U.S.

EPA, REGION 9
VECTOR-BORNE
DISEASES
WORKSHOP
U.S. EPA OPENING
REMARKS
 BIOLOGY AND
CONTROL OF VECTORS
AND PUBLIC HEALTH
PESTS
 Vector-Borne Diseases
Biology and Control of Vectors
and Public Health Pests
CDR Joe Laco, MSEH, RS/REHS
Environmental Health Officer
CDC National Center for Environmental Health
Division of Emergency Environmental Health
Services Environmental Health Services Branch

National Center for Environmental Health

Division of Emergency and Environmental Health
Services
 REGIONAL TRIBAL OPERATIONS COMMITTEE
SUMMER MEETING SPECIAL SESSION:
VECTOR-BORNE DISEASES WORKSHOP

Monday, August 8, 2016

CDR Joe Laco, RS/REHS, MSEH

The findings and conclusions in this presentation have not

been formally disseminated by the Centers for Disease
Control and Prevention and should not be construed to
represent any agency determination or policy.

National Center for Environmental Health

Division of Emergency and Environmental Health
Services
 Brain Teaser –

What percentage of all diseases

known to affect human-kind
throughout history are zoonotic (of
animal origin) and often transmitted
by a vector?

60 Percent!
 Brain Teaser – 2

What percentage of all new or

emerging diseases that threaten
human health today are zoonotic
or vector-borne illnesses?

75 Percent!
 What animals are
responsible for more human
illness and death than any
other group of mammals?

Rats and Mice

 How many
human
diseases can be
transmitted by
rodents?

61
Using the current CDC statistical
model, how many West Nile
infections occurred in Texas in
2012?

118,160
 Based on a published study in the
October 2012 edition of Epidemiology
and Infection, how many projected West
Nile virus infections have occurred in
the U.S. since 1999?

Over 3 Million!!!
What disease vector
ranks #1 in pathogen
diversity?

Ticks
 Emergence/Resurgence of Vector-
• Pesticide Borne Diseases
• resistance
Decreased resources for surveillance,
prevention and control
• Deterioration of public health infrastructure
• Unprecedented population growth
• Uncontrolled urbanization
• Changes in agricultural practices
• Deforestation
• Increased travel
*Encyclopedia of Public
Health
 Vecto
r
Transmitters of disease-
causing organisms that
carry a pathogen from one
host to another
Vector-Borne Disease
Transmission
Biological
• Most significant mode of transmission
- Arthropod ingests a pathogen while taking a
blood meal from an infected host
- Pathogen multiplies within the arthropod
(reservoir)
- Pathogen is transmitted to another host
when arthropod takes another blood
meal
Vector-Borne Disease
Transmission
Mechanical
• Vector physically carries pathogens from
one place or host to another, usually on
body parts or through the gastrointestinal
tract
Mosquito-Borne
Disease
 Clinical spectrum of human WNV infections
~ 1% ~ 10% of WNND are fatal
WNND = West Nile WNND
Neuroinvasive Disease:
Meningitis,
Encephalitis, 1 WNND case =
Acute Flacid Paralysis 20 - 30% 140 - 250 infections
“West Nile Fever”

70 - 80%
Asymptomatic – Inapparent
 WNV: Long-Term Outcomes
• WN Encephalitis and WN Fever
– Persistent disabling neurologic sequelae
common
– Tremors, movement disorders, cognitive
problems in >50%
– 8 published studies show complaints frequently
persist >1 year post infection (Some > 3
years)
– Fatigue, pain, subjective memory / concentration
problems
– Higher all-cause mortality rates >1 year post-
infection
*# Sejvar et al., J Neuropsychol 2008; ^Greenberg et al., EID
2005
 WNV Human Cases 1999-
2012*
Year
16,045 WNND Cases
WNND
Cases
Fever
Cases
Total
cases
1999 59 3 62 x 140 Infections/WNND
2000 19 2 21
2001 64 2 66 ~ 2.24 million infections
2002 2946 1210 4156
2003 2866 6996 9862
16,045 WNND Cases
2004 1148 1391 2539
x 250 Infections/WNND
2005 1309 1691 3000
2006 1495 2761 4256 ~ 4.01 million infections
2007 1227 2371 3598
2008 689 667
1356 U.S. Population 311M
2009 386 334 720
Estimate 0.7% - 1.2% of population
2010 629 392 1021
2011 474 216 690
infected with WNV
2012 2734 2653 5387
Total
* data 16,045
as of 12/11/2012 20,689 36,734
 West Nile Virus Total (Neuroinvasive and
Fever) Cases Reported in the United States
1999-2012*
WNND Cases Fever
Cases
10000
9000
Number of Cases

8000
7000
6000
5000
4000
3000
2000
1000
0
1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2012
2011
* data as of 12/11/2012
West Nile virus neuroinvasive disease incidence reported to ArboNET,
by state, United States, 2014

Source: ArboNET, Arboviral Diseases Branch, Centers for Disease Control and Prevention
West Nile virus cases incidence reported to ArboNET, by county, United
States, as of August 20, 2014
West Nile Virus Neuroinvasive Disease Incidence by State – United States,
2015 (as of January 12, 2016)

Source: ArboNET, Arboviral Diseases Branch, Centers for Disease Control and Prevention
 West Nile Virus Disease Cases by State – United States, 2014

Non- Total
State Neuroinvasive Neuroinvasive Cases Deaths*

Arizona 80 27 107 13

California 561 240 801 31

Nevada 3 0 3 0

New Mexico 19 5 24 1

Texas 253 126 379 6**

* Over 1700 deaths from WNV since ** 89 deaths in Texas,

199 2012
Source: ArboNET, Arboviral Diseases Branch, Centers for Disease Control and Prevention
 Dengu
• e
Dengue is transmitted between people by
Aedes aegypti and Aedes albopictus
• More than one-third of the world’s
population living in areas at risk for
transmission
• Over 100 million people are infected yearly
• No vaccine and no specific treatment.
 Dengu
• Dengue fever - e
high fever, severe
headache, severe pain behind the eyes,
joint pain, muscle and bone pain (“break-
bone fever”), rash, and mild bleeding
• Dengue hemorrhagic fever – 2 to 7 days of
high fever followed by persistent vomiting,
severe abdominal pain and difficulty
breathing. Next
phase is a 24- to 48-hour period when
capillaries become “leaky” leading to
pleural effusions. May
lead to circulatory system failure and
shock, followed by death, if not treated.
Global Distribution of Dengue
Imported Acquired Dengue
Human Cases – US 2015
State Travel Associated Cases
Arizona 15

California 138

Nevada 1

New Mexico 3

Texas 32

Hawaii 19
 Locally Acquired Dengue
Human Cases – US 2015
State Local Cases
Arizona 0

California 0

Nevada 0

New Mexico 0

Texas 0

Hawaii 200
 Chikungunya Virus (CHIKV)
• Mosquito-borne alphavirus

• Transmitted by Aedes aegypti and Ae.

albopictus

• Main epidemic reservoirs are non-human and

human primates

• Endemic in Asia and Africa

3
Chikungunya Transmission Cycles

3
 Chikungunya Virus Disease
• Characterized by acute onset of fever and severe polyarthralgia
• Acute symptoms typically resolve in 7‒10 days
• Mortality is rare; occurs mostly in older adults
• Variable proportions of patients report:
• Relapse of rheumatologic symptoms* in the months following
acute illness
• Persistent joint pains for months or years

• Often occurs as large outbreaks with high attack rates

• 40-60% of population infected
• Majority (72-97%) of infected persons are
symptomatic

*Polyarthralgia, polyarthritis, tenosynovitis, Raynaud’s

syndrome 3
6
 Chikungunya
Countries with reported local
transmission of Chikungunya virus (as
of April 22, 2016)
Imported Acquired Chikungunya
Human Cases – US 2015
State Travel Associated Cases
Arizona 24

California 275

Nevada 1

New Mexico 0

Texas 54

Hawaii 7
Locally Acquired Chikungunya
Human Cases – US 2015
State Local Cases
Arizona 0

California 0

Nevada 0

New Mexico 0

Texas 0

Hawaii 0
 Zika virus disease (Zika)
• Disease spread primarily through the
bite of an infected Aedes mosquito.
• Many people infected with Zika virus
won’t have symptoms or will only
have mild symptoms.
• However, Zika can cause birth
defects and other problems such as
stillbirth and
miscarriage.
 Zika
• Zika can be spread
through:
• Mosquito bites
• Aedes

• From a pregnant woman to her fetus

• Sex with an infected man
• Possibly blood transfusion, organ and
tissue transplant, fertility treatment,
and breastfeeding
 Zika

What are the symptoms?

• The most common symptoms of
Zika are:
• Fever
• Rash
• Joint pain
• Conjunctivitis (red eyes)
• Muscle pain
• Headache
 Zika

How does Zika

affect
pregnancies?
• Zika infection in
pregnancy can
cause microcephaly and
other severe fetal brain
defects.
• Microcephaly: birth defect in
which a baby’s head/brain is
smaller than expected.
• No evidence that previous
infection will affect future
 Zika

How does Zika affect

•preOgtnhearnpcrioebsl?ems
have been detected in
fetuses and infants
infected with Zika virus
before birth.
• Miscarriage, stillbirth,
absent or poorly developed
brain structures, eye
defects, hearing deficits,
and impaired growth
• No reports of infants
getting Zika through
 Zika

Does Zika cause Guillain-Barré

syndrome?
• GBS is very likely
triggered by Zika in a
small proportion of
infections.
• GBS is an uncommon
sickness of the nervous
system in which a
person’s own immune
system damages the
nerve cells, causing
Zika
 Zika

US Travel-Associated Cases, as of July 27,

2016
 Where Is Zika Found?

US States* US Territories
• 1657 travel-associated cases†  21 travel-associated cases†
• 0 locally transmitted cases‡  4729 locally transmitted cases‡

• 433 pregnant women  422 pregnant women

• 5 case of Guillain-Barre syndrome  17 case of Guillain-Barre
• 15 sexually transmitted cases syndrome
 0 sexually transmitted
cases
*46 states and District of Columbia
†Includes cases in travelers and their contacts with presumed sexual or in utero transmission
‡Presumed local mosquito-borne transmission

as of July 27, 2016

 Imported Acquired Zika
CONT US, as of July 27, 2016
State Travel Associated Cases
Arizona 10

California 87

Nevada 11

New Mexico 3

Texas 76

Hawaii 10
 Zika

• The virus can be

passed from an
infected person to a
mosquito through
bites.
• An infected mosquito
can spread the virus
to other people. Zika virus can stay in blood for
• Protect yourself from about a week, and mosquitoes
can bite you and then infect
mosquito bites. During others through bites.
the first week of
illness, Zika virus can
 Tick-Borne Disease

Brown dog tick American dog tick

Western blacklegged tick

Rocky Mountain wood tick
 Geographic Range of Tick
Vectors

Transmits: Rocky Mountain spotted

fever
 Geographic Range of Tick
Vectors

Transmits: Tularemia and Rocky Mountain spotted

fever.
 Geographic Range of Tick
Vectors

Transmits: Rocky Mountain spotted fever, Colorado tick

fever, and tularemia.
 Geographic Range of Tick
Vectors

Transmits: Anaplasmosis and Lyme

disease.
 Geographic Range of Tick
Vectors

Transmits: Lyme disease, anaplasmosis, babesiosis, and

Powassan disease.
 Lyme
• Disease
Caused by the bacterium Borrelia burgdorfer
i
• Transmitted to humans through the
bite of infected blacklegged
ticks
• The deer tick, (Ixodes scapularis) spreads the
disease in the northeastern, mid-Atlantic, and
north-central United States, and the western
blacklegged tick (Ixodes pacificus) spreads the
disease on the Pacific Coast.
• Symptoms - fever, headache, fatigue, and a
characteristic skin rash called erythema migrans
(70 - 80% of infections)
• If left untreated, infection can spread to joints,
the heart, and the nervous system
Reported Cases of Lyme Disease
United States – 1996/2011

199 201
6 4
2012 – Texas, 33 cases
2012 – Pennsylvania,
4146 cases
 Lyme Disease

State Confirmed Cases Confirmed Cases

2007 2013
Arizona 2 22
California 75 90
Nevada 15 11
New Mexico 5 0
Texas 87 48
Hawaii 0 0
Pennsylvania 3994 4981
Wisconsin 1814 1447
 Rocky
Mountain
• Spotted
Caused by the bacterium Rickettsia rickettsii
• Fever
Transmitted in the U.S. by the American dog
tick (Dermacentor variabilis, Rocky Mountain
wood tick (Dermacentor andersoni), Lone Star tick
(Amblyomma americanum) and brown dog tick
(Rhipicephalus sanguineus)
• Symptoms - fever, headache, abdominal pain,
vomiting, and muscle pain. A rash may develop,
but is often absent in the first few days, and in
some patients, never develops
• RMSF is a serious illness that can be fatal in the
first eight days of symptoms if not treated
RMSF Incidence, 2010
RMSF in the United States, 1920–2010
 Tularemi
•
a
Caused by the bacterium Francisella tularensis.
• Transmitted to humans by the dog tick (Dermacentor
variabilis), the wood tick (Dermacentor andersoni), and
the lone star tick (Amblyomma americanum).
• Deer flies (Chrysops spp.) have been shown to
transmit tularemia in the western U.S.
• Highly infectious. A small number (10-50 or so
organisms) can cause disease.
• Potential bio-terror weapon. Commonly occurs in
nature. People who inhale an infectious aerosol
would experience severe respiratory illness,
including life-threatening pneumonia and systemic
infection.
 Tularemi
a
• Ulceroglandular - Occurs following a tick or deer fly
bite or after handing of an infected animal. Skin ulcer
appears where the organism entered the body (most
common form).
• Glandular - Similar to ulceroglandular but without an
ulcer.
• Oculoglandular - Bacteria enter through the eye.
Can occur when touching the eyes while butchering
an infected animal.
• Oropharyngeal - From eating or drinking contaminated
food or water (sore throat, mouth ulcers, tonsillitis, and
swelling of lymph glands in the neck.)
• Pneumonic - Most serious form. Symptoms include
cough, chest pain, and difficulty breathing. Results
Reported cases of Tularemia, United States
2003-2012
Flea-Borne Disease
 Plagu
• e
Caused by the bacterium Yersinia pestis.
• Usually transmitted by the bite of an
infected rodent flea or by handling an
infected animal
• The last U.S. urban plague epidemic
occurred in Los Angeles in 1924-25
• Most human cases in the United States
occur in two regions: 1) northern New
Mexico, northern Arizona, and southern
Colorado; and 2) California, southern
Oregon, and far western Nevada
 Plagu
e
• Bubonic plague: enlarged, tender lymph
nodes, fever, chills and prostration (total
exhaustion/collapse)
• Septicemic plague: fever, chills, prostration,
abdominal pain, shock and bleeding into
skin and other organs
• Pneumonic plague: fever, chills, cough
and difficulty breathing; rapid shock and
death if not treated early
 RODENTS
Norway
Rat

Roof
Rat
Hous
e
Mous
e
 ECONOMIC IMPORTANCE
• Rats in the human environment
cause enormous economic loss
- Consume and contaminate
vast quantities of food
- Cause fires by gnawing the
insulation from electric wires
• Commensal rodents cost billions
of dollars each year in the United
States.
-Internal destruction to
computers and other sensitive
equipment
-Structural damage to
homes and businesses
Human Health Impact
Human Health Impact
 RODENT-BORNE DISEASES
• Rats and mice spread diseases in
two distinct ways.
– Directly - by contamination of food, water and
air with their urine and feces
– Indirectly – by way of rodent fleas, ticks and
mites Direct Indirect
• Rat bite Plague
fever Murine
• Salmonellos typhus
is Scrub
• Leptospirosi
typhus
s
Tularemia
• Hantavirus
 Bed
• Resurgence of a pest health
Bugs
departments have not dealt with
in over 50 years.
 Why are they
back?
Greater international and domestic
travel
 Lack of knowledge regarding
control of bed bugs due to their
prolonged absence
 Increased resistance to
available pesticides
 The continuing decline s or
.
elimination of effective vector/pest
control programs at state and local
Photo courtesy of Dr. Harold Harlan, Armed Forces
Pest Management Board Image Library (

public health agencie

http://www.afpmb.org)
Photo courtesy of Dr. Harold
Harlan Armed Forces Pest
Management Board

Courtesy: Jody Gangloff-Kaufmann, Allison

Taisey New York State IPM Program
 2012 NPMA Bed Bug
Survey 2010 2011
College dorms 35 54 47
Hotels/motels 2012
67 80 75
Nursing homes 25 46 46
Office buildings 18 38 36
Schools /day care centers 10 36 41
Hospitals 12 31 33
Transportation 9 18 21
(train/bus/taxi)
Movie theaters 5 17 10
• Survey respondents continue to treat bed bugs in
retail stores, laundromats, libraries, restaurants and
airplanes.
 Integrated Pest
Management
Integrated Pest Management (IPM) is
the coordinated use of pest and
environmental information with
available pest control methods to
prevent unacceptable levels of pest
damage by the most economical
means and with the least possible
hazard to people, property, and the
environment.
 IPM
• Food Food

• Harborag
e
• Water IPM
Water Harbor
• Life -age

Cycle
 CONTROLING MOSQUITOES
Understanding the Mosquito Life-
Cycle
Egg Larva
s e

Pupa
e
Adul
t
 CONTROLING MOSQUITOES
Understanding Mosquito
Breeding Habitats
 CONTROLING MOSQUITOES
Understanding Mosquito
Breeding Habitats
CONTROLING MOSQUITOES
Monitoring
and
Surveillance
CONTROLING MOSQUITOES
Source
Reduction
CONTROLING MOSQUITOES
Adulticide
CONTROLING MOSQUITOES

ULV Mist Blowers

 CONTROLING MOSQUITOES
Larvicides

Oils
• Suffocation – mechanical barrier at

surface
• Poisoning due to toxic properties

of the volatiles
CONTROLING MOSQUITOES
Larvicides
 CONTROLING MOSQUITOES
Preventing Mosquito
Bites

Keep Mosquitoes Outside

 CONTROLING MOSQUITOES
Preventing Mosquito
Bites

Cover Up
 CONTROLING MOSQUITOES
Preventing Mosquito
Bites

Use Repellent
• Use
Environmental
Protection
Agency (EPA)-
registered insect
repellents.
• DEET, picaridin,
IR535, or oil of
lemon eucalyptus
or
 CONTROLING MOSQUITOES
Preventing Mosquito
Bites Use Repellent
For babies and children
• Do not apply onto
hands, eyes, mouth,
and cut or irritated
skin.
• Adults: Spray onto
your hands and then
apply to a child’s face.
• Do not use insect
repellent on babies
younger than 2 months
Controling Zika Infection
 CONTROLING TICKS

Preventing Tick Bites

• Repellents
• EPA-Approved
Products
• DEET, Picaridin, Oil
of Eucalyptus
• Clothing Applications
• Permethrin
• Tick-Checks
• Light-colored clothing
 CONTROLING TICKS

Removing
Ticks
 CONTROLING TICKS

Managing
Habitat
 CONTROLING TICKS

Managing
Hosts
 CONTROLING RATS
Recognizing the
Signs
Gnawin Rub
g Mark
s
 CONTROLING RATS
Recognizing the
Signs
Dropping Sightings,
s Odors, Sounds
CONTROLING RATS
Recognizing the
Signs
Burrows
 CONTROLING RATS
• Remove Harborage – No Place to
Live!
• Clean-Up
• Sanitation
 CONTROLING RATS

• Eliminate Food and Water –

Starve Them!
 CONTROLING RATS

• Prevent
Entry –
Keep Them
Out!
 CONTROLING RATS

• Prevent
Entry –
Keep Them
Out!
 CONTROLING RATS

• Prevent Entry
– No Place To
Live!
 CONTROLING RATS

• Traps and Bait Stations – Wipe

Them Out!
 CONTROLING RATS
• Traps and Bait Stations – Wipe
Them Out!
 CONTROLING RATS

• Traps and Bait Stations – Wipe

Them Out!
Questions?
FEDERAL AGENCY
PANEL
 BRIDGET COYLE
ASSOCIATE DIRECTOR, U.S. EPA
REGION 9 – COMMUNITIES
BRANCH, LAND DIVISION
 U.S. EPA, REGION 9
VECTOR-BORNE
DISEASE
WORKSHOP
LAND DIVISION
Communities Branch & Pollution Prevention
Branch
Bridget Coyle, Associate Director, Communities Branch
 WHAT ROLE DOES YOUR AGENCY
PLAY IN VECTOR
• General Assistance Program CONTROL?
• Pesticides Program
• Education an d Outreach • Education a n d Outreach
• Illegal Dump Clean-Up a n d • Technical Assistance
Closure • Pesticide Safety
• Development of • Integrated Pesticide
planning documents Management Plans
• Zero Waste Program • Toxics Program
• Technical assistance a n d • Children’s Health Program
support to tribes on solid waste • Environmental Education –
planning and cleanup a n d Healthy Schools
closure of dumps • U.S. Mexico Border Program
• Environmental Health
Education
• RFP in Spring 2017
 CURRENT EPA EFFORTS:
• Tribal Program • Pesticides Program
• Vector-Borne Disease • Technical assistance to tribes
Workshop August 8, 2016 • Applicator certification
• General Assistance Program
• U.S. Mexico Border Program
~
$700K in FY2017 Funding for: • Environmental Health Symposia
• Development and planning • September 27 in Mexicali, Baja
for Vector Management CA
Programs • October 14 in Nogales, Sonora
• Clean-up and Closure of
Illegal Dump to lower risk of
VBDs
• Zero Waste Program
• Technical Assistance on
Open Dump Closure Forms
and implementation
• Technical Assistance on
Integrated Solid Waste
 DO YOU HAVE ANY ADVICE
FOR
• Become Informed
• Attend trainings
TRIBES ON THIS TOPIC?
• Participate in informational conference calls/webinars
• Connect with your neighboring jurisdictions’ vector and public health
programs and find out what they are doing to prepare (consider borrowing
from their texts!)
• Make a Plan
• Pest Management Plan
• Vector-Borne Disease Plan
• Solid Waste Management Plan
• Inform your communities
• Outreach to general population, elders, schools, neighboring jurisdictions
• Practice
• Hold a tabletop exercise with all of your partners – refine and repeat as
needed!
QUESTIONS
?
 JOSEPH LACO
CENTERS FOR DISEASES CONTROL
(CDC)
 U.S. EPA, REGION 9
VECTOR-BORNE
DISEASE
Centers forWORKSHOP
Disease Control and
Prevention National Center for
Environmental Health Environmental Health
Service Branch
CDR Joe Laco, Env Health Scientist
August 8, 2016
 WHAT ROLE DOES YOUR AGENCY
PLAY IN VECTOR
CONTROL?
Outbreak and Emergency Response Support
• NCEZID • Laboratory
• Division of Vector-Borne Diseases • Biological
• Arboviral Disease Branch • Chemical
• Bacterial Diseases Branch • Toxicology
• Dengue Branch
• Rickettsial Zoonoses Branch • NCEH
• Epidemiology
• Technical Support
• Environmental Health Expertise
• CDC Emergency Operation • Medical Toxicology
Center
• Response Logistics and Resources • Partnerships
• SMEs • Tribal Nations, IHS,
NAACHO, ASTHO, EPA,
NEHA
 ARE YOU CURRENTLY WORKING
WITH TRIBES ON THIS
Outbreak and Emergency Response TOPIC?
Support
• NCEZID • NCEH
• RMFS • Technical Assistance
• CHIK • IPM Training
• Dengue • 3-Day Course
• AZ, OK, AK

• Offi ce of State, Tribal, Local

and Territorial Support • ATSDR
• Project Funding and • Tribal Environmental Initiatives
Research

• CDC EOC
• Zika
 WHAT RESOURCES ARE AVAILABLE?
CDC NCEH
• www.cdc.gov • Environmental Health
• CDC A-Z Index Services Branch
• Communication Tools • EH Workforce
• Materials for: Development/Traini
• Providers ng
• Parents • VCEHP Online
• Churches Course
• Daycares • Prevention Tools
• Housing/Lodging • IPM
• Infographics and Posters
• Technical Support
• Information, Education,
and Guidance
Articles, Links
• Needs/Gaps
• Disease and Vector Info
Identification
• PREVENTION
• NEHA
• Tools/Resources/
Training
 DO YOU HAVE ANY ADVICE
FOR
Understanding Vectors TRIBESand
Education ON THIS TOPIC?
Outreach
• Biology an d Ecology • Community Members
• What/When/Where • Schools
• Complete Life Cycles • Healthcare Providers
• Vector
Identification • Communication Tools

• Monitoring an d • Prevent Exposures

Surveillance • IPM
• What is Truly • Break the Cycle (Life Cycle)
There?
• What Are the
True Risks?
QUESTIONS
?
CAPTAIN KENNY HICKS
AND VINCENT
GARCIA
PHOENIX AREA INDIAN HEALTH
SERVICES
 U.S Department of Health & Human Services
Phoenix Area Indian Health Service
Office of Environmental Health & Engineering

U.S. EPA, Region 9 Vector-borne Disease Workshop

Division of Environmental Health Services

CAPT Kenny Hicks, Director, Division of Environmental Health Services
CDR Vincent Slayton-Garcia, District Environmental Health Officer, Western AZ
District
WHAT ROLE DOES YOUR AGENCY PLAY IN
VECTOR CONTROL?
Public Health Advisor
• Facilitator
• Field Support
• Risk
Communication
• Health Education
• Resource
Manager
ARE YOU CURRENTLY WORKING WITH TRIBES
ON THIS TOPIC?
• Arbovirus Surveillance
• Mosquito testing (WNV, SLE, Dengue, Chik,
Zika)
• Cross-training
• Capacity Building
• Workforce development
• Partnership building
• Disease Monitoring
• Statewide health alerts
• Healthcare facility notifications
• Public Health Outreach
• Community presentations
• Fact sheets a n d flyers
• Press releases a n d PSAs
WHAT RESOURCES ARE
AVAILABLE?
• Internal
• Funding for field testing
• Personnel
• Projects (emergency funding)
• External
• Federal, State, County, non-Gov Orgs a n d Tribal
partners
• CDC, HUD
• ADHS
• County Health Departments
• Tribal Environmental Protection Offi ces
• Universities
• Bayer Corp.
DO YOU HAVE ANY ADVICE FOR TRIBES ON
THIS TOPIC?
•Stay informed
•Be involved
•Identify partners
•Maintain existing partnerships
•Anticipate challenges (sustainability)
Questions
?
 IHS DEHS
12300 Twinbrook Parkway, Ste. 610 Rockville, MD
20852
301-443-1054 http://ww.dehs.ihs.gov
Aberdeen Area/DEHS Billings Area/OEHE Oklahoma City
115 4th Avenue 2900 4th Avenue Area/DEHS 701 Market
S.E. Aberdeen, SD North Billings, MT Drive Oklahoma City, OK
57401 59101 73114 Ph. (405) 951
Ph. (605) 226 7597 Ph. (406) 247 7098 3852
Alaska Area/OEHE California Area/DEHS Phoenix
4141 Ambassador 650 Capitol Mall Area/DEHS 40
Drive Suite 7 100 North Central Ave
Suite 300 Sacramento, CA Suite 720
Anchorage, AK 99508 95814 Phoenix, AZ 85004
Ph. (907) 729 3501 Ph. (916) 930 3945, Ph. (602) 364 5078
Albuquerque ext.Area/DEHS
Nashville 336
Area/DEHS 5300 711 Stewarts Ferry Portland Area/DEHS
Homestead Rd, N.E. Pike Nashville, TN 1414 NW Northrup
Albuquerque, NM 87110 37214 St Suite 800
Ph. (505) 248 4947 Ph. (615) 467 1622 Portland, OR 97209
Ph. (503) 414 7774
Bemidji Area/EHSS Navajo Area/DEHS Tucson Area/EHSB
522 Minnesota Ave, P.O. Box 9020 7900 South J Stock
N.W. Window Rock, AZ Road Tucson, AZ 85746
Bemidji, MN 86515 Ph. (928) 871 7012
56601 5807 Ph. (520) 295
Ph. (218) 444 5629
0503
EPI CASE STUDIES
& BEST
PRACTICES
Paul Mesa, Tohono O’odham Nation, Naomi Drexler,
CDC, Captain Kenny Hicks & Vincent Garcia, IHS, Dr.
Kerry Padgett
RMSF Rodeo: Field Trials and
Lessons Learned

Naomi Drexler, MPH

Rickettsial Zoonoses Branch
Centers for Disease Control
and Prevention
National Center for Emerging and Zoonotic Infectious Diseases
Division of Vector-Borne Diseases
 Rocky Mountain spotted fever
 Rickettsia rickettsii:
tickborne bacterium
 Causes widespread
vascular damage and
multi-system organ failure
 Rapidly fatal, yet difficult
to diagnose
 RMSF in Arizona
 Epidemic RMSF: Incidence
approximately 150 times the
national average
 High mortality, especially
among children < 10 years
 Cases occur year-round
 Spread by Rhipicephalus
sanguineus (brown dog tick)
 Rhipicephalus sanguineus
 Global distribution
 Feeds and breeds on dogs
 Lives in and around home
 R. rickettsii infected brown dog
ticks documented
• Mexico (1940s)
• Southwestern USA (2003)
 High rates of human exposure
• Children are particularly
vulnerable
The San Carlos Situation

 Total population
~10,000 persons
 97 cases and 10
deaths in 8 years
 10.3% case- fatality
rate
 The San Carlos Situation, cont.
 The project area
• 600 households
• Estimated 1,000 dogs
(66% free-roaming)
• 2 deaths in Spring,
2012
• No permanent vet
services
• Animal control
recently established
• Motivated community
 The RMSF Rodeo: 2012-2013
 Goal: Improve human health
by improving the health
of dogs
 PHASE I: control
• Monthly yard treatments
• Long-lasting tick collars
on all dogs
 PHASE II: sustainability
• Prove tick control
can be maintained with
collars alone
 The RMSF Rodeo Plan: Properly
Timed Pesticide Treatments
May June

Once a Summer

Once a Summer
July August
 Yard Treatment
 Bayer Ready To Spray Product
• Beta cyfluthrin spray
 3 Gallon Sprayers
• Spray around the house
• Spray dog areas
 ATVs
 The RMSF Rodeo Plan: Improve Dog
Health
 Place a long-acting tick collar
on every dog in a community
 Encourage spay/neuter for
population control
 Identify and remove strays Water
 Improved care and ownership
• Tag, collar Food
• Restrain pets (via fence or Shade
tether)
 Long-acting Tick Collars
 Seresto ®
• 4.5% Flumethrin, 10% imidacloprid
• Visible marker of treatment
• 8 months of efficacy
 Other tick control products may be
used
• Consider how often they need
to be reapplied
RMSF Rodeo Results: Tick Counts on
Dogs
Expected level of ticks without intervention
60%

Dogs with ticks 50%

40%

30%

20%

10%

0%

Phase I Phase II
 RMSF Rodeo Results:
Environmental Burden

1400
Number of ticks observed 1200
1000
800
600
400
200
0
May 2012 June 2012 July 2012 Early Late March May 2013
August August 2013
2012 2012
Adults Nymphs Larv
ae
 RMSF Rodeo Results: Human
Incidence of Rickettsia rickettsii
1.40
1.24 1.24
Human incidence
decreased 40%
Average cases per 1000 persons
1.20

1.00 0.90
0.80 0.71
0.60

0.40

0.20

0.00
Before start of RMSF Rodeo After start of RMSF Rodeo
Non-Rodeo Rodeo
Includes surveillance data 2 years prior to start of RMSF Rodeo, and 2 years after
RMSF Rodeo Partners
 Keys to Effective RMSF Control
 Controlling Ticks: Treat dogs with tick collars, and
yards with routinely applied pesticides
 Maintaining Low Levels of Ticks: Once ticks are
controlled, maintaining low tick levels with collars
alone. Monitor levels and apply pesticide if needed.
 Improving Pet Health: Introduce regular
spay/neuter programs, encourage pet restraint, and
identify and remove strays
 Establishing Programs: Hire staff, purchase
permanent equipment
 Other Tribal RMSF Prevention Efforts
 Tohono O’odham Nation
 Hopi Tribe
 Gila River Indian Community
 Many more…
 Things to Consider
 Scope of intervention needed
• Total population or targeted approach?
 Current resources
• Personnel
• Animal control
• Monetary
 Product selection
• Over the counter or restricted use?
• Water quality or agricultural restrictions?
• Period of efficacy
• Cost
 Documenting progress
 Addressing Sustainability
 Affected tribes working to implement prevention
programs based on lessons learned in RMSF Rodeo
 IHS emergency funds awarded to Arizona tribes for
RMSF prevention
 Other public and private grants available

 The big question: how can long-term vector control

programs be funded and managed?
Progress in the Battle Against RMSF on Tribal
Lands
 Arizona tribes are at various stages of implementing
RMSF prevention plans and programs
 Increased awareness and prevention programs have
led to:
• Formation of interdisciplinary RMSF coalitions
• Nearly 80% reduction in cases since the peak of
the epidemic
• Zero deaths since 2013!
 One Health: The Way Forward for
RMSF Prevention
 RMSF is preventable,
treatable, and fixable
 Partnerships between
healthcare providers, health
departments, environmental
health officers, veterinarians,
and community members
needed to prevent RMSF
 For questions
please contact

Naomi Drexler
[email protected]

Rickettsial Zoonoses Branch

Division of Vector-Borne
Diseases, CDC
The findings and conclusions in this report are those of the authors and do not necessarily represent the
official position of the Centers for Disease Control and Prevention

Reference to specific commercial products, manufacturers, companies, or trademarks do not constitute

its endorsement or recommendation by the U.S. Government, HHS, or Centers for Disease Control and
Prevention.
 Estimated 5 Year Control Costs,
Arizona Estimated
Estimated Outside
Estimated Tribal
Tribe number of Funding
Funding
Households
Reservation 1 3,0 $1,768,415 $600,000
00 $600,000
Reservation 2 $1,430,915
2,0 $600,000
Reservation 4 $1,768,415
00
Reservation 5 $1,430,915 $600,000
3,0
Reservation 6 00 $16,752,115 $1,200,000
Reservation 3 2,0 $1,768,415 $600,000
00

State RMSF surveillance and46,0

00 $375,000
education (for 5 years)
3,0 $4,200,000
SUBTOTAL $25,294,190
00
 RMSF in Mexico
 Mid-1940s: Sinaloa, Sonora,
Durango, and Coahuila
 Case-fatality rates as high
as 80%
 Re-emergence of disease in early
2000s particularly states
bordering the USA
 Cases occur in impoverished
communities with free-roaming
dogs
Different country, same ecology
 RMSF Prevention in Sonora
 2016 pilot project in highly affected community
 40% deaths from 2010-2014 occurred within 10
block radius
 Modelled after RMSF Rodeo in San Carlos
 Seresto collars
 Routine pesticide
 Education
 500 household community, 600 dogs
VECTOR
CONTROL
Pest Management & Pesticide Safety

Fabiola Estrada
Patti TenBrook
Land Division
US EPA R9
 Overview
Integrated Pest Management
(IPM)

Pesticides and

Safety IPM and

Vector Control EPA’s

Response to Zika

Resources
 What is IPM?
Low
Commo Better impact
Long-
n- understandi on
term ng
human
sense
solution of pests health &
strateg
s the
y
environme
nt
 Identif
y
Pest
Monitor
Assess and
the Effect Assess
of Pest Numbers
Manageme and
nt Damage
IPM
Practice
s and
Principle
s Guidelines
Pest
Manageme for
nt Manageme
nt Action
tools

Preventi
on of
Pest
Problems

Adapted from the UC IPM Statewide Program

Integrated Pest Management

Interventi
on

Preventio
n EDUCATION/SANITATION
What is a Pesticide?

A pesticide is any
substance "intended
for preventing,
destroying, repelling,
or mitigating any
pest....”
Pesticide Safety
Pesticide
Use
 Pesticide Risk
Aging Compromis
Population ed
Immune
s Systems

Exposure Toxicity

RIS
K
Pregnan
Childre
t
Wome n
n 17
1
 IPM
for
Ve c t o r s

P
hysical
Public Information and Education
Protect Yourself and Others
• Long Sleeves/Pants
• EPA-registered Repellents
• Window/Door Screens, Nets, A/C

• Media
campaign/coverage.
• Participation in
community events.
• A comprehensive
school program
 Mosquito Vector Surveillance
Collect and analyze data on
abundance mosquito populations.

Monitor distribution patterns of

mosquito species.

Determine risk periods of public

exposure to mosquito-borne
diseases.

Evaluate mosquito control

activities.
Physical Control: Guidelines to Eliminate
Mosquito Development Sites

For managed wetlands,

stormwater and wastewater
systems, swimming pools,
cemeteries, and tire storage
facilities.

Prevent or eliminate standing

water, even very small
containers.

Minimize emergent
vegetation and surface debris
on the water.
 Biological
Gambusia affinis (Mosquito
fish)
Microbial and Chemical

Larvicide Bacillus thuringiensis

s (Bt)

Adulticid
es
 Know Your Pest

Aedes Tipula Culex

Species genus Species
Zika,
Chikungunya, Not a West
Yellow Fever, Vector Nile
Dengue

Daytime Nighttime
biters biters

Tropics/Southern Throughout
US US
 Know Your Pest

Aedes Culex
aegypti tarsalis

Aedes Culex
albopictus pipiens
EPA’s Role in Zika
Response
Provide Pest Tire/Trash Cleanup
Management Tools

Suppo
rt Registered
Products
Factsheets

Insect
Repellent
Search Tool
https://www.epa.gov/insect-repellents/find-insect-repellent-right-
you#search tool
Repellency Awareness Graphic
 RESOURCES
Centers for Disease Control
http://www.cdc.gov/zika/prevention/inde
x.html

EPA Fact Sheets for Mosquito

Control
https://www.epa.gov/mosquitoc
ontrol

California Vector Control Districts

Sacramento-Yolo Mosquito and Vector Control
District: http://www.fightthebite.net/integrated-
pest-management/

Orange County Mosquito and Vector Control

District
http://www.ocvcd.org/InvasiveMosquitoes.p
hp

San Joaquin County Mosquito and Vector Control

District:
 RESOURCES
State Contacts for Mosquito/Vector
Control
http://npic.orst.edu/vecmlr.html

School IPM Webinars

https://www.epa.gov/managing-pests-
schools/webinars-about- integrated-pest-management-
schools

National Pesticide Information

Center http://npic.orst.edu

University of California Statewide IPM

Program http://ipm.ucanr.edu/

The University of Arizona Urban IPM– Arizona Cooperative

Extension http://ag.arizona.edu/urbanipm/
 Fabiola Estrada, MS
Project Officer
R9 School IPM Coordinator
[email protected]
(415) 972-3493

Patti L. TenBrook, Ph.D.

Manager, Pesticides Section
Land Division, U.S. EPA Region 9
[email protected]
415-947-4223
SOLID WASTE
AND
VECTORS
SOLID WASTE
AND
VECTORS
Tribal solid waste management tools to address
vector issues Deirdre Nurre & Sebastian Beshk
Region 9 Zero Waste Section – Tribal Solid Waste
Team
This session will
cover:
• How to complete an updated Open Dump Survey
Form
• How to provide a plan for outreach and education
around a cleanup event to cover vector-borne
disease and prevention of future dumping
• How to provide a budget for cleanup by site which
may include both cleanup costs and prevention-
related costs
1. COMPLETING
OPEN DUMP
SURVEY FORMS
-- and how to include vector-borne
disease analysis
How are survey forms
used?
• Developing site universe information
• SDS and OMDS Lists
• Site-specific review by EPA HQ for GAP
funding
Open Dump Survey
Form
Open Dump Survey: Estimate
Site Size
HQ Area of a football
approach field…?
Find
latitude/longitude
• What do you want to find? If you know roughly where your dump
is, use Google Earth to find the site.
• Zero in on tribe location, then use roads and natural features to
find where you want to be.
• Example: an unauthorized landfill site
Use the pushpin in the tool bar
to set a location, then ---
-- in lower right hand screen
you find latitude & longitude
Use the polygon function in the
toolbar to draw the area around
the site – the finished shaped will
calculate the area for you (next
slide)
More uses for
GoogleEarth
• Allows you to send photos of your site along with your site
descriptions
• Allows you to go ‘back in time’ and view earlier photos of your
site to show how site may have changed (although photos are
updated with different frequency depending upon your area)
Open Dump Survey: Methods to
Estimate Site Volume
• Provide information in cubic yards
• A cubic yard can be estimated
• What about the volume of material you’re dealing with? Various
online resources can help you estimate a number.
Resources available to estimate
volume based on truck bed size:
Another tool
to estimate
volume of
dump
Online Cubic Yard Calculator
from
http://www.todayshomeowne
r.com
/cubic-yard-calculator/
Hazard
Factors
Pretty self-explanatory
Site
Drainage &
Leachate
Potential
What are the risks to
groundwater/surface
water?
Other
Factors
Other
Factors
General Description of your site:
example
A Community member was allowing two non-Community
members to dump pal fr nd household waste on his home site.
On Tuesday, February 23, 2016, the
Police Department seized the truck and trailer belonging
to the waste
dumper. The p s waste was illegally burned by the dumper
and Community member shortly after the truck and trailer were
seized. The waste dumper has not been caught but likely will not
return to the site, thus leaving a pile of solid waste approximately
60 feet long and 8 feet high. The piled waste is a risk to human
health and the environment, and may become a fire hazard as
summer weather approaches. Community members have
complained about the waste pile and have expressed concerns of
associated hazards. The site is on Palm Lane between St p ly
dH e, north of McD ll Rd
Example Site description:
‘Backforty dumping area’
The Backforty dumping area are mounds of discarded materials
approximately 7 feet high at the highest point, and a 25’ x 10’ trenched
area containing burnt debris where garbage has been burned in the past.
There are 4 residences in the area immediately around the site, the closest
being 0.6 miles from the northeastern end of the Wash. The Backforty
Dump is no longer used since an open top bin was made available in the
town of Appaloosa in January of 1995. Household solid waste is accepted
there for a fee. Because of the fee and the fact that there is no convenient
alternative disposal for special wastes such as tires and white goods,
casual disposal at Backforty Dumping Area still occurs from time to time.
There are seven discrete waste disposal areas within the Backforty
Dumping Area. They extend for approximately 1.5 miles along the length
of Water Wash. The average width of the disposal areas is 50 feet and the
average depth is 20 feet. There are no wells or other water sources within
one mile, however, this area has the potential to become a watercourse
after heavy rains. There is no sewage sludge or industrial waste at any of
the disposal areas. See attached table for the area, volume of waste,
distribution, and type of waste present for each disposal area. See also
attached site photos.
Helpful Descriptive
Elements
•Describe features of surrounding land: near arroyo, wash, canyon, intermittent
stream or riverbed, pond, or lake? On or near hillside or hilltop? Distance
from the site to these nearby features?
• Take pictures from each of the four sides of the site showing surrounding
topography. Do any of the surrounding surface features show signs of
wastes being wind blown or washed down from the disposal site?
• Identify and take pictures of any stressed vegetation near or down gradient
from the site (possible sign of contamination). Identify and take pictures of any
areas of stained soils (e.g., soils stained by used oil dumping, etc.).
• Characterize and describe any potential hazards or problems relating to clean
up/removal in the vicinity of the site. Look for such things as water lines, gas
lines, power lines, and accesses to the site. Will temporary roads need to be
constructed to allow access for necessary equipment? What is the
destination of excavated wastes and will they need to be hauled out through, or
near residential areas?
Attach Vector-Borne risk
assessment as a helpful
descriptive element --
OUTREAC
H+
PREVENTI
Region 9 - Tribal Solid Waste
Team: Deirdre Nurre

ON Sebastian
Beshk Jenny
Stephenson
Shannon Davis
Causes of Illegal
Dumping
• Convenience

• Cost
• Lack of Information
• Past Practice (i.e. routine)
• No Solid Waste Plan or
infrastructure
• No codes nor enforcement
Developing a prevention +
enforcement program

Communi Develo
Understa
ty p
nd Support Strate
gy
Step 1: Understand the
problem
• Tools:
• Some tribes have
Door-to-door survey used their
• Hold a community Environmental staff
gathering to conduct surveys
• Survey the dumpsites to their local
community.
One tribe found that
people were using
the illegal dumpsites
because they did not
know it was unsafe
and illegal!
Step 2: Gain Tribal + Community
Support
• Tools:
• Maps
• Pictures
• Press coverage
• Tours
• Explanation of
cost
Step 3: Choose your
strategy
We’ll cover more on this topic in the following
slides, but keep in mind how the selected
strategy/strategies…
• Reflects the values and goals of the tribe
• Provides for tribal control and sovereignty
• Involves tribal government and community members
• Builds on local knowledge, experience and expertise
• Allows for continuous feedback including a complaint mechanism
(!)
• Is feasible
NON-
ENFORCEME
NT
What you can
MEASURES
do…
Overvie
w
• • Barriers
Community Outreach
and Education • Hotlines
• Cleanup
• Rewards
• Dump Tracking • Monitoringand
• Posting Signs Surveillance
• Lighting Cameras
 Community Outreach +
Education
Outreach and education
may include:
• Press releases
• Publicity photographs
• Outreach materials
• Public hotline
• Presentations
• Cleanup days

For more information and tips on starting

a tribal outreach/education program, see
CDC
Materia
ls
Clean up + Dump
tracking
• There are many considerations to
be taken before a site clean up Pinoleville Tribe
can occur, see: converted a former
• Technical Advice for Cleanup of dumpsite into a
Accumulated Waste Sites on Tribal native garden. By
Lands (2008) beautifying the former
dumpsite, the tribe is
• simultaneously
Data collection should include, at reducing the
least, the following: likelihood that waste
• Location will again be left on
• Size & Contents
the site and creating
• Responsible party (if known) a special place on
• Enforcement actions taken their tribal land for
• Resources expended tribal members to
experience nature!
Supplemen
tal
Language
Tribes can request
for funds to host a
community clean-up
or to clean up an
open dumpsite, BUT
tribes must follow
the procedures
outlined in this
presentation to
clean up open
dumps
Signs + Lights +
Barriers
Hotlines +
Rewards
Example of a
tribal illegal
dumping
prevention
billboard
offering a
reward
 Monitori
ng
Monitoring can
include:
• surveillance
cameras
• motion sensing
• beepers
• patrolling by
environmental
rangers or
police.
ENFORCEME
NT
MEASURE
What you can
S
do…
Understa Impleme
nd the nt
problem

Choose Measur
your e
approac
h

Outreach Gain Tribal Reasse

+ gov’t + ss
educatio community Progra
n support m
Overvie
w
• Illegal Dumping
Codes
• Penalties
• Enforcement Body
• Judicial Body

• Strategy
for
Enforcement
• Resources
Illegal Dumping
Codes
Components to Illegal
Dumping Codes Tribes have
• Dumping Code Purpose extensive
• Dumping Definition authority to
create illegal
• Dumping Sanctions dumping
• Dumping Enforcement Responsibility codes!
• Dumping Adjudicative Responsibility
Sample Language-
Hopi
Purpose Definition
“2.1. The open dumping and open “6.1. It shall be unlawful for
burning of solid wastes shows any person … to dump,
disrespect for the natural scatter, or place, or cause to
resources of the Reservation, and be dumped, scattered or
for the Reservation community; it placed any solid waste
causes irreparable damage to the
material, hazardous or
land and the environment; it is a
not . . . .”
threat to the health and safety of
Hopland residents.”
Sample Language-
Hopi
Sanctions Common Sanctions
“9.1. Any person who violates any Include
• Fines
of the provisions of this Code is
subject to an assessment of civil • Legal action against
damages for such unlawful property owners
activities.... Any person who is • Property seizure and
found by the court to have vehicle
impoundment
committed the alleged violations
• Community service
shall be subject to … a civil
penalty in an amount up to • Court-ordered cleanup
$500.00 dollars for each day of and
GAP AND
VECTORS
 HOW TO USE THE
GENERAL ASSISTANCE PROGRAM

for Vector Control Planning and Capacity

Building, and Solid Waste
Implementation
 EPA’S ROLE USING GAP

• Planning and Developing

Programs
• Outreach and Education
• Capacity Building
• Implementing Solid Waste
Programs
HOW CAN THOSE BE TOOLS
FOR VECTOR BORNE DISEASE
MANAGEMENT?
 CAPACITY BUILDING

• Training
• How to write plans, and develop programs for Vector
Management
• Pesticides Management
• Integrated Waste Management
• Writing Ordinances
• And MORE!
 PLANNING AND
DEVELOPING PROGRAMS

• Planning
• Integrated Solid Waste Management
Plans
• Integrated Pesticide Management
Plans
• ETEPs
• Environmental Inventories
• Emergency Response Plans
 OUTREACH AND EDUCATION

• Methods for getting messages out to the

community
• Newsletters
• Public Service Announcements
• AND MORE!

• Conducting Outreach and Education

• Youth
• Elders
• Entire Community – Community Cleanup Events
SOLID WASTE IMPLEMENTATION

Do you know the four

implementation activities in
order of priority according to
the GAP Guidebook?
 SOLID WASTE
IMPLEMENTATION
ACTIVITIES

1. Program Administration
2. Compliance and Enforcement
3. Solid Waste Management, Resource
Recovery, and Resource Conservation
Support
4. Cleanup and Closure
 HOW CAN THAT HELP IN
VECTOR- BORNE DISEASE
MANAGEMENT?
• Program Administration
• Ensuring that the tribe has a Solid Waste Program in place to do all the
activities we will describe:

• Enforcement and Compliance

• Creating Ordinances or Enforcement Programs

• Resource Recovery
• Community Clean-Ups
• White Good Clean Ups
• Special Clean up Days for Elders
• Clean up of Tire Piles
 WHAT ABOUT CLEANUP AND CLOSURE?

• We can do cleanup and closure under GAP!

•There are some steps we need to follow AND

we need approval from AIEO.
 REVIEW HQS APPROVAL FORM FOR
SOLID WASTE CLEAN-UP &
CLOSURE
 ACTIVITY

Match your Capacity Indicators

with Associated Workplan
Activities
QUESTIONS?
Thank you for joining
us!!!