NEW APIC Public Health Update September, 2009. Public Health Update Data Data HAI grant HAI grant H1N1 H1N1 HAI legislation HAI legislation HCW influenza

NEW APICNEW APIC Public Health Update Public Health Update

September, 2009September, 2009

Public Health UpdatePublic Health Update

DataData HAI grantHAI grant H1N1H1N1 HAI legislationHAI legislation HCW influenza vaccination resultsHCW influenza vaccination results Bureau briefsBureau briefs

Number of persons reported with HIV infectionNumber of persons reported with HIV infectionby year of report, Wisconsin, 1990-2008by year of report, Wisconsin, 1990-2008

0

100

200

300

400

500

600

700

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

1998-2008:Average cases per year = 38495% confidence interval: 338-430 cases per year

2008 = 391 cases total deaths = 37182008 = 391 cases total deaths = 3718

DIVISION OF PUBLIC HEALTH 1 WEST WILSON STREET P O BOX 2659 Jim Doyle MADISON WI 53701-2659 Governor State of Wisconsin 608-266-1251 Karen E. Timberlake Department of Health Services FAX: 608-267-2832 Secretary TTY: 888-701-1253 dhs.wisconsin.gov Date: July 6, 2009 To: Users of state-supplied vaccines From: Jeffrey P. Davis, M.D. Chief Medical Officer and State Epidemiologist for Communicable Diseases Subject: Updated recommendations for use of Haemophilus influenzae type b (Hib) vaccine Effective immediately, the Centers for Disease Control and Prevention (CDC), in consultation with the Advisory Committee on Immunization Practices, the American Academy of Family Physicians and the American Academy of Pediatrics, is recommending reinstatement of the booster dose of Hib vaccine for children aged 12-15 months of age who have completed the primary 3-dose series. Infants should continue to receive the primary Hib vaccine series at ages 2, 4 and 6 months. Children 12-15 months of age should receive the booster dose on time. Older children for whom the booster dose was deferred should receive their Hib booster at the next routinely scheduled visit or medical encounter. Although the supply of Hib containing vaccine is sufficient to reinstate the booster dose and begin catch-up vaccination, supply is not yet ample to support a mass recall process to immunize all children who have had their booster dose deferred because of the temporary supply shortage. At this time we do not recommend the use of reminder/recall systems to actively identify and contact children for the booster dose of Hib only. When supplies of Hib containing vaccine improve we will notify you when mass recall is warranted. While production of the Merck Hib product (PedvaxHIB) is still suspended, production of the other two Hib containing vaccines, monovalent (ActHIB) and the combination DTaP-IPV/Hib (Pentacel), manufactured by Sanofi Pasteur, has been increased and resulted in supplies sufficient to reinstate the booster dose. Although Wisconsin’s allotment for both ActHIB and Pentacel has increased, it will not be sufficient to allow for an all-monovalent schedule of ActHIB, as the current allocation for Hib-containing vaccine is approximately 70% Pentacel and 30% ActHIB. When submitting orders for State Supplied Vaccine through the Vaccines for Children (VFC) Program, the Immunization Program will continue to review doses ordered and will limit the amount of ActHIB shipped until supplies are adequate to accommodate all orders. Requests for Pentacel should be able to be filled in their entirety. We remind providers that the combination vaccines should be used for infants and children starting the Hib series. Children who need the Hib booster dose and who already have received 4 doses of DTaP should receive monovalent Hib vaccine (ActHIB) as their Hib booster dose. However, if DTaP-IPV/Hib is the only Hib-containing vaccine available, this combination product can be used to complete the series of Hib vaccination, even if the child already has Wisconsin.gov received all the necessary doses of DTaP and IPV. During the Hib shortage, children received protection from certain vaccine preventable diseases in their primary vaccination series through various available combination vaccines (e.g., DTaP-IPV/Hib [Pentacel] and DTaP-IPV-Hepatitis B [Pediarix]) and monovalent vaccines (e.g., ActHib, Hepatitis B, and IPV). Therefore, a mismatch might exist between patient vaccination needs and the available stock of different vaccine formulations (e.g., combination products versus single-antigen vaccines) in local provider offices. This situation presents a challenge for providers to administer vaccines to ensure appropriate coverage while minimizing extra doses of unneeded vaccine. For example, if a provider is using DTaP-IPV/Hib (Pentacel) vaccine to protect infants against Hib disease, the provider should ensure that an adequate stock of monovalent hepatitis B vaccine is available to complete the hepatitis B vaccine series. Please note that recommendations for high-risk children have not changed, and the CDC recommends that providers continue to vaccinate these children with available Hib conjugate vaccines according to the routinely recommended schedules, including the 12 through 15 month booster dose. Also, for your convenience is a Q and A document adapted from the CDC documents to answer common questions and concerns surrounding the reinstatement of the booster dose. If you have any additional questions please contact the Wisconsin Immunization Program at 608-267-9959. Thank you. Enclosure

Five reportable STDsFive reportable STDs

(Chlamydia) Chlamydia trachomatis (Chlamydia) Chlamydia trachomatis (Syphilis) Treponema Pallidum (Syphilis) Treponema Pallidum (Gonorrhea) Neisseria gonorrhea (Gonorrhea) Neisseria gonorrhea (Chancroid) Haemophilus ducreyi (Chancroid) Haemophilus ducreyi (PID) Pelvic Inflammatory Disease (PID) Pelvic Inflammatory Disease Two most common are______ and ____Two most common are______ and ____

0

4,000

8,000

12,000

16,000

20,000

24,000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Cases

Chlamydia

Gonorrhea

Reported cases of Chlamydia and Gonorrhea Reported cases of Chlamydia and Gonorrhea by year of diagnosis, Wisconsin, 1999-2008by year of diagnosis, Wisconsin, 1999-2008

0

20

40

60

80

100

120

140

160

180

200

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Ca

se

s

Reported cases of Syphilis by year of diagnosis, Reported cases of Syphilis by year of diagnosis, Wisconsin, 1999-2008Wisconsin, 1999-2008

TuberculosisTuberculosis

WI cases by county WI cases by county http://dhs.wisconsin.gov/tb/statistics/Dhttp://dhs.wisconsin.gov/tb/statistics/DocsStatistics/TB2002_2008.pdfocsStatistics/TB2002_2008.pdf

2008:2008: Brown = 3 casesBrown = 3 cases Manitowoc = 1 caseManitowoc = 1 case Sheboygan = 3 casesSheboygan = 3 cases

68 new cases in WI in 200868 new cases in WI in 2008 Rate = 12 per million populationRate = 12 per million population

WNVWNV

How many confirmed/probable human How many confirmed/probable human cases in WI for 2009 to date? cases in WI for 2009 to date?

HAI Prevention GrantHAI Prevention Grant

For state health departments to build For state health departments to build and sustain HAI surveillance and and sustain HAI surveillance and prevention programsprevention programs

Supplemental grant using ARRA fundsSupplemental grant using ARRA funds Three activitiesThree activities

Development of HAI prevention planDevelopment of HAI prevention plan Surveillance Surveillance Creation of prevention collaborativesCreation of prevention collaboratives


Five year plan-three tiersFive year plan-three tiers 1 = general acute and critical access 1 = general acute and critical access

hospitalshospitals 2 = ambulatory surgery centers2 = ambulatory surgery centers 3 = nursing homes3 = nursing homes

HAI Prevention GrantHAI Prevention Grant Targeted HAIsTargeted HAIs

CLABSICLABSI C. difficileC. difficile CAUTICAUTI MRSAMRSA SSISSI VAPVAP


Three new positionsThree new positions Plan coordinator (program/policy manager)Plan coordinator (program/policy manager) Surveillance coordinator (epi-adv)Surveillance coordinator (epi-adv) Prevention coordinator (PH educator)Prevention coordinator (PH educator)

Albertoni, Rick Kaiser, Kathy

Borlaug, Gwen Kiel, Dianne

Bowler, William Millett-Metzler, Karen

Breitborde, Sandra Nimsgern, Angela

Bremer, Jacquelyn Potts, Marian

Bresnahan, Jeanine Richardson, Dana

Brost, Christine Riederer, Nancy

Davis, Jeffrey, MD Safdar, Nasia, MD

Dobrovolny, Peg Siemers, Sheri

Dums, Terri Stokes, Mary Jo

Ericksen, Kayla Streicher, Eric, MD

Heffernan, Richard Werner, Kathryn

Will, Lorna

Wisconsin Healthcare InfectionsWisconsin Healthcare Infections

Multidisciplinary Advisory CommitteeMultidisciplinary Advisory Committee

H1N1H1N1

EpidemiologyEpidemiology Infection controlInfection control SurveillanceSurveillance VaccinationVaccination

H1N1H1N1

SurveillanceSurveillance SyndromicSyndromic Hospital-basedHospital-based LaboratoryLaboratory Reportable:Reportable:

Hospitalized patients—case report form and 5 Hospitalized patients—case report form and 5 page supplemental formpage supplemental form

DeathsDeaths

H1N1H1N1

VaccinationVaccination Pregnant womenPregnant women Contacts of children less than 6 monthsContacts of children less than 6 months HCP and EMS HCP and EMS with direct patient contactwith direct patient contact 6 mo-24 years (6 mo-24 years (4 years4 years)) 25-64 years with health conditions (25-64 years with health conditions (5-185-18))

___priority within priority groups___priority within priority groups

National LegislationNational Legislation

HR3104HR3104 HAI Reporting Act was introduced June 26 HAI Reporting Act was introduced June 26

and referred to the House Energy and and referred to the House Energy and Commerce Committee. The bill would require Commerce Committee. The bill would require hospitals (including critical access hospitals) hospitals (including critical access hospitals) and ambulatory surgery centers to report and ambulatory surgery centers to report each HAI to the NHSN, would require public each HAI to the NHSN, would require public posting for comparison of HAI incidence, and posting for comparison of HAI incidence, and would require reporting of number of would require reporting of number of infection preventionists in each facility. infection preventionists in each facility.


HR2937 and S1305 HR2937 and S1305

MRSA Infection Prevention and Patient MRSA Infection Prevention and Patient Protection Act was introduced June 18 and Protection Act was introduced June 18 and referred to the Committee on Health, referred to the Committee on Health, Education, Labor and Pensions. This bill Education, Labor and Pensions. This bill requires hospitals to report HA MRSA cases requires hospitals to report HA MRSA cases and implement incremental screening of and implement incremental screening of patients for MRSA, starting with ICU patients.patients for MRSA, starting with ICU patients.


S1299 S1299 Worker Infection Prevention Act introduced Worker Infection Prevention Act introduced

June 18 and referred to Committee on Health, June 18 and referred to Committee on Health, Education, Labor and Pensions. The bill Education, Labor and Pensions. The bill would direct the Secretaries of Labor and would direct the Secretaries of Labor and HHS to jointly develop and issue workplace HHS to jointly develop and issue workplace standards, recommendations, and plans to standards, recommendations, and plans to protect healthcare workers and first protect healthcare workers and first responders, police, firefighters, emergency responders, police, firefighters, emergency medical personnel, and other workers as risk medical personnel, and other workers as risk of workplace exposure to infectious agents of workplace exposure to infectious agents and drug resistant infections such as MRSA.and drug resistant infections such as MRSA.

HCW Influenza Vaccination HCW Influenza Vaccination 2008-09-Hospitals2008-09-Hospitals

Median Hospital Employee Vaccination Rates 2005-2009

716764

58

0

20

40

60

80

100

2005-06 2006-07 2007-08 2008-09

Influenza Season

Perc

en

t


38 hospitals (27%) achieved 80% rate 38 hospitals (27%) achieved 80% rate compared to 35 last yearcompared to 35 last year

*70% used declination forms*70% used declination forms *88% offered at multiple locations*88% offered at multiple locations

**statistically significantstatistically significant


DistributionDistribution

Percentile Rate (%)Percentile Rate (%)

10 5610 56

25 6325 63

50 7150 71

75 8075 80

HCW Influenza Vaccination HCW Influenza Vaccination 2008-09-Nursing Homes2008-09-Nursing Homes

Median Nursing Home Employee Vaccination Rates 2005-2009

50

56

65 66

0

20

40

60

80

100

2005-06 2006-07 2007-08 2008-09

Influenza Season

Perc

en

t


113 nursing homes (28%) achieved 80% 113 nursing homes (28%) achieved 80% rate compared to 72 last yearrate compared to 72 last year

*71% used declination forms*71% used declination forms 50% offered at multiple locations50% offered at multiple locations

**statistically significantstatistically significant


DistributionDistribution

Percentile Rate (%)Percentile Rate (%)

10 3510 35

25 5025 50

50 6650 66

75 8175 81

HCW Influenza VaccinationHCW Influenza Vaccination

Dr. Seth Foldy:Dr. Seth Foldy: "moral imperative" for health care workers "moral imperative" for health care workers

to vaccinate themselves to protect patients to vaccinate themselves to protect patients and familyand family

health care organizations are free to require health care organizations are free to require flu vaccine the way they do other vaccines. I flu vaccine the way they do other vaccines. I

efforts to mandate HCW vaccination are not efforts to mandate HCW vaccination are not on the horizon but if voluntary improvement on the horizon but if voluntary improvement efforts plateau it might be one of the efforts plateau it might be one of the approaches taken. approaches taken.

Bureau BriefsBureau Briefs

Bureau of Communicable Diseases and Bureau of Communicable Diseases and Emergency ResponseEmergency Response AIDS/HIVAIDS/HIV EpidemiologyEpidemiology ImmunizationImmunization STDSTD TB/Refugee Health/Respiratory DiseasesTB/Refugee Health/Respiratory Diseases PreparednessPreparedness

PHPH Hospital/EMSHospital/EMS Pandemic influenzaPandemic influenza

Bureau BriefsBureau Briefs

New support for investigation of New support for investigation of foodborne outbreaksfoodborne outbreaks

““SOS Team”SOS Team”

Surveillance Outbreak SupportSurveillance Outbreak Support

TriviaTrivia

Who are these Who are these gentlemen?gentlemen?

What was their What was their contribution to the contribution to the field of infectious field of infectious diseases?diseases?

What country are they What country are they from?from?

Gwen Borlaug, CIC, MPHGwen Borlaug, CIC, MPHBureau of Communicable Diseases Bureau of Communicable Diseases

1 West Wilson Street Room 3181 West Wilson Street Room 318Madison, WI 53702Madison, WI 53702

[email protected]@wisconsin.gov

Documents

NEW APIC Public Health Update September, 2009. Public Health Update Data Data HAI grant HAI grant H1N1 H1N1 HAI legislation HAI legislation HCW influenza