HomeMy WebLinkAbout2017 Communicable Disease Performance Measures ReportPROGRAMS:, Communicable Disease (CD), Tuberculosis, Immunizations, Travelers Immunizations, Sexually Transmitted Disease, HIV, Syringe Exchange Program, Public Health Emergency Preparedness
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
2013
Actual
2014
Actual
2015
Actual
2016
Actual
2017
Planned
2017
Actual
Goal 1:
Timely investigation of notifiable conditions.
Investigate reports of notifiable conditions per DOH disease specific guidelines. Develop & update protocols and forms as needed. Use DOH electronic reporting systems PHRED, PHIMS,
and PHIMS-STD, to receive reports and send completed reports to DOH.
Total number of communicable disease reports confirmed, interventions applied, and processed for reporting to the State
143
180
(21 gonorrhea)
201
(42 pertussis)
178
160
155
Total number of STD cases reported to the State
83
103
69
73
80
68
Number of chlamydia cases reported to the State: female, male, total
Fe: 68
M: 13
T: 81
Fe: 59
M: 18
T: 77
Fe: 42
M: 15
T: 57
Fe: 41
M: 15
T: 56
60
Fe: 30
M: 22
T: 52
Number of gonorrhea cases reported to the State: female, male, total
Fe: 2
M: 1
T: 3
Fe: 13
M: 8
T: 21
Fe: 5
M: 4
T: 9
Fe: 4
M: 7
T: 11
9
Fe: 6
M: 5
T: 11
Goal 2:
Inform medical providers about current CD trends, outbreaks, 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, emailed, or mailed to providers
(not including DOH Influenza Updates)
15
23
8
17
15
15
Goal 3:
Maintain the low rate of active Tuberculosis (TB) in Jefferson County
Encourage appropriate screening and treatment for latent TB infection and active TB disease.
Number of clients tested for TB infection with PPD or QFT test;
Number of positive tests
165
3
149
2
148
2
180
1
148
1
145
0
Number of clients started on preventive treatment for latent TB infection.
1
2
1
0
1
0
Number of cases of active TB reported
0
0
0
0
0
0
Goals
Objectives
Performance Indicators
2013
Actual
2014
Actual
2015
Actual
2016
Actual
2017
Planned
2017
Actual
Goal 4:
Work with local clinics and DOH to 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, and VFC program up-dates to VFC provider clinics in Jefferson County. Monitor VFC vaccine usage 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
5,067
4613
4724
4627*
4800
4278
Number & percent of doses of publicly funded vaccine (pediatric) administered by private health care providers
4,545
89.7%
3967
86%
4222
89.4%
4198*
90.7%
4160
87%
3763
88%
Number & percent of doses of publicly funded vaccine (pediatric) administered by JCPH
522
10.3%
646
14%
502
10.6%
429
9.3%
640
13%
515
12%
*Issues with the reporting function of the WA State Immunization Information System (IIS) caused errors in the monthly Doses Administered reports, in 2016, therefore the number for
2016, for the Jefferson Healthcare clinics, is taken from the IIS Doses Ordered report.
Goal 5:
Assure quality of immunization services in clinics providing VFC vaccines, as required by DOH.
Perform vaccine quality assurance visits for 50% of clinics annually. Assess childhood immunization rate for pediatric patients in 25% of clinics annually.
Number of clinics visited for VFC Program Quality Assessment and/or to assess childhood immunization rates in clinic patients.
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
2
+1 visit by DOH
Total =3 clinics
Goal 6:
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. Train on new modules as they become available.
Number of clinics using WAIIS to order vaccine, track monthly vaccine inventory, track monthly vaccine doses administered
2 (40%)
4 (80%)
5 (100%)
4* (100%)
4 (100%)
4 (100%)
Number of clinics trained to use WAIIS vaccine return module
0
0
Clinics trained but module not functioning correctly.
4 (100%)
4 (100%)
4 (100%)
*Total number of clinics decreased from five to four in 2015 when two Jefferson Healthcare Clinics merged into one clinic.
Goals
Objectives
Performance Indicators
2013
Actual
2014
Actual
2015
Actual
2016
Actual
2017
Planned
2017
Actual
Goal 7:
Maintain access to vaccines for international travel, in part to prevent travel associated outbreaks in Jefferson County.
Provide travel immunization clinic (includes all disease prevention recommendations, including for malaria and other diseases).
Number of clients immunized in travel immunization clinic
Adults:
162
Adults:
140
Adults:
152
Adults:
174
Adults:
150
Adults:
162
0 – 18 yr:
23
0 – 18 yr:
31
0 – 18 yr:
55
0 – 18 yr:
36
0 – 18 yr:
35
0 – 18 yr:
42
Total:
185
Total:
171
Total:
207
Total:
210
Total:
185
Total:
204
Number of private supply vaccine doses (routine and travel) administered by JCPH (primarily for adults)
819
600
781
701
700
709
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 IIS registry, and some providers in Washington state don’t participate in the registry. The CDC NIS survey is more complete.
Completeness of full immunization series for children seeing Jefferson County providers, at age 19-35 months:
4 DTaP, 3 Polio, 1 MMR, 3 HIB, 3 Hep-B, 1 Var, 4 PCV.
Jeff Co:
53% (IIS)
WA:
71% (NIS)
Jeff Co:
55% (IIS)
WA:
56% (IIS)
67% (NIS)
Jeff Co:
58% (IIS)
WA:
58% (IIS)
77% (NIS)
Jeff Co:
66% (IIS)
WA:
59% (IIS)
76% (NIS)
Jeff Co:
61%
Jeff Co:
64% (IIS)
WA:
NA as of 7/14/18
Percent of children seeing Jefferson County providers having 1 dose of MMR by age 19-35 months (IIS data)
Jeff Co:
75%
Jeff Co:
78%
WA: 79%
Jeff Co:
80%
WA: 82%
Jeff Co:
89%
WA: 81%
Jeff Co:
85%
Jeff Co:
86%
WA: NA
Percent of children seeing Jefferson County providers having 4 doses of DTaP by age 19-35 months (IIS data)
Jeff Co:
69%
Jeff Co:
66%
WA: 68%
Jeff Co:
80%
WA: 69%
Jeff Co:
74%
Jeff Co:
81%
WA: NA
Goal 9:
Assist schools to increase student compliance with Washington State immunization requirements.
Provide training and assistance for school secretaries to access WAIIS records for students. Provide schools with immunization information for parents. Link schools to updated State
information on submitting annual immunization report.
Percent of Jefferson County kindergarten students out-of-compliance for required immunizations as reported to DOH in school immunization report each fall.
*Some schools did not report in 2012 and 2013.
* Jeff Co:
11.2%
WA:
10.3%
Jeff Co:
21.9%
WA:
10.9%
Jeff Co:
30.5%
WA:
8.6%
Jeff Co:
11.1%
WA:
8.2%
Jeff Co:
10%
Jeff Co:
16.4%
WA:
8.0%
Goals
Objectives
Performance Indicators
2013
Actual
2014
Actual
2015
Actual
2016
Actual
2017
Planned
2017
Actual
Goal 10:
The Family Planning and STD clinics will assist in controlling Chlamydia transmission in Jefferson County.
Women seen in JCPH 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
368
320
311
290
320
249
Percent of female FP clinic clients age 24 and under screened for Chlamydia
60.4%
63.4%
60.3%
WA:47.8%
US:49.8%
74.2%
WA: Medicaid: 51%
Commercial: 43%
63%
70.5%
WA: NA as of 7/14/18
Number of chlamydia cases reported to the State, female, male, total
Fe: 68
M: 13
T: 81
Fe: 59
M: 18
T: 77
Fe: 42
M: 15
T: 57
Fe: 41
M: 15
T: 56
60
Fe: 30
M: 22
T: 52
Goal 11:
Maintain access to HIV testing in the community.
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
94
140
125
152
140
167
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
185
350
238
242
240
308
Number of syringes exchanged
24,596
42,809
35,328
47,790
35,000
91,290
Goal 13:
Prevent fatal opioid overdoses in Jefferson County.
Provide overdose prevention education to SEP clients. Provide naloxone, for opioid users, families and friends.
Number of naloxone kits dispensed, included training for proper use. New program in 2016.
NA
NA
NA
45
130
135
Goals
Objectives
Performance Indicators
2013
Actual
2014
Actual
2015
Actual
2016
Actual
2017
Planned
2017
Actual
Goal 14:
Annual report to BOH for CD Programs.
Complete Annual Report
Pass/Fail
PASS
PASS
PASS
PASS
PASS
PASS
Goal 15:
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
PASS
PASS
PASS
PASS
PASS
PASS
2017 STUDY/ANALYSIS OF RESULTS:
Communicable Disease
There weren’t any disease outbreaks in Jefferson County in 2016 or 2017 (other than seasonal influenza), however the overall number of notifiable conditions reported did not decrease
to pre-2014 levels. In 2014 and 2015, the communicable disease team responded to outbreaks, in addition to non-outbreak related reports. There was a gonorrhea outbreak in 2014 and a
pertussis outbreak in 2015.
Immunizations
The value of Federal and State funded vaccines supplied to Jefferson County in 2017 was $249,573.
As new vaccine management modules were added to the WA Immunization Information System (WAIIS) the Immunization Program Coordinator has provided the local clinics with training and ongoing
technical assistance on each module. These modules have had frequent technical issues requiring immunization program staff to trouble shoot with the clinics and consult with the WAIIS
staff.
The CDC National Immunization Survey (NIS) has tracked national and state immunization rates since 1994. This is a telephone survey of parents, and immunization records are validated
by clinical review. This survey reports 76% of Washington State children age 19-35 months completed the recommended full immunization series in 2016, similar to the 77% reported for
2015. The 2017 report will be published in the fall of 2018.
The WA State Immunization Information System (IIS) is a State immunization registry containing immunization records entered by health care providers and insurance plans. The IIS immunization
data is not complete. All Jefferson County VFC immunization providers submit records to the IIS. All children born in WA State are entered into the registry database at birth. Children
moving into the state are not in the registry until an immunization record is entered. Some providers in the state are not yet contributing immunization records to the IIS. At times,
the IIS servers are overloaded, both with records being sent from electronic medical record systems, and staff trying to use various modules, such as ordering, inventory, and doses
administered. Records sent during these times may not make it into the registry. For all of these reasons, the IIS is missing some immunization records, causing the reported immunization
rates from the IIS to be lower than the rates reported in the CDC NIS. WA DOH was planning an upgrade of their server capacity in the fall of 2017, this has been delayed until the fall
of 2018.
For the first time, in the spring of 2017, the State Department of Health (DOH) published IIS immunization rate reports for the State and all counties, going back to 2014. These reports
are more complete than those JCPH staff can run from the IIS, in that children who receive immunizations from out-of-county providers are only included in the reports available to DOH.
JCPH in-house reports include only doses administered in our county. The ability to use the DOH generated reports provides a more accurate report for Jefferson County. Being able to
compare our County rates with the State rates from the IIS report, instead of just the State rates from the CDC NIS, gives a better comparison, in that the rates are produced from the
same database, with the same methodology.
Using the DOH IIS reports, the full series completion rate for Jefferson County children, age 19-35 months, was 63% in 2016. This is up from 58% in 2015, and 55% in 2014. The WA State
rate was 59% in 2016 and 58% in 2015. The DOH reports for 2017 are projected to be available by August 2018.
Three possible causes for the immunization rate improvement seen from 2013 - 2016 are: improved completeness of Jefferson County immunization records in WAIIS, immunization rate evaluation
and feedback for individual clinics provided by the JCPH Immunization Program coordinator, and the beginning of the Community Health Improvement Plan (CHIP) Immunization Workgroup efforts.
The IIS report produced by JCPH staff showed a leveling off of the immunization rate improvement from 2016 to 2017, 66% and 64% respectively. The possible contributing factors to this
stalling of improvement will continue to be discussed in the CHIP Workgroup.
The CHIP process for Jefferson County identified improving immunization rates for children and adults as one of the four health priorities to be addressed. The planning process was completed
in 2016. Some of the immunization improvement activities started in mid-2016, through the work of the CHIP Immunization Workgroup. The roll-out of CHIP activities continued throughout
2017. These included activities aimed at increasing immunization rates in the clinics, and JCPH working in partnership with the schools to improve school immunization rates.
The Jefferson County out-of-compliance rate for students entering kindergarten (incomplete immunizations or no records on file) decreased from 30.5 % in 2015 to 11.1% in 2016, and went
back up to 16.4% in 2017. The State rate was 8% in 2017. The JCPH Immunization Program staff have been working with the schools, providing training on registering for and using WAIIS,
to assist parents to get their child’s immunization records. Part of JCPH’s partnership with the schools includes entering immunization records into WAIIS for any student with out-of-state
records. JCPH has been providing updated fliers for schools to include in the kindergarten registration packets, to help parents understand which immunizations are required for school
and where these immunizations are available. JCPH has been working with schools to encourage and support the enforcement of State immunization requirements for school attendance. JCPH
also sent an updated flyer, specific to immunizations required for child care, to the Department of Early Learning Child Care Licensor for Jefferson County, to send to all of the child
care facilities.
The immunization exemption rate for Jefferson County students entering kindergarten in 2017 was 12.3%, down slightly from the 13.5% for 2016. The WA State rate for 2017 was 4.7%. This
is an issue that the CHIP work will continue to address.
JCPH staff provide information to schools about the DOH website for reporting school data, and remind schools every year 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 - 2017.
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.
STD Prevention
The JCPH Family Planning and STD clinic follows the CDC screening recommendations for high risk age groups. The percent of female JCPH FP clients under age 25 screened for chlamydia
has been above 70% for the past two years (Ahlers data). The 2016 WA State chlamydia screening rate for women in this age group covered by Medicaid was 51%, and was 43% for those with
commercial health insurance (WA Health Alliance data). The 2015 WA State screening rate for all insurance types was 47.8% and the national rate was 49.8% (HEDIS data).
The number of chlamydia cases reported has decreased each year since 2013, with 52 cases reported in 2017. Fifty six percent of 2017 cases were diagnosed through the JCPH clinics (main
clinic and School Based Clinics), 21% were diagnosed other clinics in Jefferson County, and 23% were diagnosed at out of county clinics. The number of reported cases reflects both the
disease incidence and the testing rates for all providers. JCPH STD Program staff ensure that exposed partners are treated, both for cases diagnosed at the JCPH clinics, and those diagnosed
at other provider clinics.
The number of reported gonorrhea cases has not decreased to the pre-2014 baseline, after an outbreak in 2014 resulted in 21 cases. There were 11 cases reported per year in 2016 and 2017.
In the 5 years before 2014, 1-3 cases were reported per year. JCPH 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 increased in 2017, with 308 visits, up from 242 visits in 2016. The number of syringes dispensed was 91,290, up from 47,790 in 2016.
Fifty eight new clients visited the SEP in 2017. New clients come 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 2017 Annual SEP Report for details and more in depth discussion.
The number of HIV tests provided increased to 167, up from 152 in 2016, and 125 in 2015. HIV case management services are provided by a regional case manager for Jefferson, Kitsap, and
Clallam Counties. In 2016 JCPH arranged for this case manager to use one of our clinic rooms for client visits, to facilitate wrap-around services. The case manager is at JCPH two times
per month.
Opioid Overdose Prevention
JCPH started a naloxone kit dispensing program in March of 2016. The number of kits dispensed, along with training in proper use, increased from 45 in 2016 to 135 in 2017. In January
2017, JCPH provided 40 Evzio kits (auto-injector naloxone product), and training for their use, to the Jefferson County Sheriff’s Department. These kits were obtained through a Kaleo
naloxone donation grant. Kits and training were also offered to the Port Townsend Police Department. The PTPD declined this offer, reporting there was not a need for police officers
to carry naloxone due to the rapid EMS response within the city limits. Several Boiler Room staff were provided the nasal spray naloxone product and trained to use it, in the capacity
of a Good Samaritan. Other family, friends, and interested members of the public have also been provided the nasal spray naloxone product and trained to use it.
Public Health Emergency Preparation and Response
Staff participated in Region 2 Healthcare Preparedness meetings, local Healthcare Coalition meetings, the Jefferson Healthcare Emergency Operations Committee meetings, JPREP and DEM
meetings, and worked with neighborhood preparedness groups. JCPH staff participated in the Federal CBRN (Chemical, Biological, Radiological, Nuclear) Regional Exercise in December 2017.
Staff attended 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.
7/14/2018