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Priority Health Topic: Infectious Disease


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

ActionThe 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.
MeasureNumber of providers who request that the Immunization Program conduct reminder/recall on their behalf.
Timeframe2020-2030
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

ActionEvaluate 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.
MeasureReminder/Recall Success Report developed by State of Alaska, Division of Public Health, Section of Epidemiology
Timeframe2020-2030
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

ActionAssess data quality of the VacTrAK system of the State of Alaska, Division of Public Health Section of Epidemiology, Immunization Program.
Measure2020 and 2021 Immunization Information System Annual Report (IISAR) developed by State of Alaska, Division of Public Health, Section of Epidemiology
Timeframe2020-2022
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

ActionEnsure 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.
MeasureReport on % of providers receiving VFC vaccines participating in IQIP visits
Timeframe2020-2030
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

ActionPer 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.
MeasureNumber of patient visits during which the provider schedules the next immunization visit before the patient leaves the office
Timeframe2020-2030
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

ActionSupporting 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
Timeframe2020-2030
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

ActionBuild 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.
Timeframe2020-2022
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: http://www.epi.alaska.gov/hivstd/history.htm).

Routinely collecting specimens for testing, using HER 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

ActionIncrease extra genital testing in Alaska
MeasureUse State Public Health Lab (SPHL) data to measure extra-genital specimens submitted to the lab annually.
Timeframe2020-2030
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 I Want to Know (IWTK) Program
• UAA Student Health and Counseling Center
• State of Alaska, Division of Public Health, Laboratories

Action Step 2

ActionTest for gonorrhea resistance – Gonococcal Isolate Surveillance Project (GISP)
MeasureGISP 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
Timeframe2020-2030
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

ActionIncreased 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.
Timeframe2020-2030
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

ActionPromote 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.
MeasureResponses 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?
Timeframe2020-2030
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

ActionIncrease 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.
MeasureIncreased 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.
Timeframe2020-2030
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:
https://www.cdc.gov/std/tg2015/default.htm

Action Step 1

ActionDecrease the time from laboratory confirmed diagnosis to treatment to five days or less.
MeasureTime from diagnosis to treatment over a 12 month period.
Timeframe2020-2030
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

ActionIncreased promotion of CDC treatment guidelines regarding partner notification to healthcare providers
MeasureNumber of publications and training events conducted related to partner notification guidelines and best practices
Timeframe2020-2030
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

ActionPromote expedited partner therapy among providers to reduce incidence.
MeasurePublications produced, training events conducted as reported by partner program records
Timeframe2020-2030
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

ActionPromote comprehensive sexual health education including the normalization of STI prevention, condom use, STI testing, treatment and partner communication.
MeasureSchool 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
Timeframe2020-2030
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

ActionIncrease 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.
MeasureSupportive 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.
Timeframe2020-2030
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)

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HA2030 Co-Chairs

Lisa McGuire, MPH


Public Health Performance Improvement Manager
State of Alaska
Department of Health and Social Services
Division of Public Health
lisa.mcguire@alaska.gov

Cheryl Dalena

Tobacco Prevention Program Coordinator
Alaska Native Tribal Health Consortium
Division of Community Health Services
cadalena@anthc.org

Contact HA2030

Email: healthyalaskans@alaska.gov

© Healthy Alaskans 2020