Board of Health

Skokie Board of Health September 8th, 2016 Present Absent Excused Mr. Abbasi Dr. Polin Mr. Nidetz Ms. Nickisch Duggan Dr. Dave Dr. Shim Dr. Prince Dr. Usman Dr. Drachler Dr. Sood Dr. Vernon Dr. Varma Dr. Gaynes Dr. Topouzian Dr. Williams Ms. Jones Thorne Ms. Urbanus Ms. Nickisch Duggan Dr. Werner Mr. Pandya Guest, Adeed Ansari Guest, Lesly Bintsamou Guest, Guilermo Adao Dr. Catherine Counard, Director of Health Mr. David Clough, Staff Call to Order - The meeting was called to order at 7:32 p.m. by Dr. Drachler, Chairman. Approval of Minutes – Minutes from the June meeting were reviewed and approved with one minor correction. Communicable Disease in Skokie – Claudia Braden, RN, BSN, MPH A copy of the presentation is attached Nurse Claudia Braden mentioned that she is the communicable disease investigator for the Health Department, and would be reporting communicable disease statistics for Skokie from the past five years. She focused on five topic areas: Hepatitis, Gastrointestinal (GI) Illness, Vaccine Preventable Diseases, Rare Diseases and Tuberculosis. Viral Hepatitis: Hepatitis A is the only hepatitis virus that has caused acute infections in Skokie residents. The hepatitis B & C infections have all been chronic (i.e. present for longer than 6 months) • Hepatitis A: There have been four cases in five years. Two of those cases were people who traveled to Mexico and the others were part of food-related outbreaks in Chicago and Cook County. Ms. Braden pointed out that hepatitis A is vaccine preventable, and vaccination may be needed prior to international travel. • Hepatitis B: affects the Skokie foreign-born population. Typically the infection was transmitted from a mother who has a chronic infection to her children at birth. Ms. Braden stressed the importance of pregnant women being screened for hepatitis B infection, because the baby can be treated to prevent infection. Ms. Braden added that hepatitis B is also a vaccine preventable disease, and in the U.S. babies are vaccinated at birth. She added that people who have chronic hepatitis B infection are at greater risk of liver cancer and cirrhosis. • Hepatitis C: is more common in people age 50 - 60 years, and all “Baby Boomers” (people born between 1945 and 1965) should be tested for hepatitis C at least once. A treatment center for hepatitis C opened at Skokie Hospital in 2014, and the number of people being tested has increased as a result. She stated this disease is usually contracted through IV drug use or is sexually transmitted, and many people do not know they have been infected. GI Illness: Ms. Braden stressed that Skokie’s borders are not walls and many diseases are related to national outbreaks. For example she traced a listeria case back to a nationwide outbreak from salad greens that were bagged in Ohio. Salmonella cases were traceable back to outbreaks in Iowa, Wisconsin, and Mexico. She also pointed out that Norovirus and Clostridium difficile are not killed by alcohol-based hand gels. She strongly encouraged everyone to wash with soap and water instead of relying exclusively on hand gels. Vaccine Preventable Diseases: • Influenza: continues to be an issue each year. The Health Department receives reports of people who are sick enough with influenza to be admitted to the intensive care unit, and all deaths caused by influenza. All of the people who were admitted to the ICU over the past five years were not vaccinated. Some died. One outbreak in a long term care facility led to the requirement that all employees receive a flu vaccine. • Mumps: The mumps cases in Skokie residents have been related to outbreaks on college campuses. The outbreaks occurred despite most college students having had the required two doses of MMR vaccine. A 3rd dose of MMR vaccine is being given during outbreaks, and may become a requirement in the future. • Varicella (Chickenpox): a few cases continue to occur each year; some are mild cases in children who were vaccinated. Ms. Braden stressed that getting the vaccine is much safer than just allowing a child to catch the disease as some people recommend with Chickenpox. Shingles is caused by the varicella virus re-activating in older people. People over age 60 years should receive a shingles vaccine. Currently the shingles vaccine is given once. • Pertussis: Pertussis cases continue to occur regularly, and there have been outbreaks in area high schools, even though the teens all received the required vaccine doses. The immunity from pertussis vaccines given in childhood wanes over time. Dr. Drachler brought up the issue of vaccines wearing off eventually. He is seeing a number of women in his practice who are not immune to either German measles or Pertussis. Ms. Braden agreed that the length of efficacy for Tdap and a number of other vaccines were coming into question. Ms. Jones Thorne asked if there was an anti-vaccination movement in Skokie and Dr. Counard responded that childhood vaccination rates are very high in the Village. There is not a significant anti-vaccination movement in Skokie. Dr. Drachler mentioned that California has enacted a law requiring unvaccinated children to be homeschooled. #504462 • Rare cases: do sometimes affect Skokie residents who have traveled out of the country. It is very important to talk to a travel medicine practitioner prior to traveling, to obtain necessary medications or vaccinations to prevent infections. Over the past five years Skokie residents have contracted Dengue Fever, Malaria and Typhoid Fever after traveling. There are also sporadic cases of Lyme disease and West Nile Virus that were contracted locally. Tuberculosis (TB): Over the past five years 22 Skokie residents developed active tuberculosis infections; all but one were foreign-born. “Active” TB infection means that a person is very ill, coughing, losing weight and will die without treatment. These cases can spread tuberculosis infection to others. • The challenge with TB is that active disease may not develop until many years after the person was infected. If the initial infection does not cause active disease right away, the TB bacteria can remain alive for years in a person without causing illness until some point in the future. This is called “Latent” TB infection, which can be detected with either a TB skin test or a blood test. A person with latent TB carries the infection but has no symptoms and cannot spread the disease to others. • About 10% of people with a latent infection will develop active TB at some point in their lives. A person infected in another country may not develop active disease until long after arriving in the United States. Anyone found to have latent TB infection should be treated; however, because only 10% will go on to develop active disease, many people opt not to have the treatment. Only treatment for active disease is required, to prevent spreading the disease to others in the community. • Tuberculosis infection is still common in many parts of the world, and the Skokie population is 42% foreign-born. Ms. Braden showed a map of the world indicating which countries still had significant tuberculosis infection rates. Most foreign-born Skokie residents come from countries that have high rates of tuberculosis. • Over the past 2 years the Health Department conducted 863 TB skin tests with 47 positive. Although only 38% of the people tested were foreign-born, 89% of the positive tests were in foreign-born individuals. Ms. Braden mentioned that people born in countries with high TB rates are often vaccinated with BCG to prevent TB. Many people think that the BCG vaccination they received as a child will give them a positive TB skin test as adults but this is not true. • Ms. Braden reminded everyone that a positive TB skin test means that a person is infected with TB, but unless they have active TB infection they cannot spread the infection to others. All people who test positive at the Health Department are referred to the Cook County Department of Public Health TB clinic in Des Plaines for further evaluation and treatment. Ms. Braden concluded her presentation and Dr Counard mentioned that she is hoping to include some routine public health work, such as testing and treating tuberculosis, in the 2017 Community Health Plan. Dr. Polin asked if there was any screening for tuberculosis during the immigration process. Ms. Braden answered that while people are screened for TB, unless they have active TB disease and pose a risk to others they are not barred from entry. So a positive TB skin test without other signs of illness would not preclude someone from coming into the United States. #504462 2017 IPLAN State Re-certification Process – Dr. Catherine A. Counard, Health Director (A copy of the report is attached) Dr. Counard reported on progress towards completing the 2017 IPLAN State re-certification process. She showed a chart representing the multiple layers of the project, including key informant interviews, immigrant group health assessments, and the community health data review. She mentioned that possible priorities for the 2017 Community Health Plan might include: Healthy Living, Access to Healthcare, Substance Abuse, and Health Disparities. Responding to the substance abuse topic, the group discussed the U.S. opioid epidemic. Mr. Clough stated that hospital admission data shows that very few Skokie residents were admitted for opioid overdose. Dr. Counard added that discussions with Skokie police and EMS indicated that opioid overdoses were not a significant problem in the Village. Dr. Gaynes mentioned an article in the New York Times equating loneliness and isolation with higher rates of disease in the elderly. The article cited a survey in Great Britain in which many respondents reported not speaking to another person for more than a week. Dr. Counard thanked Dr. Gaynes for bringing this important issue to the attention of the group. She added that we are conducting interviews with the North Shore Senior Center and other groups that serve adults over age sixty-five. Mr. Clough said that many interviewees felt that a Senior Center in Skokie for socialization would be a good step. Chair’s Report Dr. Drachler proposed starting the Board meetings at 7:00 PM, and ending at 8:30 PM, so the Board could head home while there was still some daylight. The idea was unanimously supported. Dr. Drachler announced that the next Board of Health meeting would be held at 7:00 PM at the Skokie Public Library. Dr. Drachler reported that the Environmental Sustainability Plan was presented to the Board of Trustees in August. The Sustainable Environment Advisory Commission will have responsibility for implementation of the plan moving forward. Dr. Drachler also announced that the Board summer dinner at Ruby of Siam restaurant was quite enjoyable. He would like to solicit ideas to increase attendance at the Board summer dinner for next year. Health Director’s Monthly Report – a copy of the report is attached Access to Health Care Improves in Skokie Dr. Counard reported that more Skokie residents in need are able to receive health care as a result of increased health insurance coverage through the Affordable Care Act, and the two new Federally Qualified Health Centers in our area. We recently learned that between the Asian Human Services and Erie Family Health Center clinics 3,100 Skokie residents who did not have local access to care previously are now receiving care. #504462 Dog Mauling Dr. Counard reported that in August a dog badly mauled a young boy. The boy was bitten over 30 times and is only alive because his teenage sisters pulled the dog off. The dog owner is currently fighting the court order that the dog be euthanized. Old Business: In response to a question from Dr. Polin, Dr. Drachler stated that there is currently no plan for Skokie Hospital to become an “orthopedics and neurology only” hospital. No major changes will happen at the hospital until the potential merger between the Advocate and NorthShore Health Systems is finalized. Dr. Drachler brought two obesity related articles. One concerned the use of bariatric surgery in children. The other discussed the negative effect of maternal obesity on fetal brain growth. Dr. Polin brought up the issue of waste management. He mentioned a community that instituted a weight-based tax on garbage but did not tax recycling. This would be a possible way to incentivize people to recycle over throwing everything in the garbage. Meeting adjourned at 8:58PM. The next meeting of the Skokie Board of Health will be: Thursday, October 13 Skokie Public Library nd 2 Floor Business Center 7:00 – 8:30 PM #504462