Board of Health - Regular Meeting

All right. We will call the meeting to order for the Board of Health for the City Of Appleton. Can we all stand and start with the Pledge of Allegiance? Pledge allegiance to the flag of The United States and of to the republic for which it stands, one nation under God, indivisible, with liberty and justice for all. Thank you.

Roll Call a membership. We're expecting Aldersperson Jones I think she's probably running a little late because of the elevators And that Emma is excused today. At this time, I'm going to ask Doctor. Vogel if she would like to introduce any guests in the audience. Oh, that one are you.

Sorry. Thank you. I thought I had you on.

No, not quite. Which one is what does it say

on the

District 2. Oh, that's why. Okay. Okay. Good morning. We have, as usual, resident representation representation when they are on the rotations that involve community engagement experiences, public health, and the like. And so we have Doctor. Madeline Lenz, who's a first year resident joining us, and Doctor. Samuel Hayes, who is a second year resident joining us.

Welcome. Enjoy your time in Appleton, learning from our esteemed leadership at Mosaic. '25, ten, twenty seven. I'm seeking a motion to approve the minutes of the Board of Health meeting from August 13. So moved. Second. Okay. Duckworth and Vogtle. Are there any comments, questions, changes? All in favor say aye. Aye. Opposed? Extensions? Passes. We have no public hearings or appearances.

We'll go directly to action items 20 five-ten-thirty two, approve the tuberculosis program policy. Can I have a motion to approve it to get on the table? So moved. Second. Second again, Doctor. Vogel. Doctor. Siepers.

And I will have Deputy Director Jensen talk about this. But just to kind of orient us, this is one policy, many different procedures. We tried to shrink this down as much as we could, but these are independent enough to where it makes sense to have them broken out as they are. But I'll turn it over to Deputy Director Chance.

Don't see her on.

She was on. She may have dropped. She may have dropped. So we'll I'll just go ahead and go into it. So twenty five, ten thirty two, again, is the orientation for all of the procedures, just the sort of grounding document, if you will, of what the program is, the different elements of it, and then all of the subsequent attachments, the procedures then map on to what that is. Happy to take any questions regarding that.

Are there any questions?

Any significant changes to the program under this policy review?

Not at all. Just sort of codifying what it is that we currently do.

And that's the case with all the subsequent action items on the agenda? That is correct. Okay. Thank you.

And then how many actually active TB cases are we dealing with right now?

Currently, I don't believe we have an active TB case.

Oh, that's nice. Because if you could explain to the audience what has to happen and then how it involves our nursing staff.

Yeah. And so annually we receive about two to four active TB cases, usually on that low side, that two. An active TB case does require a significant amount of resources across a number of different processes. It is a matter of ensuring medication compliance. It's working with the health care providers, infectious disease docs depending on what the progression of that active case looks like.

And really it's management of that person's condition for the subsequent amount of time for treatment, can be a significant amount of time. Part of that is a direct observation therapy which is face to face verification of medication compliance. There's a lot more that goes into it but at the high level that's a lot of what that work is by the public health nurses.

Okay. And Mayor?

I think worth noting the distinction between active tuberculosis and latent tuberculosis with respect to communicability.

Yep. So active, yes. Thank you, Mayor. Active TB is exactly what it sounds like. It is transmissible version of that virus. We also deal with latent TB, which is some evidence that the person has been exposed to and has had an active infection at some point in time in their life but is not currently transmitting virus but still benefits from treatment for their own personal health.

And we do conduct ongoing monitoring and treatment services for latent TB as well. And we do have a number of those cases in the community.

Yeah, Barings National and State Resources usually the medication is a limiting factor in that but we do provide the direct observational therapy for latent TB as well.

Are there any other questions or comments? All in favor of approving the tuberculosis program policy say Aye. Opposed? Abstentions? Passes. 20 five-ten-thirty three, can I have a motion to get approved active tuberculosis disease case management procedure on the docket?

Chair, I'd like to make a motion, to take up items 20 five-ten 33, ten thirty four, ten thirty five, ten thirty six, and ten thirty seven under a single motion to approve.

Excellent. I didn't know we could do that on Granicus.

So is there a second? I'll second that.

All right. Are there any comments or questions on those action items? For those in the audience, just so you know, we're putting all of this together. Okay. All in favor say aye. Aye. Opposed? Passes. I'm sorry, I did not realize we could do that.

I don't know if we can. That'll reflected in the minutes. And it's the action taken by the committee. So this will come forward to counsel with each item recommended for approval. My motion was made given the fact there are no significant changes to the policy And we had relevant discussion under the first action item.

I agree totally. So let's move on to 25, ten, thirty, dangerous animal declarations. Any comments or questions on that information item?

We'd just say this is two of probably a number that we have coming. So there's likely a few more coming here in the next month or two. None of these have been contested. So no action for this body. But just know that it is dangerous animal season as it appears.

Okay. Moving on, 25, ten, twenty eight, new noise variances. Are there any comments or questions on that? Doctor. Sievers.

No, this is the only thing I would note. It doesn't seem as if the nominal noise variance fee that was implemented in 2025 has had any effect, any deterrence on those seeking noise variances, which is one of the things that we're watching for.

Okay. And then 209, Health Department Newsletter.

Yeah. So just have you answer any questions. But just the newsletter does feature you, chair. So it's a good opportunity for us to highlight staff, community members, board members, that kind of thing. So we're making the rounds and so happy that you could be a part of that to learn much of your history of public service in Appleton and the county.

Thank you. Are there any other questions for Doctor. Seifress before we adjourn?

I just have a comment about the newsletter just in terms of putting a stake in the ground and a commitment to our partnership. But we will be, at Mosaic Family Health and our Fox Valley Family Medicine Residency Program, our residents will start to participate, I suspect a little later than we anticipated as we get it going in a column in the newsletter that we hope will be relevant. My suspicion is that we will be focusing on trying to educate with, clear facts around much misinformation that can be out there about children's vaccines, you know, health risks, the role of public health, so that we're kind of a voice of science.

Looking forward to that change.

Okay. Kathleen Kush.

In the area of vaccines, it's not directly addressed in the newsletter, but I'm wondering if you could comment to us about what might be going on at either the local or the state level to make sure that children's and all vaccines are available to those who wish to receive them.

Yeah. And so, you know, we've seen some challenges with that with changing COVID recommendations that does present challenges. So I'll say first and foremost, for anyone seeking a vaccine, the best resource that they have for understanding whether or not they should get a vaccine would be their primary care provider. And so that's first and foremost. So secondly, you know, we have a number of programs that help assist with vaccine uptake.

We the City of Appleton Health Department is part of the Vaccines for Adults program and the Vaccines for Children. And so with that, no cost vaccines for anyone that qualifies. I think that in many aspects your corner store local retail pharmacies are deployed in a way that really allow for a large accessibility. So that's obviously directing people towards their medical home for those questions and that kind of thing is a much better aspect. But for those that are just meeting their vaccine requirements for influenza, COVID-nineteen, that kind of thing as head into cold and flu season, that's good option for folks as well.

We've submitted a grant to look at increasing the number of vaccine clinics that we can hold. So that's something that we're doing here locally. And then there's some regional planning with that as well. That's locally some of the things that we are doing. I'll say at the state level, so like we are not much has changed at that sort of level.

Again, at the federal level we are seeing some changes in those vaccine recommendations which as Doctor. Bogle had alluded to may or may not be based on the scientific literature that we're seeing.

I know it's hard to predict, but do you see any effects on private insurance coverage of vaccines?

Yeah. Well, that is going to be hard to predict. I think that with the recommendations changing, I think insurance companies pay attention to those recommendations and what it is that they cover. We could see changes there possibly, but my crystal ball broke during COVID and so I'm unable to predict the future in any way.

Thank you.

Any other questions?

Walter Wolf has a he's had his hand up for a while.

Oh, okay. I'm sorry. We'll let go to you first. Sorry. I'm not used to those screens all the time.

That's all right.

Variances. It

seems like those are going a lot better and smoother. And I just wanted to check-in and make sure that that is the case. It seems like things are definitely on very good path.

So feedback, you were asking about noise variances?

Yeah.

It was, yeah, I would say, no pun intended, but a very quiet year for complaints around noise variances. So yeah, it's been a very smooth summer concert season. So haven't had a whole lot of feedback that way.

All right. And I'll work on getting you a new crystal ball. I know those things are hard to replace.

Thank you. Back

to immunizations. Who is eligible to participate in the Appleton Health Department's clinics?

Yeah, so anyone that is eligible for Medicaid is eligible, so even in an under insured context in that way. There are some changes to the vaccines for adults program, which has increased the number. And I'm struggling just off the top of my head exactly what those changes were. But that has increased the larger availability of those that are eligible in that VFA program. And so we have seen a large uptick in those in interest in that program for those that do qualify.

Are there any other questions? I just have one. I know that each of the coasts are developing on a state level, a multistate advisory commission to give out their own recommendations for vaccines. Is there any talk about a Midwest recommendation, Or are we too early in that discussion?

Not that I'm aware of. It's not that I can't say that it's not happening. I have no knowledge of it. I know that we talked about it at the state level state level recommendations, you know, something that could happen. I would imagine that's likely to happen. Whether or not that becomes a regional effort, I have no knowledge of that.

Okay. It's just that I'm very concerned because I remember, being young enough to see people that weren't vaccinated that had measles. And that's concerning to me because that is a very deadly disease. There was a reason why we chose to have vaccines come into play in the 60s and 70s. And so, I'm hoping that the insurance companies do the correct thing and keep covering all the vaccines for everyone.

And I'll say that one of the efforts that we are a part of is the sort of milestone notification. So children over six months will get a or parents will get a notification if they've missed a milestone. They can receive up to three notifications over the life of child. And so we look for natural points. You know, if it looks like they're on a treatment schedule that may not be exactly in line with what those milestones might be, but it's clear that they're working with their pediatrician to receive the vaccines, then that's a letter that probably won't go out.

But otherwise, milestones are caught. We do have those conversations as well.

Excellent. Think, did you Yeah, I have

a few comments. Just simply, this particular Board of Health meeting is, for the public, to know, catching us at a time where there's very little time to synthesize and react to some of the federal level statements and approaches that have been recently announced. I can't speak for the state Department of Health, except I can speak about the state of Wisconsin's public health efforts, which have been incredible over the years. We really have a well constructed and well intentioned, well fact based state level public health leadership historically. And it wouldn't surprise me that they come out with recommendations that are consistent with science.

The things that we know to say that pulls it together from what the federal level says and what we know on the ground is that there are indeed recommendations for the COVID vaccine for 65 and beyond. And there are indeed recommendations for anybody 18 65 that has health conditions and to be able to get that. Whether or not that's going to require a prescription if you go to a pharmacy is up in the air right now because all different pharmacies are looking at their liabilities in terms of risk because, they feel the need to prove that somebody has a health condition and they're not a physician. And so there's a lot uncertainty about that. The kinds of conditions have not even been listed.

But as a general rule, for the public to be thinking about yourself, talk to your family your primary care physician, as, Doctor. Seaper said. And additionally, they're not unlike the conditions that were approved previously. I mean, conditions that we identify for people being at risk for influenza were similar to COVID interns with hospitalization and death. And they include things like diabetes and all of the just about any heart condition, including hypertension, lung conditions such as asthma, COPD, which is chronic obstructive pulmonary disease an older term for that is emphysema.

You know, even being overweight, it puts you at risk. And people are surprised that the risks for COVID hospitalization and death actually included mental health disease, including depression. People who are suffering from mental health have a difficult time taking care of themselves. So there's other categories as well to discuss. But if you're in any one of those categories, you're likely to be able to get a vaccine.

The question about insurance coverage is, again, insurances usually follow what Medicare recommends, Medicare recommends what the CDC and the FDA are. And the current well, former immunization committee. And my hope is that insurance companies recognize, as they often do, their bottom line. And it's a lot cheaper to give vaccines for the public and for their members that they ensure than it is to care for them in the hospital. So even I hope that there's I think there's other motivations, but, you know, that's as much as I think we probably know or can summarize for right now. A lot of uncertainty.

Any other comments or questions? Seeing none, I seek a motion to adjourn.

So moved.

Is there a second? Second. All right. All in favor say aye. Aye. Opposed? We are adjourned. Thank you all for your time.

Have a good day, everyone.