HomeMy WebLinkAboutCommunicable Disease (PDF)Jefferson County Public Health – Performance Measures Report 2014
Communicable Disease Program
PROGRAMS: Tuberculosis, Communicable Disease (CD), 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 Objectives Performance Indicators 2010
Actual
2011
Actual
2012
Actual
2013
Actual
2014
Planned
2014
Actual
Goal 1:
Maintain the low
rates of active
Tuberculosis (TB)
in Jefferson
County
Encourage appropriate
screening and treatment for
latent TB infection.
Number of clients tested for TB
infection with PPD or QFT test
244 201 198 165 200 149
Number of positive PPD and QFT TB
tests evaluated
+PPD: 8
+QFT: 2
-QFT: 4
+PPD: 2
+QFT: 2
-QFT: 1
+PPD: 0
+QFT: 0
-QFT: 0
+PPD: 3
+QFT: 0
-QFT: 0
+PPD: 2
+QFT: 0
-QFT: 1
2
Number of clients started on
preventive treatment for latent TB
infection
2 3 2 1 2 2
Goal 2:
Timely
investigation of
reportable
conditions.
Develop & update forms
and protocols as needed for
investigation of notifiable
conditions using DOH
electronic reporting
systems PHIMS, PHIMS-
STD, and PHRED.
Total number of communicable
disease reports confirmed,
interventions applied and processed
for reporting to the State
132 117 150 143 120 180
Number of Cryptosporidiosis cases
reported to the State 8 7 7 2 5 2
Number of Giardiasis cases reported
to the State 9 7 9 6 6 7
Number of STD cases reported to
the State 71 52 57 83 60 103
Goal 3:
Inform medical
providers about
current CD trends
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 Regional Duty
Officer.
Number of alerts, updates and
newsletters faxed or mailed to
providers (not including weekly DOH
Influenza Updates)
13 13 14 15 13 23
Jefferson County Public Health – Performance Measures Report 2014
Communicable Disease
Goals Objectives Performance Indicators 2010
Actual
2011
Actual
2012
Actual
2013
Actual
2014
Planned
2014
Actual
Goal 4:
Support universal
access to vaccines
for all children.
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
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
5,389
Not
including
H1N1
5,574 5,403 5,067 5400 4613
Number & % of doses of publicly
funded vaccine (pediatric)
administered by private health care
providers
4,741
88%
5,001
89.7%
4,855
89.9%
4,545
89.7% 4800 3967
86%
Number & % of doses of publicly
funded vaccine (pediatric)
administered by JCPH
648
12%
573
10.3%
548
10.1%
522
10.3% 540 646
14%
Number of adult vaccinations
administered by JCPH 1,037 944 1,057 819 1040 600
Number of visits to clinics to provide
vaccine education, updates and
technical support for clinic staff
8 19 20 24 15 34
Goal 5:
Promote more
extensive use of
Washington State
Immunization
Information
System (WAIIS)
functions by the
provider clinics.
Continue to provide training
and support to provider
clinics for ordering vaccines
using the Economic
Ordering Quantity (EOQ)
system to place orders
through WAIIS.
Number of providers using EOQ to
place on-line vaccine orders through
WAIIS
N/A N/A 5 5 5 5
Provide training and
support to provider clinics
for use of all WAIIS vaccine
management functions to
accurately and efficiently
track vaccine supply,
administration and client
records.
Number of providers using WAIIS to
track monthly vaccine inventory N/A N/A 2 4 5 5
Number of providers using WAIIS to
track monthly vaccine doses
administered
N/A N/A 2 4 5 5
Percent of Jefferson County children
< age 6 with two or more
immunizations in WAIIS system
87%
WA = 88%
89%
WA = 89%
87%
WA = 89%
88%
WA = 89% 89% 89%
WA = 90%
2
Jefferson County Public Health – Performance Measures Report 2014
Communicable Disease
Goals Objectives Performance Indicators 2010
Actual
2011
Actual
2012
Actual
2013
Actual
2014
Planned
2014
Actual
Goal 6:
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 registry and some
providers in WA don’t enter
immunizations into the
registry).
Completeness of full immunization
series for children seeing Jefferson
County providers, at age 19-35
months:
4 DTaP, 3 Hep-B, 3 HIB, 1 MMR, 4 PCV,
3 Polio, 1 Var.
(Report generated by JCPH, includes
only immunizations administered by
providers in Jefferson County).
3%
29%
54%
53%
54%
56%
4 DTaP, 3 Hep-B, 3 HIB, 1 MMR,
3 Polio.
(PCV and VAR not included, DOH uses
this report along with full series report.
Report generated by DOH, includes
immunizations administered by out of
county providers).
53%
State = 52%
53%
State = 52%
57%
State = 57%
56%
State = 58%
57%
61%
State = 61%
Goal 7:
Assure quality of
immunization
services in clinics
providing State
supplied vaccines.
Perform vaccine quality
assurance visits for 50% of
clinics and childhood
immunization rate
assessment for 25% of
clinics receiving State
supplied vaccines, as
required by DOH.
Number of clinics visited, to assess
childhood immunization rates and/or
do VFC Program Quality
Assessment
2 2 2
2
+ 1 visit by
DOH
Total
3 clinics
2
+ 1 visit by
DOH
Total
3 clinics
2
+ 1 visit by
DOH
Total
3 clinics
Goal 8:
Assist schools in
increasing student
compliance with
Washington State
immunization
requirements.
Provide training and
assistance for school
secretaries to access
WAIIS records for students
who are out of compliance
with State immunization
requirements so that the
school can notify parents of
missing immunizations.
2014: Number of schools that
received a training visit this year
2010-2013: Cumulative number of
schools with secretaries trained in
use of WAIIS
N/A N/A 6 7 9 4
3
Jefferson County Public Health – Performance Measures Report 2014
Communicable Disease
Goals Objectives Performance Indicators 2010
Actual
2011
Actual
2012
Actual
2013
Actual
2014
Planned
2014
Actual
Goal 9
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) will be
screened for Chlamydia
annually
Total # female FP clinic clients at
high risk for Chlamydia (age 24 and
under) screened for Chlamydia
379 388 301 368 340 320
% of female FP clinic clients at risk
for Chlamydia (age 24 and under)
screened for Chlamydia
49.0% 62.2% 56.5% 60.4% 60% 63.4%
Goal 10:
Maintain access to
federally funded
HIV testing and
counseling for high
risk persons with
no medical
insurance.
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.
Number of persons counseled and
tested for HIV infection
DOH
Lab:38
Quest
Lab:69
Total:
107
DOH
Lab:19
Quest
Lab:63
Total:
82
DOH
Lab:27
Quest
Lab:75
Total:
102
DOH
Lab:19
Quest
Lab:75
Total:
94
90
DOH
Lab:5
Quest
Lab:135
Total:
140
Goal 11:
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
81 142 150 185 140 350
Number of syringes exchanged 9,156 17,726 17,405 24,596 17,000 42,809
Goal 12:
Annual report to
BOH for CD, TB,
SEP, Immunization
Programs.
Complete Annual Report Pass/Fail PASS PASS PASS PASS PASS PASS
Goal 13
Maintain and
enhance Public
Health Emergency
Preparedness and
Response (PHEPR)
capacity.
Update regional PHEPR Plan,
coordinating with Region II
partners Clallam and Kitsap
Health Depts., local DEM,
Jefferson Healthcare, local
health care providers and
agencies.
Develop and update Public Health
Emergency Preparedness and
Response Plan
1 1 1 1 1 1
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SUMMARY OF KEY FUNDING/SERVICE ISSUES: (From plan written 8/27/13)
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 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. Staff respond to public requests for information about
communicable diseases and screen 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.
State funding for the JCPH Communicable Disease and Immunization programs was reduced by $21,000 for
2010-2011 and by another $22,000 for 2012 - 2013, continuing at this level for 2014. Funding supports staff
positions in these programs. Due to reduced funding, the CD/Immunization program decreased staffing hours in
2012 and 2013 by reassigning staff hours, funding shortfalls were met by using CD carryover funds. The
funding will shift in 2014 from the DOH Consolidated Contract to a State Treasurer’s Office block grant.
Jefferson County rates for Cryptosporidiosis and Giardiasis, both waterborne diseases, are frequently above the
State average. We are monitoring these, looking for trends, and added these to our PM indicator table in 2012.
The number of infants seen in the JCPH immunization clinic has been decreasing as more infants are seen for
immunizations by their primary care providers in their medical homes. This shift appears to have stabilized over
the past two years. The immunization team will continue to monitor vaccine usage across the County. The new
County View reports module in the Washington State Immunization Information System (WAIIS) will provide
more information on county wide immunization rates.
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.
All clinics receiving State supplied vaccines participate in the Washington Immunization Information System
(WAIIS) registry. New WAIIS functions allow direct electronic vaccine ordering, receiving, inventory tracking
and monthly doses administered reporting. JCPH will continue to provide training and technical assistance to all
clinics in the use of these functions. DOH requests clinics receiving vaccine for children use these modules.
The July 2011 State law requiring most parents wishing to exempt their children from the required school
immunizations to get risk/benefit information from a medical provider may have had an effect on the exemption
rates. It is difficult to make year to year comparisons on the exemption rates as Jefferson County has not had
100% of schools reporting, and the individual schools reporting each year has varied. JCPH will continue to
provide encouragement and information to all schools about the required State report.
The Immunization team will also continue to update the school secretaries’ training in using WAIIS to get
immunization records for 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.
STD
The Family Planning and STD clinics follow the CDC'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
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appropriate testing and testing data collection. The new EMR program, EMDs, will be assessed for the types of
data reports available.
HIV Prevention
HIV/AIDS case management services are provided by Clallam County Health Department for the two counties.
The CDC funding guidelines focus on HIV Prevention Programs for high risk populations, based on HIV
prevalence in the local area. Jefferson County is classified as a low prevalence county. Since 2012 HIV
prevention funding has not included funding for low risk counties. The State Public Health Lab continues 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 continue to provide free HIV testing services for low income high risk clients
with no medical coverage. Others requesting testing will be tested through Quest lab and billed for the cost of
testing. JCPH staff will continue to provide SEP services. For the past two years DOH has provided a one-time
bulk purchase of SEP supplies to supplement our program.
Public Health Emergency Preparedness and Response (PHEPR)
Federal funding includes developing response capacity for 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.
PHEPR funds were reduced by 15% for the 2011-2012 Federal funding cycle and will remain at that level for
2013-2014.
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.
2014 STUDY/ANALYSIS OF RESULTS:
Communicable Disease
There was an increase in gonorrhea cases in 2014, with 21 cases reported, up from 1-6 cases per year in the
previous 10 years. Nurses began offering gonorrhea/chlamydia testing to all clients coming in for syringe
exchange. SEP clients were asked to share flyers about the outbreak, and free testing, with their friends. If
repeated efforts to encourage partners of a case to come in for testing were not working, medication was
provided to the case to be given to the exposed partners. This treatment protocol is through a longstanding DOH
STD program called Expedited Partner Therapy, with medication provided by the State.
State funding for the JCPH Communicable Disease and Immunization programs was reduced by $21,000 for
2010-2011 and by another $22,000 for 2012 - 2013, continuing at this level for 2014. This funding supports
staff positions. The CD/Immunization program decreased staffing hours in 2012, 2013, and again in 2014.
Immunizations
The number of doses of publicly funded vaccine administered to children in Jefferson County was fairly stable
from 2010 – 2012 and decreased in 2013 and 2014 to 4,613 doses. The WAIIS doses administered report has
had issues with accuracy, so the accuracy of the reported number of State supplied pediatric doses administered
in 2014 is not assured. The percent of the pediatric vaccines that were administered at JCPH increased in 2014
while the percent administered in the Jefferson Healthcare clinics decreased. The value of vaccines supplied by
the State to Jefferson County in 2014 was $254,119.
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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 affect on the
number of adult doses administered by JCPH.
By the end of 2014 all clinics using State supplied vaccines were ordering and receiving vaccines, tracking
inventory, and reporting monthly doses administered through WAIIS, as requested by DOH. The Immunization
Program Coordinator provided the clinics training and technical assistance on these WAIIS modules throughout
the year. These modules, have had frequent technical glitches requiring trouble shooting and consultation with
the WAIIS staff.
One clinic discontinued offering State supplied vaccines in 2014; Jefferson Healthcare Walk-in and Internal
Medicine. Another clinic joined the Vaccines for Children program and is now offering State supplied vaccines;
Jefferson Healthcare Madrona Family Medicine. There are 5 Jefferson Healthcare clinics participating in this
vaccine program, in addition to JCPH.
A 11/7/13 CDC report on the percentage of children under age six having 2 or more doses of vaccine recorded
in a State Immunization Information System registry gives a national rate of 86% for 2012. The Jefferson
County rate was 87% in 2012, 88% in 2013, and 89% in 2014.
The CDC National Immunization Survey has been used for many years to track national and state immunization
rates. This is a telephone survey of parents and immunization records are validated by clinical review. This
survey reports 71% of Washington State children under age 3 completed the recommended series in 2013, up
from 65% in 2012. The national rate was 70% in 2013, up from 68% in 2012.
The County View Reports, available in WAIIS, allow JCPH staff to assess immunization rates for Jefferson
County children using the immunization records in WAIIS. The full series completion rate for children under
age 3 was 56% in 2014, up from 53% in 2013. WAIIS is populated by immunization records entered by health
care providers and insurance plans. All children born in WA State are entered in the registry database at birth.
Children moving into the state are not in the registry until an immunization record is entered. The children’s
records available to JCPH for this assessment are those who are residents of Jefferson County and who received
immunizations from providers in Jefferson County. At this time, children who receive immunizations from out-
of-county providers are not available for the reports run by Local Health Department staff.
Two possible causes for the improvement since 2011, in the Jefferson County immunization rate, are: improved
completeness of immunization records in WAIIS, and evaluation and feedback given to individual clinics
resulting in increased efforts in the clinics to remind parents when children are due for immunizations, and to
administer all recommended vaccines at every visit. We will continue to explore options for assessing
immunization rates for different populations in Jefferson County.
The 2011 school immunization exemption law may have had an effect on exemption rates. The exemption rate
for Jefferson County students entering kindergarten decreased from 15.9% in the fall of 2010 to 9.5% in 2011,
12.4% in 2012 and 11.7% in 2013. The Washington State rate decreased from 5.9%% to 4.6% over the same
period. It is not known how much of the decrease was due to reduced “convenience exemptions” and how much
was due to parents making different choices after having a risk/benefit discussion about immunizations with a
health care provider. DOH will publish the 2014-2015 school year report in late spring 2015.
In Jefferson County, the number of students who are reported as “Out of compliance” continues to be an issue.
These are students that are either not up-to-date on required immunizations, or don’t have complete records at
the school. This rate for Jefferson County kindergarteners was 36.9% in the fall of 2011, 31.9% in 2012 and
11.2% in 2013.
JCPH staff continued to provide information to schools about the DOH website for reporting school data, and
remind schools about the reporting deadline. More schools reported in the fall of 2012 than had in any previous
year, 11 out of 14 schools. This increased to 13 out of 14 schools in 2013 and all 14 in 2014.
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JCPH participates in several patient assistance programs to make vaccines available to uninsured low income
adults. The free tetanus, diphtheria, pertussis (Tdap) vaccine from Sanofi/AmeriCares is for low income
uninsured clients who have contact with infants less than 1 year of age, 6 doses were administered in 2014.
JCPH also had free State supplied Tdap vaccine for uninsured adults, 17 doses were administered. Clinics refer
family members of pregnant women to JCPH for this program and clients have been identified through our WIC
program. The State supplied a limited number of doses of free Hepatitis A/B vaccine for high risk clients, five
doses were administered. Three doses of Human Papillomavirus (HPV) Vaccine and 4 doses of varicella
vaccine were provided to uninsured low income adults through Merck’s Patient Assistance Program. Since most
clients are now enrolled in health care insurance the number needing free vaccines has significantly decreased.
STD
The Family Planning and STD clinics follow the CDC screening recommendations for high risk age groups.
The percent of female Family Planning clients screened for chlamydia increased from 60.4% in 2013 to 63.4%
in 2014. In 2012, the national screening rate for women in this age range was 49.2% for those covered by
commercial health insurance and 59.9% for those with Medicaid. In WA, in 2012, 44.3% of women in this age
range who were covered by commercial health insurance were screened, and in 2011-2012, 48% covered by
Medicaid were screened.
The number of chlamydia cases reported has increased over the past two years, with 76 cases in 2014 and 78
cases in 2013, up from 48-58 cases per year in the previous 5 years. The increase in reported cases may partially
reflect increased testing but may also be a true increase in incidence.
As discussed above, the number of gonorrhea cases increased significantly in 2014. JCHP staff continue
increased 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 significantly in 2014, with 350 visits, up from 185 visits in 2013. The
number of syringes dispensed was 42,809, up from 24,596 in 2013. Fifty new clients visited the SEP in 2014.
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 2014 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.
Public Health Emergency Preparation and Response
Staff participated in Regional Healthcare Preparedness meetings, local Healthcare Coalition meetings, JPREP
and DEM meetings, and worked with neighborhood preparedness groups. Staff participated in State training
webinars and meetings with Jefferson Healthcare regarding Ebola preparedness.
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 phone message now 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 new system has been working well
most of the time, but some issues have been identified by the 3 counties. Kitsap County is the lead county
working with the answering service for improvements in service.
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5/8/2015