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 Belkot present.
Councilor Little here.
>> Sorry. I'm off video.
>> Councilor Fuentes. Here 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
Gavenn Elbon. This is in memory
of my son, Cleghon Ringo,
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 want to pull back the
curtain on the law. Excuse me,
on the physical and
psychological destruction
occurring inside the Clark
County main jail in Vancouver.
Incarcerated 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 corrections system,
the reality is a slow daily
poisoning of the mind and the
body. This crisis becomes an
out right 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, highly
processed food lacking basic
nutritional density.
Compounding this is the
municipal water supply, heavily
treated with synthetic fluoride
and chemicals, which inmate
inmates must drink daily in and
out. This combination of toxic
stress, lack of movement, and
subpar diet triggers severe
gastro enteritis, distress
causing chronic bad bowel
movements, and systemic
inflammation. Excuse me.
Inflammation, which he's
experiencing. The body begins
to physically fail under the
weight of its surroundings. The
physical, psychological terror
of confinement 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. Dannen Gasperino, 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?
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 I
I I motion carries. Then moving
rapidly along to new business
doctor Brienna da Silva Busha
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 want to thank you
for meeting. You met with each
of us individually. And if you
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.
>> Hi. Good morning. I'm
Brienna da Silva Busha, and as
you mentioned, 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 ten 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 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 Doctor Da
Silva as our interim health
officer.
>> So moved.
>> Thank you. Second. Moved and
seconded. Thank you very much.
Any discussion? Chair? 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
health officer is is not
available to perform that role.
But just a quick comment and
very supportive of this interim
appointment, I want to
acknowledge Phac and, you know,
the comments that they have
directed to us, and I believe
it is our intention to fully
involve the Phac in the
ultimate decision process on,
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?
Hearing none. All those in
favor, say I, I, I. I motion
carries. So welcome aboard. And
then moving right on with our
agenda. You're you're up next
with the health officer's
update on measles and
Cyclospora.
>> All right. Hello again and
good morning, councilors. 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 buy 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, and those have not
necessarily been linked to
Taylor Farms. The CDC has
received reports of just over
17,000 cases. Confirmed cases
of Cyclosporiasis acquired
inside the United States since
May 1st, 2026. For comparison,
last year, during the same time
frame, there were just around
1100 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 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. Health
care 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 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. Cook,
cutting or cooking. Certainly
watch out for
cross-contamination. So.
Cutting boards, utensils,
kitchen counters, Wasch 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 of at least 158°F.
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. Do you have a
question? Good morning doctor,
and congratulations on being
appointed interim health
Officer. Just a really quick
question. What are some
symptoms people can experience
when exposed 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 health care providers
about your symptoms. 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 what
how it evolves?
>> So for most people who are
healthy, not immunocompromised,
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,
you know, 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, 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. You know, folks who
already have chronic kidney
disease, folks who may have
medications that become
dangerous if they be if they
develop a kidney trouble as a
result of that. So certainly
anybody that is not able to eat
or drink sufficiently, that
raises the issue to, to
something more important and
something that they definitely
need to reach out for to their
health care providers sooner
rather than later.
>> Thank you doctor.
>> Great. Great questions.
Councilor Belkot your hands up.
>> Councilor little was first
and then I'll go.
>> Thanks councilor Little.
>> Oh thanks so much. I this is
more a comment. I just wanted
to say thank you for this. I
it's an excellent example 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 this.
>> Thank you. Now, Councilor
Belkot.
>> I was wondering, doctor, is
are these outbreaks worse in
some regions rather than others?
>> 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
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 than
others.
>> Thank you.
>> Councilor Young, did you
have any questions? Okay. I'm
curious about the distribution
system itself. And I don't want
to deem demonize any particular
farm. But how many farms, for
example, have been identified
as the source and where 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. 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 the 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.
>> I'll start with a brief
overview of measles nationally.
As of August 20th, the US has
confirmed 2777 cases of measles,
94% are unvaccinated or have an
unknown immunization status. An
unknown immunization status
means the the person with the
illness or the public health
system cannot locate an
immunization record, and the
person or their guardian,
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, 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 immunization.
There is 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 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, 87% of
kindergartners were up to date
on an MMR. For school aged
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 Phac 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 it takes a
lot of time and effort 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 long standing safety
record. We give our first dose
at 12 to 15 months and our
second dose at 4 to 6 years. In
general, adults now need at
least one MMR, and certain high
risk adults should have two MMR,
so that may look like
international travelers. Folks
who live in crowded spaces. So,
you know, dorms, folks in the
military. I'll pause there if
you have any questions or
thoughts.
>> If someone had had measles,
did that, then their their
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. Thank you.
Who are not sure can talk to
their health care provider
about titers, which is blood
work. However. That is that is
a poke. There is a cost for
labs. You do need an
appointment. You do need to go
to the lab. If folks are
uncertain if they've been
immunized or if they're immune,
they can also choose to just
get an MMR vaccine, right?
>> We learned at an earlier a
few months ago, Doctor Melnick
informed us, you know, just
looking at Ridgefield as a
school district that was
impacted with with a previous
outbreak and how they were more
prepared this time in
understanding who was immunized,
including their teachers, so
they wouldn't have to isolate
for what, the 21 days if
they've been exposed. So I
think 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.
>> Other questions from anyone.
>> Yeah. Just a really quick
follow up on something that you
said, doctor. You mentioned
that adults, some may need 1 or
2 MMR s. These are adults that
have never been immunized
immunized, correct?
>> Correct. Okay. Also.
>> Folks who don't have or
can't find their immunization
records, they have the same,
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 in your body
that can fight the illness.
>> Thank you.
>> Great. And I would second
facts recommendation and really
looking at this and how we can
elevate those. And if it if it
requires legislation that would
be. And 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 where, how
we can prevent things. These
these measles is clearly
preventable. And however, we
can focus our energy on
increasing those immunization
rates, that would be great.
Okay. Anything else from anyone?
Okay. Thanks very much. Public
Health Advisory Council report
out. Welcome. 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 kind
of one of the comments on
measles that happened yesterday
and at our previous meeting is
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 entry,
measles vaccination. And it was
in part the work of this Board
of Health and the fact that
kind of supported and 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
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 you 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, just and that's that's
a conversation that that fact
had last night as well. And you
know, 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, you know,
making recommendations to this
board. 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 Colombian, and
we had a lot of interest in
several positions and a little
bit of interest in several
others. And so we're we're
hoping to have a good, 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 Corissa alerts.
This wildfire season and the
importance of that. In addition
to that, I'll just address with
the recent significant changes
to leadership in Clark County,
public health members of Fqhc
have come to the executive team,
and members of the community
have come to Phac kind of
asking for information about
that. I know there was
information in the Colombian.
We would really like to
participate in those
conversations, and I think that
that timely information is
needed for the community. The
fact has a couple members who
have served for 22 years, many
who have served for more than
ten because they're part of
their own institutional bodies
that brought them forward. We
have a lot of institutional
knowledge about these processes.
We have 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. 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 and we welcome your
input. Great. Anything else?
Any questions from any board
members? Okay. Thank you.
>> Thanks.
>> 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 in a heartfelt
thank you to Doctor Melnick and
the service that he's provided
through many years in our
community. And just, you know.
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
in our community for sure. But
I just wanted to, you know,
mention that yesterday Council
Little and I, we, we joined in
the opioid Abatement Council
meeting. And Doctor Melnick has
been on that committee for
quite some time. And his voice
wasn't there. And so it 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, you know, county manager
can help with this, but in
terms of timing for the
selection of the permanent
replacement, what are we
looking at? I mean, and because
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, what
we 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 because we can
have a special meeting even
with back. I mean, it's they're
obviously a lot of folks on
fact that we want to 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 it by legal because 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 we I am
working on a couple frameworks
that Council can consider
moving forward.
>> Great. And I appreciate the
the memo that was provided to
us from PAC, you know, asking
for involvement. 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 Doctor Melnick. I
had this in my notes as well.
And really to recognize Doctor
Melnick for his, 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 very all the very best
in his retirement. So taking
taking a little break is well
worth it. And I do agree he'll
still be involved with public
health for his entire life.
Okay. Anything else from the
board? And if not, that
concludes our agenda. And
without objection, the meeting
is adjourned