SULLIVAN DEPT OF HEALTH



CORONAVIRUS (2019 NOVEL CORONAVIRUS)

Recently, a new coronavirus called 2019 Novel (new) Coronavirus (2019-nCoV) was detected in Wuhan, Hubei Province, China that has not been previously found in humans. This coronavirus can lead to fever, cough and shortness of breath. There are thousands of confirmed cases in China, including cases outside of Wuhan. Additional cases are being identified in a growing number of countries, including the United States. 

This letter is to provide guidance in light of this new virus as well as federal guidance recently issued from the Centers for Disease Control and Prevention (CDC). 

At this time, there are no cases in New York State. The risk to residents and students is low. At this time of the year, there are many possible causes for respiratory illness. Therefore, there is no need to cancel school or social events, and there is no need for students.

As a reminder, all student health information is confidential and may only be shared in accordance with FERPA. Students should not be excluded from school or any school activities based on race, country of origin, or recent travel, including to any part of China.

What do we know?
Since this virus is very new, health authorities continue to carefully watch how this virus spreads. The Centers for Disease Control and Prevention (CDC) is working hard to learn as much as possible about this new virus, so that we can better understand how it spreads and causes illness. The CDC considers this virus to be a serious public health concern. Based on current information the CDC recommends avoiding travel to China. Updated travel information related to 2019‚ÄźnCoV can be found at
https://wwwnc.cdc.gov/travel/notices/warning/novel-coronavirus-china

How Does 2019 Novel (New) Coronavirus Spread?
Health experts believe the virus probably spreads from animals to humans and from person to person. It’s not clear yet how easily the virus spreads from person-to-person.

The 2019 Novel Coronavirus (2019-nCov) is not currently a concern for the general public and is not actively circulating among New Yorkers at this time. Therefore, there is no need to cancel school or social events, and there is no need for students or school staff to wear surgical masks at school.

Prevention
There are currently no vaccines available to protect against this virus. The New York State Department of Health (DOH) recommends the following ways to minimize the spread of all respiratory viruses, including 2019-nCoV:

• Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Stay home when you are sick.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing. If you use a tissue, throw it in the trash.
• Routinely clean and disinfect frequently touched objects and surfaces.
• CDC recommends that travelers avoid all travel to China.


Symptoms
Information to date suggests that 2019-nCoV causes mild-to-moderate illness and symptoms like the flu, including fever, cough, and difficulty breathing.


Are visitors from China being screened?
Yes, as of February 2nd new screening protocols are conducted for individuals entering the US from China at designated airports.

PreK-12 schools may have students who attend school and have traveled to various areas in Asia, including China. Students should not be excluded from school or any school activities based on race, country of origin, or recent travel (or a family member’s recent travel), including to any part of China. Schools may only exclude a student if a local health department informs the school that a student must comply with a quarantine order or the student is symptomatic of a communicable or infectious disease pursuant to Education Law §906.

Important Health Information for Those Who Have Recently Traveled to Wuhan, Hubei Province, China and Experience Symptoms
If you recently traveled to Wuhan, China and feel sick with fever, cough or trouble breathing; OR you develop symptoms within 14 days of traveling there, you should:

• Seek medical care right away. Call ahead and tell them about your travel and symptoms.
• Avoid contact with others.
• Stay home, except for seeking medical care.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
• Wash hands often with soap and warm water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Contact your local health department.

Q. Can students who traveled to China before February 2, 2020 attend school?

A. Yes, students who visited China and returned before February 2, 2020 should return to school, unless a local health department informs the school that a student must comply with a quarantine order.

If a student who has traveled in the last 14 days to areas designated by CDC as areas of risk for 2019-nCoV, AND they develop fever and respiratory symptoms (cough or difficulty breathing), the school should advise the parent or guardian to immediately call the local health department. The local health department can assist the family with determining what additional evaluation is needed and where it should take place.

Pursuant to Education Law § 906(1),

[w]henever,… a student in the public schools shows symptoms of any communicable or infectious disease reportable under the public health law that imposes a significant risk of infection of others in the school, he or she shall be excluded from the school and sent home immediately, in a safe and proper conveyance. The director of school health services shall immediately notify a local public health agency of any disease reportable under the public health law.

In addition, effective February 1, 2020, the 2019- Novel Coronavirus was added to Public Health Law as a significant threat to the public health, and NYS Commissioner of Health designated 2019-Novel Coronavirus as a communicable disease under 10 NYCRR Section 2.1.

If a local health department informs the school that a student must comply with a quarantine order, but the child shows up to school, the school should contact the local health department immediately. 

Q. Should any action be taken with respect to a student whose family member has recently traveled to China?

A. No. There are currently no recommendations for any restriction of an individual who has not recently traveled to China, including family members. If schools have questions about symptomology or 2019-nCoV, the local department of health should be contacted. 

This is an emerging, rapidly changing situation. For questions please contact your local department of health or the NYS DOH Novel Coronavirus hotline at 1-888-364-3065.

Additional Resources

We encourage you to keep up to date about 2019-nCoV, its treatment and prevention by visiting the following websites:

CDC’s dedicated 2019-nCoV website at https://www.cdc.gov/nCoV.

NYSDOH’s dedicated 2019-nCoV website at: https://www.health.ny.gov/diseases/communicable/coronavirus/

In addition, NYS has established a Novel Coronavirus Hotline, which can provide additional information. Call 1-888-364-3065 with Questions or Concerns About Travel and Symptoms.

Contact information for your local Department of Health may be found at: https://health.ny.gov/contact/contact_information/

Thank you for your continued partnership in this ever-changing situation. 

Sincerely,


Howard A. Zucker, M.D.,                                     J.D. Shannon L. Tahoe 
Commissioner of Health                                      State Education Commissioner



Statement on Legislation Removing Non-Medical Exemption from School Vaccination Requirements

On June 13, 2019, Governor Andrew M. Cuomo signed legislation removing non-medical exemptions from school vaccination requirements for children. The United States is currently experiencing the worst outbreak of measles in more than 25 years, with outbreaks in pockets of New York primarily driving the crisis. As a result of non-medical vaccination exemptions, many communities across New York have unacceptably low rates of vaccination, and those un-vaccinated children can often attend school where they may spread the disease to other un-vaccinated students, some of whom cannot receive vaccines due to medical conditions. This new law will help protect the public amid this ongoing outbreak.

What did the new law do?
As of June 13, 2019, there is no longer a religious exemption to the requirement that children be vaccinated against measles and other diseases to attend either:
• public, private or parochial school (for students in pre-kindergarten through 12th grade), or
• child day care settings.

For those children who had a religious exemption to vaccination, what are the deadlines for being vaccinated?
Children who are attending child day care or public, private or parochial school, and who had a religious exemption to required immunizations, must now receive the first age appropriate dose in each immunization series by June 28, 2019 to attend or remain in school or child day care. Also, by July 14, 2019 parents and guardians of such children must show that they have made appointments for all required follow-up doses. The deadlines for follow-up doses depend on the vaccine. The New York State Department of Health follows the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices catch-up immunization schedule and expects children to receive required doses consistent with Table 2 at the following link in order to continue to attend school or child day care:
https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

What is the deadline for first dose vaccinations if my child is not attending school until September? 
Parents and guardians of all children who do not have their required immunizations are encouraged to have them receive the first dose as soon as possible. The deadline for obtaining first dose vaccinations for children attending school in the fall is 14 days from the first day of school. Within 30 days of the first day of school, parents and guardians of such children must show that they have made appointments for all required follow-up doses.

Additional information will be forthcoming.






A note about the measles from Sullivan Health Dept.

As you know, areas of New York State are currently experiencing a measles outbreak, including the lower Hudson Valley and parts of New York City. Measles spreads easily and can be dangerous to anyone who is not vaccinated. If you have questions about measles or the measles vaccine, do not hesitate to call the New York State Measles Hotline at 888-364-4837.

Sullivan County has had two confirmed cases of measles but the individuals are no longer contagious.

WHAT PEOPLE CAN DO
Locally, anyone who is concerned about their risk if exposed to measles should locate their immunization records. Those born before 1957 are presumed to be immune. Prior to 1989, it was common to only receive one MMR (Measles, Mumps, Rubella vaccine shot). Two are recommended for full (up to 97%) immunity and protection. Most people should have had two MMRs, but there will be residents who are either immune compromised and cannot receive it, or are too young to be fully vaccinated (infants and young children, pregnant women without MMR history).

The best course of action is for the parents and adults to look into their medical histories and then speak to their health care provider. If they are unsure of their immunity, they can have what’s known as a titer test to see if they are immune and then, if low, get a booster MMR.

The Sullivan County Public Health Department strongly recommends that:

  • All school nurses and parents ensure that children and are up-to-date with their immunizations per the Advisory Committee on  Immunization Practice (ACIP) guidelines
  • Be alert to signs and symptoms of measles and other vaccine preventable disease (VPD)
  • Schools should maintain current and accurate immunization records for all students. Additionally, schools should maintain a detailed list of students who are not fully protected against VPD.

RECOGNIZING MEASLES SYMPTOMS

What is Measles?
Measles is a highly contagious respiratory disease (in the lungs and breathing tubes) caused by a virus that is spread by direct contact with nasal or throat secretions of infected people (when a person infected with the measles virus breathes, coughs, or sneezes). Measles is one of the most contagious viruses on earth; one measles infected person can give the virus to 18 others. In fact, 90% of unvaccinated people exposed to the virus become infected. You can catch measles just by being in a room where a person with measles has been, up to 2 hours after that person is gone. And you can catch measles from an infected person even before they have a measles rash.

Common symptoms
Symptoms usually appear 10-12 days after exposure but may appear as early as 7 days and as late as 21 days after exposure. Measles typically begins with

high fever,
cough,
runny nose (coryza), and
red, watery eyes (conjunctivitis)

Then:
Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth.
Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person's fever may go up to more than 104° Fahrenheit.

After a few days, the fever subsides and the rash fades.

People are considered infectious from four days before to four days after the appearance of the rash.
Immunity takes approximately 2 weeks after vaccination for full protection if someone has low immunity or has only had one MMR and receives a second MMR. Please visit our website or refer the public there, http://sullivanny.us/Departments/Publichealth/Measles .

WHAT WE’RE DOING
We have sent a letter to all summer camp operators through the NYS Department of Health office in Monticello and all Sullivan County youth summer recreational youth camps. We are placing posters and flyers in the lobbies of County buildings and local businesses. We are conducting outreach to various community groups and would be happy to schedule something as resources allow.

I have met with and am in communication with BOCES Superintendent Robert Dufour. Should it become necessary to conduct immunization clinics or push out communications for the public to be aware of, our offices have a plan in place to ensure immediate notification of all districts or a specific school as appropriate.

PLEASE SHARE THESE RESOURCES
Please share a link to our webpage with measles information on your websites and newsletters as appropriate. It is currently live:  http://sullivanny.us/Departments/Publichealth/Measles. Residents can call the Sullivan County Public Health Information Line at 845-513-2268 or the New York State Department of Health Measles Information Line at (888) 364-4837.

The Measles Vaccine
A safe and effective measles vaccine that can prevent suffering and death has been available for more than 50 years. For more information click here or visithttps://www.cdc.gov/vaccines/parents/diseases/child/measles.html .

High community vaccination rates help protect people who cannot get vaccinated because they are too young or have specific health conditions.  

WHERE TO OBTAIN VACCINATION
MMR vaccines are available at your local health care provider or by calling a local federally qualified health center, such as Refuah Health Center in South Fallsburg (845) 482-9394; and Hudson River Health Care in Monticello (845) 794-2010. The federally qualified health centers see uninsured or underinsured patients on a sliding fee scale and by appointment. They may require patients new to their centers to have a well visit first, before a vaccine can be given. In addition, the Greater Hudson Valley Health Care System operates four primary care centers as well in Callicoon, Livingston Manor, Monticello and Bethel.

Our monthly immunization clinic for uninsured or children receiving Medicaid is available at Sullivan County Public Health Services. The next immunization clinic is May 8 from 5-7 pm or parents may call us at (845) 292-5910.

We want to reassure school officials and parents that the greatest number of persons who are fully immunized will provide the broadest protection for residents and minimize any outbreak if measles exposures do occur in Sullivan County.

Sincerely,
Nancy McGraw, LCSW, MBA, MPH
Public Health Director
Sullivan County, NY

Resources

Please click below:
Top 4 Things Parents Need to Know About Measles
Additional Frequently Asked Questions About Measles


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