Special Notice / Hearing: No__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Michael P. Callagy, County Manager
Subject: Board of Supervisors’ Response to the 2018-2019 Civil Grand Jury Report, “Is San Mateo County at Risk of a Large Measles Outbreak?”
RECOMMENDATION:
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Approve the Board of Supervisors’ response to the 2018-2019 Civil Grand Jury Report, “Is San Mateo County at Risk of a Large Measles Outbreak?”
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BACKGROUND:
On July 17, 2019, the 2018-2019 San Mateo County Civil Grand Jury issued a report titled “Is San Mateo County at Risk of a Large Measles Outbreak?”. The Board of Supervisors is required to submit comments on the findings and recommendations pertaining to the matters over which it has some decision-making authority within 90 days. The Board’s response to the report is due to the Honorable Donald J. Ayoob no later than October 15, 2019.
DISCUSSION:
The Grand Jury made seven findings and four recommendations in its report. The Board responses follow each finding and the four recommendations that the Grand Jury requested that the Board respond to within 90 days.
FINDINGS
Finding 1:
Outbreaks of measles occur when an infected individual enters an under-immunized community.
Response: Agree
Finding 2:
For the 2017/18 school year, the overall measles vaccination rate for public and private school students in San Mateo County exceeded the 93 percent herd immunity level experts say is needed to protect the community as a whole.
Response: Agree
Finding 3:
Following the January 1, 2016, effective date of SB 227, use of the personal belief exemption dropped from two percent of students to zero in San Mateo County.
Response:
Agree. During the 2017/18 school year students with Personal Belief Exemptions (PBE) was zero percent.
Finding 4:
Schools that admit students with overdue vaccinations create pockets of unimmunized individuals that may facilitate the development of a measles outbreak.
Response: Agree
Finding 5:
The vaccination status of some schoolchildren-notably those who are home-schooled and those in schools with fewer than 20 students-is unknown.
Response: Agree
Finding 6:
Adults born after 1957 who never had a measles infection and who lack sufficient vaccination may also be at risk of a measles infection.
Response:
Agree. Most people born before 1957 are thought to have been infected naturally with the measles virus through measles outbreaks. People who got the standard two doses of the measles, mumps, and rubella (MMR) vaccine after 1967, should also be protected against measles. Persons who previously received a dose of measles vaccine in 1963-1967 and are unsure which type of vaccine it was or are sure it was inactivated measles vaccine may not be immune.
Finding 7:
Recent outbreaks in Washington State, New York, and Los Angeles illustrate that pockets of unvaccinated people can pose a risk of outbreaks.
Response: Agree
RECOMMENDATIONS
Recommendation 1:
School districts that enrolled students who did not meet state vaccination requirements for the 2018/2019 school year should report to their Governing Board whether overdue vaccinations have been completed by October 1, 2019, and the Governing Boards of these districts should publish updated vaccination data for its schools on the school district’s website by November 1, 2019.
Response:
This Board cannot implement this recommendation, as it pertains to school districts, which are independent public agencies and not under the governance of this Board.
Recommendation 2:
Beginning with the 2019/2020 school year, school districts that enroll students who do not meet vaccination requirements in subsequent school years should report to their Governing Board whether overdue vaccinations have been completed by March 31 of each year, and the Governing Board should publish updated vaccination data for its schools on the school district’s website.
Response:
This Board cannot implement this recommendation, as it pertains to school districts, which are independent public agencies and not under the governance of this Board.
Recommendation 3:
The San Mateo County Health Communicable Disease Control Program should study the feasibility of testing people visiting San Mateo County clinics for their level of measles immunity. The results of the study should be reported to the San Mateo County Health Department Board by January 1, 2020.
Response:
The recommendation will not be implemented. Most adults in the United States are low risk for measles. In general providers do not need to actively screen low-risk adult patients for measles in non-outbreak areas in the United States. A pilot to determine community immunity level would be time consuming, require multiple visits for residents without sufficient immunity, and increase cost to residents who receive the titer screening and MMR vaccine when applicable. Public Health Policy and Planning, Communicable Disease Control will continue to provide measles guidance using Centers for Disease Control and Prevention guidelines to primary care providers and issue measles health alerts and advisories regarding the various aspects of measles.
Recommendation 4:
Within three months of this report, the San Mateo County Health Communicable Disease Control Program should request funding for upgrading the resources needed to address outbreaks of measles and other communicable diseases from the Chief of the San Mateo County Health Department. San Mateo County Health should respond within three months of receiving those requests.
Response:
The recommendation has been implemented. The California Health Executive Association and California Counties requested that the State allocate ongoing funding for disease control infrastructure in 2018. The 2019-2020 Governors’ budget allocated $35 million in state funding to Local Health Jurisdictions over a four-year period. We anticipate receiving an annual allocation of approximately $100,000 over the next 4 years to increase infectious disease laboratory testing, enhance San Francisco International Airport surveillance and prepare for emerging infectious diseases and the ability to surge. We anticipate receiving the allocation within the next few months.
SHARED VISION 2025:
Acceptance of the report contributes to the Shared Vision 2025 outcome of a Collaborative Community by ensuring that all Grand Jury findings and recommendations are thoroughly reviewed by the appropriate County departments and that, when appropriate, process improvements are made to improve the quality and efficiency of services provided to the public and other agencies.
FISCAL IMPACT:
There is no Net County Cost associated with the acceptance of this report.