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Jefferson County Public Health – Planned Performance Measures 2012
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
(DOH), Region 2 Emergency Management partners and other agencies while working toward this
purpose.
GOALS FOR 2012:
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. Promote more extensive use of all Child Profile Immunization Registry functions by the
provider clinics.
6. Assess childhood immunization rates for children served by private health care provider 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, SEP, Immunization Programs.
11. Maintain and enhance Public Health Emergency Preparedness and Response (PHEPR)
capacity.
OBJECTIVES (INTERVENTIONS) FOR 2012:
1. Encourage appropriate screening and treatment for latent TB infection. (TB)
2. Develop & update 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, up-dates and information
on changes in the State vaccine program to provider clinics in Jefferson County.
5. Continue to provide training and support to provider clinics for ordering vaccines using the
Economic Ordering Quantity (EOQ) system to place orders through Child Profile. (Imm)
6. Provide training and support to provider clinics for use of all Child Profile vaccine related
functions to more accurately and efficiently track vaccine supply, administration and client
records. (Imm)
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7. Perform vaccine quality assurance and childhood immunization rate assessment for 50% of
clinics receiving State supplied vaccines, as required by DOH. (Imm)
8. Assess Jefferson County childhood immunization rate using the new Child Profile County
View Reports. (Imm)
9. Women seen in Family Planning clinic who are at higher risk for Chlamydia (age 24 and under)
will be screened for Chlamydia annually. (STD)
10. 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)
11. Promote utilization of syringe exchange program services. (SEP)
12. 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)
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PERFORMANCE INDICATORS
2010
Actual
2011
Planned
2012
Planned
(TB) Number of clients tested for TB infection with PPD or
QFT test
( 244 ) New for
2012
New for
2012
(TB) Number of positive PPD and QFT TB tests evaluated (+ PPD: 8)
(+QFT: 2)
(-QFT: 4)
New for
2012 New for
2012
(TB) Number of clients started on preventive treatment for
latent TB infection
2 2 2
(CD) Total number of communicable disease reports
confirmed, interventions applied and processed for reporting to
the State
132 110 110
(CD) Number of Cryptosporidiosis cases reported to the State 8 8 8
(CD) Number of Giardiasis cases reported to the State 9 8 8
(CD) Number of STD cases reported to the State 71 65 65
(CD) Number of alerts/updates/newsletters faxed or mailed to
providers about communicable disease outbreaks or other
urgent public health information
13 10 10
(Imm) Total 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
5,389
Not
including
H1N1
5,200 5,200
(Imm) Number of doses of publicly funded vaccine (pediatric)
administered by private health care providers
4741 4600 4600
(Imm) Number of doses of publicly funded vaccine (pediatric)
administered by Public Health
648 600 600
(Imm) Number of adult vaccinations administered by Public
Health
1037 1030 1030
(Imm)Number of visits to clinics to provide vaccine education,
updates and technical support for clinic staff
8 6 8
(Imm)Number of providers using EOQ to place appropriate
vaccine orders through Child Profile
New for
2012
New for
2012 5
(Imm) Number of providers using Child Profile to track
monthly vaccine inventory
New for
2012
New for
2012 5
(Imm) Number of providers using Child Profile to track
monthly vaccine doses administered
New for
2012
New for
2012 5
(Imm) Number of Jefferson County children <6 with 2 or more
immunizations in Child Profile system
87% 86% 88%
(Imm) Number of clinic site visits, to assess childhood
immunization rates in clinic patients and/or do VFC Program
Quality Assessment
2 2
2
(Imm) Jefferson County childhood immunization rate, using
Child Profile County View Report
New for
2012
New for
2012
Assess
baseline,
& report
options
(STD) Assess total # and % of female FP clinic clients at risk
for Chlamydia (age 24 and under) screened for Chlamydia.
379
49%
280
50%
350
50%
(HIV) Number of persons counseled and tested for HIV
infection
DOH Lab:38
Quest Lab:69
Total: 107
90 100
(SEP) Number of visits to SEP 81 60 80
(SEP) Number of syringes exchanged 9,156 10,000 10,000
(PHEPR) Develop and update Public Health Emergency
Preparedness and Response Plan
1 1 1
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SUMMARY OF KEY FUNDING/SERVICE ISSUES:
Communicable Disease/Immunizations
JCPH CD programs address locally identified and defined public health problems. Communicable
disease prevention is primarily a locally funded program, county milage was returned from the state to
counties for TB control. Immunization funds from the state are 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 provide 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, Infection Control Committee 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. This funding was reduced by 20% for 2010-2011 and has been reduced by another 30% for
2012. A report on these performance measures is sent to DOH.
The Jefferson County rates for Cryptosporidiosis and Giardiasis, both waterborne diseases, are
frequently above the State average. We have been following these, looking for any trends, and have
added these to our PM indicator table this year.
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 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 can spill over into the following year, as was seen in 2008-2009. A new meningococcal
vaccine for infants may be added to the schedule in the upcoming year. The number of infants seen in
the JCPH immunization clinic has been decreasing over the past several years as more infants are seen
for immunizations by their primary care providers in their medical homes. The number of adults seen
in the JCPH clinic has been increasing. The Immunization team will continue to monitor vaccine usage
across the County. The new ability to run the new County View reports in Child Profile will provide
more information on county wide immunization rates.
The new Washington State law requiring most parents seeking exemption from school vaccine
requirements to have a discussion with their health care provider about the benefits and risks of
immunizations and with-holding immunizations may have an effect on our vaccine dose numbers. This
law is especially designed to reduce “convenience exemptions”. The Immunization team consults with
the school secretaries to assist them in using Child Profile to get immunization records for those
students who do not have a complete Certificate of Immunization Status on file. The immunization
team participates in the annual school secretary orientation discussing updates in school immunization
requirements.
The JCPH Immunization Program staff provide technical assistance to the clinics, immunization
updates, vaccine refrigeration incident follow-up, training of new vaccine coordinators in the clinics,
and clinic immunization program quality 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.
All clinics receiving State supplied vaccines participate in the statewide Child Profile Immunization
Registry. New Child Profile functions allow direct electronic vaccine ordering, receiving and inventory
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tracking, and monthly doses administered reporting. These functions will more accurately and
efficiently track vaccine supply, administration and client records.
STD
The Family Planning and STD clinics follow the Center for Disease Control's STD testing
recommendations for the high risk age groups. The Family Planning and CD program staff will
continue to monitor and explore ways to assure appropriate testing and testing data collection.
HIV Prevention
HIV services are funded by the state and federal government. HIV case management services are
provided by Clallam County Health Department. The new CDC guidelines focus on funding HIV
Prevention Programs for high risk populations based on HIV prevalence in the local area. Jefferson
County is classified as a low prevalence county. In May 2011 JCPH submitted a successful RFP for
continued funding of the Syringe Exchange Program (SEP), receiving $10,000 for 12 months, similar
to the 2011 funding. The 2011 HIV prevention funding, $9,766, was a 50% reduction from the 2009
funding level of $19,702. The 2012 HIV prevention funding does not include any funding for HIV
testing in low risk counties. The State Public Health Lab will continue to do a limited number of free
tests for high risk clients but there is no funding for staff time for counseling and testing services.
JCPH staff will however continue to provide free HIV testing services for low income high risk clients
with no medical coverage. Others requesting testing will be tested through the Quest lab and the cost of
the testing will be billed to the client.
The syringe exchange program 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. The number of client visits to the Syringe Exchange Program increased to 81 in 2010
after remaining stable over the past three years, while the number of syringes exchanged decreased in
2010. A mid-year projection for 2011 shows an expected increase in the number of syringes exchanged
in 2011. The number of new SEP clients increased in 2009 and 2010. This trend appears to be
continuing in 2011, with more clients coming to SEP rather than solely relying on other exchangers to
supply them with clean syringes through secondary exchange. This allows SEP staff to offer other
disease prevention services and referrals to more individual SEP clients. The number of visits in which
clients reported exchanging for other people as well as themselves (secondary exchange) decreased in
2009 and increased in 2010. This increase appears to be continuing in 2011.
Public Health Emergency Preparedness and Response (PHEPR)
Federal funding originally for developing bioterrorism response capacity now includes all hazards
emergency response. Response capacity is developed in coordination with Region 2 PHEPR partners
Kitsap and Clallam Counties, local emergency response agencies, Jefferson Healthcare and other
health care providers. 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 increased in
2010 due to funding for H1N1 influenza response. As of August 2011 PHEPR funds will be reduced
by at least 15% for the 2011-2012 Federal funding cycle.
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.
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