HomeMy WebLinkAbout2016 Communicable DiseaseJefferson County Public Health –Performance Measures Report 2016
Community Health – Communicable Disease Program
[1]
PROGRAMS:, Communicable Disease (CD), Tuberculosis, Immunizations, Travelers Immunizations, Sexually Transmitted Disease, HIV, Syringe Exchange Program, Public
Health Emergency Preparedness
MISSION: The purpose of the Communicable Disease Health program is to protect Jefferson County residents from serious communicable diseases by providing disease
surveillance, investigation and reporting, along with education, screening, treatment, and immunization services. The program interacts with community members, medical
providers, the Washington State Department of Health (DOH), Region 2 Emergency Management partners and other agencies while working toward this purpose.
Goals Objectives Performance Indicators 2012
Actual
2013
Actual
2014
Actual
2015
Actual
2016
Planned
2016
Actual
Goal 1:
Timely investigation
of notifiable
conditions.
Investigate reports of
notifiable conditions per DOH
disease specific guidelines.
Develop & update protocols
and forms as needed. Use
DOH electronic reporting
systems PHRED, PHIMS, and
PHIMS-STD, to receive
reports and send completed
reports to DOH.
Total number of communicable disease
reports confirmed, interventions applied
and processed for reporting to the State
150 143 180
(21
gonorrhea)
201
(42
pertussis)
160 178
Total number of STD cases reported to
the State 57 83 103 69 80 73
Number of chlamydia cases reported to
the State: female, male, total
Fe: 36
M: 13
T: 49
Fe: 68
M: 13
T: 81
Fe: 59
M: 18
T: 77
Fe: 42
M: 15
T: 57
60
Fe: 41
M: 15
T: 56
Number of gonorrhea cases reported to
the State: female, male, total
Fe: 0
M: 1
T: 1
Fe: 2
M: 1
T: 3
Fe: 13
M: 8
T: 21
Fe: 5
M: 4
T: 9
9
Fe: 4
M: 7
T: 11
Goal 2:
Inform medical
providers about
current CD trends,
outbreaks, and new
CD control
recommendations.
Provide updates, outreach, and
training to providers about
local, state, and national CD
outbreaks and disease control
recommendations. Provide
reminders about reporting
notifiable conditions and using
the after-hours reporting
number.
Number of alerts/updates/newsletters
faxed, emailed, or mailed to providers
(not including DOH Influenza Updates)
14 15 23 8 15 17
Goal 3:
Maintain the low
rate of active
Tuberculosis (TB)
in Jefferson County
Encourage appropriate
screening and treatment for
latent TB infection and active
TB disease.
Number of clients tested for TB
infection with PPD or QFT test;
Number of positive tests
198
0
165
3
149
2
148
2
160
2
180
1
Number of clients started on preventive
treatment for latent TB infection. 2 1 2 1 1 0
Number of cases of active TB reported 0 0 0 0 0 0
Jefferson County Public Health –Performance Measures Report 2016
Community Health – Communicable Disease Program
[2]
Goals Objectives Performance Indicators 2012
Actual
2013
Actual
2014
Actual
2015
Actual
2016
Planned
2016
Actual
Goal 4:
Work with local
clinics and DOH to
support universal
access to vaccines
for all children
through the federal
and state funded
Vaccines for
Children Program
(VFC).
Maintain an efficient system
for supplying vaccine,
recommendations, and VFC
program up-dates to VFC
provider clinics in Jefferson
County. Monitor VFC vaccine
usage in Jefferson County.
Total number of doses of publicly
funded vaccine (pediatric), administered
by private health care providers and
JCPH clinics, supplied and monitored
through JCPH immunization program
5,403 5,067 4613 4724 4800 4627*
Number & percent of doses of publicly
funded vaccine (pediatric) administered
by private health care providers
4,855
89.9%
4,545
89.7%
3967
86%
4222
89.4%
4200
88%
4198*
90.7%
Number & percent of doses of publicly
funded vaccine (pediatric) administered
by JCPH
548
10.1%
522
10.3%
646
14%
502
10.6%
600
12%
429
9.3%
*Issues with the reporting function of the WA State Immunization Information System (IIS) have caused errors in the monthly Doses Administered reports, therefore the number for
this report, for the Jefferson Healthcare clinics, is taken from the IIS Doses Ordered report.
Goal 5:
Assure quality of
immunization
services in clinics
providing VFC
vaccines, as required
by DOH.
Perform vaccine quality
assurance visits for 50% of
clinics annually. Assess
childhood immunization rate
for pediatric patients in 25%
of clinics annually.
Number of clinics visited for VFC
Program Quality Assessment and/or to
assess childhood immunization rates in
clinic patients. 2 2
2
+1 visit
by DOH
Total = 3
clinics
2
+1 visit
by DOH
Total = 3
clinics
1*
+1 visit
by DOH
Total = 2
clinics
1*
+1 visit
by DOH
Total = 2
clinics
*Total number of clinics decreased to four in 2015 when two Jefferson Healthcare Clinics merged into one clinic, reducing required number of clinic assessments per year.
Goal 6:
Promote more
extensive use of all
Washington State
Immunization
Information System
(WAIIS) functions
by the provider
clinics.
Continue to provide training
and support to provider clinics
for use of all WAIIS vaccine
related functions to accurately
and efficiently track vaccine
supply, administration, and
client records. Train on new
modules as they become
available.
Number of clinics using WAIIS to order
vaccine, track monthly vaccine
inventory, track monthly vaccine doses
administered
0 2 (40%) 4 (80%) 5 (100%) 4 (100%) 4 (100%)
Number of clinics trained to use WAIIS
vaccine return module 0 0 0
Clinics
trained but
module not
functioning
correctly.
4 (100%) 4 (100%)
Jefferson County Public Health –Performance Measures Report 2016
Community Health – Communicable Disease Program
[3]
Goals Objectives Performance Indicators 2012
Actual
2013
Actual
2014
Actual
2015
Actual
2016
Planned
2016
Actual
Goal 7:
Maintain access to
vaccines for
international travel,
in part to prevent
travel associated
outbreaks in
Jefferson County.
Provide travel immunization
clinic (includes all disease
prevention recommendations,
including for malaria and
other diseases).
Number of clients immunized in travel
immunization clinic
NA
Adults:
162
Adults:
140
Adults:
152
Adults:
150
Adults:
174
0 – 18 yr:
23
0 – 18 yr:
31
0 – 18 yr:
55
0 – 18 yr:
35
0 – 18 yr:
36
Total:
185
Total:
171
Total:
207
Total:
185
Total:
210
Number of private supply vaccine doses
(routine and travel) administered by
JCPH (primarily for adults)
1,057 819 600 781 700 701
Goal 8:
Assess childhood
immunization rates
for Jefferson County
children.
Assess Jefferson Co.
childhood immunization rate
trends, for children seeing
Jefferson County providers,
using immunizations recorded
in WAIIS.
Some children are not in the
IIS registry, and some
providers in Washington state
don’t participate in the
registry. The CDC NIS survey
is more complete.
Completeness of full immunization
series for children seeing Jefferson
County providers, at age 19-35 months:
4 DTaP, 3 Polio, 1 MMR, 3 HIB, 3 Hep-B,
1 Var, 4 PCV.
Jeff Co:
54% (IIS)
WA:
65% (NIS)
Jeff Co:
53% (IIS)
WA:
71% (NIS)
Jeff Co:
55% (IIS)
WA:
67% (NIS)
56% (IIS)
Jeff Co:
58% (IIS)
WA:
77% (NIS)
58% (IIS)
Jeff Co:
60%
Jeff Co:
63% (IIS)
WA:
(NIS NA)
59% (IIS)
Percent of children seeing Jefferson
County providers having 1 dose of
MMR by age 19-35 months (IIS data)
Jeff Co:
75%
Jeff Co:
78%
WA: 79%
Jeff Co:
80%
WA: 82%
Jeff Co:
82%
Jeff Co:
83%
WA: 81%
Percent of children seeing Jefferson
County providers having 4 doses of
DTaP by age 19-35 months (IIS data)
Jeff Co:
69%
Jeff Co:
66%
WA: 68%
Jeff Co:
70%
WA: 68%
Jeff Co:
71%
Jeff Co:
73%
WA: 69%
Goal 9:
Participate in CHIP
process to assist
schools to increase
student compliance
with Washington
State immunization
requirements.
Provide training and assistance
for school secretaries to access
WAIIS records for students.
Provide schools with
immunization information for
parents. Link schools to
updated State information on
submitting annual
immunization report.
Percent of Jefferson County
kindergarten students out-of-compliance
for required immunizations as reported
to DOH in school immunization report
each fall.
*Some schools did not report in 2012
and 2013.
* Jeff Co:
31.9%
WA:
7.5%
* Jeff Co:
11.2%
WA:
10.3%
Jeff Co:
21.9%
WA:
10.9%
Jeff Co:
30.5%
WA:
8.6%
Jeff Co:
15%
Jeff Co:
11.1%
WA:
8.2%
Jefferson County Public Health –Performance Measures Report 2016
Community Health – Communicable Disease Program
[4]
Goals Objectives Performance Indicators 2012
Actual
2013
Actual
2014
Actual
2015
Actual
2016
Planned
2016
Actual
Goal 10:
The Family Planning
and STD clinics will
assist in controlling
Chlamydia
transmission in
Jefferson County.
Women seen in Family
Planning clinic who are at
higher risk for Chlamydia (age
24 and under, CDC) will be
screened for Chlamydia
annually.
Number of female FP clinic clients age
24 and under screened for Chlamydia 301 368 320 311 320 290
Percent of female FP clinic clients age
24 and under screened for Chlamydia 56.5% 60.4% 63.4% 60.3% 62% 74.2%
Number of chlamydia cases reported to
the State, female, male, total
Fe: 36
M: 13
T: 49
Fe: 68
M: 13
T: 81
Fe: 59
M: 18
T: 77
Fe: 42
M: 15
T: 57
60
Fe: 41
M: 15
T: 56
Goal 11:
Maintain access to
HIV testing in the
community.
Clients at high risk for HIV,
without medical insurance,
will be tested through the State
Public Health Lab, others
requesting testing will be
tested through the Quest Lab
and charged for testing.
Number of persons counseled and tested
for HIV infection
DOH Lab:
27
Quest:
75
Total: 102
DOH Lab:
19
Quest: 7
5
Total: 94
DOH Lab:
5
Quest:
135
Total: 140
DOH Lab:
13
Quest:
112
Total: 125
115
DOH Lab:
4
Quest:
148
Total: 152
Goal 12:
Prevent the spread
of blood borne
communicable
diseases among
injecting drug users
and their partners.
Promote utilization of syringe
exchange program (SEP)
services.
Number of visits to SEP
150 185 350 238 240 242
Number of syringes exchanged 17,405 24,596 42,809 35,328 35,000 47,790
Goal 13:
Prevent fatal opioid
overdoses in
Jefferson County.
Provide overdose prevention
education to SEP clients.
Provide naloxone, for opioid
users, families and friends.
Number of naloxone kits dispensed,
included training for proper use. New
program in 2016. NA NA NA NA 45 45
Jefferson County Public Health –Performance Measures Report 2016
Community Health – Communicable Disease Program
[5]
Goal 14:
Annual report to
BOH for CD
Programs.
Complete Annual Report Pass/Fail PASS PASS PASS PASS PASS PASS
Goal 15:
Maintain and
enhance Public
Health Emergency
Preparedness and
Response (PHEPR)
capacity.
Update regional PHEPR Plan,
coordinating with Region II
partners Clallam and Kitsap
Health Departments, local
emergency response agencies,
Jefferson Healthcare, local health
care providers and agencies.
Update Public Health Emergency
Preparedness and Response Plan PASS PASS PASS PASS PASS PASS
2016 STUDY/ANALYSIS OF RESULTS:
Communicable Disease
In each of the previous two years, the communicable disease team was required to respond to outbreaks, in addition to the non-outbreak related
reports. There was a gonorrhea outbreak in 2014 and a pertussis outbreak in 2015. There were not any outbreaks in Jefferson County in 2016,
however the overall number of notifiable conditions reported did not decrease to pre-2014 levels.
Immunizations
The value of Federal and State funded vaccines supplied to Jefferson County in 2016 was $242,352.
As new vaccine management modules are added to the WA Immunization Information System (WAIIS) the Immunization Program Coordinator has
provided the clinics training and ongoing technical assistance on each module. These modules have had frequent technical issues requiring trouble
shooting with the clinics and consultation with the WAIIS staff.
JCPH Immunization Program staff and County IT staff worked with DOH from mid-2015 through mid-2016 to develop, test, and continue to trouble
shoot a data bridge for sending records from our EMR, EMDs, to WAIIS.
Two Jefferson Healthcare clinics merged in 2015, Jefferson Medical and Pediatrics and Jefferson Healthcare Primary Care, now together under the
Jefferson Healthcare Primary Care name. There are now 3 Jefferson Healthcare clinics participating in the Vaccines for Children program, in addition
to JCPH.
Jefferson County Public Health –Performance Measures Report 2016
Community Health – Communicable Disease Program
[6]
The CDC National Immunization Survey (NIS) has tracked national and state immunization rates since 1994. This is a telephone survey of parents,
and immunization records are validated by clinical review. This survey reports 77% of Washington State children age 19-35 months completed the
recommended full immunization series in 2015, up from 67% in 2014.
The WA State Immunization Information System (IIS) is a State immunization registry containing immunization records entered by health care
providers and insurance plans. All Jefferson County VFC immunization providers submit records to the IIS. All children born in WA State are
entered into the registry database at birth. Children moving into the state are not in the registry until an immunization record is entered. Some
providers in the state are not yet contributing immunization records to the IIS. At times, the IIS servers are overloaded, both with records being sent
from electronic medical record systems, and staff trying to use various modules, such as ordering, inventory, and doses administered. Records sent
during these times may not make it into the registry. For all of these reasons, the IIS is missing some immunization records, causing the reported
immunization rates from the IIS to be lower than the rates reported in the CDC NIS. WA DOH is planning an upgrade of their server capacity in the
fall of 2017.
For the first time, in the spring of 2017, the State Department of Health (DOH) published IIS immunization rate reports for the State and all counties,
going back to 2014. These reports are more complete than those JCPH staff can run from the IIS, in that children who receive immunizations from
out-of-county providers have not been included in the reports available to local Health Department staff. JCPH in-house reports include only doses
administered in our county. The ability to use the DOH generated reports provides a more accurate report for Jefferson County. Being able to
compare our County rates with the State rates from the IIS report, instead of just the State rates from the CDC NIS, gives a better comparison, in that
the rates are produced from the same database, with the same methodology.
Using the IIS reports, the full series completion rate for Jefferson County children, age 19-35 months, was 63% in 2016. This is up from 58% in
2015, and 55% in 2014. The WA State rate was 59% in 2016 and 58% in 2015.
Three possible causes for the immunization rate improvement since 2013 are: improved completeness of Jefferson County immunization records in
WAIIS; the evaluation and feedback for individual clinics provided by the JCPH Immunization Program coordinator, covering clinic immunization
rates, resulting in increased efforts to remind parents when children are due for immunizations and to administer all recommended vaccines at every
visit; and the beginning of the CHIP Immunization Workgroup efforts.
The Community Health Improvement Plan (CHIP) process for Jefferson County has identified improving immunization rates for children and adults
as one of the four health priorities to be addressed. The planning process was completed in 2016 and the overall implementation process will be
rolled out in 2017. Some of the immunization improvement activities started in mid-2016, through the work of the CHIP Immunization Workgroup.
Jefferson County Public Health –Performance Measures Report 2016
Community Health – Communicable Disease Program
[7]
The Jefferson County out-of-compliance rate for students entering kindergarten (incomplete immunizations or no records on file) decreased from
30.5 % in 2015 to 11.1% in 2016. The State rate was 8.2% in 2016. The JCPH Immunization Program staff have been working with the schools,
providing training on registering for and using WAIIS, to assist parents to get their child’s immunization records. Part of JCPH’s partnership with the
schools includes entering immunization records into WAIIS for any student with out-of-state records. JCPH has been providing updated fliers for
schools to include in the kindergarten registration packets, to help parents understand which immunizations are required for school and where these
immunizations are available. JCPH has been working with schools to encourage and support the enforcement of State immunization requirements for
school attendance. JCPH also sent an updated flyer, specific to immunizations required for child care, to the Department of Early Learning Child
Care Licensor for Jefferson County, to send to all of the child care facilities.
The immunization exemption rate for Jefferson County students entering kindergarten increased in 2016, after having decreased for the past three
years. The exemption rate for 2016 was 13.5%, up from 7.5% in 2015, 8.2% in 2014, and 11.7% in 2013. The WA State rate for 2016 was 4.7%. The
2015 exemption rate for Jefferson County had been the lowest recorded in the past 15 years. This is an issue that the CHIP work will continue to
address.
JCPH staff provide information to schools about the DOH website for reporting school data, and remind schools about the reporting deadline. Eleven
out of 14 schools reported in the fall of 2012, 13 out of 14 reported in 2013, and all 14 reported in 2014, 2015, and 2016.
JCPH staff work with student groups that are traveling internationally to improve routine immunization coverage and offer additional travel related
vaccines. Our goal is to protect the students and also protect the community from the importation of vaccine preventable diseases.
The Jefferson Healthcare clinics started stocking more private supply adult vaccines for their patients in 2014. In the past, adults were referred to
JCPH for most vaccines. This shift may have an ongoing effect on the number of adult doses administered by JCPH.
STD Prevention
The JCPH Family Planning and STD clinic follows the CDC screening recommendations for high risk age groups. The percent of female FP clients
under age 25 screened for chlamydia increased to 74.2% in 2016, from 60.3% in 2015 and 63.4% in 2014 (Ahlers data). The 2015 WA State
screening chlamydia rate for women in this age group covered by Medicaid was 51%, and was 39% for those with commercial health insurance (WA
Health Alliance data). The 2015 national screening rate for all providers was 49.8% (HEDIS data).
The number of chlamydia cases reported in 2016, at 56, remained similar to that in 2015, at 54. The past two years have seen a decrease in the
number of cases reported, with 76 cases in 2014 and 78 cases in 2013. In the previous 5 years, 48-58 cases were reported per year. Fifty two percent
of 2016 cases were diagnosed through the JCPH clinic, 30% were diagnosed through Jefferson Healthcare clinics, and 18% were diagnosed at other
clinics, mostly out of county. The number of reported cases reflects both the disease incidence and the testing rates for all providers. JCPH STD
Program staff assure that exposed partners are treated, both for cases diagnosed at the JCPH clinic, and those diagnosed at other provider clinics.
Jefferson County Public Health –Performance Measures Report 2016
Community Health – Communicable Disease Program
[8]
The number of reported gonorrhea cases has not decreased to the pre-2014 baseline, after an outbreak in 2014 resulted in 21 cases. There were 9
cases reported in 2015 and 11 cases in 2016. In the previous 5 years, 1-3 cases were reported per year. JCPH staff continue outreach and testing for
both chlamydia and gonorrhea.
HIV Prevention
The syringe exchange program (SEP) success is not easily measured in disease prevention numbers but the number of clients seen and syringes
exchanged reflects the disease transmission prevention capacity of this program. SEP utilization increased in 2016, with 242 visits, up from 238 visits
in 2015. The number of syringes dispensed was 47,790, up from 35,328 in 2015 and 42,809 in 2014. Twenty eight new clients visited the SEP in
2016. New clients are coming to SEP rather than relying on other exchangers to supply them with syringes through secondary exchange. This allows
SEP staff to offer disease prevention services and referrals to more individuals. Continued education in safer practices during each SEP visit is
important for continuing the disease prevention mission of this program. See the 2016 Annual SEP Report for details and more in depth discussion.
The number of free HIV tests sent to the State Public Health Lab has decreased as more clients have been enrolled in health insurance. The number
of tests sent to Quest, a commercial lab, has increased. The total number of HIV tests increased from to 152, from 125 in 2015 and 140 in 2014.
HIV case management services are provided by a regional staff person for Jefferson, Kitsap, and Clallam Counties. In 2016 JCPH arranged for this
case manager to use one of our clinic rooms for client visits, to facilitate wrap-around services. The case manager is at JCPH two times per month.
Public Health Emergency Preparation and Response
Staff participated in Region 2 Healthcare Preparedness meetings, local Healthcare Coalition meetings, the Jefferson Healthcare Emergency
Operations Committee meetings, JPREP and DEM meetings, and worked with neighborhood preparedness groups. Staff helped plan and participated
in the three day statewide Cascadia Rising exercise. Staff attend the quarterly Jefferson Healthcare Infection Control meetings.
The Regional Duty Officer 24/7 contact system for Public Health was replaced in November 2014 with an answering service serving the 3 counties
in the Region. The JCPH main number phone message gives an after-hours option to be connected to the answering service. The answering service
calls the JCPH manager on call, who then calls the subject matter expert for the issue prompting the call. This system has been working well for the
most part. When issues are identified, Kitsap County is the lead county working with the answering service to improve the service.
7/6/2017