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In this episode of ClackCo Works, Dr. Sarah Present, Clackamas County’s health officer, gives listeners a behind-the-scenes look at how her team protects the community from infectious diseases. She shares real stories about tracking illnesses like measles and tuberculosis, and describes how quick teamwork stopped a hepatitis A outbreak before it spread. Dr. Present highlights the importance of prevention, education, and strong partnerships in keeping people safe. This episode offers a fresh perspective on the dedicated professionals working every day to keep Clackamas County healthy. Tune in to discover how their compassion and expertise make a real difference.
Transcript
Dylan: Welcome to ClackCo Works. Today, we're joined by Dr. Sarah Present, the Clackamas County Health Officer and a family physician. Thank you for being here, Sarah.
Sarah: Thank you for having me.
Dylan: Besides being a practicing doctor, you're very involved in the county's Infectious Disease Control and Prevention program. Can you tell us a little about what that program does?
Sarah: Absolutely. As the health officer, my statutory role is to provide medical and clinical advice to the local public health director on all aspects of public health work. The Infectious Disease Control and Prevention program is where I spend most of my time. We take reports of reportable diseases, investigate them, and work to prevent their spread. There are about 20 to 30 diseases that are reportable to public health by law in Oregon. Our team collects reports of these diseases in Clackamas County residents every day and responds in various ways.
Dylan: Do all counties in Oregon have something similar, like a state statute requiring this?
Sarah: Yes. There's a large list reportable to the CDC at the federal level, but each state has some variability. For example, chickenpox is not reportable in Oregon, but it is in Washington. We still help protect against outbreaks or potential spreads in schools.
Dylan: On the Clackamas County website, some of the diseases listed are measles, whooping cough, bird flu, and pox. What are we most concerned about in Clackamas County, or does it vary?
Sarah: It does vary. What’s most visible on our website are the things of concern right now. We've had increases in measles and other outbreaks that make the news. But there are also diseases we prevent every day that you don’t hear about. We separate our work into three major categories: the tuberculosis team, the sexually transmitted infections team, and the general communicable disease team, which includes enteric diseases like salmonella, shigella, and E. coli. We investigate these to make sure, for example, that a restaurant isn’t serving contaminated food.
Dylan: Are those diseases spread from person to person, or mainly from a localized source like food?
Sarah: Usually, a person spreads it into the food, and then someone else gets it by eating that food. We also have respiratory diseases like measles and tuberculosis, and we work with long-term care facilities during outbreaks. We also follow up on animal bites because of the risk of rabies.
Dylan: Is there one type you see more frequently with outbreaks—STDs, E. coli, or airborne diseases?
Sarah: It's pretty seasonal. Animal encounters are more common in summer, especially with bats. Respiratory diseases are more common in fall and winter when people are indoors. Enteric diseases also tend to be more in the summer, when people have picnics and food sits out. Some diseases are consistent throughout the year.
Dylan: I’ve seen you and your team spring into action during emergencies. Can you walk us through the hepatitis A exposure in Sandy?
Sarah: That was early in my career, around 2014. Hepatitis A can be passed from a person to food to others and is pretty infectious. We found out about a case working at a movie theater concession stand. We assessed the risk and realized hundreds of people could have been exposed. We put out a media notification, partnered with a local clinic, and set up a vaccination clinic within two days. Post-exposure vaccination does a good job of preventing illness.
Dylan: As you mentioned earlier, the program focuses a lot on tuberculosis. Why is that?
Sarah: Many diseases we work with are ones people think don’t exist anymore because we do a good job preventing them. Tuberculosis was prominent in the US until the 1950s. It’s still common worldwide and is the leading cause of death from any single infectious agent globally. It usually infects the lungs and can be spread through coughing, but it can also affect other parts of the body. Most people infected have a strong immune response that walls it off, called latent tuberculosis. About a quarter of the world is infected, but much less in the US—about 3%. Of those, 5 to 10% will have it activate at some point in their life. Both latent and active TB are treatable with antibiotics.
Dylan: How is TB treatment managed?
Sarah: TB is reported to public health. It’s a slow-growing bacteria with resistance potential, so treatment is 6 to 12 months of antibiotics, often starting with four different types. Our TB team watches patients take their medicine every day, now mostly through a special app or video. This direct observed therapy is why TB rates are low in the US. It also builds relationships with patients, helps with contact investigations, and ensures people get support if they need to be out of work.
Dylan: Are TB patients generally isolated?
Sarah: In the first couple of weeks, yes, especially if they have active pulmonary TB. But antibiotics quickly reduce the risk of spread.
Dylan: How many TB patients are there each year in Clackamas County?
Sarah: It varies, but usually around 5 to 10 per year.
Dylan: What do you wish Clackamas County residents knew about the Infectious Disease Control and Prevention program?
Sarah: I wish people knew how amazing this team is at working with individuals every day to keep outbreaks and infections out of the news. They do so much to help people manage rare diseases and protect the community, often without recognition because prevention means you don’t hear about it.
Dylan: Dr. Sarah Present is the county health officer and a family physician. Thanks for joining us and for everything you do for the community.
Sarah: Thank you.