for mothers. And signups and counseling took place over the phone.

But breastfeeding classes, which were open to anyone, not just participants who qualify for WIC, have been shut down in all six counties in which MCHD WIC operates: Monongalia, Preston, Marion, Harrison, Doddridge and Taylor.

“And we’ve missed seeing our participants face-to-face,” said Cami Haught, MCHD WIC’s program director.

Slowly, however, that’s all going to change. Starting Aug. 1, the offices in Morgantown, Kingwood, Fairmont, Bridgeport, West Union and Grafton will re-open.

For one month, Haught said, only new participants will be visiting the offices to sign up. “And then, on Sept. 1, we will be opening 100%.”

WIC offers nutritional counseling and benefits, breastfeeding counseling and support and health screenings, immunizations and referrals, to those who qualify. 

Those who qualify for WIC are individuals who meet income guidelines and also are: 

• Pregnant women
• Women breastfeeding an infant up to the infant’s first birthday
• Postpartum women up to six months after delivery or end of pregnancy
• Infants up to their first birthday
• Children from age one until their fifth birthday

Income guidelines are updated yearly and are generous. Gross annual income for a family of one is $23,828 or under; for two, $32,227; for three, $40,626 and for four, $49,025. You can see the full list on our website.

For those who might be interested in joining when offices reopen, here’s how the initial visit will go. 

“New participants come in and bring in their pay stubs,” Haught said. “If they are on Medicaid, they will automatically qualify.”

After participants qualify, all participants — mothers and children — move on to the lab, where a technician gets a weight, height and performs a finger stick to get iron levels.  

“Then they go to see a nutritionist, and they’re going to ask them some questions about their diet and fruits and vegetables consumption, and dairy consumption and sweetened drinks, if they smoke or consume alcohol before or during the pregnancy,” Haught said.

The nutritionist will then go over the nutrition package with the participant. Foods that can be purchased with WIC benefits have been expanded in recent years and include not only fresh fruits and vegetables, beans, peanut butter and dairy and bread items, but also frozen fruits and vegetables, yogurt, and a wider selection of whole wheat grain options and breakfast cereals.

And about two years ago, Once Upon a Farm items, created by actress and West Virginia native Jennifer Garner, also made it to the WIC list. 

Finally, if the participant is or will be breastfeeding, she would meet with a breastfeeding counselor. “If they are pregnant, they talk about breastfeeding and what to expect, and if she has delivered, they can help with latching and positioning, and they can check if baby is receiving enough breast milk,” Haught said.

After that initial assessment, the participant will have an appointment every three months. Every other appointment is an online assessment, so participants generally only need to visit their local WIC office twice a year.

MCHD WIC also celebrates Breastfeeding Awareness Month, which is August. Prior to the pandemic, this was done with an annual walk and event at the WVU Erickson Alumni Center. After skipping these events in 2020 and 2021 because of the pandemic, it will be returning in 2022.

And even though WIC doesn’t reopen until Aug. 1, there will be weekly drive-through events at each office every Thursday in July. 

Last week’s event was held in Marion County. The other events will be held from 4-6 p.m. July 8, Cornerstone Community Church in Preston County; 4-6 p.m. July 15, Blueville Church of the Nazarene in Taylor County; 3-6 p.m. July 22, Clarksburg City Park for Harrison/Doddridge counties and 3-6 p.m. July 29 at the MCHD WIC office in Morgantown. 
Participants will receive a goody bag with items such as a WIC cup and a book, such as “The Very Hungry Caterpillar” or “Monsters Don’t Eat Broccoli.”

​“We just want to get people excited about being able to come to the clinic again and to let more people know that we are here,” Haught said. “We want to encourage everyone to come out and get signed up on the program if they do qualify.”

As a former restaurant grill cook and the sanitarian at Monongalia County Health Department who teaches food safety courses, Walther is well-versed on how to make sure to prepare foods and grill them properly.

“Obviously, now, being a sanitarian and knowing the food code led me to understand ways to prevent cross-contamination and to cook the food properly,” he said. 

He also advises to keep surfaces clean and avoiding cross-contamination there, including when he goes back inside the house to grab more food. 

“You want to be conscious of not touching surfaces that could become contaminated with bacteria from raw meat,” he added.

Keeping your hands clean is a habit that has been elevated in the face of the COVID-19 pandemic, and when you are grilling is no different.

“Hand-washing is very important, especially after handling raw meat,” Walther said. 

As with just about every public health topic, the Centers for Disease Control and Prevention is a great resource for checking out just about any food safety information you might want to know. Also, for some basic facts, you can check out MCHD Environmental Health’s food web page.

Here are some tips on handling raw meat, chicken and seafood from the CDC:

• When shopping, pick up meat, poultry and seafood last, right before checkout. Separate them from other food in your shopping cart and grocery bags. To guard against cross-contamination, put packages of raw meat and poultry into individual plastic bags.

• Keep meat, poultry and seafood refrigerated until ready to grill. When transporting, keep 40°F or below in an insulated cooler.

• Wash your hands with soap before and after handling raw meat, poultry and seafood. Wash work surfaces, utensils and the grill before and after cooking.

• Use a moist cloth or paper towel to clean the grill surface before cooking. If you use a wire bristle brush, thoroughly inspect the grill’s surface before cooking. Wire bristles from grill cleaning brushes may dislodge and stick into food on the grill.

• Throw out marinades and sauces that have touched raw meat juices, which can spread germs to cooked foods. Use clean utensils and a clean plate to remove cooked meat from the grill.

• Use a food thermometer to ensure meat is cooked hot enough to kill harmful germs.

When smoking, keep temperatures inside the smoker at 225°F to 300°F to keep meat a safe temperature while it cooks.

According to the CDC, those correct temperatures for different types of protein are:

• 145°F — Whole cuts of beef, pork, lamb, and veal (stand-time of three minutes at this temperature)

• 145°F — Fish

• 160°F — Hamburgers and other ground beef

• 165°F — All poultry and pre-cooked meats, like hot dogs

• And then keep food at 140°F or warmer — until it’s served

Grills that have an extra rack on top are a great way to grill vegetables safely without coming into contact with meat, Walther noted. “It’s like low heat and not directly on the flame,” he said. “If you’re doing something like squash and zucchini, wrapping it in aluminum foil with olive oil, salt and pepper on a low heat rack, it keeps it away from the meat.”

And when you’re done cooking, it’s also important to put the leftovers in shallow containers and place in the refrigerator or freezer within two hours, or one hour if it’s above 90°F outside, which it has been lately.

Grilling out is a great summer pastime and also can be a healthy way to cook your food, as long as you follow safety tips. So have fun with your family and friends and fire up the grill.

More than 40 years after the first documented case of HIV and AIDS in the U.S., the country is still mourning the 700,000 deaths from AIDS that have occurred since this epidemic began. 

June 27 is National HIV Testing Day (NHTD). As a disease that disproportionately affects drug users, gay and bisexual men, African Americans and Latinos, the epidemic has been long stigmatized. Discrimination, fear and judgment have led to widespread misinformation about HIV. 

Here are the facts: 1.2 million people in the U.S. are living with HIV, and roughly 13% of them don’t even know it.

HIV stands for human immunodeficiency virus and is spread through sex, unclean needles or can be passed on through birth. AIDS is the most severe form of HIV. Even if you don’t belong to any high-risk groups, HIV is a lot closer to home than you might think.

Charleston, West Virginia has long been a hub for opioid use, namely heroin and fentanyl, which are both injection drugs. Besides overdose deaths, there is another reason why injection drugs are so dangerous. Sharing needles often leads to the spread of viruses like hepatitis B and C and, of course, HIV. 

The Centers for Disease Control and Prevention (cdc.gov) has announced that there is an HIV outbreak in Charleston that is the most concerning in the country. Dr. Robin Pollini, associate professor of behavioral medicine and psychiatry and epidemiology at West Virginia University, talked to Here & Now’s Peter O’Dowd about the outbreak in Charleston. Pollini demonstrates just how alarming the scale of the outbreak is when she compares the number of new cases in Charleston to those in New York City last year. The difference? In a city 150 times larger than Charleston, the number of new HIV cases last year was the same in both cities.

This is a stark comparison. While the COVID-19 pandemic was ravaging the country, another epidemic emerged in our state, attacking some of our most vulnerable citizens. 

West Virginia’s Syringe Services Programs (SSPs) are a good way for those who inject drugs to receive clean needles in exchange for used ones. Dr. Pollini advocated for the SSPs that exist in Charleston, Huntington and Morgantown.

Milan Puskar Health Right’s harm reduction program has been operating in Morgantown for six years, said executive director Laura Jones. She describes it as a non-judgmental program, offering services to people who might otherwise have trouble accessing care. The clinic offers plenty of services, like HIV and hep C screenings, case management services and a syringe exchange.

The first time I heard of the idea to supply needles for people to inject drugs, it seemed counterintuitive. Wouldn’t it just make it easier and safer to consume drugs? 

Well, that’s kind of the idea.

“People will inject drugs regardless of whether or not they have a clean syringe,” Jones said. “There is no evidence that this enables drug-related behavior. People don’t wake up one day and decide to go run down to the local syringe exchange, get some syringes and start using heroin.”

Reusing or sharing needles leads to deadly diseases, like hepatitis B and C and HIV. When our goal is to make sure people recover from addiction, the first step is to keep them alive. And with such a concerning HIV outbreak in the state, having clean needles is more important than ever.

The initial shock I had when hearing about a needle exchange is a result of stigma. Stigma around drug use runs deep and it’s seeped into our politics. As of April of this year, Gov. Jim Justice has signed into law a bill that makes SSPs harder to access for those in need of needles. 

According to Laura Jones, the new bill is a result of the stigma that surrounds drug use. “A lot of rhetoric that we heard at the Legislature for this bill was related to a very negative image that people have of people who use drugs,” she said. “You know, one of the very first people who came to our program was a grandmother who showed us pictures of her grandchildren. She had a job.” There’s a very negative perception of drug users, Jones said, and it’s often not true.

Part of this bill will introduce a “one-to-one” needle exchange, meaning a person must bring in a used needle to the clinic in order to receive one clean needle. Ideally, a system this simple would work perfectly. But as Jones said, it’s not that simple. 

“From an outsider’s point of view, that might make perfect sense,” she said. “From the understanding of addiction, that’s not an adequate way of doing business. The CDC and the World Health Organization both recommend need-based programs.”

Jones said lack of transportation in West Virginia poses serious problems for the syringe exchange. “A lot of people have trouble getting here,” she said. “So what we’ve done in the past is we’ve given people syringes and supplies to one person who then gives them to someone else back in their home community. That practice has to stop with this new bill; we can only give syringes to people who can actually come to the clinic.”

Besides the new one-to-one policy, the new bill also requires those coming to the clinic to have a West Virginia ID. Jones said that due to all the borders we share in West Virginia, the harm reduction program has frequently seen people from Pennsylvania, Maryland and Ohio. And because of the close proximity of West Virginia University, the clinic has seen many out-of-state students as well. “People don’t always stay within the borders of their state.”
And, of course, diseases don’t always stay within the borders of their state.

Jones suspects the new law is a result of people concerned about finding used needles in the community, worried about the danger it might pose to accidentally come in contact with a used needle. The harm reduction program has a solution for that, too. By calling or texting the number for the harm reduction program, someone will come collect the needle and safely dispose of it. 

Jones weighed in on why Charleston and Huntington’s have concerning HIV outbreaks while Morgantown does not. She credits the success of the harm reduction program. “Increasing syringe access is actually a benefit to a community and speaks to why Morgantown does not have the kind of problems they are seeing with HIV increases in Charleston,” she said.

Needle services are part of what’s called “harm reduction,” and this illustrates why they can be helpful. While the syringe exchange gets people in the door, the clinic offers plenty of services, like HIV and hep C screenings, case management services and other social service programs. That can include, eventually, treatment for substances misuse.

There are ways you can prevent HIV transmission, like using condoms during sex and/or getting a PrEP (pre-exposure prophylaxis) prescription. It is also incredibly important to use clean, sterile needles if you are injecting drugs. 

The only way to know if you have HIV, the only way to get treatment, is to first get tested. The theme for this year’s NHTD is “My Test, My Way.” Getting tested for HIV is the first and most important step we can all take to stop HIV deaths. HIV testing is now easier than ever, so let’s explore some options.

You can get tested for HIV and other STDs for free at Monongalia County Health Department and receive free treatment should your test come back positive. Call 304-598-5119 to make an appointment.

The CDC recommends everyone ages 13-64 get tested for HIV at least once in their lifetime. If you have multiple partners and/or inject drugs, you are at higher risk and should get tested more often. You can discuss this with a health care provider.

This National HIV Testing Day, take that important first step so we can end this epidemic together.