Health Services

Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products | Electronic Cigarettes | Smoking & Tobacco Use | CDC

CDC, the U.S. Food and Drug Administration (FDA), state and local health departments, and other clinical and public health partners are investigating a multistate outbreak of lung injury associated with use of e-cigarette, or vaping, products. 

Latest Outbreak Information:


  • This complex investigation spans almost all states, involves over 2,000 patients, and a wide variety of brands and substances and e-cigarette, or vaping, products.
  • As of November 5, 2019, 2,051* cases of e-cigarette, or vaping, product use associated lung injury (EVALI) have been reported to CDC from 49 states (all except Alaska), the District of Columbia, and 1 U.S. territory.
    • Thirty nine deaths in 24 states:
      • The… age of deceased patients ranged from 17 to 75 years (as of November 5, 2019).
    •  More deaths are under investigation.
  • Among 1,378 patients with data on sex (as of October 15, 2019):
    • 70% of patients are male.
  • Among 1,364 patients with data on age (as of October 15, 2019):
    • The median age of patients is 24 years and ages range from 13 to 75 years.
    • 79% of patients are under 35 years old.
    • By age group category:
      • 14% of patients are under 18 years old;
      • 40% of patients are 18 to 24 years old;
      • 25% of patients are 25 to 34 years old; and
      • 21% of patients are 35 years or older.
  • Among 867 patients with information on substances used in e-cigarette, or vaping, products in the 3 months prior to symptom onset** (as of October 15, 2019):
    • About 86% reported using THC-containing products; 34% reported exclusive use of THC-containing products.
    • About 64% reported using nicotine-containing products; 11% reported exclusive use of nicotine-containing products.


Health Conditions

If your child has a potentially life threatening health conditionwe need a new care plan and if needed, an authorization for your child to have a medication at school, each school year. The school lists most life threatening health conditions as asthma with a rescue inhaler, allergy with an EpiPen prescribed, seizures, diabetes with insulin and heart conditions.

All forms must be completed & signed by parent and licensed health care provider (LHCP) and received in your child’s school health room prior to classes starting on the first day of school. If an emergency medication is prescribed, they need to have the medication on the bus as well.

Please be aware that the forms can be found under each health concern in this webpage under  >Parent forms for Student Health Conditions. 

If your child has had an emergency medication in the past, but you feel they no longer need it, then we have to have a LHCP note stating that they no longer need the medication at school.

The School Nurse will be available during regular school hours starting August 26, 2019. Please call Sonja at 360-477-7728, with any questions or concerns.

Clallam County Department of Health and Human Services

111 E. 3rd Street-Port Angeles, WA 98362_ Phone 360-417-2303- Fax 360-452-

From:   Allison Berry Unthank, MD, MPH, Clallam County Health Officer

  *** NOTICE ***

MMR Vaccine Exemption Law Change 2019

In 2019, the Washington State Legislature passed a bill that removes the personal and philosophical option to exempt children from the MMR (measles, mumps, and rubella) vaccine required for school and child care entry. The bill was signed into law by Gov. Jay Inslee on May 10, 2019.

We know there is great interest in the effects of this law. The department is working on interpreting the new law. Once we know the scope of the final law, we will begin the form change process. At that point we will communicate with interested groups to share next steps.

This page contains quick information and resources on this change to school and child care immunization requirements. Find more detailed information in the Frequently Asked Questions. As more information becomes available, we will share it.

As we prepare for the new law to take effect, we’ll continue our work in helping parents and the public understand the safety record of vaccines and the critical role they have in saving lives.

Law Change Quick Facts

  • The new law will take effect July 28, 2019 and applies to public and private schools.
  • The law also requires employees and volunteers at child care centers to provide immunization records indicating they have received the MMR vaccine or proof of immunity.  
  • This law does not change religious and medical exemption laws. Children who have one of these types of exemptions on file are not affected by the new law.
  • Access your family’s immunization records if you need to check whether you or your child meets the MMR vaccine requirements.
  • This law will not affect most students. More than 9 out of 10 kindergartners in Washington are complete with both doses of MMR vaccine, and 96 percent of 6th graders have both doses. These students, along with those who have medical or religious exemptions, will notice no change from the new exemption law.


Health Services staff will be performing school vision and hearing screening for grades Kindergarten, 1st, 2nd, 3rd, 5th and 7th grade students. Please let me know if you have any questions or concerns.

Thank you,

Sonja Bittner RN
District Nurse

Sequim School District Annual Vision and Hearing Screening

WAC 246-760-020

Frequency for schools to screen children.

(1) A school shall conduct auditory and distance vision and near vision acuity screening of children:

(a) In kindergarten and grades one, two, three, five, and seven; and

(b) Showing symptoms of possible loss in auditory or visual acuity and who are referred to the district by parents, guardians, school staff, or student self-report.

(2) If resources are available, a school may:

(a) Expand vision screening to any other grade;

(b) Conduct other optional vision screenings at any grade using evidence-based screening tools and techniques; or

(c) Expand vision screening to other grades and conduct optional vision screenings as outlined in (a) and (b) of this subsection.

(3) If resources permit, schools shall annually conduct auditory screening for children at other grade levels.

[Statutory Authority: RCW 28A.210.020. WSR 17-03-009, § 246-760-020, filed 1/4/17, effective 7/1/17. Statutory Authority: RCW 28A.210.200. WSR 02-20-079, § 246-760-020, filed 9/30/02, effective 10/31/02. Statutory Authority: RCW 43.20.050. WSR 91-02-051 (Order 124B), recodified as § 246-760-020, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 28A.31.030. WSR 87-22-010 (Order 306), § 248-148-021, filed 10/26/87.]



Sequim School District
Health Services Staff
Contact Us

School Nurse 
Sonja Bittner BSN, RN

Health Services Specialist 
Ardis Mangano

Helen Haller Health Clerk
Cherie Hendrickson

Middle School Health Clerk
Jennifer Meysenburg

High School Health Clerk 
Celene Frick

Greywolf Health Clerk
Jane Sallee