HomeMy WebLinkAboutCommunicable Disease (PDF)Jefferson County Public Health – Performance Measures Report 2015
Community Health – Communicable Disease Program
[1]
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 2011
Actual
2012
Actual
2013
Actual
2014
Actual
2015
Planned
2015
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
201 198 165 149 160
148
Number of positive PPD and QFT TB
tests evaluated
+PPD: 2
+QFT: 2
-QFT: 1
+PPD: 0
+QFT: 0
-QFT: 0
+PPD: 3
+QFT: 0
-QFT: 0
+PPD: 2
+QFT: 0
-QFT: 0
+PPD: 2
+PPD: 2
+QFT: 0
-QFT: 0
Number of clients started on preventive
treatment for latent TB infection 3 2 1 2 2 1
Goal 2:
Timely investigation
of reportable
conditions.
Develop & update protocols
and forms 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
117 150 143 180
(21
gonorrhea)
160 201
(42
pertussis)
Number of Cryptosporidiosis cases
reported to the State 7 7 2 2 2 3
Number of Giardiasis cases reported to
the State 7 9 6 7 5 3
Number of STD cases reported to the
State 52 57 83 103
(21
gonorrhea) 80 69
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 after-hours reporting
number.
Number of alerts/updates/newsletters
faxed or mailed to providers
(not including DOH Influenza Updates)
13 14 15 23 15 8
Jefferson County Public Health – Performance Measures Report 2015
Community Health – Communicable Disease Program
[2]
Goals Objectives Performance Indicators 2011
Actual
2012
Actual
2013
Actual
2014
Actual
2015
Planned
2015
Actual
Goal 4:
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, 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
5,574 5,403 5,067 4613 4800 4724
Number & % of doses of publicly
funded vaccine (pediatric) administered
by private health care providers
5,001
89.7%
4,855
89.9%
4,545
89.7%
3967
86%
4160
87%
4222
89.4%
Number & % of doses of publicly
funded vaccine (pediatric) administered
by JCPH
573
10.3%
548
10.1%
522
10.3%
646
14%
640
13%
502
10.6%
Number of visits to clinics to provide
vaccine education, updates and technical
support for clinic staff
19 20 24 34 24 15
Goal 5:
Maintain access to
vaccines for
international travel.
Provide travel immunization
clinics (includes all disease
prevention recommendations,
including for malaria and
other insect borne diseases).
Number of clients immunized in travel
immunization clinic:
Adults
Age 18 and under
Total
NA NA
Adults:
162
Adults:
140
Adults:
140
Adults:
152
0 – 18 yr:
23
0 – 18 yr:
31
0 – 18 yr:
31
0 – 18 yr:
55
Total:
185
Total:
171
Total:
171
Total:
207
Number of private supply vaccinations
(routine and travel) administered by
JCPH (primarily for adults)
944 1,057 819 600 700 781
Goal 6:
Assure quality of
immunization
services in clinics
providing State
supplied vaccines, as
required by DOH.
Perform vaccine quality
assurance visits for 50% of
clinics. Assess childhood
immunization rate for
pediatric patients in 25% of
clinics receiving State
supplied vaccines.
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
2
+ 1 visit
by DOH
Total =
3 clinics
2
+ 1 visit
by DOH
Total = 3
clinics
Jefferson County Public Health – Performance Measures Report 2015
Community Health – Communicable Disease Program
[3]
Goals Objectives Performance Indicators 2011
Actual
2012
Actual
2013
Actual
2014
Actual
2015
Planned
2015
Actual
Goal 7:
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.
Number of clinics using Economic
Ordering Quantity (EOQ) to place
appropriate vaccine orders through
WAIIS
5 (100%) 5 (100%) 5 (100%) 5 (100%) 4*
(100%) 4 (100%)
Number of clinics using WAIIS to track
monthly vaccine inventory 0 2 (40%) 4 (80%) 5 (100%) 4 (100%) 4 (100%)
Number of clinics using WAIIS to 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 0 4 (100%) 4 (100%)
*Total number of clinics decreased to four in 2015 when two Jefferson Healthcare Clinics merged into one clinic.
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
registry and some providers in
WA state don’t participate in
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)
29%
54%
WA =
65%
53%
WA =
71%
56%
WA =
67%
57%
59%
WA =
NA
Percent of children seeing Jefferson
County providers having 1 dose of
MMR by age 19-35 months
75% 77% 79% 81%
Percent of children seeing Jefferson
County providers having 4 doses of
DTaP by age 19-35 months
69% 66% 69% 70%
Goal 9:
Assist schools in
increasing student
compliance with
Washington State
immunization
requirements.
Provide training and assistance
for school secretaries to access
WIIS 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 6 7 4 4
0 - Staff
focused on
three
student
groups
traveling.
Will
include in
CHIP work.
Jefferson County Public Health – Performance Measures Report 2015
Community Health – Communicable Disease Program
[4]
Goals Objectives Performance Indicators 2011
Actual
2012
Actual
2013
Actual
2014
Actual
2015
Planned
2015
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 388 301 368 320 320 311
Percent of female FP clinic clients age
24 and under screened for Chlamydia 62.2% 56.5% 60.4% 63.4% 64% 60.3%
Goal 11:
Maintain access to
federally funded
HIV testing and
counseling for high
risk persons with no
medical insurance.
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:19
Quest
Lab:63
Total: 82
DOH
Lab:27
Quest
Lab:75
Total:
102
DOH
Lab:19
Quest
Lab:75
Total: 94
DOH
Lab:5
Quest
Lab:135
Total:
140
110
DOH
Lab:13
Quest
Lab:112
Total:
125
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
142 150 185 350 350 238
Number of syringes exchanged 17,726 17,405 24,596 42,809 42,000 35,328
Goal 13:
Annual report to
BOH for CD
Programs.
Complete Annual Report Pass/Fail PASS PASS PASS PASS PASS PASS
Goal 14:
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 1 1 1 1 1 1
Jefferson County Public Health – Performance Measures Report 2015
Community Health – Communicable Disease Program
[5]
2015 STUDY/ANALYSIS OF RESULTS:
Communicable Disease
There was a pertussis outbreak in Jefferson County in the spring of 2015, with 42 cases reported. Typically, 0 – 2 pertussis cases are reported per
year. The only other recent local pertussis outbreak was in 2012, with 25 cases reported. In this instance, the CD/Immunization team was prepared to
respond to outbreaks, by working with providers, following up with cases, making sure contacts are identified and treated/educated depending on the
disease, and getting information to providers, schools and the public.
In past years the Jefferson County rate for Cryptosporidiosis, a waterborne disease, was frequently well above the State rate, with 5 – 8 cases per
year. Since 2013 the number of cases has declined to 1-3 per year, with 3 cases reported in 2015.
Immunizations
The value of Federal and State funded vaccines supplied by the State to Jefferson County in 2015 was $259,869, up from $254,119 in 2014.
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.
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.
The CDC National Immunization Survey has tracked national and state immunization rates for many years. This is a telephone survey of parents, and
immunization records are validated by clinical review. This survey reports 67% of Washington State children age 19-35 months completed the
recommended full immunization series in 2014. The WAIIS County View Reports, allow JCPH staff to assess immunization rates for Jefferson
County children. The full series completion rate for children age 19-35 months was 59% in 2015, up from 56% in 2014. 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 records available to JCPH for this assessment
are for residents of Jefferson County who received immunizations from providers in Jefferson County. At this time, children who receive
immunizations from out-of-county providers are not included in the reports available to local Health Department staff.
Two possible causes for the immunization rate improvement since 2013 are: improved completeness of Jefferson County immunization records in
WAIIS; and 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.
Jefferson County Public Health – Performance Measures Report 2015
Community Health – Communicable Disease Program
[6]
The immunization exemption rate for Jefferson County students entering kindergarten decreased from 11.7% for the 2013-14 school year to 8.2% in
2014-15 and 7.5% in 2015-16. The Washington State exemption rate has been 4.5% - 4.6% over the same period. This is the lowest exemption rate
recorded for Jefferson County in the past 15 years. The Jefferson County out-of-compliance rate for students entering kindergarten (incomplete
immunizations or no records on file) continues to be an issue. This rate was 21.9% for the 2014-15 school year and 30.5% in 2015-16. The
corresponding State rates were 10.9% and 8.9%.
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 and 2015.
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 current Community Health Improvement Plan (CHIP) process for Jefferson County has identified improving immunization rates for children and
adults as one of the four priorities to be addressed by the CHIP plan. The planning process is nearly complete and the overall implementation process
will begin later this year (2016). Some of the immunization improvement activities have started in the spring of 2016.
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.
The State has supplied a limited number of doses of free adult vaccine for uninsured low income adults. Thirteen doses of free Tdap vaccine were
administered in 2015. Clinics refer family members of pregnant women to JCPH for this program, and clients have been identified through our WIC
program. The State also supplied a limited number of Hepatitis A/B vaccine doses for high risk clients, 2 doses were administered in 2015. Since
most clients are now enrolled in health care insurance the number needing free vaccines has significantly decreased.
STD Prevention
The Family Planning and STD clinics follow the CDC screening recommendations for high risk age groups. The percent of female FP clients
screened for chlamydia decreased from 63.4% in 2014, to 60.3% in 2015. The WA State screening rate for women seen in all Title X Family
Planning or Planned Parenthood clinics in 2014 was 65%. The 2014 national screening rate (all providers), was 47.9% for women covered by
commercial health insurance and 51.2% for those with Medicaid (HEDIS data). The WA State rate for 2013, was 39% for women covered by
commercial health insurance and 50% for those with Medicaid (WA Health Alliance data).
The number of chlamydia cases reported in 2015 decreased to 54, after an increase over the previous two years, with 76 cases in 2014 and 78 cases in
2013. In the previous 5 years, 48-58 cases were reported per year. The number of reported cases reflects both testing rates for all providers and
disease incidence.
Jefferson County Public Health – Performance Measures Report 2015
Community Health – Communicable Disease Program
[7]
The number of gonorrhea cases decreased in 2015 to 9 cases, after an outbreak in 2014 resulted in 21 cases. In the previous 5 years, 1-3 cases were
reported per year. JCHP 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 decreased in 2015 after increasing significantly in
2014, with 238 visits, down from 350 visits in 2014. The number of syringes dispensed was 35,328, down from 42,809 in 2014. While the 2015 SEP
utilization decreased from 2014, it remained higher than in all years before 2014. Thirty six new clients visited the SEP in 2015. 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 2015 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 a Region 2 Public Health and Tribal table top 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.
5/11/2016