Category Archives: immunization and infectious disease

From the Field: Strategies to Increase Hepatitis C Screening and Linkage to Care through SSPs

By Nicole Miller, MSN, RN; Lela Riherd, BSN, RN, CIC; Zac Doobovsky, BSN, RN, CIC; and Harp Cheema, BSN, RN, Whatcom County Health Department (WA)

This post originally ran in NACCHO’s Healthy People, Healthy Places Blog.

The Centers for Disease Control and Prevention (CDC) estimates nearly 2.4 million Americans are living with the hepatitis C virus (HCV), with transmission via injection drug use being the most common mode of HCV acquisition. In Washington State, there has been a 126% increase in newly acquired HCV infections between 2013 and 2017 that is linked to the opioid crisis. In 2018, Whatcom County had approximately 13 acute HCV cases and 306 chronic HCV cases, an increase from 4 acute and 241 chronic in 2017. On July 26, 2019, in response to these increasing numbers, Washington Governor Jay Inslee launched the Hep C Free Washington Plan to Eliminate Hepatitis C in Washington State by 2030, expanding upon a 2018 proclamation calling for a coordinated strategy between state and local public health agencies, tribal governments, and other partners to eliminate hepatitis C.

Expanding prevention and screening services and increasing access to treatment are critical to Washington’s efforts to eliminate hepatitis C, yet many barriers exist for people who inject drugs (PWID) when trying to access care and needed services. Opioid misuse is a complex issue that requires a multifaceted, collaborative approach across disciplines and agencies. The Whatcom County Health Department (WCHD) is working to expand its Syringe Services Program (SSP) and Adult Health Clinic services to address the hepatitis C challenges. By expanding our services, we hope to provide our clients with the resources they need to make informed decisions regarding their health and to encourage testing and treatment for people who are living with hepatitis C.

Syringe Services Program

SSPs are shown to be safe, effective, and play an important role in reducing the transmission of viral hepatitis and other infections. The WCHD SSP is a community-based prevention program that can provide a range of services, including access to clean syringes, safe disposal of syringes, testing for infectious diseases, and linkage to treatment services. Hepatitis A and B vaccines are also available.

The WCHD started its SSP to combat the disease transmission of HCV, HIV, and other infectious diseases among PWID. The number of participants served has increased fourfold since 2009, from 219 unique participants to 881 in 2018.

Participants in our SSP reported stigma as the most common reason for avoiding medical care. We work towards a no-judgment approach to help build a trusting relationship with our clients, which is crucial in the participant’s road to change and healthy outcomes.

The increasing number of unique participants has forced our SSP to change what we ask our clients, how we test, when we test, clinic flow, and how we provide follow up services and referrals. We made changes to our dialogue with clients to facilitate a more engaging conversation and achieve a positive rapport. Our clinic flow is set up to create a safe comfortable space that allows for point of care testing in all of our exchange rooms. Clients often reported time restrictions as a barrier to testing and this change has helped us to provide testing and results in a more timely manner to meet client needs.

A standing order was approved to draw confirmatory HCV RNA testing for any of our clients that are reactive for the point of care HCV antibody test or who have received a reactive test with us in the past with no additional follow up or linkage to care. By providing confirmatory testing we can help clients document chronic HCV and initiate treatment sooner. Clients are more likely to be compliant with care if services can be provided in one centralized location.

SSPs are a tool that can help reduce transmission of viral hepatitis and other infections as well as serve as a bridge to other healthcare or treatment services. Program participants have reported that our services decrease needle reuse and sharing. This in turn helps to reduce disease transmission in our community.

Linkage to Care

Follow-up testing and linkage to care is essential for clients with a new diagnosis, but understanding the next steps for follow-up can be challenging. Our SSP program staff met with a local community health clinic about the potential to expedite referrals that screen reactive to HCV at our SSP. We worked on creating a process that ensured the appropriate testing and linkage to care happened in a timely manner. The community health clinic created a flow sheet, standing orders for HCV testing, and signed a Memorandum of Understanding (MOU) for this process. This MOU allows expedited referrals for better client outcomes.

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NACCHO CEO Releases Statement on Ongoing Measles Outbreaks

By Lori Tremmel Freeman, NACCHO CEO

“Yesterday, the Centers for Disease Control and Prevention confirmed there have been 626 individual cases of measles diagnosed across 22 states in the United States since the first of this year. We are on track to have the highest number of measles cases in the United States in 25 years, and for man this disease of the past is becoming a threat of the present.

“626 cases are far too many. These cases are not just numbers—they represent sick children, missed days of work, and an incredible financial strain on our tax dollars that must be pulled away from other public health priorities. Continue reading

How Local Health Departments Protect Families from Vaccine-Preventable Diseases

Q&A with National Association of County and City Health Officials Chief Executive Officer Lori Tremmel Freeman

Measles have reemerged as a public health threat in the United States in 2019. New York and Washington state are facing the worst measles outbreak in a generation, but cases have also been reported in 10 states so far this year. Below, National Association of County and City Health Officials (NACCHO) CEO Lori Tremmel Freeman discusses the importance of vaccines, vaccine hesitancy, and how local health departments work diligently to protect communities from vaccine-preventable diseases including measles. NACCHO represents the nation’s nearly 3,000 local health departments. Continue reading

Preventing HIV Perinatal Transmission and Congenital Syphilis in Broward County Florida

The following Model Practice was submitted by the Florida Department of Health in Broward County. To access this Model Practice and to view the full application, click here. NACCHO is currently accepting applications for the 2018–2019 Model Practices Program until December 12. Learn more and apply today.

Broward County, Florida has a population of approximately 1.9 million people and hosts an estimated 10 million visitors each year. It is a very diverse community with residents from 200 different countries and nearly 130 languages spoken throughout the county. Minorities account for nearly 59.5% of the population, making it a minority/majority county. Continue reading

Implementing Quality Improvement to Address Low Adolescent Vaccination Rates

By Maria Stock, Fairfax County Health Department, VA

This article originally ran in NACCHO’s Stories from the Field.

When the opportunity to join the third cohort of the NIPA Quality Improvement Learning Collaborative arose, the Fairfax County Health Department (FCHD) joined to help address challenges related to adolescent vaccination rates.

A couple years ago, Fairfax County was struggling with low HPV vaccine initiation and completion rates, and the health department was considering how to initiate a quality improvement (QI) project targeting adolescent vaccination. In 2016, we were given the opportunity to join the third cohort of the National Immunization Partnership with the APA (NIPA), a large-scale, QI Learning Collaborative designed to prioritize HPV vaccination at every adolescent visit. Continue reading

Florida Epidemiologists Combating HAIs by Becoming CIC Certified

By Luz Caicedo, MPH, CPH, CIC and Danielle Walden, MPH, Florida Department of Health in Orange County

In 2018, the Florida Department of Health (Department), Health Care-Associated Infections (HAI) Infection Prevention Program, in collaboration with the Florida Department of Health in Orange County (DOH-Orange), established the HAI Certification in Infection Prevention and Control (CIC) Study Group.

The Centers for Disease Control and Prevention (CDC) recently reported that in 2011 there were an estimated 722,000 HAIs in U.S. acute-care hospitals. Approximately 75,000 of those patients with HAIs died during hospitalization. Public health surveillance, prevention and response are key to reducing the number of HAIs in local communities. Currently, health department involvement in HAI prevention is primarily through surveillance of reportable diseases and conditions as well as HAI outbreak response. According to CDC, outbreaks in health care settings are often attributed to failures in infection control practices or contaminated equipment or medications. It is important for public health staff to be knowledgeable in infection prevention and control. One of the key challenges for HAI prevention and response for public health staff is access to education and training on infection control. Based on a recent survey, 10 out of 104 (9.6%) epidemiology public health staff members in the Department hold the CIC credential. This low prevalence illustrates the need to implement a strategy to increase education and training in infection control for public health staff. Continue reading

Influenza Season: Resources and Information for Local Health Departments

This story originally ran in NACCHO’s Preparedness Brief.

Flu season is upon us. The Centers for Disease Control and Prevention (CDC) reports increasing and widespread flu activity across the United States. According to CDC surveillance, influenza-like illness activity is higher than it was during the peak of the 2014-2015 flu season and so far hospitalization rates are similar to that same time period. Continue reading