Board of Health — Skokie, IL
Date: 2016-09-08

Skokie Board of Health
 Thursday September 8, 2016
 Village Hall Conf. Rooms D/E
 7:30 p.m.

 AGENDA
 U




 I. Call to Order

 II. Approval of Minutes


 III. Claudia Braden, RN, BSN, MPH
 David Clough, MPA
 Skokie Communicable Diseases


 IV. Catherine A. Counard, MD, MPH
 IPLAN State Re-Certification Process Update



 V. Chair’s Report


 VI. Director’s Monthly Report


 VII. Old/New Items of Business



 VIII. NOTE OCTOBER MEETING WILL BE AT THE LIBRARY:

 Thursday, October 13, 2016

 Becky Smith, MD
 Hospital Epidemiologist
 Head, Division of Infectious Diseases
 NorthShore University HealthSystem
 Zika Virus Update

 7:00 p.m.
 Skokie Public Library
 nd
 2 Floor Business Center

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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.

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• 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.




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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.



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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




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