County Health Officer Clinician Newsletter - April 2025
April 16, 2025
Health Officer Monthly Newsletter for Orange County Clinicians April 2025
Regina Chinsio-Kwong, DO County Health Officer
Protecting the Public’s Health - A Shared Responsibility
Last week marked the 30th anniversary of National Public Health Week, a time to recognize the essential role public health plays in all of our lives. While much of the impact happens quietly behind the scenes, public health is foundational to longer life expectancy, reduced disease burden, and stronger, more resilient communities.
In Orange County, generations of public health leaders, dedicated staff, clinicians, researchers, scientists, epidemiologist, inspectors, and community members have worked together to prevent disease, improve access to care for all, and respond to health threats both old and new. Their collective efforts helped control deadly infectious diseases, respond to emerging threats, and build a healthier foundation for future generations. Learn more about our rich public history by visiting OC historical blog spot here
Learn more about how public health connects all at: https://www.youtube.com/watch?v=IEwhK92yv60
Today, we face complex challenges which include climate related incidents like flooding, wildfires, and extreme heat, as well as the emergence of new health threats with infections, a rise in chronic conditions, mental health related needs, injury related incidents (accidents), and the resurgence of vaccine-preventable illnesses. These risks come at a time when local, state and federal funding of public health may decline, threatening our ability to respond swiftly and effectively. To meet these challenges, our county must collectively find ways to continue to invest in research, surveillance, diagnostics, and medical countermeasures, and at the same time emergency preparedness planning, public education and communication.
As we honor the legacy of Orange County’s public health pioneers, let us also recognize the critical importance of supporting those working today to keep our communities informed, protected and thriving.
Save the Date! As the Orange County Health Officer, I am providing a “State of Health Webinar” to provide highlights of key trends in public health on Wednesday, May 28 from 11:30 a.m. to 1 p.m. Registration information will be in the May Health Officer Newsletter.
1. Health Alerts
(Centers for Disease Control (CDC), California Department of Public Health (CDPH), OC Health Care Agency (HCA), Food and Drug Administration (FDA))
Algal Bloom and Elevated Domoic Acid
Image from Stuart, Jacqui & Smith, Kirsty & Rhodes, Lesley & Murray, J. Sam & Passfield, Emillie & Robinson, Natalie & Ryan, Ken & Nishimura, Tomohiro. (2024).accessed at https://www.researchgate.net/publication/386873564_Not_so_toxic_Antarctic_Pseudonitzschia_isolates_give_domoic_acid_the_cold_shoulder
The toxic algal bloom affecting the Southern California coast led to the CDPH to issue a shellfish advisory April 14 urging the public to not consume sport-harvested bivalve shellfish from Ventura, Orange and San Diego Counties As noted on the attached image, pseudonitzschia is a marine diatom that forms Harmful Algal Blooms (HABs) which can produce domoic acid, a toxin that can accumulate in bivalve shellfish (mussels, clams, scallops and oysters). When dangerous levels of domoic acid (DA) accumulate in bivalve shellfish and are consumed by humans, the toxin (which is not destroyed by cooking) can cause Amnestic Shellfish Poisoning (ASP) 30 minutes to 24 hours after eating toxic seafood. Symptoms in mild cases can include vomiting, diarrhea, abdominal cramps, headache and dizziness.
In severe cases, victims can experience a wide range of symptoms – including trouble breathing, disorientation, cardiovascular instability, seizures. In severe cases, the toxin can lead to coma or death. No confirmed human cases of DA poisoning have been reported in California. Learn more about diseases and conditions caused by eating seafood contaminated with algal toxins here.
Additionally, the domoic acid can affect marine animals (whales, seals, sea lions, and dolphins), as well as birds and other finned fish. This year’s Algal Bloom has affected local marine wildlife - including sea lions who have exhibited more aggressive behavior from exposure to high levels of domoic acid.
The public is advised that if they encounter a sick or aggressive sea animal - including sea lions - the following measures should be taken:
1) Stay safe and maintain distance
Do not approach, do not touch or feed, and do not try to help the animal yourself
2) Report the sighting
Marine Mammal Care Center - Los Angeles at (800) 39-WHALE or Pacific Marine Mammal Center - (949) 494-3050 located in Laguna Beach, serves the southern California coastline.
Be ready to provide details - describe your location, the animal’s behavior, and appearance.
3) Take a Photo (optional)
4) Other important information
Sea lions are protected by law - interacting with them can result in fines/jail time. Avoid disturbing marine wildlife.
Report Animal Bites (includes sea lions/seals)
Animal bites or exposures are IMMEDIATELY reportable to the OC Animal Care Services (or HCA Communicable Disease Control Division (CDCD). Individuals who are injured or bitten by aggressive animals or marine mammals are advised to contact the HCA or OC Animal Care for further guidance.
2. Readiness/Preparedness
Did you receive an alert ahead of the April 14, 2025 earthquake? On April 14, southern California experienced a 5.2 magnitude earthquake that originated in San Diego County. This earthquake was felt across Orange County. Residents and visitors who had the MyShake app received an alert estimating the size, location and impact seconds ahead of feeling the earthquake.
The app provides reminders of what to do during the earthquake as well as crowdsourced information about damage following the earthquake. Learn more here
The MyShake app is available in the Apple app or Google Play stores, as well as Chromebook and MacOS platforms. Consider uploading the app if you haven’t done so already!
3. Public Health/Communicable Disease Control Division Updates
A. Measles
Measles cases identified across the United States continue to rise. The west Texas outbreak continues, there are now over 500 cases in that state. This outbreak has extended to New Mexico, with over 50 cases now identified there. A total of three measles-related deaths have occurred in these states. Outbreaks have also been identified in Oklahoma, Kansas and Ohio Over 600 cases have been reported nationally, which is already twice the number reported during all of 2024.
Nine cases have been reported in California. The majority of California’s cases have occurred following international travel, particularly to Vietnam.
The CDC continues to emphasize that providers should include measles in their differential in the appropriate clinical and epidemiologic settings: Healthcare Providers: Stay Alert for Measles Cases
Local information and resources are available at: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/measles.aspx and https://ochealthinfo.com/services-programs/disease-prevention/diseases-conditions/measles
B. H5N1 Avian Influenza - Bird Flu
California’s last reported human case of H5N1 avian influenza was reported on January 14, 2025. Thirty-eight human cases have been identified in the state, 36 of these occurring after worksite exposure to infected dairy cattle. Two additional cases have an unknown source of exposure. Providers should consider H5N1 infection in patients with known history of exposure to animals with known H5N1 disease. The CDC’s summary of the current H5N1 avian influenza situation can be found here
CDPH Resources:
CDPH Human Avian Influenza A(H5N1) Quicksheet
CDPH Toolkit: Bird Flu
CDPH Avian Influenza A Infection Control for Healthcare Providers
First cases of human Avian Influenza A (H5N1) in California & Preparation for Respiratory Virus Season (COVID-19, Influenza and RSV)
Raw Milk and Raw Dairy Products
Additional Website links:
CDFA - Animal Health - Avian Influenza
H5 Bird Flu: Current Situation | Bird Flu | CDC
C. Hantavirus
You’ve probably recently heard about Hantavirus in the news - as Oscar-winning actor Gene Hackman’s wife Betsy Arakawa’s cause of death was determined to be from hantavirus pulmonary syndrome (HPS) Three cases of hantavirus were reported earlier this month in Mono County.
Hantavirus is a frequently serious disease, causing death in 30% of cases due to rapidly progressing pneumonia and sepsis. Symptoms of HPS can develop 1-5 weeks after exposure to sin nombre virus - the specific virus that causes hantavirus pulmonary syndrome in the western United States. Deer mice are the only rodent species known to carry sin nombre virus which can easily transmit to humans through exposure to infected rodent nests and droppings.
Early symptoms include fever, headache, and muscle aches, especially in the thighs, hips, back, and shoulders. Difficulty breathing can appear 2-7 days after initial onset of symptoms. Most cases are seen in rural areas. No cases have been reported from exposure in OC, but all of our surrounding counties have had at least one case occurring following exposure there The CDPH has created helpful toolkits on their website as well as an interactive story map that provides cases of hantavirus infections in California, sin nombre virus antibody prevalence in deer mice as well as educational resources (including videos). Additional information can be found at the CDPH Hantavirus Infection page.
D. Respiratory Virus Updates
Influenza and Respiratory Syncytial Virus (RSV) case rates continue to drop, while COVID-19 case rates are generally stable. The CDPH Weekly Respiratory Virus reports are available here. Updated OC respiratory virus surveillance data can be found here.
4. Public Health Awareness/Education/Observances Topics
Black Maternal Health Awareness Week (April 11-17)
In the US and OC, Black mothers have higher rates of severe maternal morbidity and Black infants have higher rates of preterm birth and low birthweight than their non-Hispanic White counterparts. These disparities often persist despite socioeconomic class and education. Black Maternal Health Week highlights the barriers Black mothers and birthing people face when it comes to quality maternal care as well as highlighting the strengths and resilience of black mothers.
The Black Infant Health (BIH) program seeks to empower Black/African American women and birthing persons by connecting them with vital care and support needed to promote health behaviors during pregnancy and beyond. Orange County’s BIH program officially opened its doors to services on February 1, 2025. Services are free and provided by family health advocates, group facilitators, public health nurses and mental health workers. Some of the services available to participants include in-person group sessions for prenatal and postpartum, support services provided by a team of health professionals, life coaching and case management, and classes in breastfeeding, nutrition, and parent education.
Orange County BIH is now enrolling! To be eligible to join, individuals should be 16 years or older, identify as Black/African American, should be pregnant or parenting (up to six months postpartum). BIH program services are provided at no charge. The OC BIH program is a collaboration between the HCA, First 5, and Breastfeed LA.
For more information, see Everyparentoc.org/supporting-black-infant-health. To enroll a client, call HCA Public Health Nursing (714) 834-7747 or email PublicHealthNursing@ochca.com and specify the referral is for BIH. Access a referral form at https://ochealthinfo.com/abouthca/public-health-services/community-and-nursing-services.
National Home Visiting Week (April 21-25)
April 21-25, 2025, is the inaugural National Home Visiting Week, an observance to celebrate and recognize home visiting professionals and the positive impact they make on maternal, child, and family outcomes. The last full week of April (Monday-Friday) will be reserved for National Home Visiting Week in subsequent years. In the US, it is estimated that more than 17.1 million pregnant women and families (including over 22 million children), could benefit from home visiting, but only approximately 280,000 received services in 2023.
Home visiting programs promote healthy development, strengthen family relationships, reduce the risk of abuse and neglect, and provide resources and support to families. In Orange County, the HCA as well as other partners provide home visiting programs to support families. 8,797 in-person visits were completed by the HCA Community and Nursing Services Division home visitors in FY 2320-24
For more information about HCA’s Pregnant and Parenting Support programs, see https://everyparentoc.org/providers/#paps.
California Mosquito Week (April 14-20)
Mosquitos can spread diseases including West Nile Virus, dengue, malaria, chikungunya, St. Louis Encephalitis and Zika. With vector-borne illness such as dengue on the rise, controlling mosquitos locally is everyone’s responsibility. As noted by OC Mosquito and Vector Control, Mosquitos Suck and Together We Fight! Everyone can do their part to FIGHT back against mosquitos.
Orange County Mosquito and Vector Control District is kicking off California Mosquito Awareness Week with the premier of their Closer Look Series. Learn more at www.ocvector.org and follow them on social media!
Here are some ways to eliminate mosquito breeding sources on your property:
• Dump and drain any containers filled with water at least once a week.
• Clean and scrub bird baths and pet water bowls weekly.
• Dump water from potted plant saucers.
• Don't transport or share plant stems rooted in water.
• Drill a hole or puncture containers to eliminate standing water.
• Use our mosquito source checklist.
• Go here for more do-it-yourself mosquito issue solutions.
National Infant Immunization Week (April 21-28) and World Immunization Week (April 24-30)
As noted by the World Health Organization, Vaccines are one of humanity’s greatest achievements and with today’s innovations, immunizations for all is humanly possible! Over the past 50 years, essential vaccines have saved at least 154 million lives.
Review of local data revealed that prior to the availability of vaccines, many in Orange County suffered from the consequences of polio, measles and diphtheria The recent resurgence of the vaccine preventable illness measles is a reminder that more needs to be done to help inform the community of available vaccines that can help protect and prevent against severe illnesses! As we have seen on the news, along with measles, other vaccine preventable illnesses are on the rise globally - including polio. Residents desiring more information about available vaccines can visit their health care provider, a local pharmacy or myturn.ca.gov for more information.
Earth Day 2025
The OC Environmental Health outreach team will be at several community events throughout Orange County to celebrate Earth Day. Thank you to our city partners for hosting the events and recognizing the importance of protecting our planet. Come celebrate with us at the following events:
• April 19th – Earth Day Fair at Spring Eggstravaganza, City of Buena Park
• April 19th – Earth Day Irvine, City of Irvine
• April 24th – Santiago Canyon Community College Earth Day and Science Night, City of Orange
• April 26th – Earth Day Costa Mesa, City of Costa Mesa
• April 26th – Earth Day Mission Viejo, City of Mission Viejo
• April 26th – Earth Day San Clemente, City of San Clemente
Did you know Orange County is working on a Climate Action Plan?
In 2024, the Sustainability Office was formed and has been working on a local Climate Action Plan (CAP). The climate action plan includes greenhouse gas inventory of all county municipalities and unincorporated regions as well as target sectors of focus. In 2024, the County of Orange (County) hosted six public forums, and a Preliminary CAP was presented to the Board of Supervisors on September 24, 2024. Orange County is currently in the second phase of the CAP which involves a more detailed analysis of measures and full assessment under California Environmental Quality Act (CEQA). Find out more here.
STI Awareness Week, observed the second full week in April, provides an opportunity to raise awareness about sexually transmitted infections (STIs). STI Awareness Week focuses on how STIs impact our lives, reducing STI-related stigma, fear, and discrimination and ensure people have the tools and knowledge for prevention, testing, and treatment. Every year in OC, thousands are diagnosed with Chlamydia or Gonorrhea, and over 200 have HIV, several may be newly diagnosed with acute Hepatitis B or C, and hundreds are diagnosed with Syphilis (with over 10 cases of congenital syphilis confirmed annually since 2017)
STD Awareness Week (April 13-19)
Alcohol Awareness Month
April is Alcohol Awareness Month. The HCA created a Drug and Alcohol misuse and mortality dashboard which was published in 2023. You can access the report here
Orange County Data
• Alcohol-related deaths in Orange County have been steadily increasing from 2016 (325 deaths) to 2023 (453 deaths).
• Preliminary counts for 2024 show totals for alcohol -related deaths currently under 2023 (396 deaths) but will not have a finalized count until Fall 2025.
• The largest rates for alcohol-related deaths in Orange County are 55-64 year olds, followed by 65-74 year olds.
Rates from counts <11 deaths are suppressed
Over the past decade (2014-2023) American Indians/Alaska Natives have experienced the highest death rate for alcohol-related causes among all race/ethnicity groups, with Asians having the lowest death rate. Although American Indian/Alaska Native residents experienced the highest alcoholrelated death rate*, White residents were the majority of alcohol-related deaths (58%) in this 10year period.
*The small population size of American Indian/Alaska Natives in Orange County makes rate estimates unstable.
And as a reminder, the US Surgeon General Advisory on Alcohol and Cancer Risk 2025 was published January, 2025 and highlighted the fact that consuming alcohol increases risk of developing at least 7 types of cancer - including cancers of the oral cavity, pharynx, larynx, esophagus, breast (in women), liver, and colon & rectum. Below are some resources to share with the community.
Stay informed about alcohol. Learn what counts as a standard drink, the risks of excessive drinking & how it affects your immediate and long-term well-being. Take charge of your health today! Visit: Facts About Excessive Drinking | Drink Less Campaign | CDC]
Rethinking Drinking offers valuable, research-based information about alcohol and health, along with tips and resources for those who want to cut down or quit. Visit: https://www.rethinkingdrinking.niaaa.nih.gov/
Need some guidance to talk with your children about the risks of using drugs and alcohol? Learn information and resources needed to have a conversation with them now. Start when they are young and talk often. Visit: https://www.samhsa.gov/substance-use/prevention/talk-they-hear-you
Did you know? No amount of alcohol is safe during pregnancy including wine and beer.
Drinking at any stage can increase the risk of:
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Miscarriage
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Stillbirth
� �� Fetal Alcohol Spectrum Disorders
Protect your baby’s health say No to alcohol. Learn more: Substance Use and PregnancyEveryParentOC.
For substance use disorder treatment resources and referrals, call OCLinks, the 24/7 Behavioral Health Line at (855) 625-4657, and/or visit the OC Navigator at OCNavigator.org.
National Prescription Take Back Day
The HCA invites the community to participate in National Prescription Drug Take Back Day on Saturday, April 26, from 10 a.m. to 2 p.m. at convenient locations throughout OC. The public is encouraged to remove unneeded medications from their homes as a measure of preventing medication misuse. This initiative addresses a crucial public safety and health concern and aligns with the HCA’s commitment to the well-being of the OC community by promoting the responsible disposal of medications to prevent misuse and combat opioid addiction.
National Prescription Drug Take Back Day serves as a vital reminder of our collective responsibility in keeping our communities safe. To find a convenient Take Back drop-off location, please visit the Drug Enforcement Administration’s (DEA) website at www.DEATakeback.com or call 1 (800) 882-9539. The drop-off service is both free and anonymous.
For further information on medication misuse prevention efforts in Orange County or to discover year-round safe disposal options, please visit: www.ochealthinfo.com/adept.
5. ALERTS/RECALLS
Lead
Several types of Zaarah Herbals powders have been recalled because they may be contaminated with lead and arsenic and in violation of the Federal Hazardous Substances Act. The products included are:
• Zaarah Herbals Bhringraj Powder
• Zaarah Herbals Gurmar Powder
• Zaarah Herbals Rasayan Churan
• Zaarah Herbals Vasaka Powder
Lead is toxic if ingested by young children and can cause adverse health effects. The recalled products were distributed to retailers located in New York, New Jersey, Connecticut and California between 12/20/2024 and 01/07/2025. They are packaged in clear 100g (3.5oz) jars with gold lids. The name of the product is prominently displayed on the front of the jars. More information about this recall is available on the United States Food and Drug Administration website, including the involved product UPC codes.
CDPH and FDA Recommend Providers to:
• Advise families to:
o Immediately stop using the recalled products and return it to the place of purchase for a full refund. Consumers with questions can contact New York Wholesale Group at 1(800) 516-7606.
• Test children for lead exposure if children came into contact with this product.
Please help share this information with your families and clients and contact Orange County Childhood Lead Poisoning Prevention Program (CLPPP) at (714) 567-6220 if you have any questions or concerns.
For additional information and resources, please refer to the OC CLPPP website at: https://ochealthinfo.com/lead and CDPH website at: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/Pages/CLPPBhome.aspx.
Foodborne Illness - Multistate Outbreaks
Recalls, Market Withdrawals, & Safety Alerts | FDA Date
4/11/2025 Blue Ridge Beef Puppy Mix and Kitten Mix
Animal & Veterinary, Foodborne Illness, Pet Food, Food & Beverages, Foodborne Illness, Pet Food Salmonella & Listeria contamination. Blue Ridge Beef
04/10/2025 Marketside Celery Sticks Food & Beverages, Foodborne Illness, Produce Due to possibility of contamination with Listeria monocytogenes
04/01/2025 Walker’s Wine Juice LLC Pumpkin Juice Food & Beverages, Foodborne Illness, Juice Potential Foodborne Illness - Botulism Walker’s Wine Juice LLC
Website Links:
CDC Current Outbreak List | Outbreaks | CDC
Recalls, Market Withdrawals, & Safety Alerts | FDA
Recalls & Public Health Alerts | Food Safety and Inspection Service
International Travel Health Notices
April
• Level 1 - Oropouche in the Americas
• Level 2 - Clade I Mpox in Central and Eastern Africa
March
• Level 1 - Global Dengue
• Level 1 - Global Measles
• Level 2- Ebola Virus in Uganda
Public Health related April – mid May Observances
National Nurses Week May 6-12
The Week of May 6-12 marks National Nurses week. This year, the American Nurses Enterprise is shining light on The Power of Nurses. Nurses across the national serve in a variety of settings and make a difference on people’s lives every day. Thank you to all the nurses across our county!
Orange County Community Health Improvement Plan
The Orange County Community Health Improvement Plan Workgroups are now meeting! Do you know of someone who is interested or who would benefit our community through engagement in these workgroups? Encourage them to get involved by contacting us at occhip@ochca.com.
The HCA has published the Orange County Community Health Improvement Plan (OC CHIP) Plan update for 2024-26. The community identified six priority areas to focus efforts in: mental health, substance use, diabetes/obesity, housing/homelessness, care navigation, and economic disparities. If you would like to join us or learn more, please email us at occhip@ochca.com. To access the OC CHIP plan please visit: OC Health Improvement Plan | Orange County California - Health Care Agency.
Training and Webinar Opportunities:
• April 17 at 10 am: Network for Public Health Law – Public Health Under the New Administration: Examining State and Local Authority to Regulate Raw Milk, Water Fluoridation, and School-Entry Vaccines
• April 17 at 12 noon: Age-Friendly Public Health Systems – Building Readiness: State and Local Strategies from the 2025 Ready or Not Report
• April 18 at 9 am: CDPH Immunization Updates for Providers - Webinars – California Vaccines for Children (VFC)
• April 29-30: California Immunization Coalition 2025 Annual Summit is being held at Riverside Convention Center. Register here.
• April 30: Orange County Medical Association- CME/CE “Creating Safe Spaces: An Introduction to TraumaInformed Care”
• May 1 at 11 am: ChangeLab Solutions - Supporting Thriving Food Systems
• May 6-7: California Medical Association Health Information Technology Summit will be held in San Diego. Find out more here.
• May 13 at 12 noon: CMA – Epidemiology Update with Erica Pan, M.D., MPH
• May 13 at 6 pm: Orange County Chapter - California Academy of Family Physicians is holding their quarterly in person event. Find out more here
• May 14: Orange County Medical Association CME/CE Webinar/In Person- The Diabetic Foot: Wounds, Amputations and Prevention – Primary Care Perspective
• May 3 at 9 am: Know More, Do Better for Healthcare Providers; How to Help and Identify Human Trafficking Victims-https://forms.office.com/pages/responsepage.aspx?id=N5Qn1sjokOS1hjjCJY09xQMNzUMfB9FszoNtOxPBY9UM0Q5QkM3TlM4T0hCNEJWSTFVMVFBVDlOSy4u&route=sh orturl
• May 28 at 11:30 am: Orange County’s Health Officer will provide a State of Public Health webinar. Stay tuned for registration information.
• June 3 at 9 am: Orange County Coalition of Community Clinics is hosting a Coffee Connections event focused on Advancing Community Health: Advocacy & Power building Principles. Find out more here
• July 10-11: California Medical Association - 2025 Health Equity Leadership Summit – find out more here.
• July 14-18: NACCHO 360 Bright Lights, Bold Ideas: Shaping the Future of Public Health Practice conference is being held at the Anaheim Convention Center. Learn more here.
• September 19-21: The American Academy of Pediatrics Orange County Chapter is holding their 41st Annual Advances in Pediatrics Conference at the Irvine Marriot Hotel. Find out more here
Previously Recorded Webinars/Podcasts
• Frameworks How to Counter Public Health Myths and Elevate Science Now (recorded from 2024) Slides for discussion available here.
• California Medical Association (CMA)
Virtual Grand Rounds: Long COVID Update: What We Know Now : CMA Date: Recorded March 11, 2025
• Southern California Wildfire Response- What Clinicians Need to Know Recorded from January 29, 2025. Available on-demand for free.
• National Emerging Special Pathogens Training and Education (NETEC) Podcast: Transmission Interrupted: https://netec.org/podcast/ Episode 36: March 5, 2025 The New Joint Commission Standards, PPE, and Me Jill Morgan, Emory University Hospital and Brook Henriksen, Sacred Heart Spokane, Washington
• Online on demand courses from National Special Pathogen System, to H5N1 Town Hall updates and Mpox available at: https://netec.org/education-training/#ceus
• Center for Infectious Disease Research and Policy
Offers daily news headlines, and newsletters for specific communicable disease topics Podcast: Osterholm Update
Dr. Michael Osterholm discusses the latest infectious disease developments. Link: https://www.cidrap.umn.edu/osterholm-update
National Association Webinar Webpages
• American Public Health Association APHA APHA Webinars
• CMA Recorded Webinars Virtual Grand Rounds (cmadocs.org)
• National Foundation for Infectious Disease Webinars https://www.nfid.org/educationevents/webinars/
• Infectious Disease Society of America Public Health Page Public Health (idsociety.org)
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