Clark County Board of Health

0:00 >> Good morning and welcome everyone. Calling to order, Clark County Board of Health, Wednesday, March 25th, 2026. Would you please join me in standing for the Pledge of Allegiance? >> I pledge allegiance to the flag of the United States of America, and to the Republic for which it stands. One nation, under God, indivisible, with liberty and justice for all. >> Thank you, let's proceed with the roll call. >> Councillor Young? >> Here. >> Councillor Belcott? >> Present. >> Councillor Fuentes, is he out? >> I don't, yep, he's not here. Is he online?

0:58 >> I don't see him, I'll keep checking. >> Councillor Little? >> Present. >> Chair Marshall? >> Here. >> Thank you. Are there any amendments to the agenda? No amendments, okay. Comments from the public. Just a reminder, this is the Board of Health, and keep your comments to three minutes. Is there anyone in the room? Don't see anyone. One online? Great. >> Caller, you've been sent a request to unmute yourself. Please do so, state your name for the record, and go ahead. >> Good morning, Kimberly Goheen-Elbin. Yeah, I've got three active four-month-old puppies here, let me tell you. I'm really concerned about the chem trail. You guys have, I'm going to have to step out of the room. >> You guys know about these chem trails.

1:57 It's out there, I mean, I feel it deep. There's no insect. I mean, take a look on your damn windshield. We need help, and you guys are ahead of Clark County. Get these chem trails stopped here in Clark County. In fact, all throughout the state would be just wonderful for me. Something's gotta be done here. This is the Board of Health. The insects are dying, the birds, our land. I believe that the chem trail particles that when they fall throughout the years and months and days falling on our forests, when they dry on our trees, that's why they ignite so quickly. I also believe that it's a cause of cliff rot. And I know that when I go outside and see these jet streams going and believe me, I grew up in a flying family on an airport. I know what a jet stream is.

2:55 These things are dissipating into what looks like old cob coverage. Well, it's not. It's dissipating to try, of course, to block the sun. In winter, we want to block the sun in winter. Give me a break. Now you guys do something about these chem trails. Now I'm going to get on to another one. About a month ago you had noxious weeds. Except for tansy, and I don't have my notes with me, that I picked for farm friends because it is deadly. Those other noxious weeds, most of them, in fact all of them, are edible or nutritious or healthy herbs to make a tea, a tincture. And so we certainly don't want any more chemicals on the earth to spray them. You're killing the frogs and the bugs there. But we want to maybe get some people, you guys have a lot of money and a lot of staff, get somebody out there, cut those Japanese things down. They make excellent tea. I mean, you can read about it. I did a big study on it.

3:54 I can't find it right now. I don't want to go back in the house. But all of those are nutritious and good for your body to make a tea, and I do that all the time. So that's what I have to say about the Board of Health. But we want these chem trails done. You know darn well that they're all around America. There's nine states that banned them. And so let's ban them here in Clark County. Do something about it. Be proactive instead of doing your little whatever you guys like to do with our money. We're taxed to death. And by the way, medicine now better not be jabbing little children anymore with this damn COVID shot. It's gonna come to the truth. It's coming out. >> Okay, thank you. Your time is up. Is there anyone else? Okay, that closes public comment. Moving on to the consent agenda, it's just the minutes for approval.

4:52 February 25th, 2026, are there any changes? Hearing none, I'll entertain a motion. >> So moved. >> To approve, okay. >> Second. >> Thank you very much. All those in favor say aye. >> Aye. >> Okay, then public health in action, 2026 Measles Response Overview. Dr. Melnick? >> Good morning, counselors. I'm delighted, is it on? I'm delighted to introduce Haley King, our infectious disease epidemiologist. And Marissa Armstrong, our public health communications manager. And Kim Taves, our director of investigation and response. You're going to hear about our measles response, some measles cases this year. >> Great, welcome everyone. >> Okay, good morning.

5:51 As Dr. Melnick just mentioned, my name is Haley King, and I'm an epidemiologist with Clark County Public Health. And we're here today to talk about measles and our recent measles response here in Clark County. And we can go to the next slide. So to start off, why is measles so concerning to us here at public health? Measles is incredibly contagious. Before a vaccine was licensed here in the United States, there were three to four million cases attributed to measles each year. The virus lives in the air and on surfaces for up to two hours. And so this means that someone doesn't even have to be in the same place at the same time as an ill individual to be exposed. And people can be exposed without even knowing it. This is also compounded by the fact that measles is very good at making people sick.

6:47 Research shows that 90% of people who are exposed to measles and don't have an evidence of immunity to it will become infected. Individuals are also contagious for up to four days prior to developing a rash, which is kind of the symptom that lets people know that this is likely measles. And so this means that many people are unknowingly kind of out in public and exposing other people to measles before they're even aware that they have it. And along with this really contagiousness, measles also can have some very severe health outcomes, particularly for younger children, people with underlying health conditions. And these severe outcomes, including high fevers, severe pneumonias, brain swelling, and more. And for some, these are fatal. And all of this leads to preventable hospitalizations and deaths. Next slide.

7:39 Measles is of particular concern to us right now due to its recent uptick in cases in the United States. Measles cases were so few that it was considered eliminated in the United States in 2000, but we are now seeing a rise in cases that appears pretty drastic. And this kind of sharp increase in cases in such a short period of time is something that signals to us an increase in risk that deserves our attention here. Next slide. We can see here that here in the United States, we are already for this year half of all the cases, at the number of half of all the cases reported in 2025 while only being in the first few months of this year. And 2025 was already an unusually high year for case counts.

8:33 And it's also likely that these are underestimates as they only capture cases that sought medical care and got reported to public health. Next slide. And we can also see the impact that these cases are having on the health care system with over 200 hospitalizations and three deaths reported in 2025. And our goal at Clark County Public Health is to avoid these hospitalizations and deaths. And so with this goal in mind, we have a response plan developed for any measles cases that may impact Clark County. Next slide, please. Before we get into the response, I wanted to take a minute to provide some definitions of what our team uses when we're talking about measles. So a case is someone with measles. A contact is someone who's exposed to someone with measles during the time that that person was contagious.

9:28 A public exposure is a public location where someone who was contagious with measles was present. And so anyone else that was there during that time or for the two hours after the person left were exposed. Passive monitoring is what we use when someone is exposed to measles but has a documented immunity to it. And the risk of these individuals getting sick is significantly lower and so they are not required to quarantine. And they are asked to closely watch symptoms and reach out to Clark County Public Health or their provider if they notice any symptoms. Active monitoring is what we do for someone who is exposed to measles and is not immune to it. These individuals are asked to quarantine for 21 days after they're exposed and monitor closely for symptoms. Because once someone is exposed to measles, they most often become ill between 7 and 21 days later. The infectious disease team at Clark County Public Health checks in with them regularly to ask about symptoms and

10:24 quickly identify when a new case is starting to get sick. Someone's considered immune when they have a documented proof of immunity to measles. And so this includes measles vaccination, a prior diagnosis from a healthcare provider of measles being born before 1957 or other laboratory evidence of measles immunity, which is usually in the form of a blood test that we call a titer. Isolation is when we are keeping someone who is sick with measles away from others while they are contagious. And then quarantine is when we are keeping people who are not immune to measles and have been exposed to it out of public settings during that time period where measles is most likely to develop. To avoid them exposing others during that phase where they are contagious, but don't yet have obvious symptoms. Next slide. Clark County Public Health plays a large role in the response to a measles case.

11:23 Overall, the goal is to prevent as many measles exposures as possible. And so our response includes working with local healthcare providers to accurately identify new cases. And then part of this is approving and coordinating measles testing through the state public health lab to confirm cases. We work to isolate individuals until they're no longer infectious, which is from that four days before the rash starts until four days after the rash has begun. We identify all the close contacts and all the other larger public exposures that happened during that infectious period for the case. Again, that four days before a rash until four days after and identify all people who were exposed to the virus. We notify the people who were exposed and then begin active or passive monitoring depending on their immune status. And then we may put out media releases and other communications to the community if there were larger public events or areas that had been exposed.

12:21 And then as people who were exposed get ill, we help to facilitate testing and needed medical care while trying to avoid any additional measles exposures in the community. And so now I will take us through a measles response we did just this year to show those in action. Next slide please. I'll start with an overview of the cases that we've had in Clark County. So far in 2026, we have had eight confirmed measles cases. One of those cases was exposed and spent their entire infectious period out of the state. And so there were no Clark County exposures and Clark County Public Health didn't have to have a big response there. And then another case, again with known travel out of state and who was likely exposed out of state but did become infectious and was ill in Clark County and required our response. And this case led to six more cases who all had a direct link to that initial case.

13:19 Next slide please. So this is just a really brief overview of the timeline of events and I'll talk more in detail about each of these steps. But just to give a sense of how quickly these situations can develop and the rapid response that's required here. On January 20th, a local healthcare provider called us at Clark County to report a patient that they were concerned had measles. And so testing was arranged as quickly as possible and sent out to the state public health lab the next day. While we were awaiting results, we identified through talking to that ill individual that a public school would be considered exposed. If this was a case and we started to kind of internally prepare for the large response that that would likely entail. On January 23rd, those results came back and confirmed that this was a measles case. And so the school was notified and the process of notifying and monitoring everyone identified as exposed was started.

14:19 About a week later, we had four contacts reporting symptoms of measles and testing was arranged for them. And then the next day, two more contacts started reporting similar symptoms to measles. Around this time, we were also made aware of a healthcare facility, the testing location where more Clark County residents were exposed to a case while they were contagious. And so this led to some additional notifications and monitoring. On February 2nd, the testing results confirmed that those other contacts with symptoms of measles were in fact cases. And so we were brought to our grand total of seven cases involved in this situation. On February 6th, the monitoring period for anyone at the school was considered over. And then on February 11th, the monitoring period for anyone exposed at the healthcare facility was considered over. So now I'll go into some more detail about how our response for each of those groups was. >> Can I just ask a question?

15:17 >> Yeah. >> I'm just wondering how many people were exposed that you had to, and did they have to isolate or what response did that require of you? >> Yeah, yeah, definitely, so we will, I'll get to a couple of those in a minute, but there was the school was kind of a larger, like over 1,000, and then the healthcare facility was a smaller, around 50 or so groups of people. And both of those monitoring versions were required in both cases. But yeah, I'll get into more detail about it for sure. So for the first step when a potential measles case is reported to us is to gather information from the provider and also the potential case themselves to determine how likely it is that this is truly measles. So in this case, the initial reported patient had symptoms that were concerning for measles, had a lack of known immunity to measles, and had that recent travel out of state where they had also reported contact with other ill individuals.

16:16 And so we were pretty concerned from the beginning that this could be a case. So then we work with local healthcare providers to get testing done and confirm a measles diagnosis. We communicate with both the potentially contagious person as well as the providers that are going to be doing testing to try and ensure that someone will not just show up at a healthcare facility while they are contagious, but that the facility can be aware and prepared before they arrive. And finally, we work with that contagious individual to make sure that they understand the need to stay away from others at that time. Avoid exposing anyone else to illness. And we try and support them in that by doing things like providing letters to excuse them from work, school, daycare, etc. And then we're there to answer any questions and provide any other education about measles that might come up and address concerns as they come up during that time. Next slide.

17:16 Next we have the contacts that we're made aware of from interviewing our case. And our first step here is to notify people that they were exposed to measles. And so in this case, this happened from a phone call from a member of our Clark County Public Health team. And we explain that an exposure to measles occurred, answer any questions that they might have about measles, and provide any resources we can there. And then we also during that time start to work to figure out if the exposed person is immune to measles. And so this means asking that person to provide some documentation of immunity in one of the ways that we defined before. And for those who are able to find that and have some documented immunity to measles, they get started on passive monitoring. And so we talked through with them the symptoms that they needed to be watching for. And then made sure they knew how to reach out to us if they did notice any symptoms or have any other questions or concerns. But other than that, they're able to kind of go about their day as normal.

18:16 For those without immunity or those who aren't able to find some proof of immunity, we start them on active monitoring. And so during this time, they're required to stay home from work, school, and other public areas until either they're able to find some proof of immunity or 21 days has passed since they were last exposed to measles. And so a member of Clark County Public Health called each day to check in on symptoms, ask how things were going, and use this opportunity to kind of address any barriers they could be having to quarantining. Providing letters to excuse them from work and school, things like that. And so this allows us to be a really close resource in working with them and answer questions and address concerns as they come up. And then also allows us to be very quickly aware of when another case might be developing. And due to this process, all of our following cases that developed during that time were already staying out of public spaces and

19:14 staying away from others by the time they entered into their contagious period, and so we had no new community exposures. Next slide, please. Often, as in this scenario, there's also some larger public settings where people were exposed to measles. And so our first site was that school where, yeah, we had over 1,000 student staff and volunteers that were identified as exposed. And so we worked closely with the school administration to quickly notify everyone that they may have been exposed. So we provided a letter template with all the needed information about measles and our contact information that the school staff ensured everyone got an email copy of as soon as possible when we knew an exposure had occurred. And then the school administration was able to provide us with the immunity information they had on students and

20:09 staff so that we could try and quickly identify who was that group that was at the highest risk for getting ill. And the school staff were a really amazing partner. They worked to identify the students and the staff who they did not have some immunity information for, and started reaching out to them to ask them to find that if possible. And so then again, those who had that proof of immunity were able to kind of continue going to work, school, everything like that as normal, and just were told to watch for symptoms and to let us know if they developed. And due to the high vaccination rate at the school among students and staff, that was the case for the vast majority of people. Clark County did follow up with 36 individuals who did not have some evidence of immunity. And so these people were called by a member of our team to ensure they were aware of their exposure and explained that need for quarantining for the next 21 days and started the process of active monitoring.

21:07 They were offered the choice of daily phone calls for a member of our team or daily automated text messages, where they would get a message with a secure link to a survey where they could report what, if any, symptoms they were experiencing that day. And a member of our team would review the responses, and then we would follow up if there were any symptoms that were suggestive of measles reported. Fortunately, we had no additional cases from the school that were identified. And this is likely due to, again, that high number of people who had a known immunity to measles and are quick separating out of ill individuals and all of the individuals who were exposed and not immune so that anyone that did get ill was not out in the community while they were contagious. Next slide, please. The second public exposure was that healthcare setting, where a contagious individual went to get some measles testing.

22:06 There were a lot of really great precautions taken to minimize the exposure here. We called ahead, the facility was aware, the potentially contagious person was wearing a mask, and the testing was planned for the end of the day when there wouldn't be many people around. But the individual did have to go through an area where others were present. And so even though the risk was pretty low, we did consider that an exposure to measles for anyone that was in the area at that time or for the two hours after they left. In total, there were just 49 people who identified and only three of those didn't have any documentation of immunity to measles. And so we worked with the healthcare facility to again notify them as soon as possible of the exposure. The healthcare facility sent out a written notice and our team followed up with individuals to ensure they were aware of the exposure and confirm immune status to measles.

23:04 And so then, again, just for those three who didn't have some evidence of immunity, we did the 21 days of following up, again, with their choice of a phone call from one of us each day or an automated text message. And again, luckily, due to again the fact that most people were immune and because of those precautions that were taken to sort of minimize the risk here, we didn't have any additional cases that came from this exposure. And so now I will hand off to Marissa who can talk about how we communicated with the community about these. >> I think we have a question here. >> Quick question. Do you have to ever enforce quarantine? What would you do if someone didn't want to quarantine? >> You want to take that? >> Yeah, I'm here. >> I can't recall. >> Okay, there you go. >> The light goes off when, yeah, it's unintuitive here.

24:00 I haven't had to do enforcement around isolation or quarantine for measles. People generally cooperate. I've had to do it for a long time ago, a case of multiple drug resistant TB who refused to participate in either treatment or isolation as it was necessary. A health officer has the authority to enforce quarantine. So if that's, it hasn't come up because even in our outbreak in 2019 when we had 71 cases. And we had, I believe, over 800 folks we were actively monitoring. I didn't have to use health officer authority to do that. We have the statutory authority to do that. It's RCW 70.05, I don't know if the processing attorney wants to say anything about that, but. >> That's impressive, okay, thank you.

24:59 >> Yeah, so communication is a large piece of our response when we have a measles case in the county. Our goal is to get accurate, timely information out to the community so they can be informed to make decisions to protect themselves and their loved ones. It's also important, of course, to get information to our health care partners and other partners that we coordinate with during these responses. During this response, there were kind of a group, some priority groups that we were really focused on. And those were community members in the media, health care partners, and then our community partners like schools and child care facilities. Next slide please.

25:42 So we learned a lot about effective ways to share information with the community during our 2019 outbreak. And we applied a lot of those learnings during this. We have a measles investigation web page on our site that we created in 2019 during our outbreak to use as our central hub of information for people. That page kind of has been dormant since then, fortunately. But when we identified the first case in January and realized there was a public exposure site, we revamped the page, updated it, put new information about our current case, the public exposure location, and then also have a FAQ on there with questions about measles, as well as questions about vaccine, and additional resources for the media, the general public, and health care providers. And then we updated that web page every time we had new information that came in the investigation,

26:39 and that page was for kind of the five or six weeks where things were really active. We had about 3,000 views on that web page. Next slide. Social media is one of the primary ways that we communicate directly with residents, especially during outbreaks. Clark County Public Health has a presence on Facebook, Nextdoor, X, or Twitter. And as of just January of this year, Instagram as well. So during the outbreak, we used social media to communicate directly with residents about investigation updates, and also provide just general educational information about measles and about the MMR vaccine. Again, with that goal of making sure the community has the information that they need to make the best decisions for themselves and their families.

27:35 We have our largest following on Facebook, but we did post across all of those platforms during this. We had three investigation updates that we put on social media. So announcing our first case, and then every time there was additional location, exposure location, and then additional cases. The first post announcing that very first Clark County case had more than 257,000 views on social media. The largest portion of those were on Facebook. And of the people who saw it on Facebook, 87% were people who do not even follow Clark County Public Health on Facebook. So those three investigation posts generated in total more than 529,000 views. And they were shared frequently and generated quite a few comments. We do monitor the comments and try to respond to questions as best we can,

28:33 as well as correct any inaccurate information or misconceptions that might be bubbling up in our comments. Next slide. We also use social media, as I mentioned, to share just kind of general educational information about measles and the MMR vaccine, things like the symptoms of measles, how measles spreads, the severity of symptoms, or the potential for severe illness, as well as just information about the vaccine. So we had six of these kind of general educational posts. The most popular was the post on the screen about the symptoms of measles had nearly 40,000 views. In total, these six educational posts had over 100,000 views. And again, across all of our social media posts, the majority of the views that we

29:28 had were from people who don't follow Clark County Public Health on Facebook or other social media. So we knew that our information was reaching people who don't generally come to us or see information from us. Next slide, please.

29:46 Another way that we get information to the community is by working with our local media. We issue news releases to share updates on the investigation. So announcing our first case and then the additional exposure location and the additional cases. We do that not only to get information about those public exposure locations out to the community, but just to make sure people are informed and understand what's happening in the community and can assess their own personal risk based on that. We had quite a bit of media coverage of the cases in the investigation. It was covered by most, if not all, local media outlets, at least once, some of them multiple times. But the investigation also prompted quite a bit of additional media inquiries, both local and national outlets, reaching out for kind of broader perspective pieces about measles, about measles outbreaks, about vaccination rates and childhood vaccine recommendations.

30:42 So we've just kind of generated more broad discussion about measles as well. Next slide. And communication with our partners is critical during these outbreaks. So for healthcare providers, we issued guidance in the form of a provider advisory about increasing cases in the state and across the Portland metro area. That advisory included guidance on measles symptoms, collecting specimens for testing, how to report cases to us, and then steps to take to prevent the spread of measles in their facilities. So if they had someone show up there, things they could do to prevent exposures to other people. We also had meetings with leadership of our larger healthcare systems, as well as local free clinics, community health centers, EMS, and pediatric offices. These meetings were an opportunity for the providers to ask questions that they had about the guidance or

31:42 about measles, and then also discuss any local needs or challenges that they were encountering. We also met with the communications team from our local health systems to just make sure we're coordinated on the information that they have a priority to get out to the community. For example, they really wanted to make sure people were calling ahead before showing up at their facilities so they could prevent any additional exposures. So we partnered with them to help get that information out and just share information with them. We also worked closely with childcare providers and schools to ensure they had information to help them prepare in the event that there was a case in their facilities. And then also they wanted to get information to their families that attend their facilities about measles and about protecting themselves and how to prepare. So we were in close contact with them and answering their questions. We have a quarterly newsletter that goes out to childcare facilities in the county and that went out in early February and included information about measles.

32:42 What to expect if there was a case at the facility, and then resources and information about measles and about the vaccine. And then throughout this, our team was also supporting local school districts who did not have cases in their facilities who just had a lot of questions. When measles is kind of circulating in the community, people start to get things ready and get prepared in case it comes to their schools. So we were getting a lot of questions about what public health would be asking for and what they could be doing ahead of time to get their staff and their students prepared. And so our team spent a lot of time answering those questions and providing information to school partners. >> Next slide please. So we learned a lot through this experience to kind of better prepare us for next time. One of those things, as Marissa was kind of mentioning, we learned the importance of community members being aware of measles and

33:37 of the symptoms and of what to do if you think you might be sick with measles. We had a lot of exposures that were avoided because individuals knew to do things like call ahead and not just show up to a healthcare facility, and knew to be staying home and away from others when they started to feel sick. And so before we were even made aware that they were doing the right things. And so that's definitely a benefit to the community in general. We also learned that that process of finding a proof of immunity can take a bit of time and effort. And so making sure we're really clear about what will count as those proof of immunity and giving people as much heads up as possible of that information that will be needed. And giving them time to get that together can reduce some delays and can reduce the number of people who have to quarantine just because they aren't able to find the paperwork they need. And another great lesson was how to avoid those exposures in those healthcare settings.

34:36 And our healthcare partners found some really creative solutions, including testing outside of the facility, testing from people's cars, things like that, which will help avoid a lot of healthcare exposures moving forward. Next slide, please. And so we are trying to use these lessons to prepare for the future, as we do expect that there will be more scenarios like this one happening in our county. So we've been working on immunization promotion in a variety of languages and in a variety of ways, because a vaccine is our best tool for avoiding these outbreaks in our community. And we've also been working on, as Marissa was mentioning, some education for healthcare providers, daycare schools, and just community members in general so that people know what to expect if they are exposed to measles and what would be involved in that.

35:33 And this also includes kind of promoting that people know their immunity status and know where their proof of that immunity is before an exposure occurs that they're involved with. And while we hope for the best, we are preparing for a bigger kind of outbreak scenario with our emergency response team. And so this includes thinking about mass testing sites, mass vaccination sites if we need to, finding solutions for barriers to quarantining for individuals, barriers to transportation, to medical care and testing. And any other issues that might get in the way of people being able to best protect themselves and others in the community, if there were a bigger scenario to develop. Next slide, please. I think that is everything we have for you, but if there are any other questions, we are happy to take those.

36:31 >> Thank you very much, this is very thorough, I appreciate that. Questions, go ahead, Councilor Little. >> Yeah, thank you. So if there's a parent today watching this, or especially a new parent, what's the best thing that they can do for their child? And can you address when you would do it and the safety of it? And also curious if we're at herd immunity still or if we're way below it. >> So I know in general what we would recommend for everyone, but also especially knowing, talking with your providers about where your immune status is. And if you have some protection against measles or not, and then talking with your provider about what the options are. If you do not, our best tool, again, as we said earlier, is having some vaccination and some immunity to prevent serious illness.

37:29 But then also, yeah, just being aware of what an exposure will entail for you and what that would mean as far as needing to potentially exclude from public settings, which would include work and school, and being aware of that ahead of time. And then as far as our herd immunity, I don't know if I have the numbers off the top of my head about that, but Dr. Melnick might. >> Let me go ahead and weigh in on this, because I have a few points to make about that if that's okay. In terms of the best thing you can do is get your kids vaccinated, and we follow the American Academy of Pediatrics guidelines in terms of first vaccination is at 12 to 15 months of age, and then the second one is at four to six years. Depending on the situation though, and I'm not going to get into it, if we had a large outbreak, or if you're traveling to a measles endemic area outside the country,

38:26 sometimes there's an extra shot given between six and 12 months. But we're not at that here yet, so we're not doing that. In terms of herd immunity, this Ridgefield High School is kind of an example of how it works. And I think one of the lessons learned, we measure vaccination rates, and if I'm getting into too much detail, I apologize. We got records, whether the children have documented adequate immunization, two shots. Then there's exemptions, there's a religious exemption and medical exemption. Medical exemption is really rare. There are philosophic exemptions, but that was ended for the measles, mumps, or billow shot after our 2019 outbreak, you might remember that a statute was passed in Washington to remove the philosophic exemption for MMR.

39:23 The issue, one of the things we learned is that there were a fair number of kids who were out of compliance, and that they didn't have their records. They thought they were immunized, but they didn't have their records, the school didn't have their records. Once we were able to obtain that, the immunization rate at Ridgefield High School was between 95 and 96%, and correct me if I'm wrong, but. And you notice when Haley was giving a presentation, she said 1,000 contacts, but 36 folks needed a B. We were concerned about that needed active monitoring and quarantine. So the immunization rate, I'm sorry that the little picture that Haley had on the slide show has an animation. Shows you what happens at different levels of immunity. Ridgefield High School is like a poster child in a way for how herd immunity works.

40:23 We didn't have any other cases associated there. If this case had been in another, so the point I'm getting to is the immunization rate varies significantly from school district to school district and from building to building. And you can actually go on the state dashboard and you can look at immunization rates by school building. And it varies, and there are some schools that have immunization rates significantly lower than Ridgefield. So herd immunity works, but the county as a whole, we're below that. I think we're around 90%, correct me if I'm wrong, I'm talking epidemiologists. So the further down you get, when we had our outbreak in 2019, we were in the 80s. And unfortunately, given all the confusion that's going on recently around immunization policy, we see immunization rates dropping.

41:19 And that's why you saw that graph about measles, what's been happening, we're likely to see more of it. That's why we need to be prepared. So that's a long winded answer to your question. But herd immunity, we could eliminate, we've got worldwide herd immunity for smallpox. We don't need to give smallpox vaccine anymore because we eliminated it. We could do the same with measles, but we had it basically eradicated in the United States, but now it's back. Anyway. >> Thank you, this was really good information, and it might be good to include this kind of information in future presentations. Especially what a parent needs to do, how many shots, when they give it, that kind of thing. Thank you. >> Go ahead. >> Yeah, one question, thank you, it was very, very informational here. When was the vaccine developed?

42:11 >> I believe it was licensed in 62? >> It was in the 60s, I believe, and I think there was a killed vaccine before there was a live vaccine as well, if I remember correctly. But by the way, before we had the measles vaccine, there were about 48,000 hospitalizations every year in the United States and 400 to 500 deaths. And so, but it was in the 60s. And the reason why we don't, we're not worried about people born before 57 is it is so contagious. That basically, if you were a child before the vaccine became available in the early 60s, where almost everybody had it, but this whole idea about natural immunity. The vaccine is very effective, as you saw there.

43:06 And natural immunity would be a good idea if you didn't have the risk of dying and developing. Getting natural immunity means being at risk for measles, pneumonia, and measles encephalitis. And there's also a chronic brain condition that people can get from after recovering from measles. So yeah, going on and on, I apologize. >> It's interesting because I think this really illustrates typical human behavior over generations very well. We tend to have some sort of a calamity or stressful, whatever it is, event that happens. And we learn from it. And then as time goes on, individuals haven't experienced that and they really forget. That knowledge is really lost of the importance. >> We have an example right here in Clark County.

43:58 So in 2019, when we had our measles outbreak, because we hadn't seen measles for the most part in years. The immunization rate in the community, we have graphs about this. Both for adults and children, so our outbreak began in January. The immunization, the number of people, both adults and kids getting immunized, January, February, and March, skyrocketed. And then it dropped after, and then we forget we're six years later, but yeah, we have the example right here. >> Yeah, and it's kind of like the first generation, as soon as the vaccine's available, they all get it because they know how horrible it is to have it. And then as time goes on, people just see, if you don't see, it just doesn't really trigger in your brain. So it's very interesting. I was curious though about your comments on the high school.

44:55 And I'm wondering, is what happened there in terms of people that we identified that may not be immune, but we determined later that they were to one way or another? Was that, I mean, common, was it vaccines that they had, or was it natural immunity? >> Most often it's people that are looking for their vaccine records. And by the time students are in high school, their vaccinations for the most part took place years before, right? And so as they go through school, maybe a little bit less and less up to date. So the school nurses had a huge lift to do, and just worked tirelessly to do that to help them. Adults even more so, if you have staff volunteers at the school, right? It may be decades ago in a different state before we had computerized databases with immunization registries.

45:52 So we did some work definitely to help support the schools and sort of tag teamed on trying to support people to look across state lines, etc for their records. And that was why part of what we did with our school districts and our child care newsletter was to remind folks, go ahead and see if you can make sure that your records for staff and students are up to date in advance. Because it'll save a lot of time in the moment that people won't have to stay at home, and they could just have that documentation. >> Yeah, it makes sense. And I'm curious, when we post our vaccination rates, I mean, where are we getting that information? Because obviously, in an event like this, we have the need and the manpower to go in and actually iron out all those little details. But obviously, we are unable to do that broadly. So I'm just kind of curious, what level of impact on the rate that we believe that we have, and what actually is.

46:48 >> There's a state process in each state, and state guidance to schools, that schools need to gather that documentation when students enroll. And then they need to upload and share it with the state, and we as local public health are included in that and help support that process. So there was a percentage listed on the website that was more like 91% for that particular high school. But once they did the work to update the records for those folks who records maybe were older out of date, that's when the true percentage was a bit higher than that. But they had already, luckily, they weren't starting from zero records, right? They had a gap that they needed to work hard to fill. And the mandate is for students, not for staff, but staff can also, those are records that can be gathered. There are certain healthcare settings that's really important, right, for the employee's vaccination status to be known by the employer. Other settings, the employer doesn't necessarily have that information, but

47:47 they're also not as concerned about people who are very vulnerable to getting quite sick in those employment settings. >> Well, very interesting and great work during this outbreak that we had just recently. Thank you. >> Go ahead. >> Just one more follow up for parents. Could you address the safety of the MMR? I know in the past there's been concerns about preservatives, etc. Just if you could clarify if there's any safety risk. >> Well, it's a live vaccine, so I don't know if there are preservatives in it. It's not indicated during pregnancy, for example. And that's a particular concern, because we have somebody who's pregnant and on vaccine who's exposed, we have to give something called immunoglobulin to protect them. The vaccine is incredibly safe.

48:44 >> It's just very safe, I mean, it's rare to have a significant problem with the MMR. I don't have the exact numbers for you, but it's remote. >> I'm certainly not questioning it, I'm just trying to help you get the word out. >> Go ahead, April. >> Thank you, Chair. I thought that in the last presentation about measles, they also said that if you didn't have the records, you could just get another vaccination and it wouldn't hurt.

49:11 >> Yeah, there's no harm in getting another vaccination, but I think for our learning on this, it would be great to have folks get the records ahead of time. I think that's one of the lessons learned about this. >> There's also a blood test that folks can get to show the level of immunity in their body. And that's called a titer, and Haley referenced it. I think that healthcare providers right now are aware that a lot of people do have an increased interest in making sure they know their own vaccine status because of the situation and all the media. So they are amenable to supporting people if they can't find their records. The records are very old, don't exist in a data system that somebody could get their blood drawn and get a titer that would demonstrate that they had immunity from previous infection or from the vaccine previously. >> The titer is a measure of antibodies in your body. So either natural infection or if you're vaccinated you will have a titer.

50:09 I'm sorry, I should have responded to that first. Yeah, no need to get an additional shot. Thank you. >> Okay, thanks for all this information. It's unfortunate that the most teachable moment is when there is an outbreak and it looks as though you're maximizing that educational value. And it's good to hear the stats on all the social media and the additional people outside the usual channels that are learning about this. Thanks very much for your work. >> Just want to mention one last thing. The cost of responding to measles outbreaks is huge. So we did a cost analysis of our 2019 outbreak. It cost us well over 800,000. And if you look at the, with all the workforce involved and all the work involved. Imagine we had eight cases here, imagine when you have 71 or more, what they're going through in South Carolina.

51:06 But when you take into account the medical cost for people who get sick, the cost lost work for staying home, quarantining and all that. The total cost of the measles outbreak that we suffered in 2019 was over $3 million. So besides the health effects, making sure that our population is vaccinated has a great, incredible return on investment. >> Okay, so thank you for all of that. Public Health Advisory Council, report out. >> So yeah, I'm delighted that we have members of our Public Health Advisory Council who plan on attending a regularly Board of Health meetings, and we have here in person Emily Estes, who's a consumer member of our Public Health Advisory Council and on the executive committee. And then remotely, we've got Breen Scarlett Pfizer,

52:05 who's Legacy Salmon Creek representative on the Public Health Advisory Council. And she also brings expertise as the infection prevention program manager for Legacy Salmon Creek. So I believe she's available remotely, and they're going to report out from the Public Health Advisory Council. >> Great, thank you for being here, and also for serving on the fact. >> Yesterday, we heard the same presentation at the Public Health Advisory Council. And I think we were really impressed by Clark County Public Health's response to the measles outbreak. And also really struck by the volume of work that this is for them. And I'm glad you addressed, Dr. Melnick, the 2019 costs. Because the staffing to get these records and to respond to these individual peoples is mind blowing. I, as a parent of very young children who are fully vaccinated for

53:03 MMR, but also have pretty complex medical needs, really appreciate how we've worked to affirm the safety of vaccinations. To get that herd immunity to protect my children and other children in our community. Breen Scarlett Fisher will address the components about her experience as the infection preventionist. But I also wanted to say that one concern we heard yesterday about this presentation was from our community members concerned that it would be difficult to reach families. Because of their concerns about ice in the community and how that might impact public health's work. They affirmed that that wasn't a problem in this context, but I just wanted to bring that forward as a concern that

53:56 in other outbreak settings or different situations where they'd have to be involved that we are concerned that it could be difficult to reach families who are concerned about some of rumors or potential behaviors about how ice is attempting to access people. In addition, before Breen talks, I just wanted to say we also heard about the climate change, regional planning, and that we really appreciated that that's a conversation that's being had. The Public Health Advisory Council really wants to participate in that and I'm particularly interested in the work that Clark County Public Health did on heatmapping to protect vulnerable communities in climate resilience. >> Great, thank you. Go ahead, Breen. >> Good morning, everybody. If you don't know me, I'm Breen Scarlett Pfizer.

54:54 I'm the infection preventionist at Legacy Salmon Creek, and I also serve on FAC. I just wanted to reiterate what Emily just said, that we did hear this. Presentation yesterday at FAC as well about measles. And I was also, as the infection preventionist at Salmon Creek, was integrated into the work that our health system continues to perform around readying ourselves for a potential, the next outbreak or the next time that we have a measles outbreak in our community. And I also wanted to reiterate that the same thing that Dr. Melnick said is that this is a very costly process. And encouraging our community members to get vaccinated, to vaccinate their children, prior to having an outbreak is imperative as it is extremely costly.

55:53 And our health systems are already stretched to the max with all the other work that they're attempting to perform just in keeping our community members safe in their everyday work. So I just wanted to say that getting people vaccinated and encouraging others to spread the word about how safe vaccinations are is really important, and we really would love for you to support us with that. Thank you. >> Thank you. Any other comments on this topic from the council? >> Yeah. >> Go ahead. >> I just keep thinking of parent questions, because I'm a parent. What if your kid missed the second immunization? Can you take it at any age, the second one? Or even if you missed the first one and the kid is now in his or her teens?

56:47 >> You can get the second shot at any age as long as, it's gotta be at least 28 days after the first shot. So theoretically, you get your first shot between 12 and 15 months of age. Theoretically, you can get the second shot sooner, but it's gotta be at least 28 days. >> Okay, thanks. >> Okay, thank you very much. Okay, I guess we're ready to move on to the director's update. >> Yeah, so the first thing I want to talk about is just to give you an update on current respiratory illness. The big three, influenza, RSV, or Respiratorial Sensational Virus, and COVID-19. So it looks like influenza activity peaked in late January and has been decreasing since.

57:43 We monitor this by the percentage of tests that are positive in people visiting the emergency departments and hospitals. So during the most recent week that we have data, 18% of influenza tests came back positive. That's down from the peak of 35% in late January. We're still in influenza season. Fluenza season is based on at least two consecutive weeks of positivity greater than 10%. So at 18% we're still in flu season, but down from 35% in late January. So the trend looks like it's going down. And emergency department visits have gone down. It was 5.9% in late January and 1.2% of emergency department visits related to flu most recently.

58:35 And also hospitalizations are down, 4.1% in early February and more recently 0.5%. So that's good news. In terms of RSV, it's been increasing since early February, but it's still a pretty very small percentage of emergency department visits and hospitalizations. And then COVID-19 activity remains low in Clark County, and right now it's not impacting hospitalizations or emergency department rates, but as you know, and we've experienced, COVID-19 doesn't follow the same seasonal patterns as these other respiratory illnesses. The concerning news is about vaccination rates. They remain low for influenza, COVID-19 and RSV.

59:29 In fact, one of the things that Washington State had to do is RSV typically, the recommendations for infants around RSV vaccine are generally recommended through March. But because we had a late RSV season, the recommendations for immunization of infants was extended to the end of April. That being said, only 31.1% of infants, those who are newborn through seven months, have received the RSV monoclonal antibodies, like less than a third. Vaccination rates for other respiratory illnesses in Clark County, everybody six months in age and older is eligible for the flu vaccine. Our rate is 26.2%.

1:00:24 So like three out of four basically have not received the flu vaccine. COVID-19 vaccine, the updated one, 13.9% of anybody eligible would be six months and older. 13.9% have received the updated COVID-19 vaccine. And this one really gets to me. Adults 75 and older are particularly at risk of RSV and it's a one-time vaccine. It became available in the fall of 2023, over two years ago. 42.9% of adults older than 75 in Clark County received the RSV vaccine. Just amazes me, so, okay. That's it for, do you have any questions about respiratory illness? >> Are there any questions? No questions.

1:01:21 I'm going to go on to a foundational public health services funding. We've been monitoring the public health, our colleagues across the state have been monitoring the legislative session because of concerns about cuts to foundational public health services funding. There's two sources for, I'll call it FPHS to shorten it up. There are two sources of funding for FPHS. One was the state general fund, and the other is the vapor tax, the tax on vapor products. The general fund is the largest proportion of it. But, and the budget amendments signed by the governor did not include reductions to the general fund source of foundational public health services funding. Unfortunately, the budget amendment did not. What happened with the vapor tax is there was a change of definition

1:02:19 of tobacco products that went into effect in January. And that moved the vapor tax funding for FPHS, went back into the general fund, which meant a reduction of $21 million in foundational public health services funding across the state. That's $21 million looking into fiscal year 2027. So fortunately, 258 million comes out of the general fund, but now we're looking at this 21 million cut. Actually, we're looking at, for the current fiscal year, I believe there was a small cut of about a couple million, but we're looking at $21 million reduction statewide. So there's four, so we don't yet know exactly what the impact will be to our department.

1:03:16 We get about a little bit less than $7 million. In current year, we received about $6.8 million in Clark County Public Health for FPHS funding. Right now, so there's 21 million cut. There's four basic buckets across the state. There's funding that goes to the state health department. There's funding that goes to tribes. There's funding that goes to local public health jurisdictions. And there's funding that goes to the state board of health. How those cuts are going to be, how the $21 million is going to be distributed across that is still up and still to be determined. And also, how it's distributed, the formula, how it's distributed to local health departments across the state. Right now, that's being discussed with SALFO, our state association of local public health officials. We will vote on that and then make a recommendation to the foundational public health services

1:04:13 steering committee which will come up with a final decision about how this is going to work. I'm sorry for going on so long. It's confusing, but we're looking, if I had a, I don't want to go out too far to live here. It could be a cut of up to a million dollars for us, but that still isn't determined. It may be less than that, I don't know if there's any questions. >> Are there any questions? I think in addition to all of these advisory groups, this council could weigh in at any moment too. So keep us posted and keep Jordan posted as well if there's a need for us to weigh in. >> And we really appreciated the council weighing in during the legislative session. It was moving in the right direction, but we got to the end of the session before this could be addressed. So it died. >> It's not over until it's over. >> But the other thing is the cut is for fiscal year 2027, but

1:05:12 this is going to come up at the next legislative session, longer session in 2027, so this can be fixed. It's just that we're stuck for the 2027 fiscal year. So any, yeah, any work you can do to help with that would be great. >> Good point, thanks. Councilor Young? >> I was going to, had similar comments, but I just wanted to make sure too that as time rolls on, and as you start looking at where those cuts are going to be, make sure we have the fact as well as us involved in that from the beginning. >> In fact, it has been supported as well, so I appreciate that, yes. Okay, last topic. Good news from the legislature is the passage of engrossed substitute bill, House Bill 2242. And it has to do with immunization recommendations and response to what's happened at the ACIP and the CDC around this.

1:06:12 So the brief summary of the bill that passed is that it authorizes Washington State Department of Health to issue immunization recommendations and guidance. And it replaces the requirement, this is good news, that health plans provide coverage for immunizations recommended by the ACIP. So now the health plans will provide a coverage based on Department of Health recommendations. And it's a requirement to cover for health plans to cover immunizations that have a recommendation from Washington DOH. So instead of relying on the ACIP, the plans will have to provide coverage based on DOH recommendations. And as you know, Washington DOH as well as we are aligned with the American Academy of Pediatrics, and the American Academy of Family Practice, and the American College of Obstetricians and Gynecologists on this.

1:07:10 And it changes the recommendation, the bill also changes the recommending entity for determining which immunizations must be considered vaccines. For the purposes of the Washington Vaccine Association from ACIP to the Washington Department of Health. So that's good news. And that's it for my report. >> Great, that is great to end on some good news. Anything else from the board? >> Yes. >> I do have something. I know we have an important work session coming up, so I'll try to keep it brief. But I did want to bring up during RDPO, which is Regional Disaster Preparedness Organization meeting that we had last week. I can't remember who the presenter was, but it was generally on fire danger and evacuation routes and such like that. And there's an interesting subject brought up. There's actually quite a bit of conversation, which is kind of unusual, about Clark County.

1:08:07 And in that conversation was revealed, and I'll just use her words, basically that she had called Scott from Cressa and asked him what keeps him up at night when it comes to emergency management. And he said it is senior care facilities. And one of the things that was mentioned is that state law requires that they have emergency planning as part of their function. And that the last time they were checked, which is fairly recently, for compliance with that, there was a 100% failure rate. So that means that they are not planning sufficiently. And so I'm wondering in terms of public health, what is our involvement in this, and how can we become more involved if we're not at this point?

1:09:04 >> Thank you, Kim Taves again for the record. Not only am I the director of infectious disease, but also public health emergency preparedness and responses. The other part of my umbrella of public health that I'm in charge of. We have two sets of folks that I think we bring to the table to support that. And the great news that we've re-orged in public health so that emergency preparedness and infectious disease, both of the same director, is I can help make some more direct points of contact. Not only for outbreaks, but also for long-term care facilities. We have a whole team in infectious disease that's dedicated and specializes on working with all the different types of long-term care facilities. Because in the Vancouver area especially, we have a very large number, more per population perhaps than some other areas. And there are really vulnerable folks there that have a variety of needs and

1:10:03 the small teams of staff, and a lot of those are stretched to provide health needs, housing needs, nutritional needs, social service support needs, engage with the families. There's a lot of hats they have to wear. So our team of nurses that works with them really know the context there and know the ins and outs of those settings and what type of patients they have that would have, what kinds of needs if they needed to evacuate or transport. And then our public health emergency preparedness team also has familiarity with that during the Nakia Creek fire, right? There were two long-term care facilities that were identified in a level two evacuation zone that didn't have a whole lot of heads up. And our emergency preparedness folks in public health have mapping and have those contact names. One of the ways we can help those facilities continue to prepare better is that we have had a vacancy that we filled with someone who's very smart and bright and

1:11:02 engaged recently to coordinate our healthcare alliance, which is the hospital and health system preparedness organization that is regional. And we do have some representatives of long-term care facilities on that alliance, but I think that that's definitely one area that we're all aware as we look towards a potentially extra hot dry season with a very mild winter that we've had that we all do have concern about wildfire as well and about air quality. And so then we've got some concern to make sure those plans are in place. So I think we sort of renewed energy to support through that healthcare alliance that can, in turn, take information and support and disseminate it out to the other similar types of healthcare settings of the representatives on that alliance. But as well, I plan to pull in our nurses that have a lot more experience specifically with

1:11:58 anything from an adult foster home facility to a skilled nursing facility all fit in that long-term care. And we'll continue to have that be a focus of the planning. >> It was unclear in our meeting who is really the authority in ensuring that those obligations are fulfilled, is that Clark County? >> I believe it's DSHS. >> It is, the licensing agency is DSHS, the state human services. >> My question would be, we know we have a significant issue with this and it's not necessarily our role in terms of enforcement and such. But what can we do to get the number to change? >> Well, as we come out of flu season right now, and we're hopefully coming out of our RSV season, which as Alan mentioned is extended on a little bit longer than we expected.

1:12:53 Then we do have some time where those nurses that do work on those outbreaks have more time freed up. And one of the areas of focus that we have is on vaccination rates, but another can be to work with our emergency preparedness folks. It would be along the lines of support, education, resources, not enforcement, like you said. But I think that there's a lot we could do in our partnership with Cressa and with our other emergency operations folks to try to help share information through the points of contact that we have. >> I would just like to suggest that this could be a good topic in the future. And I really appreciate you bringing that up, Councillor Young, but it might be more that we want to dig in here. >> Yeah. >> If we have time to this morning, go ahead. >> I'm also thinking, Councillor Young, if you can send me whatever information you have, you've gleaned. I might be a conversation with DOH and see if they can work with DSHS.

1:13:51 But I think there might be a message for DSHS here, and we could talk to other folks in other jurisdictions at softball to see if other jurisdictions are facing the same issues, and something we could bring up there as well. >> Yeah, I don't think there's anything I can provide you. What I would suggest is calling Scott. >> Okay. >> I can engage with Scott, and I agree that having DOH talk to DSHS is also a good other direction to help support. >> Great, really good, is we can connect the dots here. We're happy to do that, and maybe report back at some point when there's more information sounds good. Anything else from the board? Okay, that concludes our agenda, and without objection, this meeting is adjourned.