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The History of the Charleston County Health Department and the Region 7 Public Health Office





1670

Charles Town established as a colony.

1698

Provincial Legislature requires incoming vessels produce evidence that no persons on board are suffering a contagious disease before they are allowed to dock.

1699

Yellow fever epidemic.

1707

A Pest House was built on Sullivan’s Island for isolation of those with a communicable disease.

1711

Yellow fever and smallpox epidemic.

1717

Yellow fever and smallpox outbreaks.

1736

A Health Department was established in Charleston, due primarily to concerns about the importation of diseases from ships coming into the port city.

1738

Large outbreak of smallpox.

1744

Quarantine measures were established for incoming ships.

1748

Yellow fever outbreak.

1749

Public hospital established for sick sailors and other transient people.

1754

A new Pest House was built on Sullivan’s Island to replace the one destroyed by the “Great Storm” of 1752.

1760

Extensive outbreak of smallpox.

1764

Ordinances passed that banned filth from being thrown into the streets, and stated that goats and swine roaming freely would be slaughtered.

1796

Ordinance passed that any vessel at a wharf found to be foul or offensive could be removed to a farther distance to be cleaned, ventilated and fumigated within 24 hours.

1789

The Medical Society of Charleston was established.

1799

Yellow fever epidemic killed over 2% of the entire population in the city.

1813

Ordinance passed that established a penalty for allowing dogs to roam at large.

1815

Health Department officially established as the City of Charleston Health Dept.

1836

Ordinance passed that established a $5 fine for throwing filth in the streets.

1878

State Board of Health established.

1880

“It smelled bad here and already had for 50 years.” Cases of Typhoid and Cholera reported.

1881

Implemented Smallpox vaccinations. There were 170 recorded deaths from Scarlet Fever.

1882

Began education for midwives. Gave 3,733 vaccinations.

1884

An investigation into privy vaults and cesspools determined they were poisoning drinking and household water. Quarantine laws were passed. The first case of consumption (TB) was reported.

1886

Charleston Earthquake. 96 deaths attributed to earthquake with thousands injured.

1889

Almost 14% of all deaths were due to Tuberculosis (TB).

1894

A pest house was built on Plum Island.

1895

Almost 17% of all deaths attributed to the white plague (TB).

1898

Cases of Typhoid, Diarrhea and Dysentery. 206 deaths from Typhoid.

1899

288 cases of Typhoid fever reported. 58% of all cisterns inspected were condemned due to pollution and sewage infiltration.

1901

Determination made that disease was not caused by odors (miasmus), but often by mosquitoes. 54 cases of smallpox reported.

1903

A safe, central water supply was developed to replace the systems of cisterns. The first public health nurse was hired, who was paid by the Ladies Benevolent Society.

1905

Charleston undertook the first government sponsored malaria control drainage project. State law enacted that required smallpox vaccination to attend school.

1906

A Typhoid fever epidemic was traced to milk containers being washed in polluted water. Ordinances passed to allow inspections of milk and meat. The Health Department startes inspecting food and dairy establishments.

1907

Testing of public water supplies now required by state law.

1908

Another increase in Typhoid fever due to pollution in underground cisterns.

1910

A Smallpox epidemic in a school.

1912

Increased cases of Typhoid reported, attributed to privy vaults. 32 dairies were condemned.

1915

136 deaths from Pellagra. New ordinance passed requiring that any cows kept in the City of Charleston have air space of at least 600 cubic feet and that no more than one cow be kept on any lot.

1918

“The Great Epidemic”: An Influenza epidemic and whiskey was distributed as a form of treatment. An outbreak of Cerebro Spinal Meningitis caused 33 deaths. The first public health nurse hired by the Health Department.

1919

Charleston becomes the first city in the US to require pasteurization on milk. The US Public Health Service asked for the assistance of the City Health Department at the Venereal Disease clinic at Roper Hospital because “the work has grown so heavy and is increasing in such proportions.”

1920

Hogs were allowed to stay at the dump to eat garbage. The Charleston County Health Department was established. There were 266 deaths from Smallpox. The average age at time of death in Charleston was 39 years for a white person and 22 years for a black person. The infant mortality rate was over 195 and the rate of stillbirths was 150. Heart disease was the #1 cause of death, followed closely by pneumonia, with smallpox as the 3rd leading cause. The State Board of Health formalized and standardized the training of midwives.

1923

First public health Nutritionist hired.

1925

Dairies were ordered to close unless they reduced the bacterial count.

1926

The City and County Health Departments jointly moved into a building at Society and Meeting streets.

1931

Typhoid outbreak.

1936

The City and County Health Departments combined into one, the Charleston County Health Department. The Health Department took over the Well Baby clinics which had been established by the Red Cross.

1937

Almost 3,000 cases of Influenza reported. The Health Department had 844 venereal disease visits at its clinic. Mosquito control program began in efforts to reduce the cases of malaria.

1939

Infant mortality rate was 68.5 in Charleston County and 57.7 in the City of Charleston. There were over 8,000 visits to the Health Departments Venereal Disease clinic. A program to destroy rats and to “rat-proof” buildings was started because of the continued high incidence of typhus.

1940

The average age at time of death in Charleston was 57 years for a white person and 36 years for a black person. The infant mortality rate was 64 and the rate of stillbirths was 63.6. Heart disease was the #1 cause of death, followed by Malaria and Tuberculosis.

1944

The number of visits to the Venereal Disease clinics reached 109,058.

1954

Charleston was one of only 200 counties in the US to begin providing the Salk vaccine against Polio.

1958

The first year that there were no cases of polio reported.

1960

Infant mortality in Charleston County was 32.6 per 1,000 live births, approximately 25 for white infants and 44 for black infants.

1961

The Charleston County Health Department moved from its former location, the Old Citadel Building on Marion Square, to the Leon Banov Health Center which was dedicated to Dr. Leon Banov who led the Health Department for 41 years, from 1920-1961.

1964

The Home Health Program began.

1965

44,532 patients were served at a Health Department clinic.

1969

South Carolina has the lowest life expectancy rating in the US at 68 years. County Health Departments throughout the State were grouped into 12 Districts under the South Carolina Department of Health & Environmental Control (DHEC). The Charleston County Health Department fell into the Trident Public Health District along with Berkeley and Dorchester Counties.

1971

Infant mortality rate was 15.3 per 100,000. Charleston had the highest incidence of Tuberculosis and Syphilis in the State; the Charleston rate was 29.5/100,000, while the South Carolina rate was 19.3/100,000, and the United States rate was 11.8/100,000.

1972

Immunization requirements for all school children established.

1974

The Family Planning Program was introduced in the Health Department clinic.

1975

The first satellite Charleston County Health Department clinic was established on James Island. The infant mortality rate was 17.6/100,000.

1977

A second satellite location was established near North Park Village. The average life expectancy for residents of Charleston County reached 73.2 years.

1978

The Women’s, Infants, and Children’s (WIC) Nutritional Supplement program began. It continues to this day with its goal of providing nutritious food and education for pregnant and nursing women, infants and children up to age 5. Heart disease accounted for almost 34% of all deaths in the county, followed by Cancer at 17% and Cirrhosis of the Liver at almost 15%.

1980

Charleston reported its first case of rabies in 26 years. There was an outbreak of food poisoning at a school that affected 200 students and was due to improper handling of turkey. Satellite clinic locations had grown to 6 sites in addition to the services provided from the Banov Building on Calhoun Street.

1981

County Health Department responsibilities transferred to the State Department of Health & Environmental Control (DHEC). The Charleston County Health Department, together with the Berkeley and Dorchester County Health Department now operate under the management of the Trident Public Health District of SC DHEC.

1983

Heart disease and Cancer are the top 2 causes of death in the county.

1985

The Health Department saw its first AIDS patient.

1989

Hurricane Hugo hits Charleston.

1990

Infant mortality rates in Charleston County had decreased from a rate of almost 33% in 1960 to 12% in 1990. The number of food establishments inspected by the Health Department grew from 400 in 1960 to 1800 by 1990.

1991

2 deaths were reported due to the bacteria Vibrio vulnificus in contaminated oysters.

1995

Infant mortality rate was 12.3 per 100,000.

1996

Cases of cyclospora diagnosed among women golfers who attended golf tournament. Found to be from Guatamalan rasberries contaminated with waste water. Leads to nationwide concerns about fruits and vegetables not being washed properly.

1998

Tuberculosis outbreak at a Charleston County high school. The primary case and 5 secondary cases were identified, and all associates of these cases were given preventive treatment. All students at the school were given TB tests and followed for one year.

1999

The Trident Public Health District provided flu and pneumonia shots to senior citizens at the Coastal Carolina Fair.

2000

The number of reported cases of drug resistant bacteria increased by 300% in just 4 years

The Trident District earned over 35% of our annual budget for the past 5 years. Over the same period that portion of our budget funded by Federal Grants has decreased by almost 88%

In the Trident Public Health District African Americans comprise about 30.8% of the total population, but over 75% of the new HIV/AIDS cases, with African American males accounting for over 56% of the cases in the year 2000

2001

Fiscal Year 2000-2001 budget was just over $19 million and was our lowest budget in five years. We experienced a decrease of almost 5% in our total budget over the previous year requiring us to scale back plans in many areas.

CDC grant funds to improve cardiovascular health were used to begin aerobics and nutrition classes at three predominately African-American churches

There are over 2,100 establishments selling food to consumers in the District, and our goal is to inspect each site four times a year

In the aftermath of 9/11 we recognized how vulnerable to attack we had become, and that the attacks could even be biological. Training in bioterrorism took on new importance as we once again realized how important our public health infrastructure is to our way of life. Throughout the year, we placed a new focus on how smallpox, as well as other biological agents, could be used as a weapon of mass destruction.

2002

In April of 2003, the Health Information Privacy and Portability Act (HIPPA) became effective.

Effective June, 2003, the SC DHEC became required by law to publish a list each year of health conditions for which children and staff should not attend school or child care settings

We discontinued offering well child check ups in the district, and our last maternity clinic was turned over to Medical University of South Carolina

The three leading causes of death continue to be heart disease, cancer, and stroke

Over 10% of people living in the Trident Public Health District have been told by a doctor that they have diabetes

Flu and pneumonia combined remain a leading cause of death in our district. Yet, these diseases, too, are mostly preventable by getting flu and pneumonia vaccinations. However, only 33.8% of the citizens in our three counties reported getting a flu shot in 2002.

2003

Suicide became the 10th leading cause of death in the three counties as more people chose to die than at any time in the past

Cancer is to be the leading cause of death in the Trident area, with lung cancer accounting for 1/3 of all deaths from cancer. Yet, according to the 2003 Behavior Risk Factor Surveillance System (BRFSS) over 28% of the residents in Berkeley, Charleston and Dorchester counties smokes every day. And, over 23% of all residents have been told at some time that they have high blood pressure (hypertension). Physical activity is key to preventing heart disease, diabetes, and hypertension. Yet almost 22% of our residents do not participate in any type of activity or exercises

Sent 455 animals to the state lab to be tested for rabies, of which 48 were positive

Investigated a cluster of 32 cases of varicella, or chicken pox, which affected 7 schools in Berkeley county over 4 months

Investigated 39 cases of pertussis, including 4 separate clusters

Our TB program undertook a very large contact notification and testing investigation. A total of 371 contacts were tested, of which 233 were associated with the College of Charleston. The good news was that no secondary infections were found.

2004

According to the 2000 U.S. Census, 7.4% of all women in the three counties were 15 - 19 years old, they represented 12% of all births in 2004.

The year saw the largest number of positive rabies reports in animals in at least seven years. Charleston County had 64 animals, mostly raccoons, that were positive for rabies. Almost 60% of all reports were from the West Ashley area of Charleston County and Region 7 staff coordinated a special rabies vaccination clinic with a local veterinarian in August and 730 vaccinations were given to pet dogs and cats. This was in addition to the rabies clinics coordinated in April/May each spring.

2005

Flu and pneumonia, both highly preventable diseases, caused almost 1,200 people in the three counties to be hospitalized and were responsible for 3,928 visits to an emergency room.

People with hypertension, or high blood pressure, have three to four times the risk of developing heart disease than those without high blood pressure. According to the 2005 Behavior Risk Factor Surveillance System (BFRSS) from the Centers for Disease Control (CDC) 26% of all adults in Berkeley, Charleston and Dorchester counties have been told that they have high blood pressure.

Outbreaks at two schools in October and November contributed to a 233% increase in varicella cases over 2004.

A cluster of 27 cases of pertussis was identified in a five mile radius of each other in Summerville.  The cases were associated with camps and daycares during July and August. Total cases of pertussis reported during the year was 66.

Reports of salmonella were the highest in seven years. We received reports of 230 cases, more than double the reports of cases in 2004 and 82.5% more than 2003. August, September and October accounted for 46% of the cases.
2006

Vector borne disease staff in our Environmental Health area investigated over 2,000 animal bites.

A cluster of 13 birds and 32 pools of mosquitoes from the West Ashley area of Charleston County tested positive for West Nile Virus.

Changes in Medicaid insurance reimbursements resulted in a decrease of almost $1.3 million in earned revenues for the regional budget for the July, 2005 - June, 2006 fiscal year.

In April, 2006, a case of pulmonary tuberculosis was confirmed in a person associated with a local high school. This led to the need to test 140 contacts at the school.

A significant increase in the number of cases of Cryptosporidiosis was experienced in 2006, with a total of 88 cases for the year, compared to seven cases in all of 2005. Many of the cases reported were associated with recreational water.
2007

Cancer is the leading cause of death for the three county area. Suicide and homicide are tied as the 10th leading cause of death.

In April, our Epi Team and food safety staff worked closely with law enforcement when an employee at Super Kmart in North Charleston tampered with three packages of ground meet. Kmart recalled all packages of the meat sold at the store during the time affected and all three tainted packages were recovered. Lab testing confirmed that the employee had placed rat poison in the packages. There were no customer illnesses associated with the incident.

2008

In 2008 our HIV/AIDS program tested 5,912 people, of which 100 were positive for the virus.

A grant of $2.5 million was awarded to the Roper Foundation by the U.S. DHHS ASPR  office for a local partnership consisting of Region 7, all area hospitals, the three counties, AHEC, and Charleston-Dorchester Mental Health Center. The funds supported the creation of a Regional Healthcare Coordinating Center that will serve as the coordination point for local health and medical resources in the event of a disaster. The grant also provided funds for the purchase of 18 containers of medical supplies and 9 temporary shelters that would be used for triage points or other health and medical needs.

There were 10,450 births and 5,126 deaths recorded for the year.
Cancer and heart disease continued as the leading causes of death for the three counties at 23.1% and 20.9% respectively.

At the end of 2008 there were 347 people employed in our Region. Just over 50% of our staff is located in clinics, almost 17.7 % in the administrative offices, 13.4% in environmental health, 12.3% at our home health location, and 6.3% at the BabyNet/CRS offices.

2009

Seven animals tested positive for rabies and post-exposure prophylaxis was recommended to 74 people.

5,541 people were tested for HIV of which 87 were positive.

A novel flu strain, H1N1 or "swine" flu, first appeared in April, 2009. That was the start of a pandemic flu. Vaccine was distributed at no charge by the federal government. Flu shots were provided at health department clinics, in schools, at businesses, churches and other community locations. The H1N1 pandemic flu that began in the previous fiscal year gained momentum in FY10. By the end of flu season we had provided 82,304 flu vaccinations, both seasonal and the novel H1N1, to people in Berkeley, Charleston and Dorchester counties. The recession resulted in the loss of over $500,000 from the regional budget and the region operated with 14% less staff than the prior fiscal year.

2010

The large number of people unemployed as a result of the recession created an increased demand for our services. This meant that at a time when more people needed our services we had to struggle to help them with less staff that we have had in over 15 years. 

Following a devastating earthquake in Haiti in January of 2010, the Charleston International Airport served as a repatriation center for U.S. citizens returning to this country. As the lead for ESF 8 in Charleston County, SCDHEC Region 7 coordinated medical and mental health services as well as public health surveillance. These activities lasted ten days and we helped process 992 people on 22 flights.

DHEC Region 7 received a $450,000 grant from National Association City and County Health Officials, (NACCHO) and was named one of eight Advanced Practice Centers across the country.  The region began work on Security Planning Toolkits for points of dispensing and hospitals. Community partners helping with the toolkit included the Charleston County Sheriff's Office, SLED and the USC Arnold School of Public Health. 

For the year 2010 our Epi Team investigated 20 outbreaks. Over one-half of the outbreaks were traced to Norovirus, two were salmonella, two to pertussis, one flu related and one varicella. The remaining two were gastrointestinal but the disease was never identified.

Region 7 had a 48% increase in reported cases of pertussis in 2010. Each investigation involved  interviewing client/family and other close contacts, notifying daycares/schools and making  recommendations on preventive exposure prophylaxis, obtaining information on immunization status for client and contacts as well as communication with hospital and or physician as needed.

Budget cuts continued to impact the amount of staff we have to provide services to the people in Berkeley, Charleston and Dorchester Counties. Overall, the region had the fewest number of staff in at least 6 years at a total of 332. The number of staff that we have in full-time, classified positions fell almost 21% from 308 positions to 255 positions.

As of 1/1/10 the governor designated First Steps as the new lead agency for the BabyNet Program. DHEC continues to act as the system point of entry for all children within the region who may have a developmental delay.