Priority Health Topic: Infectious Disease
Background & History
The HA2030 kept a childhood immunization objective similar to LHI 17 from the HA2020 plan, but changed it to specifically track only the DTAP vaccine to reflect the change in the data source, the National Immunization Survey questions. This objective remained in the plan since it can be tracked annually on a national level and the strategies to increase the immunization rates are incorporated into the State of Alaska’s strategic plan.
Due to the high rates of chlamydia, gonorrhea, HIV, and syphilis in the state of Alaska, the team determined it was important to keep an objective focused on sexually transmitted infections. Because strategies and actions to lower the rates of infectious disease spread are similar for each of the STIs, the team decided to choose one to focus on for data collection because the strategies and actions would address the others. Another reason that just one STI was selected for inclusion in the HA2030 plan is because the Healthy Alaskans Data Team did not at the time have the capacity to track, monitor and report on all of the STIs. Gonorrhea was chosen over the past focus of Chlamydia because it isan STI that has more serious and broader reaching health implications, has had a steady uptick in cases in AK, and has the funding for efforts to contact trace cases and implement other interventions.
Objective 10: Increase the vaccination coverage level of 4 doses of diphtheria-tetanus-acellular pertussis (DTaP) vaccine among children by age 2 years
Target: 90%
Strategy 1: Increase use of client reminder and recall systems
Client reminder and recall interventions are used to remind members of a target population that vaccinations are due (reminders) or late (recall). Reminder/recall systems are cost-effective methods to identify and notify families whose children are due soon from immunizations or are already behind. State immunization information systems (IIS), like VacTrAK, and electronic health records (EHRs) can run reports of patients who are due or overdue easily. The Community Prevention Services Task Force (CPSTF) recommends client reminder and recall interventions to increase vaccination rates in children, adolescents, and adults.
Sources:
- https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html
- http://www.thecommunityguide.org/vaccines/clientreminder.html
- http://www.epi.alaska.gov/id/iz/vactrak/docs/VacTrAK_Reminder_Recall_Basics.pdf
- http://brightfutures.aap.org/clinical/volume1.html#u1RecallAndReminder
Action Step 1
| Action | The State of Alaska DHSS Division of Public Health Section of Epidemiology Immunization Program, with the DHSS Public Information Office develops immunization reminder/recall postcards for healthcare provider offices and conducts reminder/recall on behalf of providers who receive state-supplied vaccine. |
| Measure | Number of providers who request that the Immunization Program conduct reminder/recall on their behalf. |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Department of Health and Social Services, Public Information Office • Providers who receive state-supplied vaccine • Tribal health Organizations • State of Alaska, Division of Public Health, Section of Public Health Nursing |
Action Step 2
| Action | Evaluate the success of the reminder/recall for providers. The Immunization Program will use the Reminder/Recall Success Report in VacTrAK to analyze the number of patients who received a vaccination after the reminder/recall. |
| Measure | Reminder/Recall Success Report developed by State of Alaska, Division of Public Health, Section of Epidemiology |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Department of Health and Social Services, Public Information Office • Providers who receive state-supplied vaccine • Tribal health organizations • State of Alaska, Division of Public Health, Section of Public Health Nursing |
Strategy 2: Improve data quality in Alaska’s Immunization Information System
Immunization information systems (IIS) (i.e., VacTrAK) are confidential, population-based, computerized databases that record all immunization doses given by participating providers to people who live within a certain geopolitical area. CPSTF recommends IIS to increase vaccination rates.
In 2008, the Immunization Program implemented the Alaska Immunization Information System (IIS), VacTrAK, in order to provide centralized immunization information for the entire State. The Alaska IIS provides integrated reporting functionality, vaccine ordering and management, clinical decision making tools, and the ability to both import and export data in a variety of formats.
The 2017 Immunization Information System Annual Report (IISAR) (required by CDC Cooperative Agreement) cites the 2017 NIS 4:3:1:3:3:1:4 series coverage percentage for children aged 19 through 35 months as 69.5%, while the Alaska IIS is reported as 58.5%. This difference is attributable to a number of factors, including a census (i.e., IIS) versus a sample (i.e., NIS), incomplete data, and/or problems with data quality in the Alaska IIS.
Sources:
- https://www.thecommunityguide.org/findings/vaccination-programs-immunization-information-systems
- https://www.cdc.gov/vaccines/programs/iis/functional-standards/func-stds-v4-1.html
- https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf
- https://www.cdc.gov/vaccines/programs/iis/activities/mirow.html
Action Step 1
| Action | Assess data quality of the VacTrAK system of the State of Alaska, Division of Public Health Section of Epidemiology, Immunization Program. |
| Measure | 2020 and 2021 Immunization Information System Annual Report (IISAR) developed by State of Alaska, Division of Public Health, Section of Epidemiology |
| Timeframe | 2020-2022 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Department of Health and Social Services, Information Technology Office • VacTrAK vendor (STC) |
Action Step 2
| Action | Ensure that 25% of providers receiving the VFC vaccine participate in IQIP visits (Immunization Quality Improvement For Providers) on an annual basis per the Alaska Immunization Program’s Cooperative Agreement. During these visits, providers are encouraged to keep patient records up-to-date and deactivate patients they no longer see. |
| Measure | Report on % of providers receiving VFC vaccines participating in IQIP visits |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Section of Public Health Nursing • Tribal health organizations • Anchorage Health Department • Providers who receive Vaccines for Children(VFC) vaccine |
Strategy 3: Increase provider reminders
Provider reminders let healthcare providers know when clients are due for specific vaccinations. Reminders are delivered in various ways that may include notes posted in client charts, alerts in electronic medical records, or letters sent by mail or e-mail. They may be handled separately or included in standard checklists or flowcharts. CPSTF recommends provider reminders – when used alone or when combined with additional interventions – to increase vaccination rates among people of all ages from different populations or settings.
Sources:
- https://www.thecommunityguide.org/findings/vaccination-programs-provider-reminders
- https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf
Action Step 1
| Action | Per the Alaska Immunization Program’s Cooperative Agreement, 25% of providers receiving VFC vaccine are required to participate in IQIP (Immunization Quality Improvement For Providers) on an annual basis. One of the required IQIP strategies for providers is to schedule the next immunization visit before the patient leaves the office. |
| Measure | Number of patient visits during which the provider schedules the next immunization visit before the patient leaves the office |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Section of Public Health Nursing • Tribal health organizations • Anchorage Health Department • Providers who receive Vaccines For Children(VFC) vaccine |
Strategy 4: Support and promote collaboration around immunizations in communities to build capacity, drive local efforts, and protect Alaskans
While most Alaskans choose to vaccinate, we still have individuals and pockets of populations who are not immunized or under immunized, thus leaving some individuals and communities at risk for preventable diseases and outbreaks. The compounded effects of social determinants of health, and misinformation, continue to affect immunization coverage. CDC is promoting a new framework that takes a broader community focus to engage and protect people. Vaccinate with Confidence is a framework designed to strengthen vaccine confidence by protecting communities, empowering families, and stopping myths. Increasing multidisciplinary collaboration, of state and local partners, supports collective engagement and community initiatives that address social determinants of health and inequities within the context of where Alaskans live, learn, work, and play.
Sources:
- https://www.cdc.gov/vaccines/partners/vaccinate-with-confidence.html
- https://www.naccho.org/uploads/downloadable-resources/Mobilizing-Community-Partnerships-Rural-Communities-NA608PDF.pdf
- https://www.healthypeople.gov/sites/default/files/Public-Health-3.0-White-Paper.pdf
- https://www.naccho.org/uploads/downloadable-resources/NACCHO-Healthy-People-Mtg-HCC.pdf
Action Step 1
| Action | Supporting local efforts by utilizing state and local data |
| Measure | # of community events or # of partners at: meetings, coalitions that have an immunization component as reported to Lead: State of Alaska, Division of Public Health, Section of Epidemiology by partners |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • Alaska Native Tribal Health Consortium • Local Tribal and Community partners |
Action Step 2
| Action | Build community capacity and leadership to effectively respond to outbreaks |
| Measure | • # partners at Point of Dispensing (POD) events/preparedness activities • # of communities that have PODs, coverage rate Immunization prior to and post POD event as reported by State of Alaska, Division of Public Health, Section of Public Health Nursing to State of Alaska, Division of Public Health, Section of Epidemiology. |
| Timeframe | 2020-2022 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Section of Public Health Nursing • Alaska Native Tribal Health Consortium, Tribal EpiCenter • Local Tribal and Community partners |
Objective 11: Reduce the incidence rate of gonorrhea per 100,000 population
Target: 199 per 100,000
Strategy 1: Increase testing for Sexually Transmitted Infections (STIs) – Detection
Alaska’s Neisseria gonorrhoeae infection (GC) rates are among the highest in the United States. Undiagnosed GC can lead to serious health sequelae and can increase the likelihood of acquiring human immunodeficiency virus (HIV) by a factor of 2 to 5 times when having unprotected sex with an HIV-infected partner.
Recent reports indicate that urogenital-only testing can miss asymptomatic GC infections, particularly among men who have sex with men (MSM) and heterosexuals who engage in oral and anal intercourse. The importance of taking a thorough sexual history to identify, treat, and stop transmission of GC infections in both high-risk and more general risk populations cannot be overstated. Using open-ended questions posed in a non-judgmental, sensitive manner is essential in taking a good sexual history. For guidance and resources in effective risk assessment techniques, visit the SOE Sexual History Taking webpage (available at: www.epi.alaska.gov/hivstd/history.htm).
Routinely collecting specimens for testing, using EHR screening reminders, and reminding patient to get screened or rescreened are cost-effective methods to detect and reduce incidence of STDS.
Sources:
- http://epibulletins.dhss.alaska.gov/Document/Display?DocumentId=22
- https://www.cdc.gov/std/program/interventions.htm
Action Step 1
| Action | Increase extra genital testing in Alaska |
| Measure | Use State Public Health Lab (SPHL) data to measure extra-genital specimens submitted to the lab annually. |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Section of Public Health Nursing • Military Health Coordinator at Alaska Bases • ANTHC HIV/STD Prevention Program • UAA Student Health and Counseling Center • State of Alaska, Division of Public Health, Laboratories |
Action Step 2
| Action | Test for gonorrhea resistance – Gonococcal Isolate Surveillance Project (GISP) |
| Measure | GISP CDC has work plan in place for measurements at mid-year and end of year data – State of Alaska DHSS Division of Public Health Section of Epidemiology |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Laboratories • Southcentral Foundation • Anchorage Health Department |
Action Step 3
| Action | Increased promotion of CDC treatment guidelines regarding partner notification to healthcare providers |
| Measure | # of educational publications targeted to providers to promote increased partner notification. Providers will report on partner notification activities. |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Section of Public Health Nursing • Southcentral Foundation • Military Health Coordinators on Alaska Bases • AK Native Regional Health Corporations • Planned Parenthood of the Great Northwest and Hawaii |
Action Step 4
| Action | Promote national screening standards including Universal Screenings for female adolescents and young adults under 25 years of age which are: • Annual chlamydia and gonorrhea screenings should be done for women under age 25 as well as older women who are at risk. • Screen all pregnant women for HIV, syphilis and Hepatitis B at the first prenatal visit. • Screen all pregnant women under age 25 for chlamydia and gonorrhea and aged 25 and older if at increased risk. |
| Measure | Responses to YRBS Q86: During the past 12 months, have you been tested for a Sexually Transmitted Infections (STI) other than HIV, such as chlamydia or gonorrhea? |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Women’s, Children’s, and Family Health • State of Alaska, Division of Public Health, Section of Public Health Nursing • Alaska Native Tribal Health Consortium, HIV/EIS • Tribal health organizations • Alaska Pediatric Partnership |
Action Step 5
| Action | Increase collaborative efforts between the State of Alaska DHSS Division of Public Health Laboratory and the Department of Corrections on universal screening of people within the corrections system for HIV, Hepatitis, and STIs. |
| Measure | Increased testing from Department of Corrections through the State of Alaska DHSS Division of Public Health Laboratory as reported by the laboratory to the Section of Epidemiology. |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Section of Women’s Children Family Health • Alaska Native Tribal Health Consortium, HIV/EIS • Tribal Health Organizations • State of Alaska, Department of Corrections |
Strategy 2: Increase CDC recommended treatment regimens of gonorrhea cases
CDC updates guidelines after consultation with a group of professionals knowledgeable in the field. Last meeting 2013 for the 2015 guidelines.
Sources:
Action Step 1
| Action | Decrease the time from laboratory confirmed diagnosis to treatment to five days or less. |
| Measure | Time from diagnosis to treatment over a 12 month period. |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Section of Public Health Nursing • Military Health Coordinator on Alaska Bases • Alaska Native Health Corporations • UAA Student Health and Counseling Center |
Action Step 2
| Action | Increased promotion of CDC treatment guidelines regarding partner notification to healthcare providers |
| Measure | Number of publications and training events conducted related to partner notification guidelines and best practices |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Section of Public Health Nursing • Military Health Coordinators on Alaska Bases • Alaska Native Health Corporations • Private providers • UAA Student Health and Counseling Center |
Action Step 3
| Action | Promote expedited partner therapy among providers to reduce incidence. |
| Measure | Publications produced, training events conducted as reported by partner program records |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Epidemiology • State of Alaska, Division of Public Health, Section of Public Health Nursing • Military • Alaska Native Health Corporations • Private providers |
Strategy 3: Promote prevention methods of gonorrhea
To engage innovative strategies which could modify health outcomes in the era of competing demands on public health funding. Ensuring the interventions, to reduce the incidence of Gonorrhea and other STIs, utilize a broad lens with a long-view perspective of how where people live, learn, work, and play, affects health. To change our current trajectory of continued increasing STI rates, moving upstream to address factors that contribute to the risks. A persons’ decision on lifestyle choices are complex and multifaceted. Improving protective factors and addressing risk factors are dynamic as well and have the capacity to affect multiple health outcomes across the lifespan.
Sources:
- https://health.gov/news/blog/2018/08/clinical-prevention-and-population-health-in-health-professions-education-tackling-the-social-determinants-of-health/
- https://www.cdc.gov/std/health-disparities/cars-toolkit.pdf
- https://www.naccho.org/uploads/downloadable-resources/09-10-Sexually-Transmitted-Infections.pdf
- http://www.commissiononhealth.org/WhatDrivesHealth.aspx
- https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/adolescent-sexual-health/Pages/STI-Screening-Guidelines.aspx
- http://www.strengthbasedstrategies.org/
- http://epibulletins.dhss.alaska.gov/Document/Display?DocumentId=2023
Action Step 1
| Action | Promote comprehensive sexual health education including the normalization of STI prevention, condom use, STI testing, treatment and partner communication. |
| Measure | School Health Profiles Report: • Percentage of schools in which teachers taught the following sexual health topics in a required course for students in any of grades 6, 7, or 8 during the current school year AND • Percentage of schools in which teachers taught the following sexual health topics in a required course for students in any of grades 9, 10, 11, or 12 during the current school year: -How to create and sustain healthy and respectful relationships -How HIV and other STIs are transmitted -Health consequences of HIV, other STIs, and pregnancy -How to access valid and reliable health information, products, and services related to HIV, other STIs, and pregnancy -Communication and negotiation skills related to eliminating or reducing risk for HIV, other STIs, and pregnancy -Goal-setting and decision-making skills related to eliminating or reducing risk for HIV, other STIs, and pregnancy -The importance of using condoms consistently and correctly -How to obtain condoms -How to correctly use a condom (practice) -The importance of using a condom at the same time as another form of contraception to prevent both STIs and pregnancy -The importance of limiting the number of sexual partners -Preventive care (such as screenings and immunizations) that is necessary to maintain reproductive and sexual health |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion • Alaska Native Tribal Health Consortium • Planned Parenthood • Additional non-traditional partners • Alaska Public Health Association • UAA Student Health and Counseling Center |
Action Step 2
| Action | Increase Protective factors amongst all youth. • Positive connection to other positive adults, Social/emotional competence and self-regulation skills, • Positive school climate and school connectedness, Engaged in afterschool programs and positive meaningful activities. |
| Measure | Supportive Adults (YRBS Q93) Besides your parents, how many adults would you feel comfortable seeking help from if you had an important question affecting your life School Climate and Connectedness survey Caring adults and Social and Emotional Learning broken down from grades 3-5 and 6-12. Value in looking at both ages. |
| Timeframe | 2020-2030 |
| Key Partners | • State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion • Alaska Association of School Boards Initiative for Community Engagement • Department of Education and Early Development • State of Alaska, Division of Public Health (See Objective 17 List) |
| Previous Priority Health Topic: Healthy Weight | …………………………………………… | Next Priority Health Topic: Injury Prevention |
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