Board of Health - Regular Meeting

okay well uh let's go ahead and uh call this meeting to order the uh first meeting of the year I'm happy to see so many here in person and I know we may have a few uh coming in through the meeting but um sounds like we have a couple people that need to be sworn in quite frankly so and here's one as we speak hello hello right so uh may I have a call absolutely uh president osor here vice president McMillan here Dr Farber yes Cynthia Hardy Veronica orol here Mary Shen oh Mary's on okay Mary you're online all righty yes okay and the r present and we have a quorum at this time we will uh allow for a call to the public if anyone would like to speak I do know that we have uh a request to speak but Mr Caitlyn's not here yet so he may be coming in and actually he will be one of our new board members uh and we'll give him a chance to introduce himself um he just hasn't been sworn yet so that's my understanding of everything uh I hope you all had a wonderful holiday and I had a chance to look at the minutes especially because we had a robust conversation at our our last meeting R Bob and uh so if if there were any changes or any discussion to the minutes please uh let me know now if not I would ask for a motion

to moot motion second and a second from Mr Sierra all in favor State I I oppose eyes have it right moving along um I know that supervisor leco is obviously not here but would you like to go ahead and um introduce sure us to her so to speak uh for all of you that are unaware we have three new members of our Board of Supervisors that um started their term in January um one of those is supervisor Debbie leco um you might know her from Recently she was in Congress represent she was our representative and prior to that she was at the state legislature um uh this year chairman Galvin Tom Galvin is our chair chairman and he has named um supervisor Alco to the Board of Health so she will be our representative On The Board of Health however the timing didn't work out great so um she needs to be sworn in we'll do so at the next board meeting and then she should be here meeting um as background our other two board members are also supervisor BR M who you might know from our state legislature um she uh replaced supervisor Hickman and also supervisor Stewart who's our representative from the East Valley who um he it took the place of super sellers yeah supervisor sellers so letco took Hickman's let go to yeah sorry letco took Hickman's Bry McGee took a Gates and Stewart president Osborne yes H Council was on their way so they'll be here shortly okay wonderful we also have new councel this year um Aubrey Joy corkran uh she'll be here momentarily as you just heard and we'll let her um introduce herself so she'll be our councel for this yeah

okay any anything else so uh when Aubrey gets here we'll let her introduce her to set that time okay so we'll move on to the environmental service department uh the we waiver applications and Robert hello hello second GNA get Place afternoon Madam president and members of the board this quarter we reviewed nine fee waiver applications of the applications reviewed staff determine that all meet the criteria outlined in County Environmental Heth code as a reminder an operator of a charitable nonprofit establishment to 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 the operator of an 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 will come financial hardship applications for waivers of temporary food establishment fees will be processed on a first come first serve basis in accordance with chapter 1 regulation 5A of the environmental health code the department shall only present a maximum of 25 of such applications per event to the Board of Health in addition waiver of fees associated with the administering and issuance of a food employee certificate in compliance with Arizona statute 41180 may be granted to the operator of an establishment which maintains a current 501c3 tax exempt designation from the Internal Revenue Service or to a current student enrolled in a k through2 culinary arts 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 will cause financial hardship and all fee waiver applications reviewed this quarter appear to meet the criteria happy to answer any questions or if the board has no questions I respect respectfully request approval of the applications on the fee waiver application summary sheet labeled p18 and C1 thank you for that I do have one question but I'd like to open it to board first if they had any questions no okay wondering if the chili cook off is going to lead any health concerns yes well along that lines I I actually did not understand the background of this barbecue from out of state and what it actually was doing so was there a fire I mean what this is an agency for my understanding reviewing the application as well is it's an agency that upon they they will raise money through other events to help support the uh the services they provide for types these types of emergencies so this event was not the emergency this was an event that they attended to as part of fundraising for their purposes and so they request the fee waiver as part of that because of the services that they're going to be providing will be supporting the um these uh areas for for distress so they were raising funds they're from out of state they were actually here doing an event yeah it looks like looking at let me pull that application up this one is so there was so and it was being money raised for that's for yeah so the money being raised was for Opera operation barbecue relief the permit that they pulled was

for this other event which is associated with barbecue competitions and but the agency in and of itself provides services to other entities which is which is um I can read it here for you me meals and Community to facing food insecurity um a communities and First Responders affected by natural disaster B providing um one hot meal that matters during times of me operation with the network of volunteers um and Equipment across the country can mobilize immediately following natural disasters and serving hot meals within 20 I'm just trying to get the connection points of how this yeah I I I and I fully understand the question this is one of the more unique applications in terms of the exact points that you're bringing to light typically when we have the uh requests that are associated with this one isn't a they operate a special event and we have other ones like the Kanas one is a special event that's all centered around still the fundraising related to that entity under a singular event this is an example where it was a single vendor as part of a larger event that was not humili ass associated with but this vendor and the work that they do is still it the concept is still comparable to other ones that have been approved in the past that's I'm following the dots and it's like okay where do we see that that funds that they were raising was helping ours or you know do you see option what I was trying yeah yeah and and we don't extend into uh getting into the details of when those are then eventually provided that that kind of

like getting to the the board in the past has never asked us to dig into the financial element and then the subsequent services and dates associated with those historically well considering it's an outside State entity and it's un and we want to see yes yep I completely yes yes um any other am I the only person that see okay uh all right okay board then if you are okay with this and don't have any other questions then and Madam president you know as the board if you had made a choice you know through discussion you know you can alter the the request of the and can application are you thinking maybe all them except for that one is that you're I'm just trying to get to the connection for why we would you know wave the fee for this entity um making sure it is actually helping of our own State you know um and it's you you said it was for a big event it's like well where are all those other people that were in that big of asking exactly yes so that's why I'm kind of like this this one entity under understands the system so to speak correct yeah I I do understand and from what I can gather with the event and operated that and the type of establishment is it's obviously barbecue based and they have barbecue events within the county that and the one that they worked at all but the this one well I can't speak for all but they're working on a commercial standpoint at the event this one as a 501c3 though is at the event because it brings you know you customer based within their business model of the food that they serve it's a area for them to attract and raise money

at this event but then like you said it's they're going beyond the event itself was not fundraiser for all but this vendor working at that event was raising funds to then further uh the work that they do but where if they perform any of these Services beyond the state and they weren't specifically identifying a specific event in which they responded to well I mean and that's it's if you were to say you were to say you know we all know how many fires are happening in Arizona and all around but in Arizona specifically and you were to say you know they raise money because the minute there's a a fire up and show this organization comes out to you know cook for the firefighters then I'd get it but we're not hearing that and so and I happen to have wag on firefighter son so that's like so how's this all working out are we actually waving this and all of this is going to a different state because this is an outside State I think it's said Missouri quite frankly I'm not so um I think we need to myself I doubt that this is a huge amount of money it's more it feels like it needs to be a little more Ro in understanding of how the final effects is I my question yeah type of because this is unusual not we've never heard anything like this it's at least since I've been on this board we haven't you know and St Vincent to Paul it's different yeah makes sense it's churches it's you know but this is different yeah and Madam president I can also speak to you from a historical P standpoint point with how the vast majority like you indicated most of them are fixed establishment when we talk about food

permits they're fixed establishment brick and mortar types of establishments um and in the recent years there were some uh of these larger events that were uh the entire event was fundraising with in the relation right and so that's why when I read my statement before we now had amended the code to call out specifically for temporary food events and then we were capping at 25 because we had similar situations in the past where we had events where they were applying for like 70 or 80 and in terms of the finan you know the point of that prudent for the board to prove that many in the context of a singular so the temporary event ones are much fewer and more of the exception than the norm so um and proactively in the dates in which the events happen right because those are singular events as opposed to uh a brick and motor type of establishment that operates year round it's the Nuance is is so I I completely understand what you're saying and don't disagree with the the evaluation of temporary food permits in in especially when they're one-off like this when the event as a totality is not a fundraising event where they all the vendors at the event are requesting that can we request that the vendor explain even though they're a 501c3 can they explain that those funds raised at this goes to marope county or the State of Arizona we we can we can ask the questions we want of of of the vendors right in terms of what has been in the code and and to the extent of the board has advised in the past the level in

which we dig in to verify kind of like going down that rabbit hole of the finan you know the expenditures and the financials of a 501c3 we have not been placed in that position to take that extent but we can definitely and we do follow up with uh when we see applications followup questions for Clarity on the services they are providing so that that is completely in line with what we do that only for the fact that like you brought up if it's a fundraiser in general and they go everywhere but then they're giving to everyone then that's one thing but if they fund raise and we're gonna bewave them it should support us so we should ask what support is that they're giving us through that event yeah before we would wave their feet and like I said if you if if if the boards uh would like to um withdraw that specific application for further review to be considered at a future meeting we can we can absolutely do that and the the event has already occurred so is this a reimbursement yes it's a reimbursement so I I have no problem asking for clarity you know okay question yes the statute of rules does it prohibit State present rules or statute prohibit the the in terms of the services being rendered it's the amop pakani health code does the rules do not get that specific in terms of it just says has established to the board that it's that it is intent of the services are doing is serving the poor predominantly poor are underserved that doesn't even dictate specifically within Mar mopa County it's a part I'm getting at does

it specify geography it does not in the regulations does not specify geography and to me you know as long as it was really helping Arizona I would have problem with that um but I think and I would be fine giving you the authority that if they show the clarity then fine rather than having to wait till the next quarter to bring it back to us I would be okay with staff being able to make that determination but I just think that this is the one thing that we are supposed to do right we might as well say say hey no give us clarity about it so that is my feeling and Madam president in the board that's why we bring these applications right we'll do our best assessment of the intent of the regulations and what the the board has done related to fee wavers in the past and allow you to to help you know we can look at the intent how was defined and then further inquire about it and uh and we have it's not we haven't done in the past we can hold and Pull and application for further clarification and ask them to resubmit or bring back that's all within the purview of this process and that's why we do bring it to so for the board then I would like to ask that um there be a motion to approve oh I can tell you which application yes that one is would be P5 yep so motion to approve all but P5 and then we'll have a SE separate and then a separate motion to the other one right direction I think I think you would Mo approve set four and the other one is not not approved so it just kind of is in LMBO so we don't need to give that direction then yeah I guess

uh M president you hear us I I would if the direction is to just deny it and require them to reapply that could be one or if you are the instructions to us would be to not approve it get more information and then bring it back to the April meeting if if that's the ability to do through board's [Music] action approve all a stipulation on P5 um with the direction from clarity going back to that me do it that way I guess I I would have to defer to to the legality Council on that one come on hi I'll do the introduction after I answer your question um I would say to split it in two so you can have a motion to approve the ones you're going to approve so I'll but and then have a motion on on the exception and decide what you want to do with that and make your motion for that okay did you guys get that yes recomend the second one not deny it because we don't have grounds to deny it yet we don't know correct no I I I agree with you okay so who would like to make the emotion okay have to accept everything except for5 E5 okay I second got our second all in favor State I I post have it now our followup think we need another motion on that yes yes so whatever you want to do whether it's come back whether it's deny and come back or approve with a stipulation or

what whatever it is you want to do make your motion and then um follow through with what you want to do with P5 if there's no motion and it sits out there unapproved then it would come back anyway correct it can yes you can you can hold it for the next meeting which would be no motion right I still recommend making a motion to hold it come back good so we don't want to do a motion um of an approval with stipulated Clarity on because if you come if you say that that's not clear and we've already yeah M president my my concern in Council is if the clarity is not provided by the applicant or the details don't meet it would be uh us uh making an our own assessment of is that meeting the intent of your conditional approval and without Clarity on that I would be a little bit concerned with taking it with a conditional approval that's not F that we could then measure against I was just trying to avoid yeah yeah okay we can do that so who would like to make that motion what is the motion to to hold till bring back to the April and that's what you want on the legal St I got you understood so so the motion would be do we want to hold this P5 and further information and come back to the board is that is that what I understand sorry do you make it that I can or some you have a second second second I second oh thank you we have our second all right all in favor State I I oppose I thank you the ice habit than ask a question on that just when you go back and do your research just what does the statute or rule say from my point of

view on the board I'm presence to deny something that I'm not supposed to deny so I'd be a little conservative with my vote in the future come back does a statute determine any type of geography that would be helpful for to get back from you when you come back okay thank you yes part of your clarification thank you that and because if that's not clear that may be something we need to change for understanding you could that's right take up a future future regulation very good thank you thank you would you like to introduce yourself yes hello I'm Aubrey Joy corkran I'm senior councel in the government advice and elected officials Practice Group and the Civil Division at the Maricopa County Attorney's Office I joined the office in October before that I was health unit Chief counsel at the Arizona attorney general's office where I represented the Arizona Department of Health Services for 14 years before going to law school I earned a master's degree in public health from Emory University and worked in public health for several years so my background is in public health public health law and government advice and I'm really happy to be with the county and it's vising this board and I look forward to working with all of you thank you thank you f last I can't see my that c r c r a an okay wonderful all right so we are moving right along now um we shall have some updates from our wonderful department head over here uh um I was asked to put Federal updates regarding Public Health on the agenda I'm trying to tell you I don't have a lot of updates but um I wanted an opportunity in case anyone had questions or anything that they wanted to discuss

we know there's a lot going on at the federal level that impacting Health at the moment um currently there's a blackout with Health and Human Services meaning uh they're not allowed to make any exal Communications so um we're told that is quite normal for a new Administration so we're waiting um hoping in February that gets lifted and communication will start flowing again um yeah sure I do have a question um in the event of h5n1 were what what would you do access do you have for vaccinations uh well we happen to have our medical director here so I can let Dr Sun and shine answer that okay so so uh we're doing a number of things to monitor for h5n1 there was a recent um a recent request from CDC uh turn in specimens that are consistent with influenza A uh H one for testing to see if they are um Aven of that of that type so far we have had although mult multiple exposures of Avan influenza to animals including um we had a zoo and some backyard chicken flocks and a commercial poultry area over in U panal County we have not seen any human cases so what we're what we're most anticipating could happen is more of those animal exposures for which we're working very closely with the Department of Agriculture and they are very much ready and unfortunately practiced in um taking care of those animals to make sure that nothing spreads to humans and our role in that is really monitoring the humans that have then been exposed um and so far all the exposed

individuals we've not had a single case um of Aven flu from that um we are also monitoring very closely four cases in humans um that that being said I'll address specifically your request for access to vaccination there isn't a specific Aven flu vaccine right now however we do have access to osal tavir which is the typical drug that we use for influenza in general and it can be used both for treatment and postexposure prophylaxis so it uh treats it and if you're exposed it can prevent the disease and the good news is they did a whole review of every avien flu case in the United States and um all of the disease has been Mild they also looked at all of their family members and not a single one of them has caught it from their family member which is the most likely spread that we would see so all that to say I'm optimistic that gonna need the influ vaccine yeah I I had a question um in terms of I I get that when you have an executive uh switch over that there's going to be some lag time and whatnot have we ever seen that there was ever a a executive order on sort of blocking uh reports dashboards those sorts of things and how does that affect do we usually get information that comes down and then we uh or do we give information upwards that sort of tells a bigger picture of various health things because my understanding is that there was an ex executive ORD putting a halt to uh various reports on on health related issues yeah I'm happy to comment on it so uh Mr SI thank you for the

question the the communication um from federal level to the local and state level has been halted but we're still communicating that we're still doing the surveillance and we're letting them know and my understanding is that there is an exception for any danger to life or health so I am was just recently a an employee of the Centers for Disease Control so I'm get getting used to no longer being being employed by them um but I am confident that if there was a danger to health or light uh that they would be able to communicate that um those dashboards and things my understanding from talking to colleagues at CDC is that they're actually going to get an update regarding communication February 1 so I don't think we're going to have to wait quite as long but to answer your first question this this one does tend to be a bit broader than any of the ones in the past but it doesn't affect us Madam chair did it affects us in the sense that we had meetings scheduled with folks from CDC the division of global migration and quarantine and they had to cancel those so a lot of planned events have been cancelled because of this temporary halt in Communications but I think from a long term or from a protection of health and um and human life perspective I don't think it's going to have a significant imp but you said that this was normal of administration change type of scenario been told in the past that it's very common for a a new Administration to go dark for a certain period of time while they're getting up to speed but your Assurance back of life

and and situations like that yes I'm confident that if for instance if there was any sort of new knowledge for instance there there was any sort of new knowledge regarding AV and flu or some type of exposure here in the state they would absolutely communicate that to us thank you very much all right so go on Tobacco update yes so I'm gonna invite Michael wer from our tobacco office up to give us a followup update you remember Michael was here a few meetings ago who did an update on Tobacco and there was a few questions then come back with some ansers you Janine and good afternoon got older since the last time so sometimes I need readers um so I'm going to go over some of the new information from the 2024 Arizona Youth survey first slide I just wanted to cover some of the um participation for 3000 um students that participated in the survey which is about 1% participation and so the Sur is designed to assess prevalence and work for the first one I go the next live for you we're Frozen guys give us a second I'm sure it's freezing up on us

we apologize we seem to be having having some issues with the technology it's not sharing on the screen but for those of you who are virtual you probably do see the slide so give one second please have paper I know we have your presentation just continue that way to give me two two more seconds what happened to me right I'm GNA try and share and let's see what are you able to control now do you want ITA Renzo did you do this this is all you Michael you want to try and see if that works if not we can do next screen oh there we go thank you for your pay too large yeah this one just kind of summarizing so the surveys is provided between June or January and may of 24 St there's about 42,000 students within grades 8 and 12 from about 255

schools this is showing you the breakdown for the past four years um our percentage for 24 is about the same as it was the survey year before that and the good news the percentage of Youth who report using substance or life was trending downward and that's for all Ser um all substances um so this is the lifetime substance use so this a measure of the percentage of Youth who have tried a particular substance at least once in their life focusing on ecigarettes and cigarettes we have made a trend downwards to only about 14% for ecigarette 26 previous um years and cigarettes went down almost half to 5% from % you tell me the multiple substances of so what's not on here would be over the count you know uh prescriptions or fentanyl I guess so is that just that's not part of multiple substances is it it's just those two will not I guess within the survey I have to look and see how they categorize that I was only focusing on this they were yeah on cigarettes gotcha okay yeah that would be wonderful if you could let us know that answer I think links everything because I'm going to show you the dashboard at the end so this is lifetime used and then we're freezing up would you mind just advising everyone to refer to their packets we apologize thank you and for uh everyone online if you moving oh here it goes I mean I'll keep trying it but I don't want to delay the meeting so you see me moving okay so the second slide is really looking at the substance in the past 30 days so it's also trending downwards which is also positive news it

looks about half for ecigarettes and cigarettes and so 30-day substance use is the measure of the percentage of Youth who try a particular substance at least once in the the past 30 days is how that's defined this is just the cigarette Ed percentage so this will show the lifetime and past 30 days and it's showing the different genders and ethnicities and grade levels we can tell orange is the past 24 data so you can see everything from gender to ethnicity to grade level has been decreasing same can be said for cigarette use everything trending downwards by gender inity and grade level make that link but I wanted to show you a visual there's the Arizona Youth survey data dashboard which is a really helpful tool for visualizing by County substance percentage by gender and you can slice in different ways and show different substances I think prescriptions is one of the options on this one as well art and sweet 202 cigarette and cigarette usage in terms of the the downward Trend are you seeing it specifically in places where you're doing some communication around that I think it's so we do a lot of um advertising the community through most programmatic digital so like your social medias and then um adhs is doing a lot on their un Vaped Generation Um if you use YouTube which I do every morning um I've been seeing a lot of unv generation ads targeted through that platform um I think a lot of it is within our Community Partners and getting the Outreach and the training out to schools to nonprofit

organizations um there a Catch My Breath curriculum that's been very popular and very easy to deliver so I think that's been attributing to that downward use yeah when you look at all of these different rep goodness things are trending down um and then you you kind of do you dig into so what's causing this this good trending down is it the education is it the you know getting the word out of advertising marketing to to the kids is it the fact that it was something new and now it's lost its Allure is it was it covid people are feeling better I mean you know it's kind of like all the above in a sense you know that you put together you make a great point I think they're now coming out with the pouches I don't know if you've seen those Z pouches yeah so I'm hoping that doesn't make us a trend in another usage that we show up in another survey is something that they're switching to because it's a little bit easier there's not the Vape detectors there not it's not as noticeable it got it it's on our toes have you considered bulking things together in the survey because they as the group switch from one thing to another the numbers that go up and down but the numbers overall you know the whole they're moving from something to something to something if you're measuring those somethings together as a total number then you get to see whether the abuse is going up or down overall way great yeah I mean the survey is standardized and then I think they have to have it approved to change by state if you want to add or change the data point okay you can combine them though because you don't you just could combine those right like on the pouches you said right I'm unfamiliar with that the pouches that that's something you don't have approval to to track right I don't know not at the

time so I think thank you for the question I think what you're asking is could we combine multiple variables and it really just depends on whether we have the raw data do you know if we get the raw data I do know um so that's something I can look into to and if we do get the raw data and um sometimes they'll do different things to make up for um missingness or representativeness um if we had the capacity to do that uh what would you be interested in lumping together just any but what two smoking maybe one cigarettes maybe another I don't know the tobacco I'm unfamiliar with the pouches I'm not it's smokless tobacco sure I'm not sure how you group them up just usually the more you dissect numbers a little less accurate they are you're seeing Trends in your we discussed president osbor mentioned you know the trend what the trend is and if the things jump from thing to thing to thing then you're it's hard to measure successfulness or or failure unless you're looking at larger numbers to show abuse overall down does that make sense yes it makes a lot of sense I think the good news is though because each percentage is going down the likelihood is that even if they're jumping from one thing to another overall the total number is likely going down that's probably true right we don't know where the pouches at but you're probably right I think the interesting one that unfortunately I don't know that you can can monitor is when we saw the chaos that Co was having on our kids and you look at who the 12th graders are now um from the 2020 time frame have it do we know if if they are going to continue on or are they also being able to you know decline in their trending as well that's' outlawed

haven't they outlawed keep up on this but haven't they outlawed e cigarettes the candy flavored or something for people the flavors there only something there's only 34 approved Vape devices see a lot of like there's only 34 approved Vape devices but they were getting rid of a lot of the flavors that weren't authorized to be sold so hope that's going to make a change be a driver probably too not watermelon have mango yeah they get those online they find ways yeah thank you for that thanks Michael is the asked to report back to the board at a future meeting for information discuss or are you guys proposing to just forward it in an email is that Dr sunshine I'm not sure how you want to do that I just want Clarity so it's really dependent on whether we have the raw data so would it be okay if I just looked into whether we can fulfill the request and if so we could um present it in the email thank you yes all right uh next on our agenda Dr Sunshine is GNA do a call to U CDs from our last conversation and also give us yes where is the speaker here up there familiar with the pointer now I can do it I've used a pointer before I should be able to handle this thank you before I get started on the most exciting topic of sexually transmitted illnesses of Dr Farber if you'll permit me I just wanted to I did a quick followup because I was also curious

where we are in developing an h5n1 Aven flu vaccine and um Dr stab was able to help me with that they are uh developing an mRNA vaccine they've already identified the targets and madna you remember madna from the covid vaccine they are developing one that will go into phase three clinical trials uh in 2025 so this year um and for those of you less familiar uh there's phase one through three and then it actually gets to go into humans so where to follow but probably not as far away that'll be like for dairy workers great that is a great question usually the acip um which is a a group of professionals uh and CDC will get together review all the data look at the risks versus the benefits identify which populations are most at risk and then make recommendations so to your point certainly people who are at highest risk for being exposed to it would be recommended to get it first but I I can't really predict and you've already stated that we haven't had the cases in Arizona so what I mean Nationwide what is the actual so Nationwide Dr Schroeder actually pointed out although in the New England Journal study of all the people who've gotten AVM flu the ma vast majority have had exposure to um either sick or dead birds or cows or other animals there has been one case that was recently released from Louisiana an individual with other chronic medical conditions um who was older also had exposure to sick or dead poultry um that individual pass away so we've had one severe case and in general the risk in the United States to humans is very low unless unless you are

involved in regular contact with with birds I think the point is just to be ready Cas ands yes and we are poised and ready mam president this is in response to a request during our health status report I believe we were talking about uh the trends in uh sexually transmitted illnesses and the question was well what are we doing about it so this is didn't like caring that Arizona was fourth yeah I'm not a fan of that statistic either okay so I'm just going to quickly review the data but we actually have a little bit more from then so I wanted to get everyone on a Level Playing Field and then tell you what we're doing about it um so while STI were increasing you can see now with this preliminary 2024 data our our syphilis levels are going down and that was that is one of the diseases where unfortunately we are very very high in the us so that is a promising Trend move right over toia I would love to tell you we are going down but I would see a pretty flat Trend when I look at these numbers for preliminary 2024 data and CIA of course is one of the most challenging to diagnose because it's most often asymptomatic then um goria we are um you can see that we did Peak during the pandemic but there's also a downward Trend with gonorrhea so I think that's very promising overall for all of our sexually transmitted illnesses um and wanted to provide the data on HIV AIDS we are still seeing uh the predominant increase among men who have sex with men um however there is a slight increase you can see from 590 to 635 from 2022 to 2023 and we do not have 2023 yet so that's

what are we doing we uh we have a very comprehensive case investigation process including interviews for diagnosed cases um all syphilis cases are are um interviewed and they're Partners identified we do contact tracing and partner Services uh offer testing and treatment um that is almost free of charge can be free of charge if they have an inability to pay um to both cases and and their contacts we are partnering with a lot of community-based organizations including federally qualified Health Care Centers to increase access to STI and HIV testing in the community doing a lot of community and provider Outreach to increase um STI awareness we launched a provider support line and this has been really positive so when you call the health department you don't have to jump you know get forwarded to eight different people to get the answer to what you're looking for it's just for providers and particularly if um in syphilis sometimes you have to determine is this old disease or a new diagnosis they can get right to somebody who can look up their old laes and determine yeah I need to treat this person or I don't that's been very successful uh we launched a think syphilis Campaign which is a very widespread campaign accessing people who are at highest risk and um annual renewal and distribution of our Public Health order uh which is for a third syphilis screening test for pregnant women uh which is recommended in places with high incidents of congenital syphilis and I'm going to give you a couple big ones I'm very excited to announce that um since October 1st 2024 access has decided to cover syphilis for all adults adults in quotes age 15 and above so basically all sexually active individuals we hope they're not under um

are can get syphilis screening if they go to the Ed if they go to urgent care and it what we're doing is we're taking that recommendation because it's now reimbursable to go ahead and do opt out screening similar to what we do for HIV so if they're getting blood drawn for another purpose you just run an HIV and a syphilis screen um unless the person says no I don't want to be screened then you do it automatically so that's what we're really working hard to implement and Dr Taylor who's a a world expert in congenital Sy has been working with the Eds to implement and they're all very excited this access rule change is a big deal um we've done a lot of community outreach this is just a map of uh the 63 uh episodes of community outreach that we've done education test and testing in Maricopa County is my favorite slide we um have expanded significantly a mobile health unit that we got and then we have three new sites that are projected for launching um STI satellite clinics um and I put the dates here that we hope to launch them but I'm looking at Mitch and we all know that those dates are um not 100% accurate because as with all um remodeling if you've ever done that sometimes things change but the really good news is that we're going to have both a mobile health unit and then we're going to have much better coverage across Maricopa account County and we hope to have those operating Monday through Friday from 8: to 5: um I actually um someone helped me put together this map because I think it's really important to see how far east and west I put red arrows by the sites that are going to be the new clinics here um the reason why that one at Glendale has both a blue and a green is because we have an existing

immunization site now and then we're going to be adding a new STI clinic in the future so what you can see is we've got a Far East up um sorry Southeast that purple dot over in Mesa we have a far west in Good Year and then we've got kind of a north um North Central in or Central West in Glendale and then of course we have um Phoenix in the middle so very excited about the expansion talking a little bit more specifically about syphilis that is the one that we are focusing L of energy on because it can be transmitted congenitally um from mother to child um and what we can say are the risk factors um people who are are at highest risk are people who had a prior sexually transmitted infection people who engaged in um tyly IV drug use but any substance use insation in the last 12 months and and those who have an HIV Co infection so that really tells us how to um where to aim our strategies um to try to decrease syphilis and what you can see is since 2019 the of reported syphilis cases that our female has increased so that's where we're really concerned about transmitting it to the unborn child and um increases in syphilis among pregnant persons is also reflective of increase in um males of reproductive age did have 84 preliminary congenital syphilis cases report24 you can see that that is down from 2023 there may still be some that are confirmed overall I think the trend is positive excuse me so to that to that point is uh do you find that the mothers that end

up having these children that was a I don't want to say it's a a surprise to the doctor upon delivery but um were they mothers that were not getting prenatal care and things like that so um it just came out Osborne a significant proportion of them I believe it's between 40 and 60% did not have prenatal care so the ones that are discovered at Birth because that third test is recommended at Birth those are frequently ones that did not have prematal prenatal care and I forgive me I don't remember if I covered this last time but that's one of the things that really ties into engaging in substance use and I think this is a really important connection for folks to make when moms are pregnant and they are engaged in substance use there's a fear it's actually not based on an actual law but there's a fear that if they see a provider and they're pregnant and engaging in substance use that that provider will be obligated to report them to um ACS um and that they will potentially get their child taken away the truth is there's no reporting requirement until birth so a lot of folks who use substances um are hesitant to get that prenatal care which would then get them the syphilis screening um because they're concerned about substance use can you remind us what a child that's born with cus what are those complications so congenital syphilis can can go anywhere from you can't really tell at all from you know from the naked eye um to long bone deformities so that femur uh can have sort of lesions um in the long bones and the arms and the legs uh there can be blindness and deafness

and developmental delays or mental retardation and uh even death yeah so there's a lot happening to um intervene with congenital syphilis this is something where just everybody has gone in action um we are prioritizing pregnant persons with syphilis for notification they're getting notified within 24 to 48 hours of their positive test doing follow-up partner Services we actually have one person who will go into the field and find them even if they're experiencing homelessness so a lot of effort toward finding those pregnant moms positive for syphilis um that there I mentioned the field visits for pregnant persons including those with unstable housing we actually provide them transportation to get them back to the clinic we have um pregnant cases are prioritized to our SE our senior communicable disease investigators so the ones that are most experienced to make sure that we we get the most out of those opportunities when we do see them um we are partnering with maternal he health programs to increase awareness and education uh doing a lot of increased provider education um including educating on this new access rule where they're covering these syphilis screens to make sure that everyone is taking advantage of that then I mentioned before that Dr Taylor is going to each of the large healthc Care Systems um a lot of them have requested it not only just to explain about you know the importance of syphilis screening but also the new access law and how to implement it in their workflow because she has a lot of experience so that's been very successful and had received a lot of um positive POS feedback and then we're also participating in a correctional Health work group so the state has a congenital syphilis committee and we just formed a correctional Health work

group with the Department of Corrections at the state level as well as multiple County Jail levels um and they're actually using Maricopa County as a model for how we Implement syphilis screening in the jails um to to make it more Statewide and I'll be honest the the issue with that is in the jail system people are have very rapid turnaround times so they'll only be there for maybe four to six hours and that's where we we get in trouble we may have time to screen them but we don't they're not always still there when the results come back to treat them but a lot of work being done in that Arena then we are involved in two different surveillance projects we were awarded a CDC surveillance Grant um for emerging threats to mothers and babies called the set net Network where we're monitor ing exposure to syphilis during pregnancy and helping to contribute to knowledge in that area and we were also awarded an additional grant called cargos as part of the epidemiology and lab capacity Grant um which monitors Trends and antimicrobial resistance of Gara you have those funds we got them and we have implemented them already yes it's going very well okay any questions on STI before I move on on to respiratory illnesses okay so uh we now have a respiratory illness dashboard uh we used to just put out sort of a weekly PDF so this is um we're doing a lot more work trying to get more real-time information out to folks um I put this picture up because if you get to our fall and winter virus season if you click on data and reports that is how you can find this Dash and what you'll see at the very top that graph in green um it green represents covid-19 and it shows you in

Darker green what this current season looks like and then in lighter green what the previous season looked like and I think that's a a really helpful view to kind of know where we are in comparison to last year what you can see with Co is that we really already peaked probably sometime in the end of December and we are trending down and we had a much lighter season than we did last year looking at the blue second one that's influenza you can barely see the light blue from last season because it is obscured by this season's dark blue meaning we probably had a a worse flu season this year than we did last year good news is we also peaked probably in the end of December early January and we are trending down um and then the third one in the turquoisey uh is respiratory cial virus and you can see we also have had a lighter season than last year and we are also trending down influ Al like illness is how we monitor for sort of respiratory viral illness as a whole um and you can see with II as a whole probably being driven by influenza we are we saw a worse season this year than we did last year um and above our five season average um and can't quite see it coming down yet so we are waiting for it this II is always going to be an earlier indicator than any of those other diagnosed forms because it's it's a syndromic surveillance system so it doesn't require a diagnosis and then this is to address a specific question from uh president osor how we monitor the health of our Health Care system and I hope I got the question right if I didn't please feel free to clarify but what we do is we have constant communication with our Health

Care Systems typically through our office of preparedness and response so the emergency managers no call in our office of preparedness and response if they're running short on something for instance when there was a shortage of just normal saline IV fluids that's something that will come through to our office of preparedness and response it gives us situational awareness and if they actually need to request support we'll work with adhs to um go through the steps necessary to identify additional resources um we also monitor syndromic surveillance which I just mentioned looking at influenza like illness and we have almost every ER in the county Phoenix Children's was one of the last ones and I think we're actually making progress with getting them on board but basically if someone comes in with anything consistent with respiratory illness that's how we get those data in real time and then um we also monitor the data provided State through em resource and that's what you hear about have you ever heard about uh an emergency department being on divert that concept so they'll go on divert meaning they're too full to accept an ambulance at that time so we're constantly monitoring the diversion status across the county and that helps us know how full things are getting um we have participation of monthly Statewide Healthcare collaborative Forum with Healthcare EMS postacute care so all the different um phases of healthcare are together with adhs and we give each other situational awareness there and then we meet monthly with all of our major health care System chief medical officers and that's where we're able to share information um and delve into nuance and detail for instance that recent request to send every single influenza A subtype to get it typed for Avan influenza it's quite a quite a burden there's a lot of influenza A out there so we were able to really kind go

through that and prioritize what specimens are sent so we we use multi prongs in keeping in touch with the system so that so just on that I mean you you mentioned the sailing um could that also come into play with a pharmaceutical that was would you know like you could get go to a stockpile somewhere if hospitals were low on a certain type of you know pharmaceutical or or even blood type or something like that are you part of the team so to speak I guess that you another level of being able to get those items from somewhere else so that's a great question we have a strategic National stockpile that used to be run by CDC but is now run by forgetting the acronym asper asper thank you um there what's that oh come on you said it I'm my gosh I should know and I just it's okay surge an emergency but I don't remember what the Own federal agency but they do manage that strategic National Stock file they have a lot of things in it that you think of for instance if there were a nuclear threat antidotes to nuclear exposures they've got n95s um personal protective equipment uh certain treatments treatment for influenza things like that is every single pharmaceutical in that stockpile definitely not um do they keep normal saline in there not to my knowledge um so what happens is we have our various channels um from the emergency manager level and then up at the CMO level will'll communicate and there was a time when we were really low on a chemotherapeutic agent to the point where people with certain types of cancer weren't able to get the treatment that they needed right away we'll talk about that we'll talk about the best way

to keep each other in the loop how to prioritize it and how to access it a lot of these Healthcare Systems will access it from their sister agencies um or hospitals that are in other parts of Arizona or other states but there's a lot of different mechanisms that we go about both for situational awareness and to to bring in that product and a lot of times we'll prioritize it together the chief medical officers will because the last thing they want is for all the leukemia patients to go to one Health Care system like it's in their best interest to work together and um make sure that everyone has access Administration for strategic preparedness and response say it again Administration for strategic Administration or for strategic preparedness and response and um there are lots more STI slides that you can peruse in your free time any other questions or got a general question is the vacine or the are the serums getting more EIC efficacy of these these you know prevent preventative vaccines are they they getting better and are are we getting bit quicker at developing these things and can we change in mid year if we say we're off just a big picture of that so B picture is that with the Advent of the MRNA vaccine with able to develop we're able to Pivot so if the strength changes we can PIV it much more quickly with the MRNA vaccine than we ever could when we were literally growing it in eggs we were not pivoting then we were slowly watching things move um so the MRNA vaccine has brought a lot

of opportunities to Pivot um are they getting more effective it's a much more complicated question than I wish it was um for influenza we're we're always going to vary based on how good the matches to the strains that are circulating and just how effective that particular Year's vaccine is on average it tends to be around 60% effective it's not amazing but again and I know you've heard this a million times even if you get the disease if you're vaccinated you're much more like much less likely to have severe illness or die from the there are other vaccines um I'm just going to mention the newer version of the zoster or the shingles vaccine that is like 98 or 99% effective it's so good that they actually recommended that people who got the old one go and get the new one so it really varies by type of disease the type of vaccine and a lot of different characteristics okay well that was the end of our agenda so this was a an easy day um we our next meeting is in April end of April and I know that uh an email is sent out if there are topics that you would like to hear more about be able to give staff enough time to put those things together I know it's always appreciated so um please let us know any any last questions or considerations if not uh do I have have a motion to adjourn motion to adjourn someone don't move don't move all right where's our second def want a second all right on those in favor State I I thank you see you in April good