Board of Health - Regular Meeting

So many good afternoon. Thank you everybody for coming today. I think we're gonna get started just to pay attention to people's time and if if people come late and can join us that's okay. Um for those of you that don't know I'm Mary Shraven. I am the vice president of our board and I'm going to fill in for Joanne today. So on our agenda, anything that says President Osborne I'll I'll ask for questions or comments about. But wanted to welcome everyone and and say I'm glad you're here. Um, can we do a roll call, please? Sure. And Shraven, I am here. Jack Reagan here. Catelyn. Dr. Farber here.

Cynthia Hardy here. Supervisor Leesco is not here yet. Veronica Oros here. Stephanie Schroeder is absent. Lorenzo not here yet and it so we have established a quorum with six members. Turn the meeting back over to you. Okay. Do we have anybody from the public that is here that would like to Okay. All right. On to you.

Okay. Uh good afternoon. My name is Jannine Fowler. uh executive director here at Maricopa County Public Health. I'm sorry for how warm it is in here. We have asked them to turn up the air. So, sorry about that. We could we just leave the door open a little bit circulate the air. [clears throat] Um I wanted to introduce today we have a new position here at public health, our chief science officer. Uh for those of you who are unaware of what a chief science officer does, um the chief science officer or cso plays a key role in guiding data informed decision- makingaking, supporting public health policy, collaborating with academic and local partners who are using or plan to use public health data. The position uh will work closely with our chief medical officer and our division administrators to ensure that our programs are connected to relevant data and grounded in strong public health science. So, I want to introduce you all today to Ariela Dale right there and tell you a little bit about Ariela, who is not new to public health. She's been with us for a while. Um, Ariela has a doctor of philosophy in epidemiology, a master of public health with a certificate in disease management, I'm sorry, disaster management, and a bachelor of science and biological science from the University of Georgia. Dr. Dr. Dale previously served as the healthcare associated infection surveillance data coordinator at the Colorado Department of Public Health and Environment. She's a graduate of the prestigious epidemic intelligence service or EIS where she served for two years in the US public health service as an assenee at the Maricopa County Department of Public Health and Arizona Department of Health Services. Dr. Dell brings extensive expertise in epidemiological methods and public health practice to her role as chief science officer. She provides scientific leadership and guidance, ensuring scientific ri rigor, translating public health data to action and stren strengthening collaboration with community and academic partners. We're very excited that Ariel has taken

this position. You're going to hear a little bit more from her. She is going to do a presentation a little um later with Dr. Stab. So, thank you. Well, that's exciting to hear about. Welcome to the position and to our meeting. We're excited to have you. Um, I think next on our agenda would be an approval of the minutes. Did anyone have anything they wanted to add or that we needed to notice or change in the minutes that they saw? If not, may I have a motion to approve the minutes as written? Thank you, Chuck. May I have a second? Second. Thank you, sir. Minutes are approved.

Um, actually, you need to Oh, that's right. I'm sorry. Does everyone agree to the minutes being approved? First and a second. Favor I. Any opposed? Next on our agenda would be the environmental service fee waiver applications.

Okay. Okay, good afternoon, madame vice president, members of the board. My name is Robert Strapman. I'm the deputy director for environmental services department. We're going to go over our fee waiver submitts for this quarter. So this quarter, we reviewed 17 fee waver applications. Of the applications reviewed, staff determined that all meet the criteria outlined in the Maropa County Environmental Health Code. As a reminder, only an operator of a charitable nonprofit establishment which operates to provide relief predominantly for the poor, distressed, or underprivileged may apply to the board of health for a waiver of a permit fee. A waiver of a permit fee may be granted only to an operator establishment which maintains a current 501c3 tax exempt designation from the Internal Revenue Service and who demonstrates to the board of health that payment of set fee would cause financial hardship. In addition, a waiver of fees associated with administering and issuance of a food employee certificate in compliance with Arizona Revide statutes 411080 may be granted to the operator of an establishment which maintains a current 501c3 taxexempt designation from the Internal Revenue Service or to a current student enrolled in a K through2 culinary arts school program or similar curriculum based program requiring food employee certificates. The organization or sponsoring school district must demonstrate to the board of health that payment of set fee would cause financial hardship. Again, all fee waiver applications reviewed this quarter appear to meet the criteria. And I'm happy to answer any questions or if the board has no questions, I respectfully request approval of the applications on the fee waiver application summary sheet label P1 through P13 and C1 through C4.

I had just one question on the Sorro James. I just wondered what that was because that one was not as self-explanatory as Yes. Let me because I can I have the applications available here. I can pop it open for you. I think it this one that it's providing uh traditional dry goods boxes that for low-income families. So, it's uh homeless are allowed clothing and hygienic uh hygiene essentials free once a month. So, TEFP food for low-income families one time per month.

Great. Just wondered because it wasn't self-explanatory. Thank you. Does anyone have any questions or thoughts on any of these? If not, is there a motion to approve them? I make a motion to approve the fee waver applications. Thank you. Do we have a second? A second. Thank you so much. All in favor? Any opposed? Thank you. Thank you. Okay. Go on to the presentation.

Sure. Uh per Arizona state statute um we are required to annually give a health status update. So today uh Dr. Sab and Dr. Dale will um be giving us a health status report. Thank you. Thank you.

Got it. All right. Um, madame vice president, uh, board members, thank you for, uh, having us today. So, um, Dr. Dale and I have, uh, put together slide a set of slides here, um, just to walk you through, um, some of our top priorities. We're happy to answer any questions as we go along. Um, if you have them, um, take any thoughts or recommendations down. We certainly would be happy to follow up on any of these topics or any topics that we may not have included in this update. Um, so without further ado, we'll get started.

Great. Good afternoon, everyone. So, to begin, we will be publishing a health status report, moving to a five-year report. Previously, we have done annual reports. We will be publishing a five-year report later this year. So that will be a shift and then we'll be moving towards um quarter one publishing cadence. So this is catching us up for the five years and that'll be available on our website. Next slide please. This is an overview for the last five years just to give you a glimpse into the report of the top 10 causes of death just to help orient you just because it's this is a sea of blue at first look. Um 2019 on the far left shows the lead top 10 leading causes of death. And you can see as you move across the screen 2019 to 2023 that heart disease and cancer remain our leading causes of death here in the county. But as you follow across the blue corresponds and shows you the trail of how these diseases move across time. So 2020 through 2022 you'll see COVID emerge but then does not uh reappear in 2023. Of note in 2023 our most recently available data for this slide um drug overdoses and suicides have risen within our causes of deaths as well as strokes. Next slide please. I'd like to provide just a brief overing view of our community health needs assessment progress. Next slide. This is a three-year cycle. We're in year one of this three-year cycle. We've just recently completed piloting of the new survey instrument. So, that survey instrument is what collects data from our residents here in the county and helps lead to um our community health improvement plan and the priorities that we set as for the public health protection. Um collection will begin in spring of 2026 and we could really use your support in getting the word out once that is launched. It's anticipated to be February March time frame to get surveys out. We also conduct many other

modalities to collect this information through focus groups and key informed interviews as well as bringing in population data to help us truly understand what's going on with the who are we going to be surveying? How are we going to do it?

Um so we survey through many different modalities. We trying to reach all county residents, but we also partner with local organizations to help us to reach um different populations. I can get you a more up-to-date list of who all that will be in this coming cycle. Now we're going to highlight of some of the public health issues during the last year and I'll turn it back. So um one of our big initiatives is our response to heat related illness and death in the county. So um a lot of our work here goes into surveillance of um heat related deaths and illness um and then working with community partners to ensure that we have services those individuals who are at highest risk. Um so the big news going into this past heat season um was that last heat season in 2024 we had the first decline in heat related deaths uh year-over-year that we had seen um in the last 10 years. So this is um in spite of 2024 being a rec record uh hot and long uh summer um we did see um that decline in heat related deaths. Next slide. um the demographic features uh circumstantial features of those heat related deaths really has not changed significantly over time. We've seen a lot of the same trends. So in terms of looking at um indoor versus outdoor uh related deaths um the the distinction there between um ages. So we see um individuals of um older ages uh those indoor heat related deaths um whereas the age skews um younger um for individuals uh with outdoor heat related deaths. Next slide.

Um and again here looking at that split between um indoor and outdoor deaths. You can see um that uh most recent years in 2023 and 2024 about 3/4 of those deaths um occurred outdoors. Um and then drilling down further into who is at highest risk. Um we know that individuals experiencing homelessness um or experiencing unstable housing um are amongst the the highest risk individuals with roughly half of those heat related deaths occurring [snorts] amongst that um that group. Next slide. Um we also have been calling attention to the number of heat related deaths that involve substance use. um more than half of those heat related deaths involve um some substance use. Um and specifically amongst those we know that um 89% involve stimulants. So most commonly methamphetamine. So in this time where there's a lot of focus on the opioid um epidemic, we are working with partners really to ensure um that they know of this elevated risk with methamphetamine use um and that we are messaging out to the public about the combined risk of substance use and heat. Um really trying to make sure um that that people have a plan to stay um safe during u during our heat long heat season. Next slide. And this is our uh heat related death uh and illness dashboard. Um it's come to be quite popular in the community and with the media during the heat season. A lot of people are following this um dashboard for weekly updates. Um new this summer um was a was an option highlighted in the red box in the upper right hand corner of the screen there. um where you can select by city um to look at the dashboard and the

features um or the in the subsequent um tabs um which was a request by our city partners um that we were able to fulfill. So that um was a helpful addition this past um heat season. Um also I forgot to tell everyone Barrett asked me I I have updated this slide from the slide set that was sent out so that it would be the most up-to-date slide. So, um that will be updated in the slid set that's posted online. Um but you will see here um that so far, so this is as of October 25th, we're at 293 confirmed heat related deaths with 203 under an investigation. And in that box all the way over there in the lower right hand uh corner, you will see um the same numbers from the same time last season. So last season uh compared to this uh there were 429 confirmed deaths. So again, 429 versus 293 and there were 240 deaths still under investigation versus 203 this year. So um quick math um will uh show that we are on on track to have fewer heat related deaths this past summer um compared to the summer. So, we're um hopeful that we will continue to see that downward trend while the numbers are still very staggering that this is a major problem for um everyone living in Maroba County.

I think you guys have done an incredible job with the heat machines with the cooling stations and I know it's made a huge impact and it seems like there's been more branding this year where it's easier to identify where to go. We're seeing that reflected in the numbers as well. I hope so. there there's a lot of really interesting data that we're digging into um to really better understand how how the operations that we've been doing um are are impacting these numbers and and hopefully how we can continue to just driving them down. Next slide.

Again, so as you go through the tabs on the dashboard, you get more information. As I pointed out, a lot of the demographic features are very similar year to year um those who are at highest risk for heat related deaths. Next slide. And this is a feature looking at um where heat related deaths are occurring um which is very helpful to our partners who are working in heat um response to really know where um to put resources and especially for um cities and towns across Maroba County and to know how they are being um affected by this issue. Next slide. And importantly, as you can see, everyone is being affected to some degree. Um and then this is heat related illness. So when we talk about those individuals who are impacted by heat but not those most severely impacted um there's a very different demographic um uh profile here for people who are at ris risk for HRI um and so here we start to see individuals who are older who may have morbidities. Um these are individuals who we want to make sure discuss um a plan of care with their health care providers um before the heat season so they know how to stay safe. Um it just kind of requires a little bit of a a different approach in terms of how we work with partners um to approach uh heat related illness. Next slide.

You mentioned our response. Um so here are just some of the numbers from uh the response. So, the heat relief network is the backbone um of our effort um communitywide working with a lot of partners, cities, nonprofits, faith-based organizations. Um and and that effort to kind of brand and really put out the heat relief network as this um community-based uh solution to this problem. Um I I think has been successful, especially in the last couple uh in the last two summers where we've had increased um um uh funding and and um resources to bring to the heat relief network. Um we collect a daily survey from those heat relief sites to know um how many people we are um we are um helping uh we've been working with our public health liaison within the department to go out and do site visits so that those sites feel supported and that they're kind of following all those standards so that we're trying to present a unified um system. Uh we were able to work with 211 again this summer. Um had uh almost 8,000 lift rides provided so people could get to cooling centers. Um servicing almost 3,000 unique riders. Um done a lot of education efforts. Uh I mentioned uh the the substance use. Um we made a heat and substance use brochure um that got out to many of our partners as well as um a lot of posters. Again, just trying to get um the word out about um this uh these operations. Um we provided a lot of water um out throughout the system um to make sure people stayed hydrated as well as electrolyte packets because we know that that's um also very important. Um and then once again this summer we relied on our volunteers to support relief sites throughout the summer.

Vice Chair, I have a question. Um thank you. Uh, of the heat related deaths, how many are heat caused deaths? If we go back to one, two, one, one more. There we go. [snorts] Um, yes, Supervisor Leco. Um, this is, uh, this is updated as of October 25th. Um, he Oh, I see it right there. 159 and 13. Okay. Sorry. Thank you very much. I also Yes.

Um these heat deaths do we have an idea is the home homeless population staying the same or is it decreasing? Yeah. So Mr. Um Catelyn I think so is your question amongst the heat related deaths are the numbers who are percentage that are of homelessness obviously that's

so right so the the overall population uh homeless population is difficult to trade we do have our um pit or point in time count that the Maricopa Association of Governments organizes um I don't have that number off hand get that for you um my recollection is that it has not changed significantly. Uh but again that's single point in time count on one night and so we know that there's um a lot of variability there. Um not to mention the number of people who have unstable housing who may not be included in that count. Um so that is a a difficult number to get at. One thing that we are working on doing right now is getting um working with is it MAG who hosts HMIS

theari Solari sorry Solari um hosts the homeless management information system. So that's the system that's shared um amongst homeless service provider providers and we're hoping that if we with access to that data we can better qualify the homeless population and understand kind of those um more real time changes in the population. Thank you back to whatever slide I was on.

Next slide. There we go. [laughter] There it is. Um this is just a fun thing we wanted to share with you all. Um that dashboard uh that I just took you through um did one we did win a nature model practice award this year. So we're very excited for our EP team who's been working to develop that changes to it and that it truly is a tool that is serving um our community and is an example for and nature for public health is national association of city and county health officials. So that's our national organization of all local public health departments. Thank you. And it's a big deal. So, thank you

the team, not me. [laughter] Tell them changes. All right. Okay. And I will walk you through our substance use and mental health trends, beginning with fatal overdose. Next slide.

So, I'm proud to announce that the team has launched a new fatal overdose dashboard. So, as part of our efforts to modernize, you're going to see several new reports here in substance use and mental health that are now publicly available. and that we hope to continue to refresh data to and make it more easy for our folks to understand the trends that are going on. So to walk you through this briefly, um preliminary data from 2024 did show a decrease in fatal overdoses from 2023. Next slide. Note that between the last side and this one, 2024 data is not presented for the death rate and that is because the data were preliminary. So we did not want to calculate a rate with preliminary data. That data is currently being finalized and we hope to release it within by the end of the year to have 2024 trends posted on the website. We will also be modernizing this dashboard a little bit more as well. So you build it and then you make it perfect.

So the highest overdose rate thus far was in 23.

Now we're going to look a little bit more at the drug types that were involved in these fatal overdoses. So when thinking of opioids, most of our fatal overdoses involve fentinyl and that has increased over time with an increase by 112% from 2019 to 2023. Slide please. And looking at nonopioids, the um largest proportion of our fatal overdoses in involved over the last five years by 97%. So sad trends for sure to be reporting on. Madam vice chair. Um I have a question on this particular chart. Sure we're on the same one. Um so the the fentinyl which isn't listed on here that's considered on the on this chart. Correct. So we're not having fentinel on this one. And you have the the second cause is cannabonoid which is like pot, right? is so is that the main cause of the overdose or they just happen to have that in their system?

Question. So this would be um it would be in the system not necessarily a leading cause. It's a contributing cause to their death. Okay. You like to addition? Um, did I think it was two slides back? Um, the next slide. Sorry. Jumping ahead in my thoughts. There we go. There we [laughter] go.

So, I think that that's a perfect segue to this next figure which shows that most fatal overdoses do involve more than one drug. Um, so this is many drugs can be involved and may not and could be contributing are not necessarily the um preliminary or the primary cause of death here. So as we can see here, poly substance use is definitely um the leading risk factor here for fatal overdose.

And and I think this is important to understand too when we talk about some of our programming that comes from this data. So um with opioid settlement funds, we're working with a lot of partners to do programming. Um, but it's not just addressing, it doesn't just get at at at serving people only using opiates because we know that so many individuals are using multiple substances.

Also wanted to highlight that we have now have a fatal overdose counts by city. So to start answering those requests from our city partners to understand how photo overdoses are occurring within their jurisdictions, they are able to see here a map and then to the right the um breakdowns by count and also if they click the button the rates for their cities as well recognizing that all the cities have varying sizes and populations and varying burden. Madam vice chair I have two questions. one, the colors on this map, do they correlate with the the previous page or are they just different colors for different cities? Supervisor Leco, they correlate just to the city boundaries.

Okay. And then my last question on this one, I think it's my last question, is Talison, the very last one, has 96.8 deaths. Their population is only 9,353. So, how is it that they have 97 deaths? Phoenix, which has a population of 1.7 million, has 75 deaths? It just seems really out of line. What's happening in Tison? Do they have drug rehab places where people are dying or what's going on in Talison? [clears throat]

Am I reading it right? It looks like there's 96.8. Thanks, I'm like I'm [laughter] like why can't I have you would have to scroll down if this is static image okay and on my print out it says where where are you at there surprises so under surprises tempe that says 48.3 this is the 2023 and then it says talison 96.8 eight, which seems like a huge amount for a population of 9,353 people.

Supervisor Allesco, I believe that this um image that you may be that you're referring to may be presenting rates instead of counts, but I would have to verify by accessing the dashboard since this um image doesn't seem to correspond with the one that you're referring to. Be happy to take a look at it says view counts on the bottom. Okay, that means that the rates would be presenting and you would click view counts to swap back. So I believe that is rates that are being presented on the screenshot that you So what does that mean then? What do you mean? Said 96.8. Here's the um fatal overdose rates by city.

So So you're saying I don't I don't understand what this means. So, so it is a it is a rate instead of a count. So, um, so normalizing for the city populations, right? So, you you mentioned how the population of the city is so much larger than than Talison. So, you use a rate to control for the difference in those populations. Um, and so what that is indicating is, if I can summarize, it is more of a problem in Tollison than the city of Phoenix normalized by by rate, but it's not an absolute number. So the the numbers, do you have the counts? The counts in Talison should be much lower than Phoenix.

Yes, they're not. We have bigger problems. Yeah. I guess I'm not understanding the rates because in 2019 Telison was 110.4 in 2020 163.5 so and because so and because it's a smaller city changes in those numbers will cause bigger variation in those rates. So I would be happy to kind of sit down and show you that. But it's

it like a percentage of population then is that the Nick, is it more about this is 90 per 100,000 versus 1,200 to 100,000 between Phoenix and Talison if you're looking at these numbers? Is that is that the comparison rate per 100,000? Okay. Yes. So, let's see. Yeah. Per 100,000. Okay.

You know, and and we just don't like to look at counts when we're comparing cities because it's just not fair, right? because of course the city of Phoenix is always going to look like they have more of a problem than the other cities. But what the rates allow us to do is really compare the what's going on in those cities accounting for their difference in population. And again, these dashboards are really in response to our community partners and our city partners um who use this data for a variety of reasons. they may choose for one instance to use a count and in another if they're comparing with other cities then they would use a rate. So that's that is the reason behind showing both of those in the dashboard. happy to come back and talk about that more um

okay transitioning to some more of our data here on overdose we are going to talk about our neonatal abstinence syndrome so neonatal abstinence syndrome just for let's put everybody on the same level here babies born to mothers who use substances during their pregnancy um they're required for their hospital or health care and um we use this as an indicator of public health just to understand the burden of substances outside of the fatal overdoses I just presented. So in brief um neon neonatal absin syndrome or NAS which is a lot easier for me to say quickly cases peaked in 2021 and have since decreased. Next slide please. Again just like the discussion we had for cases. We then look at the rate and the rate is similarly decreasing since 2021 in the upper left figure and on the lower right figure that's looking at hospitalizations related to NAS also decreasing. So those are indicators that we are tracking and seeing similar trends that NASreing. Next slide please to show a little bit more information about the babies affected by NAS. um American Indian and Alaskan Native newborns have almost doubled the rates of NAS among any other racial ethnic group across the years. However, since 2021, we still see that um decrease occurring amongst all of the racial ethnic groups as seen in the overall trends. Finally, I'll be presenting on suicide deaths. So suicide death rates per 100 thousand um have been on the rise over the last dec decade but have been relatively stable between 2022 and 2023 was 1700,000 in 2020. The burden is highest amongst men who were consistently three times greater um the rates of females between 2019 and 2023 at 27.4. and looking at age specific trends. This is a can be kind of a difficult figure to interpret. So I'm going to walk us

through it. So we have it stratified here starting at the left um for pediatric or those under 18 all the way up to older adults at 65 plus. So at first glance you can see that the highest burden on those older adults. So around 45 plus. But when we're looking across the trends from 2019 to 2023 the greatest increase occurred in that orange group the 25 to 44 year olds. That's where we see the largest increase from 19.6 to 23.3 deaths per 100,000. Slide please. Leading further into these suicide deaths between 2019 and 2023. Um this chart we have the racial ethnic groups along the x- axis or along the horizontal bar there. You can see that um the greatest proportion of the deaths occurred amongst those 25 to 44. again in orange for all of the racial ethnic groups except for non-Hispanic whites which the leading age group there were those 45 to 64 years old. Next slide please. And of note as well the suicide death rates among veterans have consistently been over double the rate of nonveteran adults in Maricopa County. Um most recently reported as 49.9 death per 100,000 as compared to 19.6 of the non veteran adults in Maricopa County. As part of our public health work, we also conduct fatality reviews for suicide overdose. Um they I'm highlighting here the five key findings. I won't walk through them specifically, but for this step people understand.

Yeah. So the um fatality review boards for suicide for overdose um they convene as a group and review a sample the deaths that have occurred either by suicide for mortality review board or by fatal overdose within the county in the last year and they do an indepth review of those deaths. So they look not only at death certificate information but they pull medical record information and review those together as a group to identify um potential public health actions and upstream actions that could have prevented either of these death types. So on the far right are the um findings from the most recent reports that are publicly available for each of those fatality review boards. Um we are currently working on the most recent cycle of these review boards and hope to have those reports out within the next few months.

I would just like to make one comment because I sometimes we are we are asked okay great you have a lot of data like what what are what are you doing with it? And so I think what's really important here is when I think about mental health and substance use in our community right now, um we have very limited resources in how we can respond and act and we really need to be strategic in how we are doing that. And so collecting this data and being able to present it to our partners who are working in the community allows them to be more strategic, allows us to do more with limited resources. as I look forward to the next five or ten years, I think we will continue to need to do that. Um, so that's why we're excited to be able to share this data with the community so that hopefully we can push towards being as efficient as we can in delivering these services.

Can I ask a question? Are we having any luck with the prevention dollars following with some of these trends that we're seeing? Is that part of the goal to to really work on that prevention piece?

I can speak to that actually. I served as the state suicide prevention coordinator for a handful of years prior to coming to my role here at the county. And I will say just to speak to the veteran numbers. Um there's an organization called be connected that's a nonprofit that's statewide. They specifically use our county data and other data sources like our county data to to go to the governor's office and other entities to fund their veterans specific prevention efforts statewide. And they are very successful in their work. just as one nonprofit example. So, I will say this data is very important to nonprofits and other groups statewide, not just in our county to try to fund their efforts.

And anybody that's in a nonprofit role that's wanting to do some prevention grants has access to this data to use for their funders. And so, we're making that available. Great.

I also would like to point out with the neonatal abstinence scores. So, if you think about how we're able to do surveillance with with substance use, I think that's a really key one about how we've been able to interview specifically with pregnant people who are who are using substances, right? So, you may see differences in that trend compared to other substance use data that again can help inform those partners who may be specifically working with um pregnant individuals. Um, and [clears throat] so it's exciting for me to see these new ways that we're able to share data. And that is specifically why Ariela is here is to really bring those different data pieces to programs across the department.

Thank you for sharing that. Okay, pivoting to communicable diseases. Next slide, please. I'll provide a brief overview of CO 19, influenza, and respiratory sensitial virus or RSV. So, we have launched new respiratory illness dashboards for viral respiratory illnesses. Um, these are NAKO 2025 achievement award-winning and NAO is National Association of County Someone help me out officials. Officials. Yeah, I was like, I'm pretty sure. [laughter] Um, thank you for helping me. Counties.

Yeah. Um so for co 19 um so I'm going to provide the dashboards are um triplicates of each other and that they present the same information but across the diseases I'm going to show you different views from these dashboards just to highlight how they could be very useful. So for example starting with co 19 this is the landing page that you would see for each of these viral respiratory illnesses providing you a brief overview. So along the top you'll see the different tabs that you can select. We're on the overview selection we'll be looking at the others in subsequent slides. Um the dark blue line the um creates the trend shows the five season average. Um along the bottom there you see the dates. They're very small from this view. Um the lighter green being the previous season and the darker green being the current season given that respiratory season has surveillance has only officially begun. You will note there's only three weeks worth of data of the dark green and they're very low there um in terms of number of cases reported but because those are small on the right side of the cards where you can see the current season totals of how many um cases have been reported the weekly change is um documented under each of those as well in comparison to the five season season averages so that you can see how we are trending in previous years. Can you just talk a little bit how about how we get this data for during respiratory season like where it's coming?

Sure. Um so we are getting this data we actually have several data sources that are feeding into this dashboard. Part of it is our reportable disease or laboratory information. So clinical laboratories are reporting to us positive co 19 influenza and respiratory sensitial virus tests. Um we also examine syndroic surveillance data. that's looking at um healthcare visit data from emergency departments and inpatient hospitalizations to help us understand um the trends within healthcare visits and as far as mortality we do rely on death certificate data. So as those deaths are being finalized um with the medical examiners then we uh review the causes of death and are able to identify if they were related to as determined by the healthcare provider. So you can tell this is just the tip of the iceberg because most of us who get COVID or flu aren't going to the doctors and it's never going to be reported. They're not going to be reflected in these numbers. But this is just gives us an idea of for the most severe cases what's circulating in community.

Next slide please. Just one second. There we go.

There we go. Okay. Um, so as promised, I wanted to show you some of the other views and tie them to the morbidity. So for influenza, I thought it would be nice to show you the seasonal trends tab that the team has created. And this is actually something that they um generated denovo. It wasn't something that was kind of readily available as a dashboarding feature. So um you'll note that there are different bands across the screen going horizontally for each of the most recent influenza seasons starting in 2020 leading up to this season at the very top 2025 to 2026. the darker colors as you go across the timeline here indicate ind indicate more um flu cases being reported. So you'll see that typically we see the flu season and the highest peaks from November to February most recently in the 2024 2025 season that peaked in um late December, early January. Along the right hand side you'll see the total cases and then the identified peak week. Um as you can see this week of course we are um at 109 cases. That's the most up-to-date information we have available right now. Peak week of course has not been identified as we are the beginning of respiratory

and also amazing for me to see November during 2021 and 22 just how effective COVID uh response was for also controlling flu.

Slide please. we're able to provide age detail across all of these viral respiratory illnesses, but I wanted to highlight this specifically for RSVP um because it's just such so stark and you can understand the burden for our children that are under the age of four years. So um to orient you to this one along the um left hand side are the ages and age ranges that are most appropriate for respiratory sensitial virus or RSV. um considering that kids under four are at the highest risk of conditions related to that. Um across you'll see the different seasons it should correspond to the previous um seasons. So you can see the overview and the seasonal trends um and as indicated by the very wide bands here. Um RSV burdens are highest amongst our very young and

um and with improved tools for preventing RSV. I'm very hopeful that we can watch this dashboard over the coming years and see that uh those rates decline amongst kids 0 to four. All right. Uh so another respiratory illness tuberculosis. Um so we are as always following TB cases. Here you can see um the rates that we have been following here in Maricopa County. Um you can see that during the COVID years we did see a decline um in TB. Um hard to know if that was people not seeking care um or or something else. Um but since COVID we have seen a rebound in cases um up to 112 and 110 cases in 2023 and 2024. Um TB cases can be very protracted. Um and so it takes a long time to finalize those numbers. So those are still preliminary numbers. Um but that increase uh of about 30 cases um per year um is a real significant um burden on our health department because these cases do require um so much time to follow uh monitoring uh daily uh medication compliance as well as um following these individuals for a long period of time. Um not to mention with increasing drug resistance um in tuberculosis um these cases are getting more and more complicated. Um and and again Maroba County Public Health plays a a critical role in the health care community um managing and supporting um these cases of tuberculosis. Next slide. Um and while those numbers are going up here in Maricopa County uh not quite as high as they are in the state or in the US. So again, this pattern that we've

seen here um has been similar um across the country. Um here again, we're we're reporting rates. Um and so you can see um how Maricopa County uh stacks up to the other jurisdictions. Next slide. Sexually transmitted infections. Next slide. So these are looking at gorrhea rates um both in the US and Maricopa County. So again um a lot of our clinical services are focused on um STI screening um prevention and treatment. Uh here you can see from 2019 to 2023 we had a significant increase in gorrhea and then more recently those numbers have been coming down. Um again there have been a number of new uh tools both in terms of screening and treatment and prevention. Um hopefully that is uh what we see here um working. Um but you can see that Maricopa County does um have a a significant um increase relative to the US uh in general. Next slide. Um and here is that um trend here in Maricopa County that I mentioned um where we seeing um in cases recently. Next slide. And and madam chair, why is Maricopa County wife so many sexually transmitted diseases? I mean, I had a somebody told me a long time ago that in the Sun City areas it's very high. So I have no idea if that's true or not true.

Um so yeah, very high.

Um you know, I' I've heard some of those um stories not necessarily seem to be out um in our overall data. I'm sure if you started to look at rates by city, you might see some surprising things and then you could break it down further by age group. But um you know again these have been national trends. I think there has been um access to um to testing and health care obviously that was impacted um by the pandemic. Um I think there's also you know behavioral changes that that may be impacting some regions and not others. It's hard for me to say. I could do a lot of conjecture. Um what I think is important again for the data is to really inform our operations kind of where we are being strategic in terms of um enhancing our services. Um we have expanded uh the locations of our um STI clinics ac across Maricopa County. Really trying to make sure um that we have better access for people. a lot of the clients that that are using those clinics we see come repeatedly for screening. Um and so again, we're trying to make sure um that we are decreasing um access issues, barriers to access for these individuals and using that as a as a way to try and get these numbers down. Slide. Oh, this is sorry, looks like the TV slide. Um these are syphilis cases. So, we know that syphilis um has been a a emerging reemerging problem across the US um and really highlighted here in Arizona and Maricopa County um in our congenital syphilis rates which have been amongst the highest in the nation. Um encouragingly from 2023 to 2024 um you see a decline in um syphilis cases.

These are all stages um all comers so men and women. Next slide. Um again here you'll see um a proportion of cases uh in females versus males and that we see um that females make up over one in three cases um in 2024 compared to 2019. So again looking at the missing a um a key here but the females are in orange, males are in blue. So you see that increasing proportion. So that's not typical for syphilis historically. Um and a particular concern is we're um specifically looking to try and decrease the number of congenital syphilis cases. Next slide. And here are those congenital syphilis counts. So these are counts for Maricopa County. Um and again you can see the the numbers rising there especially in 2022 and 23. um a slight decline here, but this still um puts Maricopa County um amongst the highest uh case counts and rates for congenital syphilis um in the country. It's particularly um concerning because we've also been had shortages of penicellin um that have been affecting the country. Um and so anytime we have that happen, we are having to ration penicellin, which is really the preferred treatment. um for pregnant um people who uh have are at risk for um passing syphilis on to their child. Yes.

What about emph

I haven't me I will or Okay.

I I don't so but I can add that briefly or I'm happy to chat to you about it because there's interesting things happening very recently. Next slide. Okay, so a couple things in the media and happy to talk about EMPOX here as well. Um, obviously measles has been a big issue um across the country. Um, it's certainly something we have been very busy with here locally and I have a slide to show you how that has impacted our operations. Um bird flu was a big thing this last year um across the country and then here locally in Maricopa County we had um a significant uh impact here um on the west side of town in terms of um birds impacted um and I'll describe to you kind of what our role is in public health in responding to that and then I'll briefly talk about um some of the federal changes not notably the the changes in uh that have come at CDC in terms of immunization recommendations uh coming from the advisory advisory committee on immunization practices or next slide. All right. So I mentioned measles um we are quite happy that we have not had a case of measles here in Maricopa County um in the last uh in the outbreak of the last year. We know there's an ongoing outbreak up in Mojave County that we are keeping our eyes on very closely. Um, as we know that many things in Arizona end up coming to Maricopa County. Um, but I had this slide created because I wanted to show you how it still has impacted us. So throughout this outbreak, we have been doing enhanced surveillance. So anytime there is a suspected case of measles in Maricopa County, the provider should be reporting that to public health. um we um help in kind of doing a risk assessment for that case and then

get that sample to testing at the state lab. Um in nonoutbreak times um with a disease that has been uh eliminated in the US for a number of years um we have a different level of concern for those cases that get reported to us. Some of those cases um may be tested. Other cases we may um with the provider decide to rule out or wait for additional um information. This slide I created looking back. So again from um from left to right looking at uh 2025, 2024 and 2023. um looking at period we had to cut out a period of time back in 24 um where we were having um you may remember we had two cases of measles um that were imported from um out of uh out of the country in 2024. So we removed that period because we were also doing enhanced surveillance then. But what I wanted to draw your attention here is these are the number of cases in those time periods in those three years um that have been evaluated by our staff and tested. So you can see how um that was 9 46 um up to a 100 this past year. Um those are cases that were ruled out um through testing um through investigation and testing. Um and then we also as part of those investigations look at close contacts. Um so those are individuals who would be um monitored uh for a period of time by public health um while that case is being investigated and ruled out. So, um, a significant increase in the amount of work that is undertaken here, um, at the department even though we've had no cases and I'm happy to do the work as long as we continue to have no cases. Um, and I am just to be clear, I don't do any of the work. [laughter] I'm happy that we have staff who are excellent in doing this work. Next slide. Um and just to draw your attention to uh the other issue here in Arizona and

Maricopa County and that is our relatively low immunization rates for measles um relative to other states. Um with measles we are aiming for an immunization rate of 95% uh in the community to ensure that we don't see ongoing transmission if a case is introduced. Um in Arizona um certainly in Maricopa County um we have um rates under 90%. So we are falling short of meeting that goal. Um again you can see here only a couple of states across the um country are at that 95% plus. Um but again in the ongoing outbreak that we've seen um across the country this year, we know that uh this is an ongoing issue and one that we um are excited to address as we um try to um encourage vaccination uh immunization within the um next slide. And then I mentioned bird flu. So we know that the biggest impact of bird flu or aven influenza is on uh is on the livestock or on uh on the birds. So uh specifically chickens and we know that there is a large outbreak um in a number of facilities uh in commercial uh chicken farms in the west of the county amongst a couple of other um um cases of H5N1 over the course of the last year. Um what that means for us is human monitoring. So individuals who are responding to those um outbreaks uh in those facilities. So these are often contractors who are brought in by USDA um to to control the outbreak um as well as individuals who are working in those facilities. Um all of those individuals come under um our uh jurisdiction to monitor for a period of time while they're being exposed to those sick

animals. Um here we had a large number um related to those um those events. Uh so these are some of the numbers. 540 response contractors um and 288 regular employees. Um in order to do that monitoring um we used um a daily survey that could either be emailed or text messaged to individuals to report whether they're having any symptoms. if they report that they are having symptoms, they would get uh contacted by a public health nurse um to understand what those symptoms were and if there's concern um be directed for testing. So um this was really a a great feature that allowed us to um expand our operations um meet the needs of the community um who was who's being monitored and and make sure that um we were not seeing any um infections within humans who are Vice Chair, can you give me an update on what like what's the status of the bird flu? Like has it it hasn't gone to humans, correct? Or

so there have been there have been individual cases where a human who was in contact with an infected animal became symptomatic. So I think we are at somewhere around I want to say around 90, but I'm not exactly sure. U but we're in that ballpark. What we have not seen is transmission human to human.

That's the concern with aven flu um is that if you if the virus were to mutate where it were to gain that ability to infect humanto human, that's where you see past examples of pandemic flu um that which is why we've been so closely monitoring H5N1 flu both in cattle as well as um chickens primarily. Um but luckily we've not seen that mutation and that happened. So that's been that's the silver lining to this ongoing outbreak. Vice Chair, is that just do you think by luck or do you think it's eventually going to mutate to human to human?

It certainly is lucky so far. Um but I mean from what we know about influenza that potential is there. Yeah. Which is it was why we've been so concerned and and there's been a lot of control efforts into depopulating ill chickens and limiting movement of dairy cattle um in order to try and keep that from happening. All right, thank you. Next slide.

Um and then ACIP. So um the most recent ACIP meeting was uh highly uh covered uh in the media. Um we finally got updated CO 19 vaccine recommendations which um were roughly uh uh three months or a quarter later than we typically get them. So um access to COVID 19 vaccines was was delayed this year. Um we know that there's been a lot of talk about um who is eligible to get COVID vaccines. Um and I'll I'll mention on a subsequent slide kind of the different um tax that different jurisdictions have taken specific to CO 19. Also during that ACIP meeting there was a recommendation to um no longer recommend a combined vaccine that combined the MMR so the measles ms and reubella vaccine with the vericella vaccine or chickenpox. um that combination vaccine was noted to be um associated with a higher uh incidence of of febal seizures in those children under four years of age. Um so that combination vaccine is no longer available. Um of note here in Maricopa County and our immunization clinics, we have not been given giving that combined vaccine to um kids for that first dose under four. um but we do provide it for that second dose um if parents choose it. Um also at that meeting uh a single dose uh thyomearasol free flu vaccine was recommended. Uh there was only one um presentation of that multid-dosese thyomearol containing vaccine remaining on the market. Um so that is no longer um being supplied. Um and then there was a lot of conversation around the

hepatitis B uh vaccine birth dose. Um after a lot of conversation and review uh the committee decided they were not going to vote on that issue. So that was the what happened at the ACIP meeting. Next slide. Um in response to that there have been a lot of different actions taken by different uh jurisdictions and health departments in terms of the guidance uh for that. Um several states uh have joined uh what they're calling alliances. So there's a west coast health alliance uh California, Oregon, Washington and Hawaii. Um as well as a Northeast Public Health Collaborative. these um states are are sharing combined guidance um for immunization practices um that may be um slightly out of alignment with ACIP which is the traditional federal guidance that that has been uh followed. Um several states have also looked to expand vaccine access by kind of clarifying those recommendations as to who is eligible. Um so New Mexico was one of the first states to do that. Um Arizona did it when the governor ex issued executive order 2025-12. Um and subsequently we've gotten a standing order um from the Arizona Department of Health Services um expanding access to the CO 19 vaccine by making it eligible uh for um all people who are eligible to be vaccinated in a pharmacy which is um anyone over the age of six. Um and then there have been some jurisdictions that have decided to change um vaccine requirements um for schools or uh immunization uh exemptions for schools. Um so notably Florida has eliminated the vaccine mandate for

schools. Um and then Idaho and Utah passed legislation around getting um uh immunization exemptions for school attendance. So, a lot of stuff going on right now in the immunization uh field. We are very busy here in the department because we recently became eligible for and um were awarded the um a federal grant, a federal immunization grant that largely encompasses the vaccines for children's program. Um complicatedly, we were awarded that grant for the city of Phoenix even though we told them that is not our jurisdiction. Um I mean it is our jurisdiction but not alone. Um so as soon as we are done getting a couple of final pieces in place, we will be supporting those VFC providers in the city of Phoenix through Maricopa County. Um and that has given us a unique opportunity to work directly with the Arizona Department of Health Services and their immunization program. um so that we can be um aligned to create a a good customer experience for those providers who are providing VFC vaccines. And we are hopeful that in that future that'll give us um a a seat at the table to really drive some of the policy changes um that we are hoping will expand the number of BFC providers um who are giving immunizations in the community. So it's been all immunizations around here. Um but that is the updates from that. And then I believe this is my last slide. One more slide. That's our last slide. So I'll briefly just touch on EMPOX. So um EMPOX that we saw back in 2022 um the outbreak then um associated largely um amongst men who have sex with men um is was of the clay 2 variety. So there are two varieties, two flavors of emphas was what what caused the outbreak in

2022. Um and that we have seen sporadic cases of here in the US since. There has been an ongoing outbreak of clay one in Africa where it is um endemic. Um, clay one epox is more severe typically than clay 2 emphically in Africa has um a higher impact in women and children um than certainly what we saw here with our outbreak in 2022. Um we've been carefully monitoring these sporadic cases of epox um ensuring that we're not seeing clay one um that we are still seeing clay 2. um news out of um California uh specifically around LA County um this week, last week um was that there were three cases reported that did not have any travel history. So again, all of our clay one cases that have been detected here in the US up until these three cases have had travel history to Africa. Um and so these three cases are suggestive of spread in the community um in Southern California. So um we were just on an update call at noon today um with uh partners from across the US getting an update from California on that investigation. Um so it's definitely something we are watching closely especially knowing the um how interconnected our community is with um Southern California. Um those three cases were not vaccinated. We know that the vaccine that is available uh is effective for both Clay one and Clay 2. So, um, we will continue to encourage vaccination and then we'll work closely with our healthcare partners making sure they know how to screen for and test for EMPOX and hopefully we don't see it, but we will prepare for it.

Nick, could you also just mention New World screwworm? Sure. Well, we're talking about things.

We're talking about things that we don't want. Um, so New World screwworm has also been in the news a little bit. Um we've been monitoring it here for about nine months to a year with uh federal and and state state and local partners. Um it is a uh infestation so caused by a maggot of a of a fly. It's not lunchtime conversation. Um and when uh the fly will lay its eggs into human flesh. Um and then that uh when the maggots of the infestation um it is fairly dev or it is devastating primarily amongst livestock. So that we see um in endemic areas which have um it used to be endemic in the US. We through operations in the 70s were able to push um the fly um back below Panama um in a big effort. Um and we have been seeing over the last two two to three years kind of a slow march um from Panama um up through Central America of this um fly. So it is of greatest concern I would say to our agricultural partners. So a lot of the surveillance has been done by the USDA um as well as um here locally by the um state department of agriculture. Um but there's also a human element to it. Humans can also be infected. Um, again, it's an unusual infection that a lot of providers may not be familiar with. There has been a case reported in the US in Maryland. Um and so um we have learned from that case um with our partners and put out some messaging to our healthc care um provider community to just be aware of it especially in individuals who may have been um

traveling uh to these areas in Central and South America. Um as well as there has been a stop on um on the movement of cattle over the US Mexico border related to New World screworm. Um there have been cases of new world screwworm in cattle um as close as 60 miles from the um US uh from the Texas Mexico border. So um watching it hoping it doesn't come. Don't look up pictures of what the infection looks like, but just know that we don't want it. So try and keep it at bay.

Thank you. Any other questions? Sweet dreams everyone. Thank you. Thank you. Great job. Screens on your windows.

We already did the vaccine guidance discussion. That was sort of wrapped into Ariel's presentation. So, I'll um President Osborne just asked me to keep uh public health funding on the agenda. So I can report that since our last meeting um due to the number of refugees currently coming to the United States, we were informed from our funers the EES that we would be receiving a um decrease in funding starting October 1st. So um we received a cut of about $421,000 which um forced us to lay off three individuals. So right now and for all of you who don't know our role in refugee resettlement is really to do that initial physical for people entering the the country and to offer any connection to agencies here. So um that's really our big funding update since we last met. Um in addition except for getting the vaccine grant which Nick already mentioned um I'll just jump into the government shutdown update. Um the program that we're most affected by for the government shutdown is WICK. Um a little bit about WIC. There's six WICS in Maricopa County. We're one one of them. Um information is changing as you're all reading the news very fast with with everything including WIC. So what we know today is that we have enough federal funds to pay our staff for payroll until November 30. and we have enough food funds to continue to provide food benefits for our WIC participants through November 10th. Um I say that but we've already received three different contingencies from the federal government. So every day is a new day and so we're not really sure what exactly is going to happen um as we get into the mid November. So that's where we are with it quick. Anyone have any questions?

What are some of those contingencies? Because I know the last thing I heard was November 1st there was going to be the cut off. Looks like we have money to November 10th. How are we going to get that formula and those things to those families that need it? The formula the same way that they've changed. Yeah. Okay. The way it works now is um they get they have an EBT card. So the state puts money loads the EBT cards. Yeah. We expect that'll still work for

Yes. Hopefully people will get together and be the last of it. All right, over to you. Does anybody have any other questions or comments to ask? You guys did a great presentation on that. Thank you for all that information and he's proud to be part of a county that works really hard on the health of their people. So, thank you for that. No one has anything else and it's going to be a nice easy early day for you. You need a motion. Okay, we have a motion to adjurnn.

Move. All in favor? I posted. Oh my good.