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Jefferson County Public Health – Performance Measures 2010 - Report
COMMUNICABLE DISEASE
PROGRAMS: Tuberculosis, Communicable Disease, Immunizations, Travelers Immunizations, Sexually
Transmitted Disease, HIV, Syringe Exchange Program.
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, Region 2 Emergency
Management partners and other agencies while working toward this purpose.
GOALS FOR 2010:
1. Maintain the low rates of active TB in Jefferson County. (TB)
2. Timely investigation of reportable conditions. (CD)
3. Medical providers will be informed about current communicable disease trends and new
communicable disease control recommendations. (CD)
4. Support universal access to vaccines for all children. (Imm)
5. Continue to support immunization registry in Jefferson County, promoting use by all immunization
providers. (Imm)
6. Assess childhood immunization rates for children served by Primary Care Clinics receiving State
supplied vaccines. (Imm)
7. The Family Planning and STD clinics will assist in controlling Chlamydia transmission in Jefferson
County. (STD)
8. Federally funded HIV testing and counseling clinic resources are focused on persons at risk for HIV
infection. (HIV)
9. Prevent the spread of blood borne communicable diseases among injecting drug users and their
partners. (SEP)
10. Annual report to BOH for CD, TB, Immunization Programs. (CD, TB, STD, Imm)
11. Maintain and enhance Public Health Emergency Preparedness and Response (PHEPR) capacity.
OBJECTIVES (INTERVENTIONS) FOR 2010:
1. Encourage appropriate screening and treatment for latent TB infection. (TB)
2. Develop & update protocols as needed for investigation of notifiable conditions using electronic
reporting systems, Public Health Issue Management System (PHIMS), PHIMS-STD, and Public
Health Reporting of Electronic Data (PHRED). (CD, STD)
3. Provide updates, outreach and training to providers about local, state and national communicable
disease outbreaks and disease control recommendations. Provide reminders about reporting notifiable
conditions and using the Regional Duty Officer for after hours contact. (CD)
4. Maintain an efficient system for supplying vaccine recommendations and up-dates to private Health
Care Providers in Jefferson County, including training for ordering vaccines through the Vaccine
Ordering Module (VOM) in the Child Profile system. (Imm)
5. Continue to provide private Health Care Providers support and education on the Child Profile
Immunization Registry. (Imm)
6. Perform an assessment of childhood immunization rates for 25% of clinics receiving State supplied
vaccines and Vaccines for Childern Program QA assessments in clinics, as required by DOH. (Imm)
7. Women seen in Family Planning clinic who are at higher risk for Chlamydia (age 24 and under) will
be screened for Chlamydia annually. (STD)
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8. 80% of clients who receive HIV testing through the Washington State Public Health Lab will be high
risk. (HIV)
9. Promote utilization of syringe exchange program services. (SEP)
10. Develop and update regional Public Health Emergency Preparedness and Response Plan, coordinating
with Region II partners Clallam and Kitsap Health Departments, local emergency response agencies,
Jefferson Healthcare, local health care providers and agencies. (PHEPR)
PERFORMANCE INDICATORS
2008
Actual
2009
Actual
2010
Planned
2010
Actual
(TB) Number of clients started on preventive therapy for
latent TB infection
3 1
3 2
(CD) Number of communicable disease reports confirmed,
interventions applied and processed for reporting to the
State
164 123 90 132
(CD) Number of alerts/updates/newsletters faxed or mailed
to providers about communicable disease outbreaks or
other urgent public health information
13 24 10 13
(Imm) Number of doses of publicly funded vaccine,
administered by private health care providers and Public
Health clinics, supplied and monitored through Public
Heath’s immunization program
5,167 6,100
Not
including
H1N1
4,000 5,389
Not
including
H1N1
(Imm)Number of visits to clinics to provide vaccine
education, updates and technical support for clinic staff
6 13 6 8
(Imm)Number of providers trained in VOM, vaccine
ordering and receiving module through Child Profile
New for
2009
Module
remains in
development
4 Module
remains in
development
(Imm) Number of providers participating in the statewide
Child Profile Immunization Registry
6 5 6 5
(Imm) Number of Jefferson County children <6 with 1 or
more immunizations in Child Profile system
88% 90% 88% 91%
(Imm) Number of Jefferson County children <6 with 2 or
more immunizations in Child Profile system
82% 86% 82% 87%
(Imm) Number of clinic site visits, to assess childhood
immunization rates in clinic patients and/or do VFC
Program Quality Assessment
1 1
2
2
(STD) Assess total # and % of female FP clinic clients at
risk for Chlamydia (age 24 and under) screened for
Chlamydia, includes exam visits and non-exam visits.
New for
2010.
New for
2010.
Assess
baseline. 379
49.9%
(HIV) Number of persons counseled and tested for HIV
infection
DOH Lab:73
Quest Lab:52
Total: 125
DOH Lab:31
Quest Lab:64
Total: 95
90 DOH Lab:38
Quest Lab:69
Total: 107
(HIV) Percent of persons tested for HIV infection through
the Public Health Lab that were in high-risk category
90% 95% 80% 95%
(SEP) Number of visits to SEP 70 65 50 81
(SEP) Number of syringes exchanged 21,330 14,044 15,000 9,156
(PHEPR) Develop and update Public Health Emergency
Preparedness and Response Plan
1 1 1 1
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SUMMARY OF KEY FUNDING/SERVICE ISSUES (from Plan written 7/2009 for 2010 budget):
JCPH CD programs address locally identified and defined local public health problems. Communicable
disease prevention is a locally funded program, county milage was returned from the state to counties for TB
control. Immunization funds from the state have been primarily in the form of vaccine, this vaccine is
provided to primary care clinics that care for children. County funding provides a professional staff that
prevent, identify and respond to disease outbreaks and immunization staff that work with the hospital, health
care providers, the schools and local groups sponsoring trips abroad for students. Immunization staff provides
routine immunization clinics and international travelers clinics. Substantial staff time is spent on responding
to public requests for information about communicable diseases and screening for reportable illnesses in the
process. The CD team continues to work on strengthening the notifiable conditions reporting system through
outreach to the Jefferson Healthcare lab, ER and local health care providers.
Increased funding was received in 2008 and 2009 from the Washington State Department of Health (DOH),
specifically for Communicable Disease surveillance and improving immunization uptake in children. Future
funding will depend on State Legislative decisions. (See 2010 analysis).
In May 2010 the Washington State Universal Vaccines for Children (VFC) Distribution system will change to
one in which children with private insurance will not qualify for State supplied vaccine. This will require
clinics to stock a privately purchased supply of all pediatric vaccines, and screening each child to determine
which vaccine type is appropriate for them. This will affect JCPH, Jefferson Healthcare and the five clinics
currently administering State supplied vaccines. JCPH Immunization Program staff will continue the training
that began in 2009 on screening every child for VFC eligibility and ordering and tracking separate inventories
of VFC vaccine and privately purchased vaccine and reporting doses of VFC vaccine administered. (See 2010
analysis).
The Family Planning and STD clinics follow the Center for Disease Control's STD screening
recommendations for the high risk age groups. The Family Planning and CD program staff will continue to
explore ways to assure appropriate screening and screening data collection.
HIV services are funded from the state and federal government to provide basic communicable disease
prevention, HIV testing and counseling of high-risk community members, partner notification and focused
high-risk interventions. The syringe exchange program success is not easily measured in disease numbers but
the number of clients seen and syringes exchanged reflects the disease transmission prevention capacity of
this program.
The world wide spread of the novel H1N1 Influenza strain will require increased influenza season response
capacity during the 2009/2010 flu season. This is predicted to involve immunization clinics for target groups
(not yet specified) to deliver two doses of the vaccine that is currently being developed. This will require
coordination with our community partners including Jefferson Healthcare, clinics and the schools. The
influenza season will likely require outbreak control using community mitigation strategies discussed in our
Pandemic Influenza Plan. This will include increased community education efforts with many stake holder
groups. The Notifiable Conditions reporting work load will be increased through out the flu season. We
expect a small amount of funding to assist with this work, but not enough to cover the cost of staff time
required for this response. We may need to reassign staff from other JCPH programs to assist with outbreak
response, in which case the services for which they would normally be able to bill will be suspended and
these funds will not be coming in.
Federal funding originally for developing capacity to respond to bioterrorism threats is now for all hazards
emergency response. Response capacity is developed in coordination with Region 2 PHEPR partners Kitsap
and Clallam Counties, our local emergency response agencies, Jefferson Healthcare and other health care
providers. For 2010 projects involve participating in drills to test and update the appendices and procedures
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that go with the local Public Health Emergency Preparedness and Response Plan, including the Strategic
National Stockpile plan and the Pandemic Flu plan. Public Health staff have been trained in and use National
Incident Management System protocols during communicable disease outbreaks. The roles, responsibilities
and training have been invaluable for managing communicable disease outbreaks.
JCPH participates in the Regional Duty Officer 24/7 contact system for Public Health with Kitsap and
Clallam Counties’ staff, responding to after hours calls and triaging them to the appropriate Public Health
professional if necessary. This allows JCPH to share call time and standardizes regional response to Public
Health issues. Federal funding for emergency preparedness activities decreased in 2009 and is expected to
decrease more in 2010.
Decreased funding for any program would result in scaling back on services. The Board of Health would be
involved in deciding which services would be impacted.
2010 STUDY/ANALYSIS OF RESULTS:
Communicable Disease
The Communicable Disease team shares health alerts and important updates with Jefferson Healthcare and
the medical providers by fax and email. A new fax system for collecting notifiable conditions reporting
information from providers was initiated in the fall of 2009 to assist in timely reporting from the providers.
This system worked well in 2010, decreasing the time required for CD team nurses in obtaining information
needed for investigation of reportable diseases.
Increased funding was received in 2008 and 2009 from the Washington State Department of Health (DOH),
specifically for Communicable Disease surveillance and improving immunization uptake in children.
This funding was decreasing by $20,000 in 2010. A report on these performance measures is sent to DOH.
Immunizations
The expected May 2010 change in the Washington State Universal Vaccines for Children (VFC) Distribution
system to one in which children covered by private insurance do not qualify for State supplied vaccine was
averted by the development of a new system by a coalition of health care providers, health insurance
providers and the Washington State Department of Health. The Washington Vaccine Association (VAC) was
created allow the State supplied vaccine program to continue while having the insurance companies pay the
State back for vaccines administered to their members. The transition to the WVA documentation and billing
requirements was a challenge. All Jefferson County pediatric vaccine providers have a billing program that
does not allow the generation of the WVA required Dosage Based Assessment form, so additional paperwork
has been necessary. However, the fact that the clinics do not need to order and stock private supply vaccine in
addition to State supplied vaccine has ensured that vaccines continue to be available for all children.
The number of doses of publicly funded vaccine administered to children in Jefferson County has increased
each year, from 3,748 doses in 2005 to 6,100 doses in 2009. Doses administered in 2010 decreased by 711
doses to 5,389. In the past this increase was primarily due to new vaccines being added to the schedule and
new school immunization requirements. There were no new vaccines added to the schedule or school
requirements in 2009 or 2010 and the number of babies born each year in Jefferson County has been stable
for many years. 2008 and 2009 were years in which young children and adolescents were catching up with
previous new vaccine recommendations, especially Rotateq (rotavirus) for the infants, Varicella for
Kindergarten, HPV and MCV4 (meningococcal) for the adolescents, and Hepatitis A for all ages. Seasonal
influenza vaccine doses administered in 2009 were up by 306 doses over 2008. Immunizing children against
H1N1 influenza gave providers an increased opportunity to administer seasonal influenza vaccine. By 2010
many children had received the new vaccines available for their age cohort so the number of doses
administered in 2010 decreased. This does not fully apply to influenza vaccine though, which is
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recommended every year. In 2010, 115 fewer doses of influenza vaccine were administered. However, for
those under age 9, two doses are needed in the first year, so there may have been a catch-up related surge if
more young children were getting the influenza vaccine for the first time in 2009.
While the Human Papillomavirus Vaccine (HPV) is available to all adolescents age 11-18 through the State
supplied vaccine program, this vaccine is also recommended for women through age 26. The private supply
HPV vaccine an expensive vaccine, the JCPH fee is $139/dose and three doses are needed. Many of the
young adult women in Jefferson County are in the low income bracket and are not covered by health care
insurance. In the last half of 2009 JCPH immunization clinic staff worked with the Merck vaccine company's
Patient Assistance Program to set up procedures to be able to obtain free HPV vaccine for low income
uninsured women. Individual applications are required for each woman. Twenty three doses were
administered through this program in the last half of 2009, 62 doses were administered in 2010.
The JCPH Immunization Program staff provides technical assistance to the clinics, immunization updates,
vaccine refrigeration incident follow-up, training of new vaccine coordinators in the clinics, assessment of
immunization rates for clinic patients and vaccine program quality assurance assessment. The visit numbers
do not reflect the daily work with the clinics. Many contacts are by phone and information is faxed or mailed
to clinics.
Family Planning
The Family Planning and STD clinics follow the Center for Disease Control's STD screening
recommendations for the high risk age groups. In 2010 in response to CDC and Washington State DOH
Infertility Prevention Project (IPP) Chlamydia (CT) screening guidelines, JCPH decided to assess the CT
screening rate for women age 24 and under in our Family Planning (FP) Clinic. This process included
exploring ways to assure appropriate screening and screening data collection. The report for this project was
included in the BOH meeting packet in February 2011.
HIV Prevention
Clients tested for HIV are screened for risk factors and the State Public Health Lab is used for those in the
high risk category. This allows high risk clients with no medical coverage and low income to be tested.
Others are tested through the Quest lab and the cost of the testing is billed to the client.
The number of client visits to the Syringe Exchange Program increased to 81 in 2010 after remaining fairly
stable, between 65 and 70 over the previous three years. The number of syringes exchanged decreased from
14,044 in 2009 to 9,156 in 2010. Thirteen new clients visited the SEP in 2010. There were 12 new clients in
2009, 6 in 2008 and 9 in 2007. The 13 new clients seen in 2010 have tended to exchange fewer syringes, even
though some report syringe reuse and secondary exchange. New clients often fear being found with larger
supplies of syringes. Continued education in safer practices during each SEP visit is important for continuing
the disease transmission prevention mission of this program. The number of visits in which clients reported
exchanging for other people as well as themselves (secondary exchange) increased in 2010 after decreasing in
2009. A separate annual SEP report is sent to DOH. JCPH will be submitting a competitive application to
DOH, in the spring of 2011, for continuing funding for the SEP Program after July 2011. SEP program
funding from the State for the first 6 months of 2011 was decreased by 27%.
Influenza
The H1N1 influenza outbreak in the spring of 2009 and returning in the fall and continuing through early
2010 required the implementation of our Pandemic Flu Plan for community education, and coordination and
communication with our partners. A detailed discussion of these activities was included in the 2009
Performances Measures Report. These activities continued during the first quarter of 2010. A separate report
on PHEPR activities is submitted to DOH. An After Action Report on the H1N1 response was completed in
April 2010.
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