Resources and Information for National Food Safety Month

meat thermometerLocal health departments (LHDs) are on the front lines of foodborne illness prevention and response. According to the 2013 National Profile of Local Health Departments, 78% of LHDs provide food service establishment inspections and 72% of LHDs provide food safety education in their jurisdictions.

September marks the 20th anniversary of National Food Safety Month (NFSM), an initiative by the National Restaurant Association designed to heighten the importance of food safety education. Each week highlights a different food safety issue—such as cleaning and sanitizing, cross-contamination, and personal hygiene—with educational activities and posters. Visit the NFSM website for more information.

NACCHO and its public health partners have also developed a variety of resources to help LHDs provide food safety services.

The Centers for Disease Control and Prevention (CDC) has released two eLearning tools to assist LHDs in their food safety work. Environmental Assessment of Foodborne Illness Outbreaks is a free interactive course that teaches participants how to (1) investigate foodborne illness outbreaks as part of a larger team; (2) identify the environmental causes of an outbreak; and (3) recommend control measures.

The second CDC tool is the National Voluntary Environmental Assessment Information System, which fosters information-sharing between LHDs to improve response to, and prevention of, future outbreaks. CDC encourages LHDs to register and provide data about their foodborne illness investigations.

NACCHO works with the Food and Drug Administration (FDA) to increase the use of the FDA Voluntary National Retail Food Regulatory Program Standards (Retail Program Standards), a continuous quality improvement and quality assurance program that helps LHDs achieve optimal performance in food safety programs, services, and processes. NACCHO’s Retail Program Standards mentorship program partners LHDs together to implement the Retail Program Standards. Participating LHDs benefit from the experience of other LHDs in best applying the Retail Program Standards to their food protection programs. NACCHO has also collaborated with FDA to develop a crosswalk that outlines the areas of alignment between the Retail Program Standards and the Public Health Accreditation Board’s Standards and Measures.

NACCHO co-chairs the Council to Improve Foodborne Outbreak Response (CIFOR), a multidisciplinary working group that aims to reduce the burden of foodborne illness. The council publishes the CIFOR Guidelines for Foodborne Disease Outbreak Response, which guides LHDs on how to prepare for, detect, investigate, and control a foodborne illness outbreak. Find additional CIFOR resources.

NACCHO also works closely with LHDs through its Food Safety Workgroup and the Food Safety Toolkit. NACCHO staff participate in national initiatives including the Partnership for Food Protection, the National School Safety Coalition, the Food Safety Modernization Act Working Group, and Government Coordinating Council Food and Agriculture Sector.

NACCHO, in collaboration with the National Center for Environmental Health at CDC, selected 12 LHDs to implement innovative programs in food safety within their health departments and communities. The projects focused on infrastructure, marketing, training, and program assessment. Read the report.

For more information, visit NACCHO’s food safety webpage.

Public Health Preparedness in the 21st Century: Local Health Departments’ Role in Global Health Security

September is National Preparedness Month. Visit NACCHO’s Preparedness Brief blog for more local public health preparedness news, tools, and resources.

By Laura Biesiadecki, Director of Strategic Partnerships, Outreach, and Education, Preparedness, NACCHO

“Our vision is a world safe and secure from global health threats posed by infectious diseases—where we can prevent or mitigate the impact of naturally occurring outbreaks and intentional or accidental releases of dangerous pathogens, rapidly detect and transparently report outbreaks when they occur, and employ an interconnected global network that can respond effectively to limit the spread of infectious disease outbreaks in humans and animals, mitigate human suffering and the loss of human life, and reduce economic impact.” –United States Government’s Global Health Security Vision [1]

global-prep-1In February 2014, the United States joined 28 other countries, the World Health Organization, the Food and Agriculture Organization, and the World Organization for Animal Health to commit to goals specified within the Global Health Security Agenda, which contains a vision statement and nine objectives. As part of this commitment, the United States has developed the United States Global Health Security Strategy and pledged to work with at least 30 partner countries to prevent, detect, and effectively respond to infectious disease threats, whether naturally occurring or caused by accidental or intentional releases of dangerous pathogens, over the next five years. The President’s 2015 budget has proposed an additional $45 million to prevent avoidable catastrophes, detect threats early, and mobilize effective responses to contain outbreaks. The funds would also allow for programs to enhance workforce capacity by training field epidemiologists, developing new diagnostic tests, building capacities to detect new pathogens, and building public health emergency management capacity to support outbreak responses.[2] How implementing the Global Health Security Strategy will impact programming and funding for infectious disease preparedness over the next five years at the state and local levels remains to be seen.

In May 2014, Dr. Thomas Frieden, Director of the Centers for Disease Control and Prevention (CDC), participated in the first Global Health Security Commitment Development Meeting in Helsinki, Finland, which was attended by 200 experts from 20 countries. The meeting marked an important opportunity for other countries to commit to accelerating global health security. Fewer than 20 percent of countries report that they are adequately prepared to effectively detect, respond to, or prevent global health threats caused by emerging diseases.[3] To address this issue, the CDC is combining resources and expertise with the Defense Threat Reduction Agency of the Department of Defense (DOD) to support demonstration projects in developing countries. In 2013, the CDC worked successfully with the Uganda Ministry of Health to implement upgrades in three areas: (1) strengthening the public health laboratory system by increasing the capacity of diagnostic and specimen referral networks; (2) enhancing the existing communications and information systems for outbreak response; and (3) developing a public health emergency operations center. In 2014, the CDC and DOD will commit $40 million to expand the list of demonstration site countries to include Ethiopia, Georgia, India, Jordan, Kazakhstan, Kenya, Philippines, South Africa, Tanzania, and Thailand.[4]

Over the past 12 years, catastrophic events such as 9/11, Hurricane Katrina, and the H1N1 influenza outbreak have led to large infusions of federal funding to state and local governments. However, such funding has been spent historically on disaster relief,[5] and funds are traditionally allocated categorically in response to events rather than sustained and directed to maintaining readiness. During the response and recovery phases of events, local health departments (LHDs) will increase programs and workforce but will eventually have to reduce staff and programming as funds are reduced. This cyclical response focused funding cycle creates inefficiencies and challenges in all levels of government and costs more than if the investment had been made in preparedness activities up front, leaving communities scrambling to respond to the next event.[6]

With public health preparedness funding and jobs shrinking, communities are vulnerable to emerging threats. From FY2012 to FY2013, the Department of Health and Human Services (HHS) cut $35 million from Public Health Emergency Preparedness funding and $20 million from the Hospital Preparedness Program.[7, 8] In January of FY2015, President Obama signed into law a federal spending bill that included a cut of over $100 million to the HHS Hospital Preparedness Program. That equals nearly a 30-percent reduction in a program specifically aimed at strengthening healthcare preparedness for public health emergencies. These cuts could have severe and dire consequences on the ability of communities to respond when disaster strikes. As indicated in the National Association of County and City Health Officials’ 2010 National Profile of Local Health Departments (Profile) report, 59 percent of LHDs relied solely on federal funding for public health preparedness. The 2013 Profile report shows that 23 percent of LHDs reduced or eliminated at least one emergency preparedness program in 2011, and the trend continued in 2012 with a 15-percent reduction.

As funding concerns persist, LHDs’ responsibility to remain vigilant to threats remains constant. Not only must LHDs be watchful of global health infectious disease threats, they must also acknowledge and plan for emerging threats both natural and manmade. Two examples of emerging threats related to global health security that may involve LHDs are cyber attacks on healthcare facilities and health threats that result from climate change.

Cyber Attacks

global-prep-2A cyber attack on a healthcare facility could disrupt the facility’s capacity to manage patients, prevent the facility from managing routine care, and impede the facility from handling patient surge during catastrophic events. Cyber attacks could result in identity theft or loss of patient information should personal data be exposed. Patients and practitioners might lose confidence in a healthcare provider’s ability to maintain patient privacy. System outages might disrupt care.[9]

Current policy falls short of protecting the health sector from cyber threats. To foster the improvements of the healthcare delivery system, federal guidance to state and local health departments has promoted the adoption of technology in healthcare facilities. From the executive level, President Obama issued Presidential Policy Directive (PPD) 21 and Executive Order (EO) 13636: Improving Critical Infrastructure Cybersecurity, emphasizing the need for holistic thinking about critical infrastructure security and risk management. Those directives and executive orders will drive action toward critical infrastructure systems—including healthcare—to improve network security. Additionally, those policies will help promote and incentivize the adoption of cyber security practices, increase cyber threat information-sharing, evaluate and mature public-private partnerships, and demonstrate the cascading consequences of infrastructure failures. With the release of PPD 21 and EO 13636 and their subsequent implementation, federal agencies responsible for managing preparedness funds should prioritize improving security of healthcare information systems, strengthening public-private partnerships vital to healthcare cyber security and resiliency, and adopting standards and frameworks for information-sharing and security.

Climate Change-Related Health Threats

global-prep-3The health threats that result from climate change will be inherently local, and LHDs may be best equipped to protect their communities from these threats. Such threats may include extreme weather events, wildfires, decreased air quality, threats to mental health, and illnesses transmitted by food, water, and disease carriers such as mosquitoes and ticks.[10] LHDs play an important role in preventing and preparing for the impacts of climate change. LHDs inform local policy and implement strategies to face the illnesses and potential deaths related to environmental exposure as a result of increased severe weather events, drought, and temperatures associated with climate change. The health impacts of climate change will vary community by community. LHDs can help forecast the health impacts in a region, county, or city and help community organizations, healthcare providers, and other stakeholders work to prevent the impacts of climate change and prepare for and address the impacts already occurring.

Cybersecurity and environment and global climate change are just two examples of evolving issues of concern for global and domestic health security. During the 2015 Preparedness Summit on April 14–17, preparedness professionals from across the nation and globe will meet in Atlanta to discuss the evolving vision for global health security and emerging issues that threaten community safety.

This article was originally published in NACCHO Exchange. To read the entire issue, download the newsletter from NACCHO’s online bookstore (login required).

House Minority Whip Hoyer Visits Calvert County Health Department

By Laurence Polsky, MD, MPH, FACOG, Health Officer, Calvert County (MD) Health Department

On Aug. 25, House Minority Whip Steny Hoyer (D-MD) and several of his staff joined health officers Meena Brewster (St. Mary’s County, MD), Dianna Abney (Charles County, MD), and me at the Calvert County Health Department. For an hour and a half, we discussed issues affecting public health in our southern Maryland communities. Congressman Hoyer is second in the Democratic leadership in the House of Representatives, behind House Minority Leader Nancy Pelosi (D-CA).

We talked to Congressman Hoyer about the challenges local health departments face in light of post-recession and sequester budget cuts, how local health departments are adjusting to the Affordable Care Act (ACA), and actions we have taken to help stem opiate addiction in his district.

Dr. Abney spoke about difficulties providing accessible healthcare to underserved areas of Charles County and the work her department is doing to help these residents. Dr. Brewster spoke about the 10 essential services of public health and how budget issues and the loss of the Community Transformation Grant have impacted her health department. All three of us also discussed our concern that budget cuts have diminished our disaster response capabilities.

Calvert County has struggled with a 50% increase in transportation costs for Medicaid enrollees since the launch of the ACA. This served as an entry point to talk about the unforeseen sequelae of the new healthcare law and the strain it puts on safety net providers.

We ended on a bright note, underscoring the unique position that local health departments play in community health. In response to the impact that substance abuse has had on our region and the resource limitations we have in our rural jurisdiction, Calvert County Health Department has launched a program aimed at pregnant woman struggling with addiction. Our Healthy Beginnings program illustrates the potential for a local health department to bring together traditionally isolated private and public resources. In coordination with local obstetricians, the program brings together substance abuse and mental health counseling; social services; the Special Supplemental Nutrition Program for Women, Infants, and Children program; smoking cessation classes; expanded transportation help; coordination with prenatal care; enrollment in ACA plans; and case management all under one roof.

We are indebted to NACCHO’s Government Affairs staff for helping to arrange the visit by Congressman Hoyer as part of an effort to educate Members of Congress about the health challenges faced by local health departments as we try to improve the health and safety of our residents.

I encourage all my colleagues at local health departments to pursue opportunities to invite Members of Congress and their staff to visit you and learn about what you do. This was an invaluable opportunity to raise our visibility and make sure that when decisions are made in Washington, our elected representative has a picture of how those decisions will affect our community.

NACCHO has resources to help you and make it easy to navigate setting up a visit. Learn more in NACCHO’s Legislative Action Center or contact Eli Briggs, NACCHO’s Government Affairs Director.

Chicago Health Commissioner Describes How Community Engagement Helped Advance Rigorous Tobacco Control Policies

cigarette1Interview by Ian Goldstein, Web and New Media Specialist, NACCHO

NACCHO honored the exceptional achievements of local health departments (LHDs) and local health officials at the 2014 NACCHO Annual Conference, held July 8–10 in Atlanta. NACCHO’s LHD of the Year Award recognizes and honors outstanding accomplishment of LHDs across the country for their innovation, creativity, and impact on communities. The following winners were categorized by size of jurisdiction and recognized for accomplishments in outstanding internal and external policy: Small Jurisdiction: Macon County Public Health Center (Franklin, NC); Medium Jurisdiction: Whatcom County Health Department (Bellingham, WA); and Large Jurisdiction: Chicago Department of Public Health (Chicago, IL).

The following is an excerpt from a recent NACCHO podcast featuring an interview with Chicago Department of Public Health Commissioner Dr. Bechara Choucair, who spoke about his health department’s winning tobacco control policies.

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NACCHO: What made you and your colleagues decide to apply for the LHD of the Year Award?

Choucair: Well, this past year has been a remarkable time for the Chicago Department of Public Health in tobacco control for the City of Chicago and together with all of our partners. Because of all of the work that has happened over the last year, we wanted to share the work that we’ve done with other health departments and we’re really honored and humbled to receive the Local Health Department of the Year Award.

NACCHO: Your LHD was able to implement a number of tobacco control policies. 

Choucair: A lot of tobacco policies that we’ve advanced this year in Chicago have been really cutting-edge work. In November, for example, we passed a new tobacco tax. Now we have the highest combined local, state, and federal tobacco tax in the nation and we know this is a life-saving measure. Today,  every pack of cigarettes in Chicago is taxed $7.17 in combined taxes. [The most recent measure] added 50 cents.

We’ve also passed a flavored tobacco ordinance that […] restricts the sale of tobacco including menthol within 500 feet of schools, which makes us the first and only jurisdiction in the country to restrict the sale of menthol cigarettes around schools. Also, just recently we passed an ordinance that regulates e-cigarettes just like regular tobacco products, which also makes us one of the very first big cities in the country to advance that type of ordinance.

NACCHO: What were the challenges to implementing these policies, especially with something like menthol cigarettes, which have been around for so long?

Choucair: Mayor Emmanuel asked us to engage the community in trying to identify what we could do about menthol cigarettes. What the board of health in Chicago did was host a series of town hall meetings to engage the community to see what kind of policy suggestions or intervention suggestions they had to address menthol cigarettes.

We know that menthol cigarettes are proven “starter products” for youth. We know that over 70% of black kids who smoke smoke menthol cigarettes. We know that over 70% of LGBT youth who smoke smoke menthol cigarettes. Over half of Hispanic kids who smoke smoke menthol cigarettes. Honestly, Big Tobacco is targeting our minority communities with menthol cigarettes with specific marketing and by lowering prices in African-American communities to get people addicted to this deadly product.

So by engaging the community, by engaging an amazing group of partners in Chicago and nationally, including the African-American Tobacco Control Leadership Council,  we were able to advance this ordinance that restricts the sale of flavored tobacco, including menthol cigarettes, within 500 feet of schools.

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Listen to the rest of the interview with Dr. Choucair about his community’s response to the ordinance and his advice to other LHDs that are looking to implement similar policies (start at the 3:55 mark) at http://bit.ly/1ttbj1O.

Interested in listening to more of NACCHO’s podcasts? NACCHO’s podcast series is now available for subscription on iTunes. If you have iTunes or an iPhone, download the podcast app and search “NACCHO.” Once you subscribe, the latest NACCHO Podcasts will automatically download to your phone. You can also subscribe with the following link: http://bit.ly/1zd6xrI.

PHAB Version 1.5: New Resources for Local Health Departments

By Lowrie Ward, Program Analyst, NACCHO

This summer, the Public Health Accreditation Board (PHAB) began accepting applications for its voluntary national accreditation program under Standards and Measures Version 1.5. According to PHAB, this updated version of its standards and measures clarifies the wording of requirements, stipulates the number of examples that are required for each measure, and specifies the time frame for each measure. Additionally, PHAB included a limited number of noteworthy public health issues that are emerging as important forces in the advancement of public health. Information about these changes is available at www.phaboard.org.

The changes have received praise from many in the field, with many local health departments (LHDs) indicating that the clarifications, revisions, and additions are valuable. Laurie Dietsch, Accreditation Coordinator at Columbus Public Health (accredited March 2014), thinks the changes are “PHABulous” and notes that PHAB “listened to the feedback from health departments that have gone through the process and made changes to clear up confusing areas.” She thinks that these changes “make version 1.5 a true reflection of quality improvement, which is what accreditation is all about.”

April Harris, Accreditation Coordinator at the Three Rivers District Health Department in Kentucky (accredited February 2013), has similar feelings. As a representative of an accredited agency, she is “thrilled that PHAB is demonstrating a willingness to consistently improve.” Alan Kalos, Accreditation Coordinator at the Northern Kentucky Health Department (accredited February 2013), says that “aside from more clearly identifying the purpose and types of documents required, the most helpful aspect of [Version] 1.5 is the redesigned format. The new format clearly indicates the time frame and the number of examples required. This makes preparing to meet the requirement and developing a timeline for needed processes much easier.”

As a part of NACCHO’s ongoing efforts to support LHDs as they prepare for accreditation, NACCHO has updated several resources to reflect the changes to the standards and measures:

  • In NACCHO’s Example Documentation Library, which is a collection of documentation that LHDs plan to submit to PHAB, NACCHO has removed examples that no longer meet Version 1.5 Throughout the summer, more examples will be added that conform specifically to Version 1.5.
  • NACCHO also updated its Documentation Selection Tools. These are resources that help accreditation coordinators and teams collect and organize documentation in ways other than measure by measure. For example, one popular tool is the programmatic documentation matrix. This includes a list of all PHAB measures that can be met with documentation from a program area. Teams can use this matrix to select documentation and make sure that their submissions reflect the “breadth and depth of programming at the health department,” as PHAB requires. This tool and others have been redone so that they are in alignment with Version 1.5

    Both the Example Documentation Library and the Documentation Selection Tools can be accessed from www.naccho.org/documentation.

  • NACCHO has also updated the Developing a Local Health Department Strategic Plan: A How-To Guide. This guide provides a framework for LHDs to use as they conduct the process that creates an agency strategic plan, a PHAB prerequisite. While the entire guide hasn’t been recreated, it contains an addendum document that indicates where revisions and updates are necessary.

    This guide and other strategic plan resources are available at www.naccho.org/prerequisites.

  • The Accreditation Support Initiative (ASI) from NACCHO and the Centers for Disease Control and Prevention funds LHDs around the country as they prepare for national accreditation. The ASI website (www.naccho.org/asi), which includes documentation and other valuable resources, has been updated to reflect the recipients of last year’s awards—many of which are applying under Version 1.5.

You may still find some NACCHO resources that have not been adjusted to reflect the changes in Version 1.5. Please let us know at accreditprep@naccho.org if you find something that you believe should be updated.

NACCHO staff are available as a technical assistance resource for all areas of accreditation preparation. PHAB provides guidance related to the technical aspects of the accreditation process and interpretation of the standards and measures, while NACCHO and other partners can help organizations as they prepare to meet the requirements of the standards and measures. NACCHO staff can review documentation and provide feedback based on our interpretation of the PHAB requirements. Additionally, we are also happy to connect LHD staff with peers from around the country doing similar work in their communities. If you are interested in technical assistance, visit www.naccho.org/accreditation or e-mail accreditprep@naccho.org.

Stories from the Field: Using a Low-Powered Radio Station to Bolster Preparedness Efforts

The following story was submitted to NACCHO’s Stories from the Field website by Robert Cohen from Maine Township (IL) Regional Medical Reserve Corp on July 3. NACCHO’s Stories from the Field website provides a means for local health departments (LHDs) to share their experiences and demonstrate the value of public health. Stories from the Field can be used to support advocacy, peer learning, and collaboration with state and federal partners. Share your story at http://nacchostories.org.

Throughout the country, there are hundreds of small, low-powered radio stations that provide information about an area’s attractions, special road conditions, fire hazards, and so much more. These little gems can be of significant use during public health emergencies or area disasters.

During public health and safety emergencies, a low-powered portable emergency advisory radio station can directly reach citizens via standard radio receivers. It can be a lifesaver, allowing the broadcast of critical instructions and information regarding disasters/evacuations, medical emergencies (hospital surge, points-of-distribution field information, quarantine isolation, decontamination), terrorist/shooter incidents, HAZMAT and traffic information, and critical public safety instructions. Low-powered broadcasts may be received on standard vehicle radios or portable radios over a three- to five-mile range (25­–75 square miles). Systems today are so advanced that several can be linked together for greater coverage.

Low-powered AM radio stations can provide an additional tool during non-emergency times for broadcasting helpful public health information, developing community awareness for your programs, and also as a recruiting tool that does not have to be paid for each time it is utilized. The system we have can be run from a fixed location as we do most of the time or can be loaded into the back of a car and taken anywhere in our area and setup to broadcast pertinent information regarding a public health emergency or disaster related information. Portability also makes a low-powered radio station especially useful at large public gatherings for broadcasting key information, such as schedules, traffic, parking, safety, and critical instructions for patrons approaching or exiting.

Messaging can be controlled using flash drives [...] and may also be uploaded via ethernet from a network or a laptop computer. If you need to “break in” to your messaging, you may do so live with a microphone. When you lose power in your area due to storm damage, you can still broadcast by connecting your unit to a generator.

Getting the word out to hundreds or thousands of residents on an ongoing basis can be a costly venture. Having your own low-powered AM radio station and some strategically placed signage telling people how to access your station can accomplish community outreach by continuously broadcasting your message with all of the pertinent information. We broadcast information regarding West Nile Virus, whenever there is a food recall in our area, storm-related information, flooding information, location of mass care or shelter facilities, and general community events information. Just think about an available 24/7 recruiting drive for your medical reserve corps or other programs. Look at what you might accomplish if thousands of people knew about a blood drive. Consider all of the information you could get out regarding point-of-distribution sites.

Since the inception of our station, we have increased volunteer enrollment in three of our programs. When flooding was a potential threat, those in prone areas were grateful for the extra warning we were able to give them. Our community events have been better attended as well. Most importantly, when we had to shut down our radio to change our antenna location, we got phone calls wondering what happened and why was our station off the air. This told us that our residents have embraced the system.

We found that instead of solely relying on public resources of newsprint and general radio, we are able to communicate specifically what we need to in order to keep our residents officially informed. By utilizing your own radio station, you are not limited to [whatever] time space a local television station may have to give you to get a condensed message out. Further, by having your own low-powered station, you can keep your message out there 24/7 for as long as needed, for mere pennies of electricity use.

Read more LHD stories from the field at http://nacchostories.org.

Seasonal Influenza Vaccinations for Pregnant Women, Children with Special Healthcare Needs, and Adults with Disabilities: LHD Capacity and Recommendations for the Future

Vaccine shotBy Charlene Kemmerer, PMP, Program Analyst, NACCHO, and Lindsay Tiffany, Communications Specialist, NACCHO

While flu season might seem a long way off, NACCHO recently released a research brief summarizing individual key informant interviews it conducted earlier this year about the capacity of local health departments (LHDs) to promote and administer seasonal flu vaccine and track vaccination rates among children with special healthcare needs (CSHCN), pregnant women, and adults with disabilities.

NACCHO recruited LHD staff involved in vaccine surveillance, promotion, or administration through its infectious disease prevention and control, immunization, and disability electronic mailing lists, which consist of people who self-select to receive updates from NACCHO. NACCHO selected participants based on their region, position title, and number of years on the job. Nine individuals from a group of 24 candidates participated; these LHDs were located in eight states and oversaw jurisdictions ranging in population size from 19,000 to 1.5 million residents. NACCHO transcribed and analyzed recordings from the key informant interviews to identify common themes. Results of the interviews are summarized below.

Collecting Data on Seasonal Flu Vaccination Rates for Pregnant Women, CSHCN, and Adults with Disabilities

None of the LHDs interviewed collected community-wide data on seasonal flu vaccination rates for pregnant women, CSHCN, or adults with disabilities. LHDs reported that they did not have the infrastructure or staff capacity to track community-wide flu vaccination rates. Additionally, people can receive a flu vaccination in many locations (e.g., pharmacies and private physicians’ offices) and providers may not be required to report this information.

Administering Vaccinations

Several LHDs indicated that they vaccinated pregnant women, CSHCN, and adults with disabilities for flu as part of larger efforts to vaccinate the community through school-based clinics, health fairs, and public clinics.

LHDs identified reimbursement as one challenge to vaccinating pregnant women, CSHCN, and adults with disabilities. LHDs indicated that reimbursement issues (including reimbursement for staff time) compounded the management challenges of providing vaccinations.

Promoting Vaccinations

LHDs used various strategies to promote flu vaccinations among pregnant women, CSHCN, and adults with disabilities. LHDs reported posting fliers about flu clinic dates and times at local businesses. Others used a healthcare provider or school newsletter to promote flu vaccinations. LHDs also used newspaper, radio, and television advertisements to promote flu vaccinations. LHDs indicated that vaccine misconceptions often hindered their promotion efforts.

Many LHDs said that they used Facebook or Twitter to promote flu vaccinations, and two LHDs noted that texting services could provide effective flu vaccination reminders.

Partnerships

When asked to name the most valuable partner that LHDs could engage to increase the number of flu vaccinations for pregnant women, CSHCN, and adults with disabilities, participants consistently named physicians. LHDs also mentioned working with managed care providers, federally qualified health centers, pharmacists, and schools. Sometimes LHDs in different jurisdictions worked together to promote and administer flu vaccinations.

Recommendations

Based on the findings of this research, NACCHO recommends the following:

  • LHDs should collaborate with community-based organizations and community stakeholders (e.g., businesses, employers) to increase the coordination of resources and programs to improve the health of people with disabilities.
  • LHDs should leverage existing programs for pregnant women, CSHCN, and adults with disabilities to promote and provide flu vaccinations.
  • LHDs should ensure that any flu vaccination campaigns are accessible by people with sensory disabilities through the use of accommodations like Braille/large print, American Sign Language, and closed captioning.
  • The federal government should maintain funding to state and local health departments for immunization programs, including funding for the Vaccines for Children Program.
  • The federal government should support an interoperable system allowing for information exchange between state- and local-level immunization registries and between all pertinent local users.
  • The federal government should fund activities necessary for state and local health departments to establish third-party billing systems.

To read the full-length research brief, Capacity of Local Health Departments to Track, Administer, and Promote Seasonal Influenza Vaccinations for Pregnant Women, Children with Special Healthcare Needs, and Adults with Disabilities, visit the NACCHO Bookstore.

Need information on billing for clinical services? NACCHO’s Billing for Clinical Services Toolkit was designed to help make navigating the billing process easier for LHDs. It contains resources from state billing guides, the Centers for Medicare and Medicaid Services, state health departments, local health departments, insurance companies, and vendors of products such as electronic medical records and billing clearinghouses.