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Jefferson County Public Health – Performance Measures Report 2011
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 2011:
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. Maintain access to federally funded HIV testing and counseling for persons at high risk for HIV
infection who have no medical insurance. (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 2011:
1. Encourage appropriate screening and treatment for latent TB infection. (TB)
2. Develop & update forms and protocols as needed for investigation of notifiable conditions using
DOH electronic reporting systems PHIMS, PHIMS-STD, and 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 vaccine quality assurance and childhood immunization rate assessment for 25% of
clinics receiving State supplied vaccines, 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)
8. Clients at high risk for HIV and without medical insurance will be tested through the Washington
State Public Health Lab, others requesting testing will be tested through the Quest Lab and
charged for testing. (HIV)
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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
2009
Actual
2010
Actual
2011
Planned
2011
Actual
(TB) Number of clients started on preventive therapy for
latent TB infection
1
2
2 3
(CD) Number of communicable disease reports
confirmed, interventions applied and processed for
reporting to the State
123 132 110 117
(CD) Number of alerts/updates/newsletters faxed or
mailed to providers about communicable disease
outbreaks or other urgent public health information
24 +
Weekly
DOH
Influenza
Updates
13 +
Weekly
DOH
Influenza
Updates
10 13 +
Weekly
DOH
Influenza
Updates
(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
6,100
Not
including
H1N1
5,389
Not
including
H1N1
5,000 5,574
(Imm)Number of visits to clinics to provide vaccine
education, updates and technical support for clinic staff
13 8 8 19
(Imm)Number of providers trained in vaccine
ordering and receiving module (VOM), through Child
Profile Immunization Registry
Module
remains in
development
Module
remains in
development
5 If module
not
completed
in 2010
5
(Imm) Number of providers participating in the statewide
Child Profile Immunization Registry
5 5 5 5
(Imm) Number of Jefferson County children <6 with 1 or
more immunizations in Child Profile system
90% 91% 91% 92%
(Imm) Number of Jefferson County children <6 with 2 or
more immunizations in Child Profile system
86% 87% 87% 89%
(Imm) Number of clinic site visits, to assess childhood
immunization rates in clinic patients and/or do VFC
Program Quality Assessment
1
2
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. 339
49.9%
300
50%
388
62.2%
(HIV) Number of persons counseled and tested for HIV
infection
DOH Lab:31
Quest Lab:64
Total: 95
DOH Lab:38
Quest Lab:69
Total: 107
90 DOH Lab:19
Quest Lab:63
Total: 82
(HIV) Percent of persons tested for HIV infection through
the Public Health Lab that were in high-risk category
95% 95% 90% 95%
(SEP) Number of visits to SEP 65 81 80 142
(SEP) Number of syringes exchanged 14,044 9,156 10,000 17,726
(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 (updated from Plan written 7/2010 for 2011
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
also 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 for 2008-2009, from the Washington State Department of Health (DOH),
specifically for Communicable Disease surveillance and improving immunization uptake in children.
A separate report on these performance measures is sent to DOH. This funding for 2010-2011 has been
reduced by 20%.
The number of doses of publicly funded vaccine administered to children in Jefferson County has been
increasing every year. This analysis is covered in the next section.
The Jefferson Healthcare hospital/clinics’ electronic medical records (EMR) system does not allow the
downloading of data into the statewide Child Profile Immunization Registry. All clinics receiving State
supplied vaccines are now participating in Child Profile even though this requires double entry of
immunization data by clinic staff. The Immunization team is training the school secretaries to access
Child Profile in order to get complete immunization records for those students that do not have a
complete Certificate of Immunization Status on file for the immunizations required for school
attendance.
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 by the state and federal government to provide basic communicable disease
prevention, testing and counseling to high-risk community members, and focused high-risk interventions
such as the Syringe Exchange Program. HIV case management services are provided by Clallam County
Health Department. The 2011 HIV prevention funding, $9,766, was a 50% reduction from the 2009
funding level of $19,702. 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 requesting this are tested through the Quest lab and the cost of the
testing is billed to the client.
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. Details are covered in the next section.
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. Public Health staff have been trained in and use National Incident
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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.
Decreased funding for any program would result in scaling back on services. The Board of Health would
decide which services would be impacted.
2011 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. The fax system for collecting notifiable conditions reporting
information from providers, initiated in the fall of 2009, continued to assist in timely reporting from the
providers in 2011. One reporting form was revised and a new form was created, to assist with chronic
Hepatitis C and Hepatitis B reporting.
The $20,000 decrease in State funding for the Communicable Disease and Immunization programs in
2010 was continued unchanged for 2011. This funding was saved during a dramatic State Legislative
session in which additional deep cuts to this funding had been proposed. This funding supports staff
positions in these programs.
Immunizations
2011 was the first full year of operation for the Washington Vaccine Association (VAC). This coalition
of health care providers, health insurance providers and the Washington State Department of Health was
created to allow the universal State supplied vaccine program to continue by having the insurance
companies pay the State back for vaccines administered to their members. The mid 2010 transition to the
WVA documentation and billing requirements was a challenge for the Jefferson County pediatric vaccine
providers. The system is worked smoothly in 2011 and has ensured that State supplied vaccine vaccines
continues to be available for all children.
In late 2010 and early 2011 the Immunization program received training from DOH on the new CDC
mandated vaccine ordering program, Economic Order Quantity (EOQ). This program was added to the
new Vaccine Ordering Module in the online Child Profile Immunization Registry. JCPH staff trained the
provider clinics in the first quarter of 2011. The system became operational in Jefferson County in April
2011. The EOQ program projects the suggested quantity to order for each vaccine, according to the
clinic's inventory and historical usage of the vaccine. EOQ also limits the frequency of ordering allowed
for each clinic. This required training for each clinic, to be able to plan inventory levels and order
quantities so that an order every 2 months, or quarterly for the smaller clinics, would be adequate. JCPH
Immunization Program staff must approve each clinic vaccine order.
The number of doses of publicly funded vaccine administered to children in Jefferson County increased
by 185 in 2011 to 5,574 doses. Pediatric vaccine doses administered had been increasing every year,
from 3,822 doses in 2006 to 6,100 doses in 2009 and then decreased in 2010 by 711 doses to 5,389. The
increases have been primarily due to new vaccines being added to the immunization schedule and new
school immunization requirements. A catch-up period for new vaccines spills over into the following
years, as was seen in 2008-2009. No new vaccines were added to the schedule or school requirements in
2009 - 2011. Seasonal influenza vaccine doses administered in 2011 were up by 123 doses over 2010.
The majority of all vaccine types had an increase in doses administered in 2011.
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The new school immunization exemption law took effect in July, 2011. This requires parents wishing to
exempt their children from the required school immunizations to get risk/benefit information from a
medical provider, who must sign the exemption form. JCPH staff sent information packets to the
provider clinics and the schools to assist with this education. JCPH staff had discussions with DOH about
ways to improve the completeness of the school exemption data reported to DOH by the schools, so that
trends may be more accurately monitored.
While the Human Papillomavirus Vaccine (HPV) is available to all adolescents age 11-18 through the
State supplied vaccine program, this vaccine is recommended for women through age 26. The JCPH fee
for private supply HPV vaccine is $145/dose. Three doses are needed. Many young adult women in
Jefferson County are in the low income bracket with no health care insurance. In the last half of 2009
JCPH staff worked with the Merck vaccine company's Patient Assistance Program 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 in 2010 and 22 in 2011.
The Washington State Department of Health and CDC have supplied a limited number of doses of free
Hepatitis A/B vaccine, Twinrix, for high risk clients since mid 2008. Nine doses of this vaccine were
administered in 2008, 73 in 2009, 36 in 2010, and 11 in 2011.
Since mid 2011, JCPH has offered the free "GIFT" (Give Immunity Fight Transmission) Tdap vaccine
for low income uninsured clients who have contact with infants under 1 year of age. This program aims
to protect infants from pertussis exposure. It is sponsored by the vaccine company Sanofi and the
humanitarian organization AmeriCares. Fourteen doses of vaccine were administered in the last half of
2011. The provider clinics have been referring family members of pregnant women to JCPH for this
program. Additional clients have been identified through our WIC program.
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 clinic 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 the Washington State
DOH Infertility Prevention Project Chlamydia (CT) screening guidelines, JCPH decided to assess the CT
screening rate for women age 24 and under in our Family Planning Clinic. This process included
exploring ways to assure appropriate screening and screening data collection. The first report for this
project was included in the BOH meeting packet in February 2011. This assessment project continued for
2011, with feedback provided to the Family Planning program. The 2011 final report is in process. The
percent of female Family Planning clients who were screened for CT increased from 49.9% in 2010 to
62.2% in 2011.
HIV Prevention
The number of client visits to the Syringe Exchange Program increased to 142 in 2011 and the number of
syringes exchanged increased to 17,726. Nineteen new clients visited the SEP in 2011. There were 13
new clients in 2010, and 12 in 2009. 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 2011. A separate annual SEP report is sent to DOH.
SEP program funding from the State for the first 6 months of 2011 was decreased by 27%. In May 2011
JCPH submitted a successful RFP application to DOH for continued funding of the Syringe Exchange
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Program (SEP), receiving $10,000 for 12 months, similar to the 2011 funding. This funding was later
removed as a part of the DOH budget cuts.
Public Health Emergency Preparation and Response
The January 2011 emergency response drill allowed JCPH to test the Region 2 Public Health Emergency
Preparedness and Response Plan with local and regional partners, the State Department of Health and the
State Department of Emergency Management.
5/11/2012