DPH Announces Second Human Case of West Nile Virus and First Case Detected in a Horse for 2021

DOVER (Oct. 8, 2021) – The Division of Public Health (DPH) announced today that a 79-year-old Sussex County woman has become infected with West Nile Virus (WNV), the state’s second case of human WNV in 2021. An epidemiological investigation is currently ongoing to confirm any travel history or sources that could have led to transmission. To protect the patient’s privacy, no more information will be provided on the individual at this time.

“As mosquito season continues through the fall months, it is important for everyone to take proper precautions when going outdoors in an environment where mosquitoes are prevalent,” said DPH Director Dr. Karyl Rattay. “Wearing insect repellent and wearing light-colored, long-sleeved shirts and pants are easy measures to take that can protect against this serious and sometimes deadly virus.”

The mosquitoes that cause WNV bite primarily from dusk (evening) to dawn (morning). However, other mosquitoes that cause diseases such as chikungunya, dengue fever, and Zika can bite during the day. It is important to protect yourself by wearing insect repellent whenever you go outdoors.

WNV is a mosquito-borne illness that can cause serious health problems. WNV is transmitted by mosquitoes, generally in summer and fall, with a peak period for disease transmissions from mid-August to mid-October. Nearly 80 percent of people infected with WNV will not become ill. While only a little less than 20 percent of those infected with the virus will develop West Nile fever with mild symptoms (fever, headache, body aches, a skin rash on the chest or back and swollen lymph glands), one in 150 people infected will develop severe infection (West Nile encephalitis or meningitis).

Symptoms of severe WNV infection include headache, high fever, stiff neck, and/or tremors and muscle weakness. The elderly and those with weakened immune systems are most at risk. Anyone who experiences any of these severe symptoms should seek medical help immediately. Symptoms may progress to stupor, disorientation, coma, convulsions, paralysis and possibly death.

In addition, the Office of the State Veterinarian has announced a confirmed case of West Nile Virus (WNV) in a horse. The infected horse was a 3-year-old Standardbred gelding residing in Kent County. The horse began showing signs of weakness in the hind limbs, with fever and respiratory signs on Oct. 1. The gelding lost the ability to stand and was therefore euthanized on Oct. 5. Samples were submitted to the Delaware Public Health Laboratory on Oct. 6, which confirmed the diagnosis of WNV on Oct. 7. The affected horse was not currently vaccinated against WNV.

West Nile Virus and Eastern Equine Encephalitis (EEE) are diseases transmitted to horses via the bites of mosquitoes. Humans can also be infected with WNV and EEE, but transmission requires a mosquito bite, and the virus cannot be directly transmitted between horses, or between horses and people. Signs of infection in horses include fever (although not always with WNV), anorexia, head pressing, depression or personality change, wobbling or staggering, weakness, blindness, convulsions, muscle spasms in the head and neck, or hind-limb weakness. If owners notice any of these signs in their horses, they should contact their veterinarian immediately.

“It is essential that owners of horses and other equines work with their veterinarian to set up a routine vaccination protocol to help prevent West Nile Virus and Eastern Equine Encephalitis,” said Dr. Karen Lopez, Deputy State Veterinarian. “Unfortunately, neither disease has a specific drug treatment. Eastern Equine Encephalitis infections are fatal in 70 to 90 percent of the cases, and West Nile Virus is fatal in 30 percent of the horses that contract it.”

Horse owners can take several additional steps in the barn and around the farm to help protect horses from mosquito bites. Horses should be kept inside during dawn and dusk, which are peak hours for mosquito activity. Topical insect repellents labeled for use on horses may be applied. The wind generated by fans installed in horse stalls can also help deter mosquitoes. Old tires and containers should be disposed of, and standing water eliminated. Water troughs or buckets should be emptied, cleaned, and refilled every 2-3 days if possible to remove any mosquito eggs or larvae.

Mosquito Bite Prevention: To avoid mosquito bites and reduce the risk of infection, individuals should:

  • Use Environmental Protection Agency (EPA)-registered insect repellents. Follow the manufacturer’s instructions for reapplication times.
  • If using sunscreen, apply it first and insect repellent second.
  • Adults: Spray insect repellent onto your hands and then apply it to the child’s face. Do not apply insect repellent onto a child’s hands, eyes, mouth, or on cut or irritated skin.
  • Do not use insect repellent on babies younger than 2 months of age.
  • When outside, wear shoes, light-colored long-sleeved shirts and pants. Dress your child in clothing that covers arms and legs. Mosquito netting can protect one’s face and neck, and infants in carriages, strollers and playpens.
  • Use permethrin (an insecticide) to treat clothing and gear (such as boots, pants, socks, and tents), but do not apply to skin.
  • Prevent mosquitoes from entering the house by using screens and keeping windows and doorways tightly sealed.

The Department of Natural Resources and Environmental Control’s (DNREC) Mosquito Control section announced WNV in sentinel chickens for the first time this year in July. Delawareans are reminded that the possibility of contracting mosquito-transmitted diseases, including WNV and EEE, will continue until colder autumn temperatures in mid-October or later. Until that time, in response to findings of WNV or EEE in humans or horses by the Division of Public Health and Delaware Department of Agriculture, respectively, DNREC’s Mosquito Control Section typically increases its mosquito population surveillance efforts in the vicinity of the virus findings, and then, depending on types and numbers of mosquitoes encountered, takes appropriate mosquito control measures as warranted. To report suspected cases of human WNV, call the DPH Office of Infectious Disease Epidemiology at 1-888-295-5156.

For more information about mosquitoes and mosquito-borne illnesses, use the following resources:

  • For mosquito biology/ecology and control, contact the DNREC Mosquito Control section office in Dover at 302-739-9917.
  • For requests for mosquito relief in upstate areas from Dover north, contact Mosquito Control’s Glasgow field office at 302-836-2555.
  • For requests for mosquito relief in downstate areas south of Dover, contact Mosquito Control’s Milford field office at 302-422-1512.
  • For animal health questions, contact the Delaware Department of Agriculture’s Poultry and Animal Health Section at 302-698-4561.
  • To report suspected cases of human WNV, call the Division of Public Health Office of Infectious Disease Epidemiology toll-free at 1-888-295-5156.
  • For more information on West Nile virus or Eastern equine encephalitis, visit www.cdc.gov/ncidod/dvbid/westnile/index.htm.

For more information on what you can do to prevent West Nile Virus, visit the Centers For Disease Control and Prevention’s website, www.cdc.gov/westnile/prevention/index.html.


West Nile Virus Is Detected in Sentinel Chickens in Delaware

No Human Cases of WNV Reported to Date in State

West Nile Virus (WNV) has been detected in Delaware for the first time in 2021 in sentinel chickens, the Delaware Department of Natural Resources and Environmental Control announced today. This first finding occurred in northern New Castle County at a sentinel chicken station sampled by DNREC’s Mosquito Control section on July 19. While there have been no reported WNV cases in humans this year in the state, Delawareans are reminded that the possibility of contracting mosquito-transmitted diseases, including WNV and Eastern Equine Encephalitis (EEE), will continue until colder autumn temperatures in mid-October or later.

Blood samples are collected by the DNREC Division of Fish and Wildlife Mosquito Control section each week from early July into October from the state’s outdoor-caged sentinel chickens that are humanely housed and handled at 20 monitoring stations statewide. The blood samples are tested for WNV and EEE antibodies by the Delaware Public Health Laboratory. Sentinel chickens bitten by mosquitoes carrying WNV or EEE develop antibodies to these diseases but are otherwise unaffected by them. WNV and EEE can be transmitted by mosquitoes to humans and horses.

Most people infected with WNV do not develop symptoms, but about 20% can develop a mild illness, which may include fever, body and muscle aches, headache, nausea, vomiting and rash symptoms. A small number of people can develop serious illness involving neurological problems, paralysis and possibly death. EEE is not as prevalent as WNV, but can present more severe symptoms in humans and horses.

DNREC reminds the public to take common-sense precautions to avoid mosquito bites, including wearing long-sleeved shirts and long pants when outdoors in mosquito-prone areas, applying insect repellent containing 10 to 30% diethyl toluamide (DEET) in accordance with label instructions and avoiding mosquito-infested areas and times of peak mosquito activity around dusk, dawn and at night.

Spraying to reduce mosquito populations in areas where WNV or EEE is detected may be initiated by the Mosquito Control section as warranted based on factors to include mosquito population levels and mosquito species present. To reduce mosquito-breeding habitat and chances of disease transmission, residents should drain or remove outdoor items that collect water, such as discarded buckets or containers, uncovered trashcans, stagnant birdbaths, unprotected rain barrels or cisterns, old tires, upright wheelbarrows, flowerpot liners, depressions in boat tarps, clogged rain gutters, corrugated downspout extenders and unused swimming pools.

The state veterinarian within the Department of Agriculture urges horse owners to contact their veterinarians as soon as possible to have horses and other equines vaccinated against WNV and EEE. Neither disease has a specific drug treatment, and infections in horses are fatal in 70 to 90% of EEE cases and in 30% of WNV cases.

More information about mosquitos and mosquito-borne diseases is available from the following resources:

  • For mosquito biology/ecology and control, contact the DNREC Mosquito Control section office in Dover at 302-739-9917.
  • For requests for mosquito relief in upstate areas from Dover north, contact Mosquito Control’s Glasgow field office at 302-836-2555.
  • For requests for mosquito relief in downstate areas south of Dover, contact Mosquito Control’s Milford field office at 302-422-1512.
  • For animal health questions, contact the Delaware Department of Agriculture’s Poultry and Animal Health Section, at 302-698-4500.
  • To report suspected cases of human WNV, call the Division of Public Health Office of Infectious Disease Epidemiology toll-free at 888-295-5156.
  • For more information on West Nile virus or Eastern equine encephalitis, visit www.cdc.gov/ncidod/dvbid/westnile/index.htm.

About DNREC
The Delaware Department of Natural Resources and Environmental Control protects and manages the state’s natural resources, protects public health, provides outdoor recreational opportunities and educates Delawareans about the environment. The DNREC Division of Fish and Wildlife conserves and manages Delaware’s fish and wildlife and their habitats, and provides fishing, hunting, wildlife viewing and boating access on nearly 65,000 acres of public land. For more information, visit the website and connect with @DelawareDNREC on Facebook, Twitter or LinkedIn.

Media Contacts: Nikki Lavoie, nikki.lavoie@delaware.gov; Michael Globetti, michael.globetti@delaware.gov

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Mosquito Control Spraying of Woodland Pools to Begin

A helicopter contracted by DNREC Mosquito Control sprays for woodland pool mosquitoes.

 

Spring Campaign Will Reduce Numbers of Year’s First Biting Mosquitoes

The Delaware Department of Natural Resources and Environmental Control will begin annual spraying of spring woodland pools to control aquatic immature mosquitoes Tuesday, March 23, weather permitting. Statewide spraying will originate in southern Sussex County, then expand into Kent and New Castle counties over the next several weeks. DNREC Mosquito Control works throughout the year to limit adverse impacts from mosquitoes, to maintain Delawareans’ quality of life by eliminating unbearable numbers and swarms of biting mosquitoes, and to protect public health by reducing possibility of mosquito-borne illnesses.

Up to 10,000 acres of wet woodlands near select populated areas will be treated by Mosquito Control, with a helicopter applying the bacteria-derived insecticide Bti. Like all insecticides used by Mosquito Control within the DNREC Division of Fish and Wildlife, Bti has been determined by the U.S. Environmental Protection Agency to pose no unreasonable risks to human health, wildlife or the environment when applied in accordance with product label instructions as required by federal law. Controlling larval stage early-season woodland pool mosquitoes limits the emergence of biting adult mosquitoes later in the spring.

The spring woodland mosquito larvae spraying campaign marks the beginning of Delaware’s mosquito control season, which in most years continues until late October or early November. Control activities will be expanded starting in mid-April to larval and adult saltmarsh mosquitoes, other freshwater mosquitoes, and urban and suburban container-breeding mosquitoes.

Locations and times for scheduled DNREC Mosquito Control spraying activity can be obtained by calling toll-free 1-800-338-8181. Mosquito spraying announcements can also be received by email, text or voicemail by subscribing to Mosquito Control’s Spray Zone Notification System at http://de.gov/mosquitospray.

To request local mosquito control service, please call the following Mosquito Control field offices:

  •  Glasgow Office, 302-836-2555, serving New Castle County and the northern half of Kent County, including Dover.
  • Milford Office, 302-422-1512, serving the southern half of Kent County south of Dover and all of Sussex County.

For more information on mosquito control in Delaware, call Mosquito Control’s Dover office at 302-739-9917.

About DNREC
The Delaware Department of Natural Resources and Environmental Control protects and manages the state’s natural resources, protects public health, provides outdoor recreational opportunities, and educates Delawareans about the environment. The Division of Fish and Wildlife conserves and manages Delaware’s fish and wildlife and their habitats, and provides fishing, hunting, wildlife viewing and boating access on nearly 65,000 acres of public land. For more information, visit the website and connect with @DelawareDNREC on Facebook, Twitter or LinkedIn.

Media Contacts: Joanna Wilson, joanna.wilson@delaware.gov; Michael Globetti, michael.globetti@delaware.gov

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Keep Your Family, Pets Safe This Fourth of July

DOVER  – For many, this year’s Fourth of July activities will span the entire week and weekend, and include picnics, barbecues, beach days and other gatherings spent with friends and family (including our four-legged family members). The Delaware Division of Public Health (DPH) is providing the following tips to keep everyone safe.

Prevent foodborne illness:
As temperatures rise, so do your chances of contracting a foodborne illness if you do not properly handle and sanitize your food. Be mindful of keeping food out in the hot sun too long and follow the proper procedures for cooking meats and poultry. When bringing food to a picnic or cookout:

• Use an insulated cooler filled with ice or frozen gel packs. Frozen food can also be used as a cold source.

• Foods that need to be kept cold include raw meat, poultry, and seafood; deli and luncheon meats or sandwiches; summer salads (tuna, chicken, egg, pasta, potato or seafood); cut up vegetables and fruits, especially melons; and perishable dairy products.

• A full cooler will maintain its cold temperature longer than a partially filled one. When using a cooler, keep it out of the direct sun by placing it in the shade or shelter. Avoid opening the cooler repeatedly so that your food stays colder longer when hosting an outdoor event.

• Before cooking, keep meats and eggs in a container under 40 degrees F, keeping ice for beverages in a separate container.

• Refrigerate cold foods until they’re ready to be served, keeping them on ice once they are out in the open.

• Have a food thermometer on hand so you can be sure you are cooking meats to their required temperature.

• Burgers and sausage should be cooked to 160 degrees F; chicken and turkey should be cooked to 165 degrees F; and steaks should be cooked to 145 degrees F with a three-minute rest time.

• Food should not be left out longer than two hours (one hour if the temperature is above 90 degrees F).

For more food safety tips, visit www.dhss.delaware.gov/dph/hsp/foodsafety.html or Foodsafety.gov.

Stay sun safe:
Sunburn slows the skin’s ability to cool itself, and is linked to skin cancer. Protect your, and your children’s, skin by taking the following steps:

• Use a broad-spectrum sunscreen with SPF 30+ and reapply regularly every two hours or after swimming.

• Wear UV-blocking sunglasses to protect your eyes. Wear wide-brimmed hats to cover your head, face, neck, and ears. Wear long-sleeved shirts and pants for optimal protection against the sun’s rays.

• Limit sun exposure when UV rays are most dangerous, from 10:00 a.m. to 4:00 p.m.

For more sun safety tips, visit https://www.protectyourskinde.com/.

Avoid bug bites:
Mosquitoes and ticks are active in the summer, and both can transmit serious illnesses through their bites. While spending time outdoors, prevent mosquito and tick bites.

• Use Environmental Protection Agency (EPA)-registered insect repellents. Follow the manufacturer’s instructions for reapplication times. When using sunscreen, apply it first and insect repellent second. Adults: Spray insect repellent onto your hands and then apply to the child’s face. Do not apply insect repellent onto a child’s hands, eyes, mouth, or on cut or irritated skin. Do not use insect repellent on babies younger than 2 months of age.

• Wear light-colored, long-sleeved shirts and pants. Mosquito netting can protect one’s face and neck, and infants in carriages, strollers and playpens.

• Prevent mosquitoes from entering the house by using screens and keeping windows and doorways tightly sealed.

Protect your pets from fireworks and loud noises:
The DPH Office of Animal Welfare (OAW) advises pet owners to be aware that fireworks cause many pets to run away, and that holiday foods and heat can be harmful to our four-legged family members. The following tips from the American Veterinary Medical Association can help keep pets safe from harm during Independence Day celebrations:

• If your pet is sensitive to noises like fireworks or thunder, consult your veterinarian for recommendations on how to ease anxiety caused by fireworks and loud parties. Anxiety medications and treats, “thunder” shirts and behavioral training are all tools to help keep pets calm.

• Leave pets at home if attending gatherings elsewhere. In addition to fireworks, strange places and crowds can spook an animal and cause them to flee. Utilize a crate or escape-proof area of the home during parties and fireworks.

• Those who expect guests during the holiday, or any celebration, should inform their company to be mindful of pets when entering or exiting a home or yard to avoid accidental escapes. Place signs on doors and gates that alert guests to be vigilant about pets.

• Tell guests to refrain from sharing food meant for people as these can upset your pets’ stomach, or worse. After any in-home celebrations, check yards for food scraps and fireworks debris that animals may ingest.

• Make sure sparklers, glow sticks, fireworks, charcoal and skewers are out of your pets’ reach.

• Stay vigilant about times when pets are outdoors. Pets are safest inside on hot and humid days. If they must be outside, ensure they have access to fresh water and secondary shade apart from dog and cat enclosures, which can become dangerously hot inside.

• Make sure your pets have identification tags with current owner contact information. Have your pet microchipped, if they aren’t already. A microchip is an affordable device with owner information to ensure pets can return home if they get out and are found by someone else. Make sure the microchip is registered with up-to-date owner contact information.

• If a pet does escape, post its photo and identifying information on the Office of Animal Welfare’s statewide Lost & Found Pet Registry, at animalservices.delaware.gov. Review found pet notices there as well. Your pet may have been found by a neighbor or taken to a local animal shelter.

A person who is deaf, hard-of-hearing, deaf-blind or speech-disabled can call the DPH phone number above by using TTY services. Dial 7-1-1 or 800-232-5460 to type your conversation to a relay operator, who reads your conversation to a hearing person at DPH. The relay operator types the hearing person’s spoken words back to the TTY user. To learn more about TTY availability in Delaware, visit http://delawarerelay.com.

The Delaware Department of Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. DPH, a division of DHSS, urges Delawareans to make healthier choices with the 5-2-1 Almost None campaign: eat 5 or more fruits and vegetables each day, have no more than 2 hours of recreational screen time each day (includes TV, computer, gaming), get 1 or more hours of physical activity each day, and drink almost no sugary beverages.


DPH Announces Second Human Case of West Nile Virus; Urges Delaware Residents to Avoid Mosquito Bites

DOVER – The Division of Public Health (DPH) is announcing the state’s second human case of West Nile Virus (WNV) in 2018. The 68-year-old New Castle County man was initially hospitalized in July due to illness, and remains hospitalized due to underlying health conditions unrelated to the virus. WNV, a mosquito-borne illness, can become serious, and DPH reminds people to take precautions to avoid mosquito bites. Earlier this month, DPH announced that a 60-year-old Sussex County man was the first case of WNV this year. In 2017, one case of WNV was confirmed in a Kent County woman, the first such case in two years in Delaware.

“As we begin to see additional cases of West Nile Virus in humans, it is critically important that Delawareans take preventive measures to avoid mosquito bites,” said DPH Director Dr. Karyl Rattay. “These bites can cause serious health problems, which is why we are urging everyone to protect themselves and their loved ones. Some steps you can take include using Environmental Protection Agency (EPA)-registered insect repellents, wearing light-colored long-sleeved shirts and pants when outside and using mosquito netting to protect infants in carriages, strollers and playpens.”

The Department of Natural Resources and Environmental Control (DNREC) Mosquito Control Section has seen an increase of WNV found in wild birds and sentinel chickens. Earlier this month, the Mosquito Control Section also found Delaware’s first EEE-positive sentinel chicken for 2018 in a station in Sussex County. Like WNV, Eastern equine encephalitis (EEE) can adversely affect both humans and horses – EEE is more severe than WNV, but fortunately much rarer. Heightened concerns over possible transmission to humans from both viruses, will continue into mid-October, until cooler temperatures start to significantly slow down both mosquito and virus activity.

To assist the State’s mosquito control efforts, and to reduce mosquito-breeding habitat for mosquitoes that can transmit WNV, DNREC urges homeowners to practice good water sanitation on their property by eliminating standing water, particularly as might be collected in buckets, containers, uncovered trash cans, stagnant bird baths, old tires and unused swimming pools.

To avoid mosquito bites and reduce the risk of infection, individuals should also:

• When outside, wear shoes, light-colored long-sleeved shirts and pants. Mosquito netting can protect one’s face and neck, and infants in carriages, strollers and playpens. Mosquitoes are most active at dusk and during the early-morning hours.
• Use Environmental Protection Agency (EPA)-registered insect repellents. Follow the manufacturer’s instructions for reapplication times.
• Do not use insect repellent on babies younger than 2 months of age.
• Dress your child in clothing that covers arms and legs. Do not apply insect repellent onto a child’s hands, eyes, mouth, or on cut or irritated skin. Adults: Spray insect repellent onto your hands and then apply to the child’s face.
• Prevent mosquitoes from entering the house by using screens and keeping windows and doorways tightly sealed.

WNV and EEE are transmitted by mosquitoes, generally in summer and fall, with a peak period for disease transmissions from mid-August to mid-October. Although nearly 80 percent of people infected with WNV will not become ill, and only a little less than 20 percent of those infected will develop West Nile fever, with mild symptoms (fever, headache, body aches, a skin rash on the chest or back and swollen lymph glands), one in 150 people infected will develop severe infection (West Nile encephalitis or meningitis).

Symptoms of severe WNV infection include headache, high fever, stiff neck, and/or tremors and muscle weakness. The elderly and those with weakened immune systems are most at risk. Anyone who experiences any of these severe symptoms should seek medical help immediately. Symptoms may progress to stupor, disorientation, coma, convulsions, paralysis and possibly death.

Mosquitoes in Delaware also can carry other viruses that may result in death, including dengue virus. Other mosquito-borne diseases that could occur in Delaware include chikungunya and Zika. Chikungunya, while rarely fatal, may result in severe and debilitating symptoms, including fever and joint pain.  The most common symptoms of Zika are rash, fever, joint pain and conjunctivitis (red eyes). The largest health impact of the Zika virus appears to be on infants whose mothers were infected during pregnancy. There have been reports of a serious birth defect of the brain called microcephaly, a condition in which a baby’s head is smaller than expected when compared to babies of the same sex and age, as well as other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. To date, no cases of Zika in Delaware have been linked with local mosquito or human transmission.

While there are no vaccines against WNV or EEE for humans, effective EEE and West Nile vaccines are available for horses through veterinarians, according to the Delaware Department of Agriculture’s State Veterinarian’s Office. Both WNV and EEE cause severe, and sometimes fatal, infections in horses. Signs of infection in horses include fever (although not always with WNV), anorexia, head pressing, depression or personality change, wobbling or staggering, weakness, blindness, convulsions, muscle spasms in the head and neck, or hind-limb weakness. If owners notice any of these signs in their horses, they should contact their veterinarian immediately.

To report suspected cases of human WNV, call the DPH Office of Infectious Disease Epidemiology at 888-295-5156.

For more information about:
• Mosquito biology/ecology and control – Contact the Mosquito Control Section’s Dover office at 302-739-9917.

• Reporting WNV-suspect wild birds, or for requests for mosquito relief – For upstate areas from Dover north, contact Mosquito Control’s Glasgow field office at 302-836-2555; for downstate areas south of Dover, contact Mosquito Control’s Milford field office at 302-422-1512.

• WNV or EEE in horses and equine vaccines – Contact the Department of Agriculture’s Poultry and Animal Health Section at 302-698-4500 or 800-282-8685 (Delaware only).

For more information on West Nile virus or Eastern equine encephalitis – Visit the CDC website, www.cdc.gov/ncidod/dvbid/westnile/index.htm.

 

A person who is deaf, hard-of-hearing, deaf-blind or speech-disabled can call the DPH phone number above by using TTY services. Dial 7-1-1 or 800-232-5460 to type your conversation to a relay operator, who reads your conversation to a hearing person at DPH. The relay operator types the hearing person’s spoken words back to the TTY user. To learn more about TTY availability in Delaware, visit http://delawarerelay.com.

Delaware Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. DPH, a division of DHSS, urges Delawareans to make healthier choices with the 5-2-1 Almost None campaign: eat 5 or more fruits and vegetables each day, have no more than 2 hours of recreational screen time each day (includes TV, computer, gaming), get 1 or more hours of physical activity each day, and drink almost no sugary beverages.