NEW APIC Public Health Update

1. NEW APIC Public Health Update September, 2009

2. Public Health Update • Data • HAI grant • H1N1 • HAI legislation • HCW influenza vaccination results • Bureau briefs

3. Number of persons reported with HIV infectionby year of report, Wisconsin, 1990-2008 1998-2008: Average cases per year = 384 95% confidence interval: 338-430 cases per year 2008 = 391 cases total deaths = 3718

4. 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

5. Five reportable STDs • (Chlamydia) Chlamydia trachomatis • (Syphilis) Treponema Pallidum • (Gonorrhea) Neisseria gonorrhea • (Chancroid) Haemophilus ducreyi • (PID) Pelvic Inflammatory Disease • Two most common are______ and ____

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

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

8. Tuberculosis • WI cases by county http://dhs.wisconsin.gov/tb/statistics/DocsStatistics/TB2002_2008.pdf • 2008: • Brown = 3 cases • Manitowoc = 1 case • Sheboygan = 3 cases • 68 new cases in WI in 2008 • Rate = 12 per million population

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

10. HAI Prevention Grant • For state health departments to build and sustain HAI surveillance and prevention programs • Supplemental grant using ARRA funds • Three activities • Development of HAI prevention plan • Surveillance • Creation of prevention collaboratives

11. HAI Prevention Grant • Five year plan-three tiers • 1 = general acute and critical access hospitals • 2 = ambulatory surgery centers • 3 = nursing homes

12. HAI Prevention Grant • Targeted HAIs • CLABSI • C. difficile • CAUTI • MRSA • SSI • VAP

13. HAI Prevention Grant • Three new positions • Plan coordinator (program/policy manager) • Surveillance coordinator (epi-adv) • Prevention coordinator (PH educator)

14. Wisconsin Healthcare Infections Multidisciplinary Advisory Committee

15. H1N1 • Epidemiology • Infection control • Surveillance • Vaccination

16. H1N1 • Surveillance • Syndromic • Hospital-based • Laboratory • Reportable: • Hospitalized patients—case report form and 5 page supplemental form • Deaths

17. H1N1 • Vaccination • Pregnant women • Contacts of children less than 6 months • HCP and EMS with direct patient contact • 6 mo-24 years (4 years) • 25-64 years with health conditions (5-18) ___priority within priority groups

18. National Legislation HR3104 HAI Reporting Act was introduced June 26 and referred to the House Energy and Commerce Committee. The bill would require hospitals (including critical access hospitals) and ambulatory surgery centers to report each HAI to the NHSN, would require public posting for comparison of HAI incidence, and would require reporting of number of infection preventionists in each facility.

19. National Legislation HR2937 and S1305 MRSA Infection Prevention and Patient Protection Act was introduced June 18 and referred to the Committee on Health, Education, Labor and Pensions. This bill requires hospitals to report HA MRSA cases and implement incremental screening of patients for MRSA, starting with ICU patients.

20. National Legislation S1299 Worker Infection Prevention Act introduced June 18 and referred to Committee on Health, Education, Labor and Pensions. The bill would direct the Secretaries of Labor and HHS to jointly develop and issue workplace standards, recommendations, and plans to protect healthcare workers and first responders, police, firefighters, emergency medical personnel, and other workers as risk of workplace exposure to infectious agents and drug resistant infections such as MRSA.

21. HCW Influenza Vaccination 2008-09-Hospitals

22. HCW Influenza Vaccination 2008-09-Hospitals • 38 hospitals (27%) achieved 80% rate compared to 35 last year • *70% used declination forms • *88% offered at multiple locations *statistically significant

23. HCW Influenza Vaccination 2008-09-Hospitals Distribution Percentile Rate (%) 10 56 25 63 50 71 75 80

24. HCW Influenza Vaccination 2008-09-Nursing Homes

25. HCW Influenza Vaccination 2008-09-Nursing Homes • 113 nursing homes (28%) achieved 80% rate compared to 72 last year • *71% used declination forms • 50% offered at multiple locations *statistically significant

26. HCW Influenza Vaccination 2008-09-Nursing Homes Distribution Percentile Rate (%) 10 35 25 50 50 66 75 81

27. HCW Influenza Vaccination Dr. Seth Foldy: • "moral imperative" for health care workers to vaccinate themselves to protect patients and family • health care organizations are free to require flu vaccine the way they do other vaccines. I • efforts to mandate HCW vaccination are not on the horizon but if voluntary improvement efforts plateau it might be one of the approaches taken.

28. Bureau Briefs • Bureau of Communicable Diseases and Emergency Response • AIDS/HIV • Epidemiology • Immunization • STD • TB/Refugee Health/Respiratory Diseases • Preparedness • PH • Hospital/EMS • Pandemic influenza

29. Bureau Briefs New support for investigation of foodborne outbreaks “SOS Team” Surveillance Outbreak Support

32. Trivia Who are these gentlemen? What was their contribution to the field of infectious diseases? What country are they from?

33. Gwen Borlaug, CIC, MPHBureau of Communicable Diseases 1 West Wilson Street Room 318Madison, WI 53702608-267-7711gwen.borlaug@wisconsin.gov