The regime at work: the county department's own tables

2011 — 2013, from the 2013 annual report

FluMist in the schools, TB on the rise:Its school influenza program put FluMist into the county's elementary schools at a documented scale: 5,350 children in thirty-seven schools in 2011, 4,935 children in thirty-seven schools in 2012, and 5,234 children in thirty-seven schools in 2013 — the health officer's letter that year noting, against a general decline in immunizations, "a significant increase in school influenza immunizations." Tuberculosis, a century after Healthwin, was still on its books and rising: the nursing division placed 1,947 tuberculosis skin tests in 2011, 1,673 in 2012, and 1,676 in 2013, and managed two active cases in 2011, three in 2012, and eight in 2013 — the same letter recording, plainly, "a significant increase in active TB cases to be managed." The nursing division's work, as the report lists it, ran from the immunization and HIV clinics to tuberculosis case management and case management for elevated blood lead levels, the lead work the environmental entry below carries. These are the regime's ordinary years, printed at the size its own report gives them, because the epidemic record is only half the public-health story: the other half is the standing machinery that the epidemic years test.

Sources:

1. St. Joseph County Department of Health, 2013 Annual Report (in.gov/localhealth/stjosephcounty) — the health officer's letter (nursing leadership transition; immunizations down overall; the increase in school influenza immunizations; the significant increase in active TB cases); the FluMist school figures for 2011–2013 (5,350 / 4,935 / 5,234 children, in thirty-seven elementary schools each year); the tuberculosis table (skin tests placed 1,947 / 1,673 / 1,676; active cases 2 / 3 / 8); and the nursing division's listed duties, including case management for elevated blood lead levels.