Clark County Board of Health

0:00 (upbeat music) And summarized. - Good morning and welcome. Calling to order, Clark County Board of Health, Wednesday, August 26th, 2026. We'll start with the Pledge of Allegiance if you'll all rise. - 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. - Thank you, then we'll go to the roll call. - Councilor Young. - Here. - Councilor Belcott. - Present. - Councilor Little. - Here, sorry, I'm off video. - Councilor Fuentes. - Here.

0:59 - And Chair Marshall. - Here. Okay, welcome everyone. Are there any amendments to the agenda? - None today. - Okay, thank you. Then we'll open it up to the public for comments and just a reminder, there's a three minute limit and we are the Board of Health. So is anyone in the room wanting to testify? Okay, one person online, let's hear from them. Caller, you've been sent a request to unmute yourself. Please do so, state your name for the record and go ahead with your comments. - Good morning, Kimberly Goheen-Elvin. This is in memory of my son, Cleve Goheen-Rengo, incarcerated here at Clark County Corrections. When we talk about the justice system, we often speak in abstract, laws, budgets and case numbers. But today I wanna pull back the curtain on the law,

1:59 excuse me, on the raw physical and psychological destruction occurring inside the Clark County Main Jail in Vancouver. Incarceration is meant to be a depravity of liberty, not a systemic stripping away of human health and dignity. Yet the individuals held long-term in our local correction system, the reality is a slow daily poisoning of the mind and the body. This crisis becomes an outright tragedy when you realize that many trapped in this cycle are victims of wrongful charges and predatory systemic practices and wrongful detainment punished brutally before they have even had their day in court. My son's been in there for two years. Let's look at the physical toll of this environment. The human digestive tract is highly sensitive to chronic stress and poor nutrition. Detainees are subject to low grade,

2:57 highly processed food lacking basic nutritional density. Compounding this is the municipal water supply heavily treated with synthetic fluoride and chemicals, which inmates must drink daily in and out. This combination of toxic stress, lack of movement and subpar diet triggers severe gastrointestinal and tightest distress causing chronic bad bowel movements and systemic inflation, excuse me, inflammation, which he's experiencing. The body begins to physically fail under the weight of its surroundings. The physical psychological terror of consignment triggers a constant flood of cortisol causing severe anxiety, profound mental stress and physical manifestations like rapid hair loss, which my son is experiencing and has kept his hair to show people. Your body quite literally rejects the environment it is forced to live in.

3:56 Dan Gasparino, lead prosecutor in this case, knows that he is covering up not only police brutality on a police body cam, but that he's defending the alleged victims that attacked my son. And because of a high profile case of CPS capture and corruption, that his name is well known and people have a target on him. And he's being targeted now today. You're killing him and I want something done about it. This is the Board of Health. You're also the Clark County Council. You must do something about my son. He goes to court tomorrow. I want him out of jail and he can go through the system, but I need- - Okay, thank you for your comments. Is there anyone else? Okay, that concludes comments from the public. We'll move on to the consent agenda. It's just the minutes of July 22nd, 2026. Are there any corrections?

4:55 And if not, I'll entertain a motion to approve. - So moved. - Thank you. Is there a second? - Second. - Moved and seconded. Thank you. All in favor say aye. - Aye. - Aye. - Motion carries. Then moving rapidly along to new business, Dr. Brianna DaSilva Batia is here, currently serving as our deputy health officer and likely be appointed as the interim health officer today. So welcome. I wonder if you could just, I wanna thank you for meeting. You met with each of us individually. And if you'd just take a moment so the public can hear a little bit about your background and how you see the role of the health officer. That would be great. (mouse clicking) - Hi, good morning. I'm Brianna DaSilva Batia. And as you mentioned,

5:54 I've been in the role of deputy health officer since February of last year. By training, I am an internal medicine physician and I'm approaching 10 years of independent practice. I've been in the local Vancouver area for about eight years and I'm really happy to be here. Thank you. I think I envision the role of the health officer as really giving a voice to public health and the public and really promoting a partnership with everyone here. - Great, thank you. Does the board have any questions or comments? Okay, I guess hearing none, then I will entertain a motion to appoint Dr. DaSilva as our interim health officer. - So moved. - Thank you. - Second. - Moved and seconded. Thank you very much.

6:53 Any discussion? - Sure. - Yes, please go ahead. - Happy to have you on board here to guide us during this time of transition. I think it makes sense for, I mean, that's the standard process, the deputy health officer. That's why we have one to fill in in the event that the health officer is not available to perform that role. But just a quick comment and very supportive of this interim appointment. I want to acknowledge FAC and, you know, the comments that they have directed to us and I believe it is our intention to fully involve FAC in the ultimate decision process on filling the permanent role. So I look forward to that and hopefully they can work on suggestions for how they feel they can be involved in that, but super supportive. Thank you. - Thank you for those comments. Any other comments from anyone?

7:50 Hearing none, all those in favor say aye. - Aye. - Aye. - Motion carries, so welcome aboard. And then moving right on with our agenda, you're up next with the health officer's update on measles and cyclospora. - All right, hello again and good morning, counselors. I'll start with cyclosporiasis updates. So last month you heard a little bit about the cyclosporiasis outbreak that has been linked to iceberg lettuce. As a refresher, on July 17th, Taylor Farms issued a recall of iceberg lettuce. The best by dates for these recalled products have passed and they should no longer be available to consumers in stores or restaurants. The CDC is also investigating multiple other cases of cyclosporiasis outbreaks

8:50 and those have not necessarily been linked to Taylor Farms. The CDC has received reports of just over 17,000 cases of confirmed cases of cyclosporiasis acquired inside the United States since May 1st, 2026. For comparison, last year during the same timeframe, there were just around 1,100 cases. An additional 11,844 cases require more investigation by CDC state and local health departments to determine if they do indeed meet classification to be considered part of the multiple cyclosporiasis outbreaks. In Washington, between May 1st and August 21st, there have been 71 cases of cyclosporiasis here in our state. Of those, 68 traveled internationally and were believed to acquire the illness

9:49 outside of the United States. 23 had no international travel, but around half did travel domestically within the United States to another state reporting an outbreak of cyclosporiasis. In brief, cyclosporiasis is a GI illness caused by the parasite cyclospora. Cyclospora is transmitted by the fecal-oral route, meaning people become infected when they ingest food or water that has been contaminated with human feces. Outbreaks in the United States are typically linked to imported fresh produce. Healthcare providers can help by testing people with compatible symptoms and reporting cases to the health department. Last night at the Public Health Advisory Council, we did hear and ask for some clinician resources

10:48 around diagnosis testing treatment, and we will be putting that together. Lastly, I'll add that it is very difficult to prevent cyclosporiasis when produce is contaminated because it's very difficult to wash produce thoroughly. And even when produce is washed thoroughly, it may still be contaminated. There are things that people can do to help. First and foremost, wash your hands and all fresh produce under running water before eating, cutting, or cooking. Certainly watch out for cross-contamination, so cutting boards, utensils, kitchen counters, wash in between. And it's best to use whole heads of lettuce rather than bagged or processed lettuce. It can also be helpful to scrub produce and remove outer layers of fruits and vegetables. Cooking may also kill the parasite. The CDC recommends cooking to a temperature

11:47 of at least 158 degrees Fahrenheit, so that's a little bit lower but similar to the cooking temperature for chicken. So if you're doing a stir fry with something like chicken and your chicken is cooked, you have reached the appropriate temperature for your fresh produce. This cyclosporiasis outbreak, multiple outbreaks, really brings to attention the importance of food safety. It also highlights how important members of the public are in contributing to these investigations. When the public answers calls from health officials and takes the time to engage, it helps solve food outbreaks just like this. I will pause there for a minute if you have any questions or comments about cyclospora. - Thank you. Are there any questions? Yes, go ahead. - Sharon, do you have a question? Good morning, doctor, and congratulations on being appointed our intimate health officer. Just a really quick question. What are some symptoms people can experience when exposed?

12:47 And what should they be watching out for? - Absolutely. I think we've probably all heard in the news, it is the hallmark of cyclosporiasis is explosive watery diarrhea. So folks should look for no other cause of diarrhea, ongoing and severe watery diarrhea. It is also associated with bloating, gas, and notably it lacks a lot of the upper symptoms. So folks typically do not have a lot of nausea or vomiting, and there's not systemic symptoms like fever, body aches. - And then a follow-up question. What should a person do when they are experiencing these type of symptoms? - So certainly practice good hand hygiene when cooking, interacting with others after using the restroom, and talk to your healthcare providers about your symptoms.

13:46 It's also really helpful if folks can help add that to the thought process. Maybe commenting on international travel, travel to areas that are having an outbreak. For example, a lot of the bagged iceberg lettuce was linked to Taco Bell in certain states. That information came from the public providing history and being part of the investigation. So folks that are able to flag these symptoms to their healthcare providers and provide history around travel, what they've eaten, and certainly the severity and duration of their symptoms. - Should they seek immediate medical attention or is it something that they should just monitor and check to see how it evolves? - So for most people who are healthy, not immunocompromised,

14:44 this would be a very annoying and disruptive illness to have, but most people recover fine. Symptoms can go on and even come and go for weeks to months. And so I don't think anybody wants to have that duration of symptoms, but folks who have a good immune system are healthy and well. Generally, we would not expect to see significant complications from that. However, folks that are immunocompromised can have more severe illness. I would not say that this is something that would require a visit to the emergency department, but it's not something that you would not want to bring up. I think for a lot of folks where most people get into trouble with GI symptoms is when you have a lot of diarrhea,

15:42 it can be really easy to get dehydrated. We also worry about things like kidney injury if you're not eating and drinking enough or becoming very dehydrated. And that can really trigger a lot of other things, folks who already have chronic kidney disease, folks who may have medications that become dangerous if they develop kidney trouble as a result of that. So certainly anybody that is not able to eat or drink sufficiently, that raises the issue to something more important and something that they definitely need to reach out for to their healthcare providers sooner rather than later. - Thank you, doctor. - Great, great questions. Councilor Belcott, your hand's up. - Councilor Little was first, now I'll go. - Thanks. Councilor Little. - Oh, thanks so much. This is more of a comment. I just wanted to say thank you for this. It's an excellent example

16:41 of how we should present this information to the public. It was very thorough. It was presented in a way that people can understand. They can understand what to do. I just think it's a perfect example. So thanks for leading with us. - Thank you. Now, Councilor Belcott. - I was wondering, doctor, are these outbreaks worse in some regions rather than others? (mouse clicks) - Yes, there are certain states that have been more heavily impacted. Some of that is related to the produce that we know is impacted went to certain areas due to the way that product is distributed. There's also an element of if we're not aware of the illness and we're not looking for it

17:38 and we're not testing for it, we're not going to find it. And so it is certainly possible that states that are seeing lower numbers were just not diagnosing and capturing, but certainly there are states far more heavily impacted than others. - Thank you. - Councilor Yang, did you have any questions? Nope, okay. - I'm curious about the distribution system itself, and I don't wanna demonize any particular farm, but how many farms, for example, have been identified as the source, and were they all outside of this country? - I'm not sure. Certainly the farm that comes to mind was Taylor Farms in central Mexico. That we know regarding the other,

18:37 there's at least four other suspected cyclosporiasis outbreaks. I'm not aware of us knowing exactly the product, and if we don't know the product, we cannot trace back to the source. - It's pretty remarkable to me that one farm could produce so much lettuce that could cover such a large area. - I think it highlights certainly it raises an important question of how do we source, produce, how is it transported, and certainly should raise awareness around the value and the importance of agricultural workers, and by keeping them healthy and promoting their health and safety, it impacts all of us. - Thanks very much. Okay, I don't think there's any other questions, so moving on to measles.

19:34 I'll start with a brief overview of measles nationally. As of August 20th, the U.S. has confirmed 2,777 cases of measles. 94% are unvaccinated, or have an unknown immunization status. An unknown immunization status means the person with the illness or the public health system cannot locate an immunization record, and the person or their guardian or their parent does not know if they are immunized. 66% of cases occurred in people aged 19 and below, so primarily the pediatric population. This month, we learned that two unvaccinated people died in Pennsylvania from measles. This marks the first measles fatalities of the year for this country,

20:34 and the first measles deaths in Pennsylvania for 35 years. We'll move to the state of Washington. Washington has had 55 measles cases this year. Fortunately, we have had zero deaths. Among the 55 cases, 49 are unvaccinated, and five do not know if they're immunized, and we cannot find any immunization records for them. That means one case of measles occurred in somebody with some amount of MMR or immunization. There's only one active public exposure site for our state, and that is ours. We had a public exposure site August 7th of this month, so 2026, at the AFC Urgent Care in Vancouver. We have not identified any cases

21:33 as a result of this exposure. Moving to Clark County, we have had 18 cases of measles this year. This represents about a third of the state's total, and we now have the highest confirmed cases of measles in the state. Of the 18 cases, 16 were unvaccinated, and the remaining two were unknown, meaning, again, no immunization record, and the person or parent did not know if they were immunized. Of the 18 cases, 16 of them were children. I'll end with a little bit about immunization rates. For the 2025-2026 school year, 90.6% of kindergartners in Washington were up to date with the MMR. At the county level for the same school year, 2025-2026,

22:32 87% of kindergartners were up to date on an MMR. For school-age children, that would be two doses of MMR. We talked a little bit last night at the Public Health Advisory Council meeting about how it's possible to increase immunization rates. Some states have quite high immunization rates, Maine, New York, California, West Virginia, Tennessee, and I think that's something, perhaps FAC may identify as something worth exploring. There's a lot of reasons why that is the case. Some of it has to do with very strict school immunization laws. Access to immunizations, affordability. We have to remember it takes a lot of time and effort

23:30 for a parent to find a pediatrician, call the office, get an appointment, take time off of work, take their child to this appointment. And although small, they are important barriers. And they're important barriers for a lot of people. Just a little bit about the measles vaccine. It was first licensed in 1963. After over 50 years of licensure and over 100 million doses administered worldwide every year, the MMR has an incredibly longstanding safety record. We give our first dose at 12 to 15 months and our second dose at four to six years. In general, adults now need at least one MMR and certain high-risk adults should have two MMRs.

24:30 So that may look like international travelers, folks who live in crowded spaces, so dorms, folks in the military. I'll pause there if you have any questions or thoughts. - If someone had had measles, does that, then they're immune going forward, there's no need for an additional dose at any point in their life? - That is correct. And because of the prevalence and how common measles was, we use the birth year of 1957. Folks who were born before that are considered immune. Folks who are not sure can talk to their healthcare provider about titers, which is blood work. However, that is a poke. There is a cost for labs.

25:29 You do need an appointment. You do need to go to the lab. If folks are uncertain, if they've been immunized, if they're immune, they can also choose to just get an MMR vaccine. - Right. We learned at an earlier, a few months ago, Dr. Melnick informed us, just looking at Ridgefield as a school district that was impacted with a previous outbreak and how they were more prepared this time in understanding who was immunized, including their teacher, so they wouldn't have to isolate for what, the 21 days if they've been exposed. So I think people knowing their status is really very important. Are there questions from other counselors? Go ahead. - The two deaths, what were the demographics of those two individuals? - I would need to verify that for you.

26:27 - Other questions from anyone? - Yeah, just a really quick follow up on something that you said, doctor. You mentioned that adults, some may need one or two MMRs. These are adults that have never been immunized, correct? - Correct. - Okay. - Also folks who don't have or can't find their immunization records, they have the same options. It is perfectly safe to just get another MMR if that coincidentally is their third or fourth. It's not harmful. - Okay. - The alternative is checking a titer or a special type of blood work to measure the antibodies in your body that can fight the illness. - Thank you. - Great, and I would second the facts recommendation

27:24 and really looking at this and how we can elevate those. And if it requires legislation, that would be, and what the other states are doing, how they're able to achieve a higher rate. It's not a lot of things. It's hard to figure out how we can prevent things. These measles is clearly preventable and however we can focus our energy on increasing those immunizations rates, that would be great. Okay, anything else from anyone? Okay, thanks very much. Public Health Advisory Council report out, welcome.

28:08 We appreciate you being here every time. - Thanks, I'm Emily Estes, the Vice Chair of the Public Health Advisory Council. We've had two meetings since we last saw you just because of a scheduling quirk. And so I wanted to give you updates on a few things, but I will just start with one of the comments on measles that happened yesterday and at our previous meeting. It's just kind of a reminder that in 2019, the measles outbreak was kind of started in Clark County. And prior to that, Washington State allowed philosophical exemptions to school entering measles vaccination. And it was in part the work of this Board of Health and the FAC that kind of supported and pushed for that legislation that changed it. So there's no longer a philosophical exemption. Just on that, I wonder how many of those philosophical

29:07 exemptions became religious exemptions? Or if there was a big boost in religious exemptions following that legislation. I don't know if anyone's looked at that. - I can't tell you the root cause or why, but there is a Washington State School Immunization Dashboard and I did notice that after that law was passed, the amount of religious exemptions did increase. - Thank you, go ahead. - Yeah, and that's a conversation that FAC had last night as well and how we can both increase that, what our options and what our roles are as a Public Health Advisory Council, both bringing things out into our own communities and making recommendations to this board.

30:04 So beyond that, we have new members who we will be bringing for your approval in the next month because several terms have expired and several are being renewed. There was a posting in the Columbian and we had a lot of interest in several positions and a little bit of interest in several others and so we're hoping to have a good slate. In addition to that, we heard about the Language Access Line and we had really good discussions about what that brings to our community and one thing that's come up at several meetings is just a reminder for the community to sign up for CRESA alerts this wildfire season and the importance of that. So in addition to that, I'll just address

31:02 with the recent significant changes to leadership in Clark County Public Health, members of FAC have come to the executive team and members of the community have come to FAC kind of asking for information about that. I know there was information in the Columbian. We would really like to participate in those conversations and I think that that timely information is needed for the community. The FAC has a couple members who have served for 22 years, many who have served for more than 10 because they're part of their own institutional bodies that brought them forward. We have a lot of institutional knowledge about these processes. We've had members who sat on the committee that hired the previous health director and they were also involved in conversations when those two roles were joined in 2013.

31:58 We would be happy to contribute that knowledge and we would really like to be a part of those conversations. - We would like you to be a part of those conversations as well and we welcome your input. Anything else? Any questions from any board members? Okay, thank you. Okay, comments from the board. Are there any comments? Go ahead. - So I'm sure I can speak on behalf of the whole council here, but I just wanted to give a shout out and a heartfelt thank you to Dr. Melnick and the service that he's provided through many years in our community. And just, I don't think that he's the type that will do your typical retirement. So I'm sure we've not seen the end of him in our community for sure.

32:58 But I just wanted to mention that yesterday, Council Little and I, we joined in the opioid abatement council meeting and Dr. Melnick has been on that committee for quite some time and his voice wasn't there. And so we do, I love to hear his thoughts and his opinions on those things. And I just appreciate the service and the value that he's brought to all the different things that he has touched over the years. And then just the last thing that I would like to say, and I don't know, maybe the county manager can help with this, but in terms of timing for the selection of the permanent replacement, what are we looking at? 'Cause I know the fact meets only once a month and they met yesterday. So their next meeting would be about a month from now. I'm just trying to see how we can get that process rolling.

33:56 How we can allow them to maybe give their own insight into how they would like to be involved or do we need to decide their involvement given the time constraints? - I'm not so worried about the time constraints 'cause we can have a special meeting even with VAC. I mean, there are obviously a lot of folks on VAC that we wanna make sure have access to that meeting, but we don't have to wait a month to do anything. So I'll be sharing with council different options on processes, which, and I'll have to run some of it by legal 'cause I know there were some questions that had been brought up as well from their perspective on roles and responsibilities, but how that could look for you all. But I do not have anything today for that, but I am working on a couple of frameworks that council can consider moving forward. - Great, and I appreciate the memo that was provided to us from VAC asking for involvement.

34:54 We are all in agreement that we want you to be a part of that. So I'd hope for another memo showing how you feel you can be involved. So thank you. - Okay, any other comments from anyone? Thank you for mentioning Dr. Melnick. I had this in my notes as well and really to recognize Dr. Melnick for his service to the county and really a lifetime dedicated to public health. He saw us through some very difficult times with COVID and the measles outbreak and his leadership will certainly be missed. And we wish him really all the very best in his retirement. So taking a little break is well worth it. And I do agree, he'll still be involved with the public health for his entire life. Okay, anything else from the board?

35:53 And if not, that concludes our agenda. And without objection, the meeting is adjourned.