Category Archives: Missouri

Kansas | Respiratory illnesses due to Enterovirus D68 in Kansas City MO

A pediatric hospital in Kansas City, MO, has experienced more than 300 cases of respiratory illnesses in its facility, according to the Missouri Department of Health and Senior Services.

Approximately 15 percent of those illnesses have resulted in children being placed in an intensive care unit. Testing of specimens from several cases at a specialized laboratory at the Centers for Disease Control and Prevention indicated that 19 of the 22 specimens were positive for Enterovirus D68 (EV-D68).

The St. Louis area is also experiencing a recent increase in pediatric respiratory illnesses. Many specimens from those cases have tested positive for enterovirus, and further testing for specific virus type is pending. To date, no deaths have been reported due to EV-D68 in Missouri. Other Midwestern states also are reporting an increase in respiratory illnesses.

The Lawrence-Douglas County Health Department is unaware of any cases in Douglas County. Kim Ens, director of Clinic Services, said, “Parents should contact a health care provider immediately if their child has cold-like symptoms and experiences difficulty with breathing.”

Information about Enterovirus D68:

Enteroviruses

• Enteroviruses are very common viruses; there are more than 100 types.

• It is estimated that 10 to 15 million enterovirus infections occur in the United States each year.

• Enteroviruses can cause respiratory illness, febrile rash, and neurologic illnesses, such as aseptic meningitis (swelling of the tissue covering the brain and spinal cord) and encephalitis (swelling of the brain).

• Most infected people have no symptoms or only mild symptoms, but some infections can be serious.

• Infants, children, and teenagers are most likely to get infected with enteroviruses and become sick.

• Most enterovirus infections in the United States occur seasonally during the summer and fall.

Enterovirus D68

• Enterovirus D68 infections are thought to occur less commonly than infections with other enteroviruses.

• EV-D68 was first identified in California in 1962. Compared with other enteroviruses, EV-D68 has been rarely reported in the United States.

Symptoms

• EV-D68 has been reported to cause mild to severe respiratory illness. However, the full spectrum of EV-D68 illness is not well-defined.

Transmission

• EV-D68 is not frequently identified, so it is less studied and the ways it spreads are not as well-understood as other enteroviruses. EV-D68 causes respiratory illness, and the virus can be found in respiratory secretions such as saliva, nasal mucus, or sputum. The virus likely spreads from person to person when an infected person coughs, sneezes, or touches surfaces.

Treatment

• There is no specific treatment for EV-D68 infections.

—  Many infections will be mild and self-limited, requiring only treatment of the symptoms.
—  Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy.

• No antiviral medications are currently available for treating of EV-D68 infections.

Prevention

• There are no vaccines for preventing EV-D68 infections.

• You can help protect yourself from respiratory illnesses by following these steps:

— Wash hands often with soap and water for 20 seconds, especially after changing diapers
— Avoid touching eyes, nose and mouth with unwashed hands
— Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
— Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick

USA | Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014

CDC – MMWR Vol 63. Early Release

Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014

September 8, 2014 / 63(Early Release);1-2

Claire M. Midgley, PhD1,2, Mary Anne Jackson, MD3, Rangaraj Selvarangan, PhD4, George Turabelidze, MD5, Emily Obringer, MD6, Daniel Johnson, MD6, B. Louise Giles, MD6, Ajanta Patel, MD6, Fredrick Echols, MD7, M. Steven Oberste, PhD2, W. Allan Nix2, John T. Watson, MD2, Susan I. Gerber, MD2 (Author affiliations at end of text)

On August 19, 2014, CDC was notified by Children’s Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5–19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children’s Hospital in Illinois of an increase in patients similar to those seen in Kansas City. To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68* (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing.

Of the 19 patients from Kansas City in whom EV-D68 was confirmed, 10 (53%) were male, and ages ranged from 6 weeks to 16 years (median = 4 years). Thirteen patients (68%) had a previous history of asthma or wheezing, and six patients (32%) had no underlying respiratory illness. All patients had difficulty breathing and hypoxemia, and four (21%) also had wheezing. Notably, only five patients (26%) were febrile. All patients were admitted to the pediatric intensive care unit, and four required bilevel positive airway pressure ventilation. Chest radiographs showed perihilar infiltrates, often with atelectasis. Neither chest radiographs nor blood cultures were consistent with bacterial coinfection.

Of the 11 patients from Chicago in whom EV-D68 was confirmed, nine patients were female, and ages ranged from 20 months to 15 years (median = 5 years). Eight patients (73%) had a previous history of asthma or wheezing. Notably, only two patients (18%) were febrile. Ten patients were admitted to the pediatric intensive care unit for respiratory distress; two required mechanical ventilation (one of whom also received extracorporeal membrane oxygenation), and two required bilevel positive airway pressure ventilation.

Enteroviruses are associated with various clinical symptoms, including mild respiratory illness, febrile rash illness, and neurologic illness, such as aseptic meningitis and encephalitis. EV-D68, however, primarily causes respiratory illness (1), although the full spectrum of disease remains unclear. EV-D68 is identified using molecular techniques at a limited number of laboratories in the United States. Enterovirus infections, including EV-D68, are not reportable, but laboratory detections of enterovirus and parechovirus types are reported voluntarily to the National Enterovirus Surveillance System, which is managed by CDC. Participating laboratories are encouraged to report monthly summaries of virus type, specimen type, and collection date.

Since the original isolation of EV-D68 in California in 1962 (2), EV-D68 has been reported rarely in the United States; the National Enterovirus Surveillance System received 79 EV-D68 reports during 2009–2013. Small clusters of EV-D68 associated with respiratory illness were reported in the United States during 2009–2010 (3).

There are no available vaccines or specific treatments for EV-D68, and clinical care is supportive. Health care providers should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness; suspected clusters or outbreaks should be reported to local or state health departments. CDC’s Picornavirus Laboratory (e-mail: wnix@cdc.gov) is available for assistance with diagnostic testing.

1Epidemic Intelligence Service, 2Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC; 3Infectious Disease Department, 4Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, Missouri; 5Missouri Department of Health and Senior Services; 6University of Chicago Medicine; 7Illinois Department of Public Health. (Corresponding author: Claire M. Midgley, cmidgley@cdc.gov)

References

Oberste MS, Maher K, Schnurr D, et al. Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses. J Gen Virol 2004;85:2577–84.

Schieble JH, Fox VL, Lennette EH. A probable new human picornavirus associated with respiratory disease. Am J Epidemiol 1967;85:297–310.

CDC. Clusters of acute respiratory illness associated with human enterovirus 68—Asia, Europe, and United States, 2008–2010. MMWR 2011;60:1301–4.

* Enterovirus and rhinovirus species names recently were revised to remove host names and to append the type number to the species designation; hence, human enterovirus 68 (HEV-68, also previously called EV68) is now EV-D68.

Alabama | State experiences significant H1N1 influenza activity this season

While the flu season is just getting started in much of the country, activity is already high in Alabama, along with Louisiana, Mississippi, Missouri, Oklahoma and Texas.

Reports from Alabama’s network of providers who report influenza-like illness and send influenza samples for testing to the Department of Public Health indicate the geographic spread of influenza in Alabama is widespread for the third week in a row.

Influenza type A, H1N1 (also known as 2009 H1N1, the pandemic strain, or pH1N1) has been the predominant strain circulating virus so far this season. One characteristic of pH1N1 is that, similar to the pandemic of 2009, young and middle-aged adults seem to have a greater chance of severe influenza.

Flu is a very contagious respiratory illness. Some of the symptoms of influenza can be fever, cough, sore throat, runny/stuffy nose, headache, muscle aches and extreme fatigue. Influenza can be a serious disease for anyone, even children, pregnant women and previously healthy young adults.

An annual influenza vaccination is recommended for everyone 6 months and older. The flu vaccine this year includes protection against H1N1. Flu vaccines are available as shots and nasal spray. Physicians, nurses and pharmacists can advise patients which type of flu vaccine is right for them.

In addition to taking the flu vaccine, other measures can reduce or prevent the spread of influenza. These include staying at home when sick, covering the mouth and nose with a tissue/cloth when coughing or sneezing, and washing hands or using hand sanitizer frequently.

Dr. Karen Landers, Assistant State Health Officer, said, “Even healthy people can get very sick from the flu and spread it to others. It’s not too late to get a flu shot to protect against this serious disease. People become protected about two weeks after receiving the vaccine.”

There are no reports of influenza vaccine shortages this season.

Contact your private provider, pharmacy or local county health department to receive an influenza vaccination. For more information contact the Immunization Division of the Alabama Department of Public Health at (334) 206-5023 or toll free at 800-469-4599.

USA | 317 people infected with seven outbreak strains of Salmonella Heidelberg

As of October 11, 2013, a total of 317 individuals infected with the outbreak strains of Salmonella Heidelberg have been reported from 20 states and Puerto Rico. Most of the ill persons (73%) have been reported from California.

Since the last update on October 8, 2013, a total of 39 additional ill persons have been identified from 9 states and Puerto Rico: Arizona (2), California (19), Florida (2), Kentucky (1), Missouri (5), Nevada (1), New Mexico (2), Puerto Rico (1), Texas (4), and Virginia (2).

Of the 39 additional ill persons, two have estimated illness onset dates after September 24, 2013, the last illness onset date reported in the October 8, 2013 outbreak announcement. Since the last update, one ill person originally reported from Hawaii was found to be a resident of Florida. This person is now included in the Florida case count.

Among 310 persons for whom information is available, illness onset dates range from March 1, 2013 to September 26, 2013. Ill persons range in age from less than 1 year to 93 years, with a median age of 20 years. Fifty-one percent of ill persons are male. Among 189 persons with available information, 79 (42%) reported being hospitalized. Thirteen percent of ill persons developed blood infections as a result of their illness. Typically, approximately 5% of persons ill with Salmonella infections develop blood infections. No deaths have been reported.

Illnesses that occurred after September 5, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks.

Investigation Update

To date, seven strains of Salmonella Heidelberg have been included in this investigation based on epidemiologic, laboratory and traceback information. The information collected for cases associated with each strain indicates that each of the strains is linked to this outbreak of multidrug-resistant Salmonella Heidelberg infections and that Foster Farms brand chicken is the likely source.

CDC’s NARMS laboratory conducted antibiotic-resistance testing on clinical isolates collected from ten ill persons infected with three of the seven outbreak strains. Nine of these isolates exhibited drug resistance to one or more commonly prescribed antibiotics. Of those, three were multidrug resistant. One isolate was susceptible to all antibiotics tested. To date, isolates collected from ill persons were resistant to combinations of the following antibiotics: ampicillin, chloramphenicol, gentamicin, kanamycin, streptomycin, sulfisoxazole, and tetracycline. Antimicrobial resistance may increase the risk of hospitalization or possible treatment failure in infected individuals.

On October 10, 2013, USDA-FSIS announced that Foster Farms submitted and implemented immediate substantive changes to their slaughter and processing to allow for continued operations. FSIS inspectors will verify that these changes are being implemented on a continuous and ongoing basis. Additionally, the agency will continue intensified sampling and testing of chicken products from these facilities for at least the next 90 days.

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview them about foods eaten before becoming ill. USDA-FSIS is continuing to work closely with CDC and state partners during this investigation.

Initial Announcement

October 8, 2013

CDC is collaborating with public health and agriculture officials in many states and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) to investigate a multistate outbreak of Salmonella Heidelberg infections. Public health investigators are using DNA “fingerprints” of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak. They are using data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections. Seven strains of Salmonella Heidelberg bacteria have been identified as being linked to this outbreak. Four of these strains are rarely reported to PulseNet. The other three strains are more common, with several ill persons infected with each strain reported to CDC monthly. The DNA fingerprints of the Salmonella Heidelberg bacteria associated with the current outbreak include the strain that was also associated with a multistate outbreak of Salmonella Heidelberg linked to Foster Farms brand chicken during 2012-2013.

As of October 7, 2013, a total of 278 individuals infected with the outbreak strains of Salmonella Heidelberg have been reported from 17 states. Most of the ill persons (77%) have been reported from California. The number of ill persons identified in each state is as follows: Alaska (2), Arkansas (1), Arizona (11), California (213), Colorado (4), Connecticut (1), Florida (1), Hawaii (1), Idaho (2), Michigan (2), North Carolina (1), Nevada (8), Oregon (8), Texas (5), Utah (2), Washington (15) and Wisconsin (1).

Among 274 persons for whom information is available, illness onset dates range from March 1 to September 24, 2013. Ill persons range in age from <1 year to 93 years, with a median age of 20 years. Fifty-one percent of ill persons are male. Among 183 persons with available information, 76 (42%) reported being hospitalized. No deaths have been reported.

The outbreak can be visually described with a chart showing the number of people who became ill each day or week. This chart is called an epi curve. Illnesses that occurred after September 1, 2013 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. For more details, please see Salmonella Outbreak Investigations: Timeline for Reporting Cases.

Investigation of the Outbreak

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies indicate that consumption of Foster Farms brand chicken is the likely source of this outbreak of Salmonella Heidelberg infections.

In interviews, ill persons answered questions about foods consumed and other exposures during the week before becoming ill. One hundred and five (80%) of 132 ill persons interviewed report consuming chicken prepared at home in the week before becoming ill. This proportion is significantly higher when compared with results from a survey of healthy persons Adobe PDF file [PDF - 29 pages] in which 65% reported consuming chicken prepared at home in the week before they were interviewed. Among those who had brand information available, 48 (79%) of 61 ill persons reported that they had consumed Foster Farms brand chicken or another brand likely produced by Foster Farms.

The National Antimicrobial Resistance Monitoring SystemExternal Web Site Icon (NARMS) retail meat surveillance program is an ongoing collaboration among the U.S. Food and Drug Administration’s Center for Veterinary Medicine, CDC, and participating state public health laboratories. NARMS monitors antibiotic resistance in Salmonella, Campylobacter, Enterococcus, and Escherichia coli bacteria isolated from raw retail meats. NARMS laboratorians isolated four of the seven outbreak strains from five retail samples of Foster Farms chicken breasts and wings collected in California. Four of these isolates exhibited drug resistance to one or more commonly prescribed antibiotics. Of these, two were multidrug resistant (defined as resistance to three or more classes of antibiotics). Not all isolates from poultry exhibited the same antibiotic-resistance pattern. To date, isolates collected from poultry were resistant to combinations of the following antibiotics: ampicillin, chloramphenicol, gentamicin, kanamycin, streptomycin, sulfisoxazole, and tetracycline.

Additionally, CDC’s NARMS laboratory conducted antibiotic-resistance testing on clinical isolates collected from five ill persons infected with two of the seven outbreak strains. Four of these isolates exhibited drug resistance to one or more commonly prescribed antibiotics. Of those, two were multidrug resistant. One isolate was susceptible to all antibiotics tested. To date, isolates collected from ill persons were resistant to combinations of the following antibiotics: ampicillin, chloramphenicol, gentamicin, kanamycin, streptomycin, sulfisoxazole, and tetracycline. Antimicrobial resistance may increase the risk of hospitalization or possible treatment failure in infected individuals.

Testing conducted by the Washington State Public Health Laboratories identified one of the outbreak strains of Salmonella Heidelberg in one leftover intact sample of raw Foster Farms chicken collected from an ill person’s home in Washington.

Preliminary laboratory testing identified four of the seven outbreak strains from multiple chicken product samples at three Foster Farms facilities; additional analysis is ongoing. USDA-FSIS has issued a Public Health AlertExternal Web Site Icon due to concerns that illnesses caused by strains of Salmonella Heidelberg are associated with raw chicken products produced by Foster Farms at three facilities in California. At this point in the investigation, FSIS is unable to link the illnesses to a specific product and a specific production period. The products were mainly distributed to retail outlets in California, Oregon and Washington State. Raw products from the facilities in question bear one of the establishment numbers inside a USDA mark of inspection or elsewhere on the package “P6137,” “P6137A,” and “P7632.”

CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill persons and to interview about foods eaten before becoming ill. USDA-FSIS is continuing to work closely with CDC and state partners during this investigation.

Missouri | Three confirmed cases of Cyclospora

The Missouri Department of Health and Senior Services was notified by a health provider in the Kansas City metro area of a case of Cyclospora. Previously, the department announced that health providers in Jackson County and Taney County reported two cases of Cyclospora.

This brings the total to three confirmed cases of Cyclospora in Missouri.

The Missouri Department of Health and Senior Services is currently working with the Centers for Disease Control (CDC) and other agencies to investigate whether or not these cases are linked to cases in other states.

At this point, the source of the illnesses has not been confirmed. The Missouri Department of Health and Senior Services will continue to provide information as it becomes available.

In the meantime, any individuals experiencing gastrointestinal symptoms, including diarrhea (especially, those with prolonged symptoms), severe stomach cramps, or nausea, should seek medical attention.

For more information about Cyclospora, visit the CDC website: http://www.cdc.gov/parasites/cyclosporiasis/outbreaks/investigation-2013.html.

Alabama | Health officials investigate foodborne outbreak in Sumter County

The Alabama Department of Public Health is investigating a foodborne outbreak that has affected at least 36 people who ate a meal around noon on July 6 served to persons attending a funeral at Eastern Star Baptist Church in York.

More than 100 people are reported to have attended this funeral.

Initial reports indicate that at least 30 have been hospitalized with some in serious condition. The ongoing investigation has involved hospitals in at least 9 states. These states currently include Alabama, California, Florida, Georgia, Illinois, Kansas, Michigan, Missouri and Oklahoma. Preliminary tests at the Alabama Bureau of Clinical Laboratories are positive for salmonella, and additional tests are pending.

ADPH’s investigation began July 8 after a report from a local hospital that 25 people had been seeking emergency room care late on July 6 and 7 with symptoms of fever, diarrhea, nausea and vomiting.

“If you attended this event and are ill, please contact your physician,” advised Dr. Mary McIntyre, Assistant State Health Officer for Disease Control and Prevention

Missouri | Gov. Nixon calls on General Assembly to reverse cuts to public safety and emergency response funding

During a speech before hundreds of emergency responders, planners and volunteer agency representatives at the State Emergency Management Agency’s annual conference today, Gov. Jay Nixon called on the General Assembly to reverse dramatic cuts to public safety and homeland security funding in the budget passed by the Missouri Senate earlier this week. 

“On countless occasions, here in Missouri and across the nation, we have seen the importance of local communities being able to effectively and rapidly respond to natural and man-made disasters,” Gov. Nixon said.

“Cutting by fifty percent the federal funds that help our communities respond to these challenges, as the Senate’s Fiscal Year 2014 budget would do, is simply wrong. I urge the General Assembly to take the House position to support public safety and ensure our emergency responders have the resources they need to keep our communities safe.”

The Senate’s Fiscal Year 2014 budget included a $21 million cut to federal homeland security funds, representing about half of the funding that helps local communities prepare for and respond to emergencies like terrorist attacks and natural disasters. The Senate’s budget also cut $1 million in General Revenue from the Department of Public Safety, including all the funding available for the Peace Officer Standards and Training Program (POST).

Missouri | Gov. Nixon declares state of emergency in response to flooding; activates National Guard

Gov. Jay Nixon today declared a state of emergency in Missouri after a strong storm system that included heavy rainfall led to flash flooding in many parts of the state and to rapidly rising rivers levels on the Mississippi and Missouri rivers.

The Governor activated the Missouri National Guard and citizen-soldiers are being deployed to assist the city of Clarksville and other communities along the Mississippi River to assist in the flood fight.

“The sustained periods of heavy rainfall has swollen creeks and streams and is pushing the Mississippi River over flood levels, endangering river communities,” Gov. Nixon said. “We will work closely with local officials and volunteers to support and protect communities, and the men and women of the National Guard will play a vital role in this fight.”

The State Emergency Operations Center has been actively monitoring the storm system since its activation last week to respond to the severe storms and tornadoes that impacted Missouri on April 10.  Gov. Nixon has also activated the Missouri State Emergency Operations Plan, which allows state agencies to coordinate directly with local jurisdictions to provide emergency services.

Missouri | Emergency management veteran selected to lead State Emergency Management Agency

Missouri Department of Public Safety Director Jerry Lee today named Ryan Nicholls as the new director of the State Emergency Management Agency.
“Throughout his career, Ryan has demonstrated strong leadership, a deep commitment to the communities he’s served and a determination to strengthen collaboration among disaster response agencies,” said Director Lee. “I know he will be a great addition to the team at SEMA, as they stand ready to serve communities in their time of need.”
Nicholls has served for seven years as director of the Springfield-Greene County Office of Emergency Management, which in 2012 received full accreditation from the Emergency Management Accreditation Program. Additionally, Nicholls served in disaster management teams responding to the Joplin EF-5 tornado in 2011, and Super Storm Sandy in 2012.

Missouri | Gov. Nixon outlines plans to improve access to mental health care and enhance public safety

Gov. Jay Nixon today met with law enforcement officers, educators and mental health providers in Jefferson County to discuss his proposals to help those with mental illness get timely, effective treatment in their communities and provide law enforcement with the training and resources they need to respond to persons experiencing a mental health crisis.

“Right now, many people with severe mental illness only get treatment when they reach a crisis point,” Gov. Nixon said. “That’s too late. My budget proposal strengthens our mental health system and enhances public safety by expanding access to mental health services and providing law enforcement officers with additional training and resources to identify and respond to signs of severe mental illness.”

Joining the Governor at the roundtable were Missouri Department of Public Safety Director Jerry Lee, Missouri Department of Mental Health Director Dr. Keith Schafer, Jefferson County Sheriff Glenn Boyer, Arnold Police Chief Robert Shockey, Fox C-6 School District Superintendent Dr. Dianne Critchlow and Dr. Stephen Huss, president and CEO of COMTREA (Community Treatment Inc.).

The Governor’s budget proposes an additional $10 million to strengthen Missouri’s mental health system, including $3.6 million to place Mental Health Liaisons at each of the 29 Community Mental Health Centers across Missouri.  These mental health professionals will work with courts, law enforcement, and families to help individuals with mental illness receive proper treatment.

To provide additional training to law enforcement and others, the Governor’s budget proposal includes $450,000 to help educate and train more teachers, law enforcement, clergy, employers and families on how to recognize, respond to and care for those with mental illness through Crisis Intervention and Mental Health First-Aid training.

Mental Health First-Aid training will be targeted toward groups that are likely to encounter people in mental health crises – teachers, law enforcement, clergy, and employers – so they can identify and respond to the early warning signs of mental illness.

The Governor’s budget also includes $6 million to fund emergency room intervention teams. These teams of mental health professionals could respond quickly when an emergency room requests assistance, and begin working with a patient to coordinate care. The Missouri Department of Mental Health estimates that 1,100 people could be assisted through this initiative each year.

These funding proposals were included in the Governor’s recommended balanced budget for Fiscal Year 2014, which has been presented to the General Assembly.