Board of Health - Regular Meeting

We are going to call the meeting of the Board of Health to order. Let the record show that excused is at the time at this time, Doctor. Vogel and Mayor Woodford. Twenty five-eight-ninety 8. I'm seeking a motion to approve the minutes from the prior meeting. Pledge of allegiance. Oh, I'm sorry. I forget that. I'm sorry. We don't do that at the county.

I pledge allegiance to the flag of The United States Of America and to the republic for which it stands, one nation under God, indivisible, with liberty and justice for all. I am sorry. All right. Thanks. My right hand here. All right. 2098. I'm seeking a motion to approve the minutes from the prior meeting.

Move to approve.

Second. Doctor. Jones and Worth. Are there any comments, questions, any changes? All in favor say aye. Aye. Opposed? Abstentions passes. I'd like to welcome Doctor. Vogel. And at this time, I think Doctor. Vogel would like to introduce our two guests in the audience.

We have Doctor. Devin Chase, a second year resident from Fox Valley Family Medicine Residency in Mosaic Family Health. And also a resident that's new to us as a first year is Doctor. Matt Reeder. They're both doing their rotations that involve exposure to our community and public health.

Welcome to our meeting. Hopefully we'll get it done fast enough for you to get to other things. All right. We're going on to action items 20 five-nine-four. Approve changes to the child passenger safety program policy. Do I have a motion to get it on the table?

Motion to approve.

Jones? Second. Doctor. Siepers.

Yes. And I'll go ahead and pass this over to Deputy Director Jensen to speak on these items.

Okay. So the policy and then the procedures. The policy, this is just an annual review and during the annual review we get together and see if there's any changes that need to be made. For the policy, really the only changes would be the attachment because we made some changes to the procedure. And then we just reworded it to have more of a focus on education.

Great. Any comments or questions? All in favor say aye. Opposed? Abstentions passes. 20, approve changes to child passenger safety program procedure. Can I have a motion to approve?

Move to

approve. Second. This is going to make the minutes real easy, isn't it? I assume that's Sonya again.

Yes.

Okay. With the procedures, what we did is we didn't really change what we do, but we consolidated them into one procedure instead of separate ones.

Okay. Any comments or questions? All in favor say aye. Aye. Opposed? Abstentions? Passes unanimously. 20Five-nine-eight, archived child passenger seat appointment scheduling procedure. Can I have a motion to approve? Move to approve. Second. Doctor. Vogtle Beachell. Sonya, assume.

Okay. With this one, this is an archived procedure because as in the last one, we consolidated three procedures into one just to make it more streamlined.

Okay. Any comments or questions?

I do have a question. Okay. When it's archived, what does that mean? Like you're just putting it

Basically means it's we're not using it in that format anymore. Okay. But we don't delete anything, so it will be archived in, like, older. Historical, I guess, you would say. You.

And sometimes they like to, when they're getting certified again, sometimes you have to bring that out for the inspectors. Okay. Any comments or questions? All in favor say aye. Aye. Opposed? Abstentions passes. 20Five-nine-nine, archive child passenger fitting station procedure. Is there a motion

to approve? Move to approve.

Second. Okay. Any comments Sonya, anything we need to know?

No, it would be the same as the last one where this one is archived because it's been incorporated into the OneMain procedure.

All right. Any comments or questions? All in favor say aye. Aye. Opposed? Abstentions? Oh, wait a minute. I'm sorry. I'm not used to oh, you're saying aye. All right. And and are we saying, Alderperson Wolf, you did the same. I'm sorry. Everybody did vote positively for everything. All right. Thank you. I will be watching that. I'm not used to that yet. All right. Moving on to twenty five-nine-six, Approve Changes to Tuberculosis Screening Policy.

Move to approve.

There a Okay. I assume Doctor. Siepers or is this Sonya again?

This will be Deputy Director Jensen on this one as well. Okay. On twenty five-nine-six and twenty five-nine-seven.

Okay. We'll take up twenty five-nine-six first. And that was Alderson Jones and Debworth that did the motion and second. Thank you, Deputy Director.

So this is another one of our annual reviews. This policy was approved last year around this time. So with the policy, I think we changed a little bit of the wording, but the main part of this is we incorporated it. We are using our electronic health record now to do the charting. So that was incorporated in the scheduling.

Okay. Any comments or questions?

I just have a question. Does the public health electronic record connect at all with our local Ascensions or Care Everywhere? Everywhere?

No, it is not. It is the it's called Nightingale Notes. It is not connected in that way. It will be connected with the Wisconsin Immunization Registry, though. That is something that we're working on. Okay. Good to know.

Any other comments or questions? All in favor say aye. Aye. Opposed? That it showed that it passed unanimously. All right. Twenty five-nine-seven, approve changes to tuberculin skin test procedure. Can I have a motion to approve? Move to approve. Second. All right. Deputy Director Jensen. Assume.

As with the policy, our procedure was changed to reflect the use of the electronic health record system.

Any comments or questions? All in favor say aye. Aye. Opposed? Abstentions? Motion passes. Thank you. On to information items. Twenty five-nine-ten Appleton Community Health Assessment 2025 report presented by Brianna Malkley. Is that the right way to say it? I'm sorry if I

It's close. McCooley.

McCooley. I'm so sorry. Community Health Supervisor.

Yeah. Okay. So we're really excited to share this with you. I think you probably have the, like, little PowerPoint and everything in front of you.

We do. So just to kind of go through it,

so the purpose of a community health assessment, it needs to be done every three to five years for a local health department. The goal is to identify what the health priorities are in the area and what the needs are. So we really looked at a whole bunch of data and put it together and tried to find out what are those things that are most important. So any questions you have, feel free to stop along the way and ask. Jenna knows the data a lot better than I do, but

I can help talk through the rest of it, too. And would you like to introduce Jenna

for our audience? Sure. Jenna McNeil, she's one of our nurses. She's also trained as an epidemiologist.

Thank you.

So just to go through some of the basics and logistics. So our steering committee, we asked a few different people. I think we had a steering committee of seven that were outside of the health department. We were very specific about who we were asking, trying to make sure that we were finding people who were working with different populations in the area so that we could get a perspective that really encompassed the city of Appleton as a whole. And so you can see on there, you know, some people from like New Hmong professionals or I'm sorry, not New Hmong professionals, what was with Hmong American Partnership and the New Mental Health Connection and Lawrence.

So we just tried to find people from diverse areas. So we developed a survey together with that committee. So that was our primary data that we were collecting. We worked on it for quite a while. We used a model from the community toolbox, and then we adapted it to make sure that it matched with some of the questions that we had from other local surveys.

So imagine Fox Cities and Mind Your Wellness so that we were addressing those gaps that we didn't see in the survey that we took or that we put out. And the timeline of the survey was available from March 1 to August 31 in 2024. We had it both online and in paper form. The paper forms were at the library, and we also had them translated in different locations too, like the Longcheng Market and at Fox Valley Literacy, I think, had it too translated. And then people were able to take it online.

We went to quite a few different places to offer help with people who were taking it. So making sure that, specifically we went to Eagle Flats and Oneida Heights, where some of the individuals maybe weren't necessarily able to read it themselves and take it. So we would sit down like one on one or one of us with a group and make sure that we walked through it with them. So we were really trying to make sure that we were getting voices from different perspectives who might not otherwise take it. Do you want to say a little bit about who typically takes a survey and maybe why we were In focusing on

general, when a convenience sample or survey is done like this where it's not at random, right? It's people who during their free time choose to take the survey. In general, see more women take the survey, slightly more educated individuals take the survey, and those results were definitely mirrored in ours as well. So we

did

compare the demographic makeup of our survey respondents to that to the city of Appleton. And so just, you know, making sure that we're aware of that when we're also going through the results as well. I noticed that

sorry. Just wanna

Oh, no. Go right ahead.

So you have your survey results, and I noticed that in some of here, was census reporter information. I know that with the pandemic, there are some issues with the census. What census is this information from?

Yeah. So when we were using census data, we used the five year estimates partly for that reason.

Okay.

They tend to just be a little bit more you see less variation over time.

Okay. And

can I just ask a question? Did we reach out to, like, Casa Hispanica or the religious community, the YMCA, to offer the survey there as well? We didn't offer this I mean, didn't go in person and offer the survey there, but

we did talk to some of the leaders at those places and shared the survey, especially in translated languages too.

Okay.

So, yeah, I

think And we you also had, like, I don't know what like, for advertising of the survey with QR codes, they were at, like I know the YMCA had one for a while and, like, Appleton Park and Rec and some other location.

The only reason why I ask is it's not on your report. So that's why I was curious, you know what I mean. Because in the past, a lot of those communities have stepped up and helped us get a lot of those results.

And I would say too, one of the confounding variables is that the Tri County Community Health Improvement Project was also launching about the same time. So Casa Esmana and the YMCA were both engaged in that project. And this sort of highlights the need for a regional process, right, as our stakeholder time is limited. And so they did participate in the regional work but not in the local work.

Yeah, that's a shame. But thank you.

Yeah. And just to highlight too, like we did go to Riverview Gardens and Salvation Army on purpose because we knew that both of those locations might be people who are otherwise preoccupied with basic needs and just survival. But we wanted to kind of be at a place where they were for some time and offer the survey so we could catch another perspective in our community. Yes. And so then the secondary data, which is the census and census reporter and all of that kind of information, we gathered a lot of that.

Again, some of that came local, like from Imagine Fox Cities and Mind Your Wellness. Even the police department had a survey, so we made sure that we took that information in. But then a lot of the national and state data came from places that the epidemiologists in the area or the state of Wisconsin recommend as best practices to gather the information from there. So you can see that our timeline, we started with a survey in March. Well, we started with the steering committee in November 2023.

We really put a lot of time into developing that survey. Then we had our survey out for a few months, and then we took quite a bit of time to analyze the survey information too, partly because we were working on the Tri County CHOP, but then we were also trying to figure out, as we're doing the Tri County CHOP and we're doing the Appleton CHOP, like what there is information that goes together and is aligning and is there anything in particular that we're finding in Appleton that we didn't necessarily see in Tri County? I'm not sure we really found anything that was much different. So the frameworks that we used, we looked a lot at the social determinants of health. We also used Healthy People 2030 and Wisconsin SHIP just to kind of help us organize our thoughts around that.

If you have questions, we could talk a lot more about the frameworks that we use too. And then we get a little bit into some of our data and what it actually kind of looks like in the chart. So one of the things that we thought might be interesting to share, if you didn't already pay attention to this part or notice it, is in terms of demographics, the top six languages in Appleton, that's what we translated the survey into. And we found those top six languages by talking with the school district because we were asking like what is it that the families are speaking right now or where you're getting translators or interpreters.

Oh, sure. Go over that. In

that area, but not on languages, ability status. So as a person with a disability, I would be under that 11.5. However, I recently had applied for a federal job, and they said that disability included things like anxiety, depression, ADHD. What are the outlines to have a disability for this study and thoughts on including that greater neurodivergent sector?

I mean, that specific statistic is from the census. So they have a definition of what they basically put in as ability status.

Okay.

And they even will separate it out further based on physical versus cognitive abilities. You can break that out too.

Okay. I won't get in the weeds anymore.

I apologize. No. No. I

say I definitely don't mind. I love talking about the data.

Schedule an appointment so as not to

No, no. You know, these are all questions that people out in the public might have too. So I really value, Alderperson Jones, your expertise on this area. And I know other members of our board also have that expertise. So it's important to ask those questions. And they're not afraid, which I give you a lot

of credit for. No, we had a lot of fun talking about all the data. There were some times where it was like, okay, this data is, like, kind of scary or frustrating. Is this real? And Jen is very good at explaining the data.

So send people our way if you have questions. On the next page is the executive summary. So those two areas that living in Appleton and like cost of living in Appleton and then social belonging, those were the two areas that we really focused in on because we found, again with the Tri County CHOP, but then also with ours, that those are some of the areas really speaking to us or that we heard in conversations with our community partners that families and individuals were focused on. So as you can see here, the median income or household income in Appleton is about $77,000, and one in four of the survey takers so again, those who took our Appleton Community Concern Survey said that they are concerned that they may run out of food before they have the money to buy more. So just kind of keeping some of these numbers in mind as we keep going.

And also when asked if quality child care is available, only 31% of the survey takers agreed. So some of the things that we're kind of thinking about that are all those basic needs that come together for people to do well and survive. And then, again, with social belonging, too, we see that people are saying that in the Mind Your Wellness Survey that if they make more than $150,000 a year as a household, they feel like they're a lot more likely to know how to access mental health care. So just thinking about like how those basic needs all come together in terms of or as they're related to one's economic or financial status. And again, then on the next page, we see that from our community concern surveys, fifteen percent of the households are struggling, say that they struggle to pay for their basic needs.

And that next part there, I think, is kind of it was very helpful for us to kind of pay attention to how much everything costs. So an ALICE household is

Well, think first so ALICE stands for Asset Limited Income Constrained Employed. And so oftentimes it's people who are working but kind of make just enough not to qualify for benefits oftentimes.

Did we quantify their work schedule How many hours a week they worked? Or were they in two part time jobs in order to do it from the household standpoint? No. Mm-mm. Okay. That would be interesting data to have of how many have like in a two wage earner household, how many job equivalencies they had. Because I would think that that would be interesting to look at. And then look at their mental health and anxiety.

Yeah. So this ALICE data comes right from United Way and United Way, Wisconsin. And you can scale it down based on counties. And so we used Outagamie, Winnebago, and Calumet just because we're in all three of them to kind of get a better idea. These numbers are specific to, like, a family with two adults and two children. So it doesn't really I mean it doesn't really matter who or how many jobs they have here, just how much they're making a year. So this is on the left hand side. It's the survival budget. So that's pretty much like how much do you need in order to survive every single day. You don't necessarily have emergency money.

You don't necessarily have any savings. This is just getting by. And so for that family of four in this area, you need to make $81,216 in order to be surviving. Again, when we looked back at the median household income, it's 77,000. But we I mean, it is important to say that these numbers are continuously changing. And this ALICE data is most updated from 2003. The 2023. Oh, yes. I'm so sorry. I'm twenty years behind.

2023. And the household data is from the census too. So it's over time, how is this changing? And then to see a stability budget is more so if you are able to have some kind of emergency savings, you are able to maybe put a little bit more towards your house or towards food or something. So again, it's not just survival, but it's doing a little bit better than that.

And that would be $126,000 a year that you should be making. So if the two adults were both working, it would be the different salaries are on there of how much they would need to make. Okay, next page. With the neighborhood and built environment, I think one thing that might be kind of interesting on here now the quotes. We got wonderful quotes from our community concern survey takers, which were really helpful to kind of give us a better idea of how people are feeling about these topics, and again, part of why we focused on housing as one of them, or at least the cost of living in Appleton.

So you can see here that one of the things that we found is that elders have been struggling with housing. We know this too because we talk with Pillars, and in the past few months, Pillars has said that they have had older adults so what they were saying is like 65 and older who are coming to Pillars or being dropped off at Pillars, but they're not self sufficient. And so they need a place to stay. They've lost their housing, but they don't know where to go, and they've really struggled with that.

Do you give them when we hear that, does ADRC assist in that at all?

They try. Okay. Yes. They are connected with ADRC, yes.

Okay, good.

And Adult Protective Services and all of that too, especially when the adults are not self sufficient. Then they make sure that they're trying to get that support for them right away. Thank you. Another thing that we've heard in that realm though is that some individuals may have been like renting for twenty years in the same space and then a new landlord came in and you know, the costs went up. Maybe they changed one thing, the costs went up, and now that individual isn't able to stay in their space anymore just because it's not within their budget. And you

know what? Are any of our people on Zoom? Does anyone have any questions? Nate. Okay, Nate. Go ahead. Sorry about that.

No worries. So I just wanted to, what you said, earlier about, mental health and kind of getting the numbers between the amount of jobs people were working, I really like that. I think that that actually like if we suggested that to United Way who did this study, I think that be a really big plus. I definitely think there's a correlation there, not just as a person who worked multiple jobs last year, but I I think other people as well. So I think I think that would be a good addition. I just wanted to throw that in there for my

Okay. Sorry about that. And thank you to doctor Siepers for helping me out.

Thanks Nate. And then as we look at education access and quality, one of the things we talked about is a ninety four point two percent graduation rate is pretty good compared to both the state but then also national numbers. I'm going to keep skipping ahead. So on to social and community context. Another thing that we thought was pretty great is that in our Appleton Community Concerns Survey, ninety four percent of the survey respondents said that they enjoy a good quality of life.

And as we know, that's a lot of different things coming into play. So it's not only the financial economic stuff, it's not only the sense of belonging, but it's also feeling like they have a place and people that they can talk to and they're enjoying living in Appleton too. I do think it's also important to note on the lower right hand side of there that from CDC they say that social isolation can poses a health risk to people even if they don't feel lonely. So again, that's something that we're thinking about when we're bringing together like that mental health and social connection. And then in summary, where do we go from here?

So like Chuck said, we're working on with the Tri County group and we are going to be starting our next process which is the CHIP. Well, we're in that process but we're starting to write it and so that will be encompassing this data but then all the rest of the data that we found with the Tri County and then from now on we'll be working with them on this kind of information but we'll still be able to pull out Appleton specific information whenever needed. And we'll be sharing this in a few different ways. So hopefully we'll be able to share it with some of our community partners and some one on one meetings. We do have like the way that we structured the document we'll be able to pull some of that out and use it on social media.

And we are going to talk a little bit more about what other ideas we have for how we think we should share it.

So thank you. We're And for the record, can you explain what CHIP is? I know what it is, but our audience might not. Do you want it?

So a CHIP is a community health improvement plan. And so we take the information from community health assessment and prioritize based on the data and community feedback kind of what rises to the top importance level wise. And we come up with goals and then strategies that we will be working on to try and meet those goals. And since we will be working with the entire Tri County, it will be with the other health departments and health organizations and nonprofits as well.

And it's a tremendous amount of work and effort, So I applaud both of you for taking that on and Doctor. Siepers for encouraging them to do so because, that's quite a status within the health departments in Wisconsin to have that SHIP, quantification. So good job.

Thank you. Thanks.

Anything else? And if you have questions, we'd love to talk about it later.

Okay. Any questions from our Zoom people? Okay. Just want to make sure we keep you in. Any other questions?

Twenty five-nine-three, Q2 Health Department quarterly report. Doctor. Sievers.

Yeah. So I won't spend a whole lot of time on the data. But you can see there are some changes in sort of frequency of inspections. If you look at weights and measures, for example, a lot of those differences are based on some scheduling changes that a sort of annual cycle. And so you see some variability there in that Q2.

So that's what we're seeing there. I'll just highlight a little bit. Environmental health, you see some a little bit of a flip flop in the pre inspections with your I can't talk today your regular inspections. And that is largely due to the tourist rooming house project. So we're currently sitting at, as of yesterday, 128 tourist rooming houses.

So that's an increase of about 60 over where we were last year due to that work. And then the STD data, as we can see, trending much better than we were last year, same point in time last year. And this is, again, this is more of a national trend as we've kind of talked about. So we're seeing that that play out here in Appleton. Other quick data driven note I'll give is we began the Milk Bank project in Q1.

We only have two quarters, so two data points to understand what that looks like. But we're seeing a huge increase in the interest of that program. So we're collecting a lot of breast milk through that program. But I'll just I'm sorry?

No, I just said excellent. Great.

So I'll just highlight a couple things. So as you all probably are aware, the first measles cases in the state of Wisconsin were identified in Oconto County. Nature of that is, based on my understanding is there was one traveler and the other eight are closely linked to that traveler. Because of that, DHS is indicating that the risk to the general public is low. I didn't hear this, but I'm curious if given the population, if that might be a plain community member.

I think that might be safe to say if we're thinking about that. Yes, so starting June 6 DHS announced that measles will be wrapped into the COVID-nineteen wastewater project. Earlier in the year there was a wastewater project with MPOXX. So when this rolls out and those data are not in there yet. So I don't have an ETA of exactly when those measles surveillance data will come out.

But when that gets live, we'll end up with COVID-nineteen impacts and measles all through the wastewater. Wastewater. So population level surveillance there.

Oh, older person, Wolf has a question, I believe. Correct?

Apologies, no. I was just getting a drink.

Oh, I thought you were waving at us. Okay, thank you.

Thank you for checking.

That the MPOXX surveillance started last week. So we don't yet have data on that but it is is live. As we talked a little bit about the Tri County Community Health Improvement Coalition, The first community assessment, similar to ours, which ours did inform, but pulling the data in from all regional health jurisdictions, so all three counties, City Of Appleton, City Of Menasha as well well as our four hospital partners, Children's Wisconsin, ThetaCare, Ascension, and Aurora Health. So there was a document that was developed. We're finalizing that to meet the statutory needs of local public health.

But that will be that will come out here in Q3 as well the community health improvement plan as we had talked about. So maybe with sadness and maybe joy, this will likely be the last community health assessment from the city of Appleton as a City Of Appleton only project. And we talked about these themes a little bit as Brianna was presenting these data. But the focus areas that had come out of that regional work are to increase social support and social connection, a theme that we saw pretty readily and more implied through some of the data that were included to improve accessibility and availability of basic needs support. So those are the two things that are coming out of that regional work that we saw themes in our local data.

And then just the last thing to announce, we are in the process of moving immunization clinic from the 1st Floor to the 2nd Floor. And that is partnership with Building for Kids. And so we will have twenty four hour access via elevator. But there will be a portion of a shared space. That's all that I have to highlight in that report.

Are there any questions? Great report. Thank you very much. All right. 20Five-nine-zero-zero, Dangerous Animal Declaration. Doctor. Sievers.

Yeah, we just have one that was declared and remediated here since we had last met and that is a dangerous animal named Mocha. Mocha is no longer with us.

Any comments or questions? Okay. On to 25.0899, the new noise variances. Doctor. Siegrup?

Yeah, nothing really to note, although the mayor and I have not even had a time to talk about this yet. But we are seeing about what we did expect in terms of revenue for 2025. I submitted 2026 budget numbers lower that a little bit due to what we're seeing earlier in the year. But as the summer pans out, we're able to bring back another $400 or $600 into the health department budget. And Chair,

I think worth noting on that point, part of that revenue impact is that we're trying to be more efficient with how we issue these noise variances and making clear updates to the ordinance have also helped clarify, but making clear to folks when they actually need one versus when they don't. And so we tend to have a fairly conscientious community when it comes to noise, to the point that folks will come forward and ask for a variance. And we'll let them know if they actually need one or not. And in a number of cases, we've actually communicated, no, you don't need one. So if this was a revenue grab for the city, we'd gladly sell anybody a permit if they came and asked, but that's obviously not the purpose.

So the fees that are collected are simply to cover the administrative cost of issuing the permit and doing the internal communication. So I just think worth noting that we only issue these when they're absolutely necessary, and we counsel otherwise when someone comes forward asking for one. Thank you.

Thank you, Mayor Woodford. Any other comments or questions?

Just wanted to comment just in my role as advisor to the health department. Just I have no idea how many people watch this meeting or read the meeting minutes, but there's

a

lot of misinformation out there, including at the federal government level. And this isn't a political statement. This is just trying to, provide some factual information for people. Because we have a lot in the public, we see it every day in our clinic, people with questions, doctors trying to figure out what the guidance is relative particular to vaccinations right now. The influenza vaccine that will be utilized, in America this year is effective.

And, to remind the public that most vaccines don't eliminate your risk entirely from getting the disease, but they decrease the likelihood of being hospitalized or dying from it. When it comes to COVID vaccination, the current, COVID vaccines that are available are effective against the latest strains in terms of reducing hospitalization and death. The recommendations regarding giving them, as well as whether or not your insurance will pay for them or not are kind of somewhat up in the air, which is really unfortunate. But I would encourage people who have high risks and are 65 to talk to their physician about the rationale and the reasonability of getting that vaccine. I'd like to highlight that mRNA vaccines, which have been called out as being dangerous by some of the leadership in our health professional organizations at the federal government level, is simply not true, that they're probably the most effective.

We learned from COVID that we saved nearly two million lives in America and maybe twenty million lives in the world, probably the safest safest vaccine we have seen, that the grant money for continued mRNA research has been pulled. And we should all be very concerned about that because that is related to all sorts of research that is going on, And quite frankly, has been going on for about a decade and a half that contribute to new discoveries regarding fighting cancer and all sorts of other autoimmune illnesses. We're taking a step back in science, and I just want to be a voice of science in our community. The one last thing I want to say is that regarding measles, we are at risk for an epidemic in our community and in our state. Our immunization rates have fallen below the level of what would be needed in order to prevent us from having an epidemic.

And to remind people that all of our children, whether they are in homes that believe in immunization and where other household members are vaccinated, babies until the age of 12 and 15 are not vaccinated. And I think we're still looking at, are we going to lower the age of vaccination? And there's a discussion in public health about that and greater confirmation to come. So when your child goes to a day care scenario and is exposed at or anywhere that they're exposed and they're under the age of 12 or vaccination age, all of us are at risk in terms of our families that have those infants and children. So I believe that public health evolved in America.

Some of the greatest health improving measures have been public health. And additionally to that has evolved a concept in public health that we all have a role not only in our freedoms and exercising freedoms over our own bodies, but responsibility towards a greater good. That's being a good neighbor. That's love thy neighbor as thyself. And so that's my combination of science and compassion for the day.

Doctor. Vogel, can I ask you a question that I think some of our audience might be interested in? And that has to do with there was a time period and I'm sure you're going to know this better than I do. I hope. Because people that were born, I think, from 1956 to 1963 may have had the measles vaccine but may need a booster. Can you elaborate on that? Because I think there's a lot of people that listen out there. And I may be wrong on the dates. That's why I thought you would know better

than that. Yeah. And I would have to research that. I think we've been using a cutoff point of 1957. But I do think that there are I couldn't tell you what the percentage of people born at that time that may not be immunized with a second MMR. And I would just recommend that you talk to your physician about that. I certainly think that we will be giving some public health advice if we have a case of measles in our community that will rapidly inform people around getting vaccinated. Often getting vaccinated within seventy two hours of exposure is a successful thing to do.

Great. Thank you. Thanks for allowing me to ask that Are there any other comments or questions? I seek a motion to adjourn.

So moved.

Is there a second? Second. All right. All in favor, aye.

JULIE: Aye.

JULIE: Opposed? We are adjourned. Thank you all for your time today.