DOCUMENTING EXCELLENCE IN PUBLIC HEALTH

Transcription

1 EPI UPDATE Published for Healthcare Professionals September 2013 DOCUMENTING EXCELLENCE IN PUBLIC HEALTH Pamela Hackert, MD, MPH, JD Local public health departments often operate under the radar, but every day Oakland County Health Division (OCHD) impacts the lives of people in Oakland County by tracking, treating and monitoring diseases, maintaining community partnerships to guide our residents to services and to respond cohesively in emergencies, making sure water is safe to drink, and food is safe to eat. Given the significance of public health, it was a bit odd that until 2011, there were no national standards to measure a local or state health department. To meet this need, the non-profit Public Health Accreditation Board ( PHAB ) was created in 2007 and tasked with launching a national public health accreditation program. Accreditation measures capacity to protect food and water, prepare and respond to health threats, promote healthy behaviors, and prevent diseases and injuries. These public health protections are the basis of healthy people and healthy communities. Despite public health s critical role, previously there was not a Emergency Preparedness 2013 Full Scale Exercise national accreditation program to ensure public health departments quality of service. There have, however, been state accreditation reviews every three years, the last one for Oakland County being in At that review, OCHD received outstanding marks, meeting all 117 Essential Factors and the five Important Factors. There were no unmet factors and Special Recognition was given in every section of the review. Continued, page 2 In This Issue Documenting Excellence in Public Health Influenza Season Summary 3 Influenza Vaccine Update for the Season 4 Active Tuberculosis Disease in a High School Population 5 Selected Disease Data Table 7 Vaccines for Children Program Flyer 8 Oakland County Health Division 1200 N. Telegraph Rd., Pontiac, MI L. Brooks Patterson Oakland County Executive Page 1

2 September EPI Update OAKLAND COUNTY HEALTH DIVISION OFFICES North Oakland Health Center 1200 North Telegraph 34E Pontiac, MI Toll Free FAX South Oakland Health Center Greenfi eld Road Southfi eld, MI FAX Visit us at our website: oakgov.com/health Oakland County Health Division will not deny participation in its programs based on race, sex, religion, national origin, age or disability. State and federal eligibility requirements apply for certain programs. OAKLAND COUNTY HEALTH DIVISION - CD UNIT Pamela Hackert, MD, MPH, JD Chief of Medical Services Nicole Parker, MPH Epidemiologist Richard Renas, MPH Epidemiologist Suzanne Brunette, RN, BSN Communicable Disease Nurse Anne Hocking, RN, BSN Communicable Disease Nurse Carolyn Padro, RN, BSN Communicable Disease Nurse After hours call: , ask for the health administrator on call. EXCELLENCE IN PUBLIC HEALTH Continued from page 1 Special Recognitions were in diverse areas including: Development of a Communication Guide by Health Education which was noted as should be used as (a) model for other local health departments developing health promotion procedures..., Excellence in active managerial control of Environmental Health s food service program The OCHD hearing screening program for school children Providing immunizations for children during WIC appointments to ensure that every child has access to vaccines Implementing a Nurse on Call program to handle health questions from the public with full-time staffing to help community residents with a wide variety of health concerns. (Nurse on Call phone number is , toll free at or at noc@ oakgov.com) Nurse On Call Providing referrals for persons with hearing impairments and ensuring interpreting services for services provided through OCHD Oakland County Health Division is, however, not content to rest on past accomplishments. The commitment to excellence documented in the past state accreditation reviews serve as the stepping stone to starting on the path to National Accreditation. The process is a long one and consists of seven steps: (1) Pre-application, (2) Application, (3) Documentation, Selection and Submission, (4) Site Visit, (5) Accreditation Decision, (6) Reports, and (7) Reaccreditation. Accreditation demonstrates the capacity of the public health department to deliver the three core functions and the ten essential services of public health as represented in the graphic on page 3. The benefits of National Public Health Accreditation include: Identifying strengths, weaknesses and opportunities for quality improvement - As evidenced by prior state accreditation, OCHD already has outstanding policies in place for examining ways to ensure continuous quality improvement, but stepping back and looking at these same programs with a fresh eye can often yield positive benefi ts. Recognition,Validation, and Accountability - national accreditation raises the visibility of public health and the services provided to the citizens who are served by OCHD. It also provides accountability to the public, funders, and governing entities at all levels. Continued, page 3 Page 2

3 EXCELLENCE IN PUBLIC HEALTH Continued from page 2 Improved Communication and Collaboration - this strengthens outreach and communication among staff, governing entities, partners, community members, and other external stakeholders. Potential Increased Access to Resources - lastly, as accreditation highlights the capacity and capability of the health department, this may result in increased opportunities for resources, including streamlined application processes for grants and programs as well as access to funding to support quality and performance improvement. Increased funding opportunities could also address infrastructure gaps identified in the accreditation process, opportunities to pilot new programs and acceptance of accreditation in lieu of other accountability processes. September EPI Update Currently, OCHD is working on the prerequisite checklist as well as formulating a comprehensive community health assessment. These are part of the first steps in working Core Functions and Essential Services of Public Health towards national accreditation. The comprehensive community health assessment is anticipated to take months. The pre-application phase also includes a community health improvement plan and division strategic plan. During this time, OCHD will be engaging community partners at all levels, from individuals, health care providers, hospitals, faith-based groups, to businesses. After all, public health is for everyone! INFLUENZA SEASON SUMMARY Nicole Parker, MPH The influenza season is dramatically different from the influenza season. Figure 1 shows that confirmed cases of influenza reported to the Oakland County Health Division (OCHD) were influenza A positive, 67.6%, (Figure 2). 100 Figure 2 - Reported Laboratory Positive Influenza Results 140 Figure and 2013 Influenza Seasons Influenza A Influenza B Total Influenza A & B Number of Cases Number of Cases Week of Week of did not have the mid-february peak that is typically seen in Oakland County and nationwide. Instead, the peak of the influenza season occurred during late December early January. This trend was similar to what was seen on a state and national level. In addition, the season started earlier than in years past, with the first cases of influenza being reported in late October early November. As with past influenza seasons, the majority of laboratory However, this season was also unique. In late February- early March there was a surge in the number of laboratory confirmed influenza B cases reported. Due to the late season emergence, overall, 32.4% of cases were influenza B positive. This late season emergence of Influenza B was seen across the State of Michigan and nationwide. The statewide surveillance system identified an equal number of specimens positive for influenza A 2009 H1N1 and Influenza A H3. Of the 113 influenza specimens tested at the state level, Continued, page 4 Page 3

4 September EPI Update INFLUENZA SEASON SUMMARY, Continued from page 3 83% were positive for B/Wisconsin/01/2010-like, which was the B-strain component in this season s influenza vaccine. This is unique to this season at the state and national level because, despite the B strain in the vaccine being a good match, the strain was still able to circulate and infect the population. During the season, Oakland County hospitals reported 465 inpatient cases to the Oakland County Health Division. This diligent and continued participation reporting of hospitalized influenza patients is appreciated. The number of inpatient reporting increases every year, and therefore, makes the OCHD surveillance program data that much stronger. As part of their reporting these facilities provide additional information about the patient s stay in the hospital and pre-existing risk factors that may lead to complications with influenza. This season, 333 hospitalized patients had additional stay and risk factor information reported. Of the hospitalized patients reporting risk factors for complications with influenza: 47.7% had a chronic underlying heart disease 32.4% had a chronic underlying metabolic disease including diabetes 22.2% had asthma 19.5% had a chronic underlying lung disease 14.1% had been diagnosed with cancer in the last 12 months 11.15% had a chronic underlying chronic renal disease 15.5% had a chronic underlying neurologic disease 10.2% had another immunosuppressive condition 22.5% were obese based upon their body mass index 9.8% of the 191 females were pregnant Tragically, seven pediatric deaths were associated with laboratory confirmed influenza in Michigan during the season. No pediatric deaths were recorded in Oakland County. Table 1 shows a comparison of and hospitalized patients. Table 1: INFLUENZA INPATIENT DEMOGRAPHICS <65 Years Average Age Age Range 1 month - 96 yrs 1 month yrs Reported Being Vaccinated Average Days Hospitalized Admitted to ICU Ventilator ECMO ARDS For updated influenza surveillance information visit: Michigan Department of Community Centers for Disease Control and INFLUENZA VACCINE UPDATE FOR THE SEASON Rick Renas, MPH Influenza is a serious disease that can lead to hospitalization and sometimes even death. Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. About 90% of deaths occur in people 65 years and older. The seasonal flu season in the United States can begin as early as October and last as late as May. During this time, flu viruses are circulating in the population. An annual flu vaccine (either the flu shot or the nasal-spray flu vaccine) is the best way to reduce the chances that you and your patients will get seasonal flu and lessen the chance that it will be spread to others. Flu vaccines are designed to protect against three influenza viruses that experts predict will be the most common during the upcoming season. Three kinds of influenza viruses commonly circulate among people today: Influenza A (H1N1) viruses, influenza A (H3N2) viruses, and influenza B viruses. Each year, one flu virus of each kind is used to produce seasonal influenza vaccine. The trivalent influenza vaccine is made from the following three viruses: A/California/7/2009 (H1N1)pdm09-like virus A(H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011 B/Massachusetts/2/2012-like virus Quadrivalent vaccines will include an additional vaccine virus, a B/Brisbane/60/2008-like virus. Several new, recently-licensed vaccines will be available for the season, and are acceptable alternatives to other licensed vaccines indicated for their respective age groups when otherwise appropriate: A quadrivalent live attenuated influenza vaccine (LAIV4; Flumist Quadrivalent [MedImmune]) is expected to replace the trivalent (LAIV3) formulation. FluMist Quadrivalent is indicated for healthy, nonpregnant persons aged 2-49 years without chronic respiratory conditions such as asthma. A quadrivalent inactivated influenza vaccine (IIV4; Fluarix Quadrivalent [GlaxoSmithKline]) will be available, in addition to the previous trivalent formulation. Fluarix Quadrivalent is indicated for persons aged 3 years and older. Page 4

5 September EPI Update INFLUENZA VACCINE UPDATE FOR THE SEASON Continued from page 4 A quadrivalent inactivated influenza vaccine (IIV4; Fluzone Quadrivalent [Sanofi Pasteur]) will be available in addition to the previous trivalent formulation. Fluzone Quadrivalent is indicated for persons aged 6 months and older. A trivalent cell culture-based inactivated influenza vaccine (cciiv3; Flucelvax [Novartis]), which is indicated for persons aged 18 years and older. A recombinant hemagglutinin (HA) vaccine (RIV3; FluBlok [Protein Sciences]), which is indicated for persons aged 18 through 49 years. Providers should consult the expanded 2013 ACIP influenza vaccination statement for updated information at: Additional Resources: Centers for Disease Control and Prevention Influenza - Vaccination Site Finder - ACTIVE TUBERCULOSIS (TB) DISEASE IN A HIGH SCHOOL POPULATION Nicole Parker, MPH On April 18, 2013 Oakland County Health Division (OCHD) Tuberculosis Unit (TBU) received confirmation via Michigan Disease Surveillance System (MDSS) of an active case of TB disease in an 18 year old student from a local high school. The same day, the high school s administrative staff were notified of the case s status, and class schedules for both semesters and bus rosters were requested. On April 19, OCHD administration met with school administrators and teachers to inform them about active TB and what the contact investigation would entail. Letters were sent to targeted case contacts, 273 students and staff that shared classes or a bus with the case, informing them of the OCHD testing clinics that would start on April 22. Letters were also sent to students and staff that did not come into regular, direct contact with the case informing them about the case of active TB disease. OCHD provided tuberculosis skin testing (TST) and reading at the high school on April 22, 24 and 26. A total of 208 TSTs were administered resulting in 200 negative and eight positive TSTs. The eight TST positive individuals were subsequently followed up with an additional TB blood test and chest x-ray to confirm the positive TST result. Only two (0.009% positivity rate) individuals tested positive for latent TB infection; both individuals were classmates of the case, and were of foreign birth with prior Bacille Calmette-Guerin (BCG)¹ vaccination, as well as recent travel to endemic TB countries. Targeted case contacts that did not present to the first OCHD clinic at the high school were contacted via phone by OCHD Nurse on Call and OCHD Communicable Disease Unit nurses. Their efforts resulted in 26 individuals coming to OCHD clinics from April 23 to May 20, or submitting recent private physician records of TST testing. All 26 of those TST results were negative. OCHD informed all individuals during the first testing period that a subsequent second round of testing would be conducted in 8-10 weeks at the high school. Letters were sent the week prior to OCHD s second TST clinic at the high school on June 3, 5 and 7. One hundred fifty six individuals attended for second round testing which yielded 152 negative and four positive TSTs. The four positive individuals were subsequently followed up with an additional TB blood test and chest x-ray to confirm the positive TST result. Only one individual (0.001% positivity rate) tested positive for latent TB infection; this individual was a bus contact to the case, and was of foreign birth with prior BCG vaccination and recent travel to an endemic TB country. Additional calls were made to recent graduates and first round positive TST cases to receive second round testing at OCHD clinics. This yielded 12 additional individuals who presented for testing, and all 12 of these results were negative. Despite efforts by OCHD to contact targeted case contacts by letter, phone or , 45 individuals remain that have not received any testing for TB. Fifty-six individuals have only received first round testing despite OCHD followup efforts including telephone calls and letters being sent home to inform them of the second round of testing being conducted at the high school. Eight close contacts were identified by the case, which include three family members and five friends from school. To date only two family members (0.25% positivity rate) have tested positive for latent TB infection. The two cases accompanied the case during recent travel to Asia and could have been exposed at the same time as the case. A total testing summary of OCHD s efforts is provided in Figure 1 on page 6. Continued, page 6 ¹Bacille Calmette-Guerin (BCG) vaccine is used in some foreign countries as a vaccination against childhood TB meningitis and miliary disease. The vaccination does not provide lifelong immunity against TB disease and is not recommended for use in the United states. Page 5

6 September EPI Update ACTIVE TUBERCULOSIS (TB) DISEASE IN A HIGH SCHOOL POPULATION Continued from page 5 Genotyping of the case s mycobacterium revealed that this particular PCR type has been detected in at least two other individuals in Oakland County over the last two year period (July 2010 July 2013); within the state of Michigan five other cases have been detected during the same time period. The case contact investigation did not reveal any links between those prior cases and this current case of active TB disease. The case s recent travel to Asia is believed to be where the exposure occurred, this matches the mycobacterium strain genealogy as it is linked to East Asia. Of the individuals that have tested positive, no one individuals latent TB infection can be definitively linked to this one case of active TB due to their past histories of birth and travel to endemic TB regions. In addition, amongst this population there are no more positive latent TB infections that were discovered than if a similar sized proportion of the general population were tested. Thanks to the rapid response by OCHD and the high school administrators these testing efforts were highly successful in reaching the targeted case contacts with 83% of the targeted population tested at least once for TB by OCHD or private physician. Figure 1 - High School TB Testing Summary Total = 15 Negative = 15 Latent TB Infection = 0 Total = 272 Negative = 224 Latent TB Infection = 3 ¹ Total = 8 Negative = 6 Latent TB Infection = 2 ¹ Figure 1 - High School TB Testing Summary Key ¹Additional risk factors for identification of latent TB infection were identified. Some risk factors for latent TB infection are: Recent travel to endemic TB regions A foreign country of birth Past exposure to a case of active TB disease Living for extended periods of time in endemic TB regions Page 6

7 The Oakland County Health Division will not deny participation in its programs based on race, sex, religion, national origin, age or disability. State and Federal eligibility requirements apply for certain programs. The Michigan Department of Community Health offers many solutions to those who want to quit Tobacco. Finding the right one is up to each individual and we encourage people to visit the MDCH Quit Tobacco tools and resources website. RoxanneCondit/MyBookGraphics/SubstanceAbuse/YouCanQuit/ September EPI Update The summer 2013 issue of the Michigan Department of Community Health LabLink newsletter is available at: SELECTED DISEASE DATA OAKLAND COUNTY SELECTED DISEASE DATA 2011 through through through HIV (All Stages) AIDS (HIV Infection Stage 3) Campylobacter Chickenpox Chlamydia Giardiasis Gonorrhea Hepatitis A Hepatitis B - Acute Hepatitis C - Chronic Legionellosis Listeriosis Measles Meningitis, viral (aseptic) Meningococcal Disease Pertussis Salmonellosis Shiga Toxin-producing Escherichia coli (STEC) Shigellosis Syphilis (Primary & Secondary) S. pneumoniae, invasive Tuberculosis - Pulmonary Tuberculosis - ExtraPulmonary Typhoid Fever West Nile Virus Note: Data may change slightly as new information becomes available. 1 Includes all newly diagnosed HIV cases, including those diagnosed with Stage 3 (AIDS) at the same time as their HIV diagnosis, based on date of HIV diagnosis 2 Includes all newly diagnosed Stage 3 (AIDS) cases, including those diagnosed with HIV at the same time as their Stage 3 diagnosis, based on date of Stage 3 diagnosis Contact for further information on tobacco dependence. Page 7

8 Join Michigan s Vaccines For Children Program This program protects children 0-18 years old against vaccine preventable diseases Advantages to joining: Free childhood vaccines are offered to children who do not have vaccine coverage This program helps children stay healthy Vaccines are free of charge and delivered directly to your offi ce Free staff education provided by Public Health Nurses Proper vaccine handling support Providers who are interested in joining and/or have questions: Contact Michele Maloff, Immunization Action Plan Coordinator, Oakland County Health Division, (248) The Oakland County Health Division will not deny participation in its programs based on race, sex, religion, national origin, age or disability. State & Federal eligibility requirements apply for certain programs. I:\Health\CHPIS\Health Ed\Cooper\Summer Safety Flyers 05/2013