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Health FAQ

Community Health

Why does my Child Need Immunizations?

Immunizations protect children from vaccine-preventable diseases such as measles, mumps, polio, rubella, pertussis (whooping cough), diphtheria, tetanus, Haemophilus influenza Type B (HIB disease), Hepatitis B, varicella (chicken pox) and pneumococcal infections which may cause meningitis and blood infections. Vaccines can prevent the debilitating and in some cases, fatal effects of infectious diseases.  The organisms which cause vaccine-preventable diseases have not disappeared, rather they have receded and will reemerge if the vaccination coverage rates drop.

Vaccines protect more that the vaccinated individual.  They also protect society.  When vaccination levels in a community are high, the few who cannot be vaccinated are often indirectly protected because of group immunity.

Are vaccines safe?

Serious reactions to vaccines are rare, but they do occur.  However, the risks of serious disease from not vaccinating are far greater than the risk of a reaction to the vaccine.

Do vaccines have side effects?

Side effects may occur with vaccinations.  Slight fever or reactions at the site of the injection are the most common side effects.  Minor discomfort is normal and should not cause alarm.  However, if you feel your child is experiencing a severe or persistent reaction, seek medical attention immediately.  Severe reactions may include a high fever, seizures, persistent crying lasting more that 3 hours, rash, hives, difficulty breathing and/or unresponsiveness.

Why can't I wait until school to have my child immunized?

Immunizations must begin at birth and most vaccinations are completed by age 2. By immunizing your child on time, you can protect him or her from contracting a vaccine-preventable disease.

Why is immunization record important?

When your child receives a vaccine, you will be provided with a "shot" record.  The "shot" record helps you and your health care provider track what vaccines have been provided and what your child will need at the next visit.  The shot record will be started at birth and updated each time vaccines are received.  It is important to bring the record with you each time your child visits the health care provider or Immunization Clinic.  This information will help you if you move or when your child enrolls in a child care agency or a school.  It is recommended to keep the "shot" record in a safe place within your home.

Food Protection

Can I bake in my home and sell the products to customers?

No, the Manchester Health Department requires all food preparation occur in a licensed, commercial kitchen. No home cooking is allowed.

Do I need any training to operate a restaurant?

Yes, the City of Manchester requires food safety training.

Food Service Training Requirements:
Per Board of Health Policy, each food service facility in the City of Manchester must have at least one supervisory staff member attend a food safety seminar to maintain a permit. The Department usually conducts seminars twice a year. Check our News page for announcements of upcoming training. These two-hour seminars are held during the day with a choice of a morning or afternoon session. Successful completion of nationally recognized certification class, which demonstrates competency, is strongly encouraged.

What is ServSafe?
ServSafe is a comprehensive food safety and sanitation program offered by the National Restaurant Association. Upon successful completion of this course, a certificate is awarded. This class and others that are approved by the Conference for Food Protection are strongly recommended to ensure a competent workforce.

Links to the following agency offer ServSafe training classes:

Do you inspect pools at people's private homes?

Only when we receive complaints regarding standing water or mosquito breeding or other hazardous condition.

Do you post inspection scores or grades?

Food Establishment Inspection Scores are posted within one month after each quarter on our website.

How much does a food license cost?

The permit classification and associated annual fees are based upon a combination of seating and services provided. The permit is issued for one year, expiring on the last day of the month in which it was issued. The permit is not transferable from person to person, entity to entity or from one location to another.

How often do you inspect?

The number of inspections conducted in each establishment per year varies by size of the establishment, the clientele they serve as well as with rating scores. The Health Department conducts inspections of food service facilities on an unannounced basis during regular operating hours of the establishment, including preparation time, weekends and evenings. Normally, large operations are inspected four times a year and smaller operations twice a year. However, more frequent inspections may be conducted if any serious violations are found during a routine inspection.

Can I open a food establishment in my home?

Home-based Facilities: Although home-based establishments are allowed by the NH Bureau of Food Protection, in Manchester the operation of a home-based food service establishment is not allowed. Only those food service facilities that meet the minimum requirements as set forth in the New Hampshire Rules for the Sanitary Production and Distribution of Food (He-P 2300 sections 2031 through 2328), as adopted by the City of Manchester, are eligible for permitting in the City of Manchester.

I am planning on selling food at a temporary event such as a fair. Do I need a permit? How about if we are giving it away for free?

In order to ensure food safety at events in the City, a temporary license is required in both cases. Fee structures are based on whether you represent a for-profit or a not-for-profit entity. In some cases you may be required to complete an Event Coordinator application form as well. Temporary Food Service Permit Application.

What is a food safety merit award?

There are two awards given, a Food Safety Achievement award and a Food Safety Excellence award.

A Food Safety Achievement award is earned by establishments that have been in existence for a full calendar year, have consistently met high standards (with scores of greater than 90 and no critical item violations), no substantiated food borne illness complaints and have had staff attend the Manchester Health Departments’ Food Safety Seminar. The Food Safety Excellence award is conferred when the above criteria have been met and there are employees that are ServSafe certified (or equivalent).

I am having a private party at my home. Do I need a permit? What should I look for when choosing a caterer?

A private party at one’s household is not subject to inspection or licensure by the Health Department. When selecting a caterer, one should look to see copies of their current food permit and a copy of their last few inspections. If you have any questions, feel free to contact the caterer’s licensing agency for clarification of the reports.

Under what circumstances do you close a restaurant?

A restaurant shall be closed if there exists an imminent threat to the public’s health. The following circumstances may constitute such action:

  1. There exits a sewage backup
  2. There is a complete lack of hot and cold water under pressure
  3. Electrical service is not available on the premises
  4. Following a fire or a fire suppression system discharge
  5. When there is a complete lack of appropriate refrigeration

Institutional Inspections

I watch some children in my home. Do I need a daycare license?

If you watch more than 3 unrelated children in a dwelling you would fall under the licensing guidelines of the Department of Health and Human Services Bureau of Childcare Licensing (DHHS). Contact them at (603) 271-3466 for more information.

I wish to serve meals to children in my daycare. Are there any restrictions?

If you serve meals to a group of more than 12 children you would be required to be licensed as a food service facility by the Health Department and subject to the facility and food service requirements of He-P 2300. Some restrictions may apply (see the FAQ above.)

Lead Information and Lead Poisoning

What is lead poisoning?

Lead poisoning is a serious disease, particularly in children.  Lead is a naturally occurring element and its use dates far back in history.  Lead is highly toxic and can affect many systems and organs within the body.  Lead is highly toxic and can affect many systems and organs within the body.  Young children and unborn babies are most vulnerable to lead poisoning, as lead is particularly harmful to the developing brain and nervous system.  One and two year old children are at greatest risk for lead poisoning as they have increased mobility and engage in hand-to-mouth activity. Coma, seizures and death may be related to very high levels of lead.  At lower levels, lead may cause adverse effect on the kidneys, circulatory system and central nervous disabilities, hyperactivity and learning and behavior problems.  Lead poisoning is preventable!

How would I know if my child had lead poisoning?

Many children may have no symptoms of lead poisoning.  When symptoms do occur a child may complain of upset stomach, fatigue or irritability.  A parent may mistake the symptoms for another illness.  A child may show no sign of illness, yet enough lead in his body to damage his brain, kidneys or nervous system.  A lead screening is the only way to determine if a child has an elevated lead level.

Who should receive a lead screening?

All Manchester children should be screened at one and two years of age. Children ages 36-72 months of age should receive a lead screening if not screened previously. Parents should call their health care provider to schedule an appointment for a lead screening.  The Manchester Health Department provides lead screenings at no charge Monday-Friday 8:00 am-5:00 pm. No appointment is necessary.

How can I prevent lead poisoning?
  • Wash your child's hands and face often, especially before meals and snacks, after playing outdoors or near old windows and before naps and bedtime.
  • Wash toys and pacifiers often.
  • Wet mop floors, windowsills and window wells, woodwork, etc. with water and detergent at least 1-2 times per week.
  • Provide meals and snacks high in iron and calcium.
  • Avoid letting children play in the soil alongside older buildings.
  • Keep children away from peeling and chipping paint and objects that may be painted with lead-based paint such as old windows, furniture, toys and cribs.
  • If you work with lead or engage in hobbies using lead (arts and crafts, soldering, automotive work, etc.), shower and change clothes before coming into contact with children.
  • Store and serve food in glass or plastic containers.  Avoid storing food in ceramic ware, pottery, pewter and silver.
  • Improper renovations or lead-paint removal can create hazardous levels of dust and fumes.  Before beginning renovations or removal of paint, contact your local health department.
I think my apartment may have lead- based paint, what can I do about this?

Lead paint can be a serious problem when not properly maintained. It is important to note that lead poisoning is preventable! The presence of lead paint alone is not a hazard. Loose, flaking and chipping lead paint is a hazard. The City of Manchester building code requires paint in rental property to be maintained in sound condition at all times. Issues with peeling, chipping, flaking, or other wise loose paint should be reported the landlord or to the City Building Department Housing Standards Division at (603) 624-6450.

Reminder, when leasing, buying/selling, or renting property, a Lead Disclosure form must be provided to tenants/buyers, as well as the lead brochure entitled “Protect Your Family from Lead in Your Home”. Both are available at the Manchester Health Department.

In addition, if you would like someone to walk-through your home to help identify possible lead hazards, “The Way Home” (a not for profit community partner) may be able to accommodate you. They can be reached at (603) 647-3491. This non-profit group works with tenants and property owners to minimize lead hazards in homes. The only sure way to assess risk is to have a licensed lead risk assessor test the property. A list of qualified individuals can be found at the New Hampshire Department of Health and Human Services (NH DHHS).

Can I get a copy of the Lead Disclosure form?

Lead disclosures as well as other lead information materials are available at the Health Department.

I am looking to buy a property in Manchester and want to know if there is any lead in it, can you tell me?

The Health Department does not have the capacity to test for lead. Properties built before 1950 are very likely to contain lead in them. Properties constructed before 1978 may have lead paint in them Over 46% of rental property in Manchester were built before 1950. The only sure way to assess lead hazard risk is to have it inspected by a licensed lead risk assessor

The Health Department maintains records on properties that have housed children with elevated blood lead levels. These records are not all inclusive! . Information on past incidents is available at the Department (pre-1997). Incidents post-1997 are housed at the NH Childhood Lead Poisoning Prevention Program. They can be reached at (603) 271-4786.

Can I do my own renovations to an apartment identified as lead containing?

First, any work done with the purpose of removing lead requires the use of a specially licensed contractor. Second, any remodeling or repairs that disturbs more than two square feet requires pre notification of the work to all the tenants and the distribution of a disclosure and informational materials to all tenants. It is worth noting that more than a third of all children poisoned by lead reside in dwellings that have been renovated within the previous six months. It is essential that all renovations employ lead safe renovating practices and proper containment at every step of the process.

What the regulations around sand blasting?

Exterior or interior abrasive paint removal such as sand blasting is prohibited without a valid permit from the Health Department. Due care must be made to minimize the exposure to lead and lead dust to workers and abutters. Proper safety and containment standards must be maintained during the course of the work and inspections of the work-site will be made by the Health Department to ensure compliance.

Other risky activities such as power washing and dry scraping must be done in a manner that minimizes exposure and maximizes containment.

Oral Care

What services are provided by the Manchester Oral Health Program?

Education, services and referrals are provided for children preschool through grade 12 within the community.  The Dental Hygienists provide individual screenings in public elementary schools to identify the oral health needs of Manchester children and select which children should receive prophylaxes and fluoride treatments on the Manchester van.

Parents receive information that youngsters do not need systemic fluoride as Manchester's water supply is fluoridated.  Prophylaxes and fluoride treatments are also provided at preschool clinics and other community sites.  An oral health education resource manual is available within each public elementary school for Grades K-5. Oral health education is also provided during screenings and prophylaxes. Treatment clinics, X-rays and sealants are provided periodically on the Dental Van in collaboration with local volunteer dentists.

How can I receive dental care?

Treatment clinics for children are provided on the Manchester Health Department Dental Van by volunteer dentists.  If financially eligible and no other access to care is available, a child may receive treatment and sealants on the Dental Van, with parental permission.

What emergency dental services are available for my child?

If a child is financially eligible, has no other access to care and has an emergency or urgent need, the child may be referred to the Manchester Dental Alliance at Catholic Medical Center.

What causes teeth to decay?

Germs in the mouth change the sugar in food to acid.  The acid can cause a tooth to decay and lead to a cavity.  The decay has to be cleaned out by drilling and then the tooth is filled.  The chewing surfaces of back teeth are rough and uneven because they have small pits and grooves.  Food and germs can become stuck in the pits and lead to decay.

What are sealants?

Sealants are thin, plastic coatings painted on the surfaces of the back teeth.  Placing the sealants is simple and painless.  Sealants are painted on as a liquid and quickly harden to form a shield over the tooth.  By covering the chewing surfaces of the molars, sealants prevent germs and foods from causing decay.  Children should have on their permanent molars as soon as they erupt-----before decay occurs.  A healthy tooth is the best tooth!  It is important to prevent decay.  Sealants help in preventing decay.

Pools and Spas

Do you inspect pools at people's private homes?

The Health Department does not inspect nor license pools at private homes. Hotel, condominium associations, City owned and health club pools and hot tubs (spas) are inspected at least twice a year.

How often do you check the water at Crystal Lake?

Several natural bathing areas including the water at Crystal Lake is sampled every week from June 1 – Sept 1. Crystal Lake is sampled at two separate locations: the City owned public beach and Melody Pines Day Camp.

What happens when the water is unsafe?

When the bacteria levels in the water is found to be excessive, by the Health Department’s and the Department of Environmental Services’ (DES) standards, the beach is immediately posted as no swimming and not meeting  safe bathing standards. The posted areas are subsequently re-sampled. If the sample results come back below the 88 Escherichia coli per 100 ml of water standard, the beach is reopened. If the results remain above safe bacteria levels, the posting remains. These water quality results are available on our web site.

There was a fecal accident at our condominium pool. What do we do?

Evacuate the pool immediately and notify the pool manager and the Health Department for guidance. Any materials potentially contaminating the pool should he removed with appropriate precautions and sanitary measures.

Under what circumstances do you close a pool?

A pool shall be closed if there exists an imminent threat to the public’s health. The following circumstances may constitute such action:

  1. The main drain cannot be seen due to cloudy water, is damaged or is missing.
  2. When disinfectant levels are outside the acceptable range.
  3. The presence or occurrence of vomit or fecal material in the pool.

Public Health

What is Public Health?

The health of the public is something we often take for granted but the recent attacks on the World Trade Centers and the subsequent Anthrax scares has made Public Health front page news.  Public Health is not centered on individuals, but on the community at large.  Public Health

  • prevents epidemics and the spread of disease
  • protects against environmental hazards
  • prevents injuries
  • promotes and encourages healthy behaviors
  • responds to disasters and assists communities in recovery
  • assures the quality and accessibility of health services

Some of the ways the Manchester Health Department works to assure the health of the Manchester community is providing immunization services to all Manchester children, making home visits to patients with infectious disease, inspecting all Manchester restaurants for proper food handling practices and working through local organizations to decrease teen pregnancy.  The Manchester Health Department also employs the school nurses who serve children in city schools.

Who are Public Health Workers?

At the Manchester Health Department we employ community health nurses, school nurses, public health specialists, environmentalists, epidemiologists, toxicologists, interpreters and administrative staff who work under the direction of the Public Health Director. Workers may work in the schools teaching children about smoking cessation, or appear on TV teaching about the hazards of drug and alcohol abuse.  Often we work closely with Police and Fire should there be a chemical spill or participate in a community coalition to prevent lead poisoning in children.  Public Health Workers are like detectives tracing down the source of a community health problem and then involving the community in taking steps to remedy the problem. 

School/Youth Health

How long do I need to keep my child out of school with chickenpox?

See http://www.dhhs.nh.gov/dphs/cdcs/documents/handbook.pdf for complete information.

Chickenpox is a very contagious disease caused by the varicella-zoster virus.  It usually begins with a mild fever and an itchy rash. Chicken pox is considered contagious from 1-2 days before the rash occurs and until all the chicken pox blisters have formed scabs (ww.cdc.gov). Children should be excluded from school after the rash eruption first appears and until the vesicles become dry and scab over. Chickenpox is reportable by New Hampshire law.

How does someone get strep throat?

 See http://www.dhhs.nh.gov/dphs/cdcs/documents/handbook.pdf for complete information.

Group-A Streptococci are bacteria that can cause a variety of illnesses, the most common of which are strep throat, scarlet fever and impetigo. Strep Throat is a sore throat caused by this bacterium. Cold viruses, not strep bacteria, cause the vast majority of sore throats in both children and adults. Strep sore throats tend to be accompanied by fever, tender swollen neck glands, headache and stomach ache, but can also occur with cough, runny nose, or other cold symptoms. Scarlet Fever is a form of strep infection caused by bacteria that produce a substance, which causes a skin rash. The rash is usually red with fine bumps that feel like sand paper and is most noticeable on the neck, chest, groin, or on the inner surface of the knees, thighs and elbows. The rash does not usually involve the face, but cheeks are flushed and there is paleness around the mouth. The tongue may be reddish and look like the surface of a strawberry. The rash may only last a few hours. Scarlet fever is no more serious then strep throat.  Children and staff should be excluded until 24 hours after beginning antibiotic therapy and until there is no fever present. This type of streptococcal infection is not reportable by New Hampshire law.

How long should I keep my child out of school with Fifth Disease?

Fifth disease is a common childhood viral illness with rash symptoms.  The illness typically begins with a slight fever and feeling of tiredness.  A red rash appears usually appears within the next week.  The rash has a “slapped cheek” appearance on the face, and a “lacey” pattern on the neck, arms, legs, and trunk of the body.  The rash may recur for several weeks brought on by exposure to sunlight, heat, exercise, or stress.  Fifth disease is contagious in the time period before the rash appears but the illness is usually diagnosed only after the rash appears.  Frequently, the classic rash is not present, and the mild illness resolves without ever being diagnosed.

Adults can also get fifth disease but most adults already have immunity from previous exposure.  Pregnant women who are exposed to fifth disease should consult with their health care provider.  Frequent and thorough hand washing and tissue disposal are effective means of minimizing the spread of fifth disease.  Children are no longer contagious when the rash appears so they do not need to be excluded from school.

How long should I keep my child out of school with impetigo?

See http://www.dhhs.nh.gov/dphs/cdcs/documents/handbook.pdf for complete information.

Impetigo is a very common skin infection caused by streptococcal or staphylococcal bacteria.  It may start at an injured spot on the skin, such as an insect bite, cut or burn. Bacteria can easily be spread by the person’s hands to other areas of the body. In children, the face is often involved. It is recommended that untreated children be excluded until 24- hours after they have begun treatment. Impetigo is not reportable by New Hampshire law.

How long should I keep my child out of school with conjunctivitis?

See http://www.dhhs.nh.gov/dphs/cdcs/documents/handbook.pdf for complete information.

It is recommended that children and staff with purulent conjunctivitis be excluded from childcare until they have consulted a healthcare provider and have been approved for re-admission, with or without treatment. Conjunctivitis is not reportable by New Hampshire law.

How long should I keep my child out of school with ringworm?

See: http://www.mayoclinic.com/health/ringworm/DS00489

Ringworm of the body is a fungal infection that develops on the top layer of your skin. It's characterized by a red circular rash with clearer skin in the middle. It may or may not itch. Ringworm gets its name because of its appearance. There is no actual worm involved. Also called tinea corporis, ringworm of the body is closely related to athlete's foot (tinea pedis), jock itch (tinea cruris) and ringworm of the scalp (tinea capitis). Ringworm often spreads by direct skin-to-skin contact with an infected person or animal (Contact with lesions or clothes). Antifungal medications are used to treat ringworm. Mild ringworm often responds to antifungal products that you apply to your skin. For more severe infections, you may need to take antifungal pills for several weeks.

The school nurse should refer the student to their primary healthcare provider for specific treatment guidelines. Encourage infected student to cover lesions with clothing, do not share clothes, bathe/shower daily.

Septic Systems and Sub Divisions

We are on private septic and my toilet is slow to drain and there is an odor in our back yard.  What do I do?

If you notice any wet/damp areas in the yard, excessive areas of lush plant growth, or have back-ups into the house you may want to contact a licensed septic hauler to pump your septic tank. If the situation continues, you may have a failed system and should contact the health department and a licensed septic designer to inspect your system.

I need a copy of my septic plan. Where can I obtain one?

The Department has septic plans on file for most systems build after 1980. Before that time we may or may not have plans depending on the regulations that were in effect at the time. We have very few plans before 1970.   The State Department of Environmental Services may also have information on your individual septic system.

Can I replace the exact system that I currently have?

If your current system was State approved and is on file, you may qualify for an “in-kind” replacement (restrictions apply). (Note: This option may not meet current loading and design criteria and may result in the system to be undersized). Contact the Health Department for permit application procedures.

I want to put an addition on my house and I have an existing septic system. What do I do?

You must get Health Department approval before obtaining a building permit. The Health Department has a form that must be filled out and is available on-line (septic system release for building/dwelling change form). If you are adding any bedrooms or increasing the loading you must have a new septic design completed by a licensed septic designer. You do not need to install a new system at this time, but must show that the parcel can accommodate increased loading.

Other issues to be aware of include building and structure setback requirements that can be discussed with the Department at any time.

I have a parcel of land that I want to subdivide, what do I need to do?

If the land will be serviced by private septic systems, approval must be obtained by the Health Department. Test pits need to be conducted to establish adequate leaching areas for the lots proposed. These test pits must be witnessed by Health Department representatives. Lot sizes are determined by soil type and slope. A chart is provided at our web site. Other factors, which affect lot size, include wet soils, ledge outcroppings and municipal water service availability. Contact the Planning Department at (603) 624-6450 for other requirements of the subdivision process.

My septic system is failing after 1 year, do I have any recourse?

A failed septic system is defined by sewage effluent surfacing on the ground or backing up into the house. If a system fails after a short period the cause could by one of many things. The following is a list of questions to ask:

  1. Do you have a garbage grinder? If so, is your system designed for such use? Ground up effluent can compromise the settling process in the septic tank allowing solids to clog the field.
  2. Does your home have a water filtration device and does it back wash into the system? The treatment of water may affect bacterial growth in the system.
  3. If you have a pool or spa, does it backwash into the system? This too can affect the system. 
  4. Is more water being used than the system can handle (was designed for)? Are there any leaking fixtures in the home?
  5. Has anything driven over your system (cars, landscaping vehicles)?
  6. Are you dumping chemicals down the drain? Hobbies such as painting and certain crafts can kill bacteria in the system affecting its operation. If these questions do not solve your problem, contact a licensed septic designer or a certified septic inspector for assistance. 

If your home was built after 1980 we likely have a plan on file at the health department. If your home was built prior we may have a plan on file (see "I need a copy of my septic plan where can I obtain one?"and "Can I replace the exact system that I currently have?" above).


What is the difference between TB infection and TB disease?

TB infection: The TB germ is alive in your body but not making you sick, and you will not spread the germ to anyone else.  Your immune system traps the TB germ.

TB disease: The germ becomes active.  It can attack the lungs or other parts of the body.  The individual can become very sick and even die.  If it attacks the lungs, it can then be spread to others.

How do I know if I have TB infection?

A skin test is the only way to tell if you have TB infection.

How do I know if I have TB disease?

A physical exam, a chest x-ray, and special lab test, will assist your doctor in making the diagnosis.