Author: Jodi Willemsen

Acute Infectious
Disease, Epidemiology & Preparedness
1st Quarter Report
2015/2016
Jodi Willemsen, Service Manager
Kara Ruge, Public Information Officer

PROTECTING THE PUBLIC’S HEALTH THROUGH PREVENTION OF INFECTIOUS DISEASE, IMMUNIZATION, EDUCATION AND MANAGING PUBLIC HEALTH THREATS

Quality Improvement Project

Inside this issue:

Quality Improvement Project	Pg. 1-4
Disease Surveillance & Investigation	Pg. 4
Immunizations	Pg. 5-7
Hepatitis	Pg. 7
Influenza	Pg. 7
Hep C	Pg. 8
HIV Testing	Pg. 9
STD Clinic	Pg. 10-11
PREP Activities	Pg. 11
DPS Activities	Pg. 12
ICC Grant	Pg. 12
Empowerment Grant	Pg. 13
PHEP Grant	Pg. 13

This quarter we worked to complete our QI project. We have included here, our final report showing the results from this process.
Increasing Pneumococcal Vaccination Rates for seniors in Cerro Gordo County
July 1, 2015 – January 31, 2016
Background
The pneumococcal polysaccharide (PPSV23) vaccination coverage rate for those aged 65 years and older in Cerro Gordo County in 2014 was 53%- well below the Healthy People 2020 goal of 90%. Increasing pneumococcal vaccination rates will improve health indicators in our Community Health Needs Assessment and align with our strategic plan. In October 2014, the Advisory Committee of Immunization Practices (ACIP) began recommending the Prevnar13 (PCV13) as a routine vaccination to all adults 65 years and older in addition to the Pneumovax23 vaccination. The pneumococcal conjugate (PCV13) vaccination coverage rate for those aged 65 years and older in Cerro Gordo County in 2014 was 4%.
Assemble the Team
Team Leader: Bethany Bjorklund, Immunization Nurse
Scribe: Jodi Willemsen, AIDEP Service Section Manager
Team Member: Jennifer Stiles, Infection Control Nurse
Team Member: Sandy Pals, AIDEP Administrative Aide
Team Member: Kara Ruge, Public Information Officer (PIO)
QI Coordinator/Facilitator: Kara Vogelson, Organizational
Development and Research Manager
_________________________
PLAN
Problem Statement: The pneumococcal vaccination rate for those aged 65 and older is low.
Aim Statement: Increase the pneumococcal vaccination rate by 5% for Cerro Gordo County residents aged 65 and older by 1/31/2016.

Quality Improvement Project

Current Approach
Lack of reliable county wide data for target population in state immunization registry.
Immunization program has a strong focus on childhood & adolescent immunizations.
No standardized procedure for the immunization clinic or outreach influenza clinics for checking immunization records and routinely offering either the PCV13 or PPSV23 vaccine.
Missed opportunities due to the lack of knowledge about the new PCV13 recommendation from patients, providers, pharmacies and other health care personnel in the health department.
QI Tools Used
Cause & Effect Fishbone Diagram was created to help our team identify, explore, and graphically display, in increasing detail, all of the possible causes related to our low pneumococcal vaccination rates. This process allowed our team to focus on the content of the problem, not the history of the problem.
Force & Effect Analysis was completed as a team to identify the forces and factors in place that support or work against the solution as to why our county pneumococcal vaccination rates were low to that the positives can be reinforced and/or the negatives eliminated or reduced. This process helped our team select targets for change.
5 Why’s Fish Bone Diagram
Identify Potential Solutions
Develop a standardized procedure to screen all adults 65 years and older for other immunizations recommended during immunization clinic.
Improve accessibility to the immunization registry at outreach clinics and offer both pneumococcal vaccinations at influenza outreach clinics.
Educate all clinic staff on ACIP Pneumococcal vaccination dosing recommendations and Medicare reimbursement guidelines.
QI Tools Used
Solution & Effect Diagram
Nominal Group Technique Allowed our team to quickly come to a consensus on the relative importance of increasing our pneumococcal vaccination rates by completing individual importance rankings into a team’s final priorities. This technique allowed our team to build an immediate commitment to the choices through equal participation in the process.
Impact Difficulty Matrix All potential solutions to improve our pneumococcal vaccination rates were systematically identified, analyzed and rated the presence and strength of relationship between two or more sets of information. We focused on choosing solutions what were low difficulty/high impact instead of high difficulty/low impact solutions.
________________________
DO
Promote that pneumococcal and flu vaccines are both available at outreach influenza clinics.
Direct education to target audience.
Develop new method for outreach for vaccine dissemination whether providing a curbside flu clinic and screening home care nurse patients.
Educate vaccine providers (pharmacies, nursing homes, assisted living sites, medical providers) regarding ACIP recommendations and pneumococcal vaccine importance.
Revise protocol for outreach flu clinics to include both pneumococcal vaccines.
Work with area medical providers to increase vaccination rates in Cerro Gordo County.
The team implemented a number of interventions during the course of the project:
Worked with PIO to include in media advertisements and promotions that pneumococcal vaccinations will be readily available during clinics.
Created a tear sheet that included all vaccines recommended with clinic contact information if a patient refused the pneumococcal vaccine at the time of flu vaccine. Post cards were also given to local physician offices to give to their patients if referring them to get the vaccine elsewhere.
Educated all staff on ACIP recommendations and created a pneumococcal dosing cheat sheet to have available at immunization and outreach flu clinics.
Encouraged all nurses and staff to provide a strong recommendation to their patients to receive the pneumococcal vaccination the same time as the flu vaccine.

Quality Improvement Project

Educated patients on the difference between the two pneumococcal vaccinations available and the importance of receiving the vaccination.
Reviewed current home care patients vaccination needs prior to nurses making home visits with flu vaccines.
All AIDEP nurses will have access to Surfaces and Blue Tooth internet devices access to use at outreach clinics to check immunization records.
Determine which agencies (pharmacies, nursing homes, assisted living sites, medical providers) routinely access and document vaccinations in the state’s immunization registry.
_______________________
CHECK
Once the project started the Do Phase of QI our team quickly realized the majority of adults 65 years and older needed the PCV13 instead of the PPSV23 vaccine. This required a different methodology to measure county wide pneumococcal vaccination rates given that the State immunization registry did not have the capability of measuring PCV13 vaccine county rates in adults 65 years of age and older.
Outcome tracking took place from July 2015 - January 2016 by evaluating:
Total number of doses administered each month of the PCV13 and PPSV23 to adults 65 years of age and older at the various clinic sites.
8 doses of PPSV23 administered
424 doses of PCV13 administered
Agency Statistics:
Of the total 432 pneumococcal vaccinations administered by our agency from July 2015-January 2016, 44% of adults 65 years and older received a pneumococcal vaccination.
The previous year July 2014-January 31, 2015 our agency administered a total of 52 pneumococcal vaccinations to only 4% of adults 65 years and older served.
PPSV23 vaccine county coverage rate:
July 1, 2015: 53%
January 31, 2016: 52%
PPSV23 vaccine public health agency coverage rate on July 1, 2015 and January 31, 2016:
July 1, 2015: 69%
January 31, 2016: 70%
Calculated vaccine revenue for both pneumococcal vaccinations from July 1, 2015 - January 31, 2016:
PPSV23 revenue $897.36
PCV13 revenue $78,143.20
Top Successes:
The QI Project helped create a new procedure and implement a best practice standard to routinely check every patient’s immunization records prior to administering vaccinations whether at the immunization clinic or at an influenza outreach clinic.
Staff capacity increased during the peak immunization clinic months of September-November by having an administrative aide or AIDEP Service Section manager routinely screen all immunizations needed and notify the administering nurse creating a steady workflow.
Strong pneumococcal vaccination recommendation by public health staff and local providers lead to more patients receiving the vaccine.

	2014*	2015^
PPSV23 revenue	$4,975.31	$897.36
PCV13 revenue	$1567.78	$78,143.20
Total revenue	$6,543.09	$79,040.56

Sources of information:
Doses administered reports from the Iowa Immunization Registry Information System (IRIS).
Medicare reimbursement rates for both pneumococcal vaccinations from 2014, 2015 and 2016.

Quality Improvement Project

Top Barriers:
Agencies in our state who serve a large population of adults 65 years of age and older do not use the State Immunization Registry leading to inaccurate county wide data of pneumococcal vaccination rates.
Iowa’s Immunization Registry does not have the capability of measuring PCV13 coverage rates in adults 65 years of age and older.
ACT
Standardize the Improvement
Continue to review every patient’s immunization record and offer all of the recommended vaccinations at the immunization clinic.
Continue to review all adults 65 years of age and older records at outreach influenza clinics in 2016-2017 and provide pneumococcal vaccinations to those that need it.
Continue to educate patients and staff on the importance of pneumococcal vaccinations.
Future Plans
Partner with major local healthcare provider to mail letters to all healthcare partners in the state of Iowa to encourage them to utilize the State’s Immunization Registry.
Relay concerns of inaccurate data of all adult immunization rates in the State’s Immunization Registry and to the State Department’s Immunization Program Bureau Chief.
Continue to gather pneumococcal data on a semi-annual basis (July and January).
Analyze data to determine if theory continues to achieve the desired outcomes.

Disease Surveillance and Investigation

The following lab confirmed diseases were found in Cerro Gordo County during the months of July, August and September:

	October / 14-15	November / 14-15	December / 14-15	October / 15-16	November / 15-16	December / 15-16
Campylobacteriosis	1	-	-	1	1	2
Cryptosporidiosis	-	-	-	-	-	-
E. coli Shiga toxin-producing	-	-	1	-	-	-
Giardiasis	-	-	-	-	-	-
Lyme Disease	-	-	-	-	-	-
Mumps	-	-	-	1	1	-
Neisseria meningitis	-	-	-	-	-	-
Pertussis	-	-	-	-	-	-
Rabies-animal	-	-	-	-	-	-
Salmonella	-	-	-	-	1	-
Shigella	-	2	-	-	-	-
STD	-	-	-	10	9	14
Typhoid Fever	-	-	-	-	-	-
West Nile Virus Encephalitis	-	-	-	-	-	-
Legionellosis Legionaires Disease	-	-	-	-	-	1
Total	1	2	1	12	12	17

Immunizations

Immunization Administration—Adult

CATEGORY	Fiscal Year 2014-2015				Fiscal Year 2015-2016
	19-44	45-64	65+	TOTAL	19-44	45-64	65+	TOTAL
Td	0	0	0	0	0	0	0	0
Tdap	8	10	12	30	19	45	19	83
Hepatitis B	14	6	5	25	23	22	1	46
Hepatitis A	1	4	3	8	10	4	3	17
Hepatitis A & B / (Twinrix)	0	0	0	0	20	0	0	20
MMR	4	2	0	6	11	9	1	21
Varicella	0	0	0	0	3	0	0	3
Meningococcal	0	0	0	0	2	2	0	4
HPV	3	0	0	3	13	0	0	13
PPD (TB)	28	4	3	35	32	10	1	43
Pneumo 23	1	3	33	37	1	10	4	15
PCV 13	0	0	0	0	0	3	304	309
Shingles	0	0	17	17	0	18	14	32
Total Vaccines Given	59	29	73	161	132	123	347	606

Immunization Administration —0-24 months of age

CATEGORY	FY 13-14	FY 14-15			FY 15-16
DTaP (diphtheria, tetanus, & acellular pertussis)	9	VFC	PP	5	VFC	PP	10
		5	0		7	3
DTaP-IPV-Hepatitis B (Pediarix)	10	VFC	PP	14	VFC	PP	14
		14	0		12	2
DTaP-Hib-IPV (Pentacel)	2	VFC	PP	7	VFC	PP	5
		7	0		5	0
Rotavirus	8	VFC	PP	13	VFC	PP	11
		13	0		10	1
Varicella	8	VFC	PP	5	VFC	PP	9
		5	0		8	1
MMR (measles, mumps, & rubella)	9	VFC	PP	5	VFC	PP	8
		5	0		8	0
MMRV (measles, mumps, rubella, & varicella)	0	VFC	PP	2	VFC	PP	2
		2	0		2	0
Hepatitis B	2	VFC	PP	1	VFC	PP	0
		1	0		0	0
Hib	18	VFC	PP	17	VFC	PP	20
		17	0		16	4
Hepatitis A	14	VFC	PP	14	VFC	PP	18
		12	2		15	3
PCV 13 (pneumococcal)	17	VFC	PP	27	VFC	PP	25
		27	0		23	2
IPV	0	VFC	PP	1	VFC	PP	2
		0	1		2	0
Total Vaccines Given	97	VFC	PP	111	VFC	PP	124
		108	3		108	16

Immunization Administration—Ages 3-18 years

Immunizations

Immunization Administration —Ages 3-18 years

CATEGORY	FY 13-14	FY 14-15			FY 15-16
DTaP (diphtheria, tetanus, & acellular pertussis)	0	VFC	PP	2	VFC	PP	3
		2	0		2	1
DTap-IPV-Hepatitis B (Pediarix)	0	VFC	PP	2	VFC	PP	3
		2	0		2	1
DTaP-Hib-IPV (Pentacel)	1	VFC	PP	2	VFC	PP	0
		2	0		0	0
DTaP- IPV (Kinrix)	8	VFC	PP	12	VFC	PP	7
		12	0		7	0
Td (Tenivac)	1	VFC	PP	0	VFC	PP	0
		0	0		0	0
Tdap	8	VFC	PP	54	VFC	PP	45
		39	15		28	17
IPV (inactivated polio)	4	VFC	PP	4	VFC	PP	3
		3	1		3	0
MMR (measles, mumps, & rubella)	5	VFC	PP	3	VFC	PP	7
		1	2		5	2
MMRV (measles, mumps, rubella & varicella)	8	VFC	PP	18	VFC	PP	8
		18	0		8	0
Hepatitis B	2	VFC	PP	8	VFC	PP	11
		5	3		9	2
Varicella	3	VFC	PP	10	VFC	PP	14
		6	4		10	4
Hib (haemophilus B)	3	VFC	PP	0	VFC	PP	1
		0	0		1	0
PCV 13	2	VFC	PP	2	VFC	PP	0
		2	0		0	0
Pneumo 23	0	VFC	PP	0	VFC	PP	1
		0	0		0	1
Hepatitis A	10	VFC	PP	41	VFC	PP	36
		33	8		23	13
Hepatitis A & B (Twinrix)	0	VFC	PP	0	VFC	PP	0
		0	0		0	0
PPD (TB)	6	VFC	PP	0	VFC	PP	1
		0	0		0	1
Meningococcal	8	VFC	PP	32	VFC	PP	38
		23	9		28	10
HPV	21	VFC	PP	46	VFC	PP	94
		36	10		65	29
Total Vaccines Given	90	VFC	PP	236	VFC	PP	272
		184	52		191	81

Immunizations

Immunization Administration —All Ages

CATEGORY	FY 13-14	FY 14-15	FY 15-16
DTaP (diphtheria, tetanus, & acellular pertussis)	9	7	13
DTaP-IPV-Hepatitis B (Pediarix)	10	17	17
DTaP-Hib-IPV / (Pentacel)	3	9	5
DTaP-IPV (Kinrix)	8	12	7
Td	1	0	0
Tdap	46	84	128
IPV (inactivated polio)	5	5	9
Rotavirus	8	13	11
MMR	21	14	36
MMRV	8	20	10
Hib (haemophilus B)	21	17	22
Hepatitis B	27	34	52
Hepatitis A	40	63	72
Hepatitis A & B (Twinrix)	24	41	23
Varicella	15	15	26
PCV 13 (pneumococcal)	19	34	332
PPD	42	35	44
Meningococcal	8	32	42
HPV	22	49	107
Pneumococcal	15	32	16
Shingles	32	17	32
Total Vaccines Given	384	550	1004

Influenza

This quarter we administered the bulk of our flu vaccines. We provided vaccines to a total of 81 outreach clinics as well as here at the health department. During the first quarter, we administered 31 VFC and 707 private pay flu vaccines. The table below shows a monthly comparison of vaccines provided during the second quarter:
Between first and second quarter, total flu vaccines administered totaled 3,574. The year prior we administered 4,114 flu vaccines. We attribute some of this decline to the strains not matching the viruses circulating in 2014, and that being publicized through the media. Flu mist was also late to arrive this year, so opportunities were missed with being able to provide this to the public as well.

	October	November	December
Flu Shots	1346	329	95
Flu Mist	210	151	57
High Dose	531	101	16
TOTAL	2087	581	168

Hepatitis C

2 client(s) received counseling and testing for the hepatitis C virus at Cerro Gordo Public Health this quarter. Of these clients, 0 specimen(s) returned positive for the hepatitis C virus.
7 client(s) received counseling and testing for hepatitis C at the Cerro Gordo County Jail. Of these clients, 0 specimen(s) returned positive.
22 clients participated in the Viral Hepatitis A & B Vaccine Program. Individuals that qualify for free hepatitis A & B vaccine through this program must meet the following guidelines; past or present IDU, non-intravenous drug use, men that have sex with men, history of an STD, or a person that has tested positive for hepatitis C or HIV, or sex partners of people with + HIV, HAV, or HBV.

Fiscal Year 15-16	1st Quarter	2nd Quarter	3rd Quarter	4th Quarter	Fiscal Year Total
Risk Factor	Number of Clients	Number of Clients	Number of Clients	Number of Clients	Number of Clients**
IV drug user*	11	4			15
Non-IV drug user*	41	19			60
MSM*	1	4			5
History of STD*	4	2			6
Hepatitis C or HIV +*	1	1			2
Sex partner of + person*	0	0			0
Total # of Clients	45	22			67
Hepatitis A & B Vaccines	Number of Doses	Number of Doses	Number of Doses	Number of Doses	Number of Doses
First Dose	24	7			31
Second Dose	19	10			29
Third Dose	9	5			14
Total # of Doses	52	22			74

*Some clients may list more than one risk factor (i.e.: IDU & Hepatitis C+)
**Unduplicated

HIV Testing
HIV counseling and testing was offered at the Cerro Gordo County Jail monthly and upon request. A total of 9 individuals were counseled and tested through this outreach clinic.
HIV counseling and testing continues to be offered at the health department. A total of 23 individuals received counseling and testing services this quarter.
Out of the 23 HIV tests performed this quarter at the health department, 6 were paid tests. Five of the paid tests were Cerro Gordo County residents.

HIV Testing

HIV Testing In-House and Outreach Comparison Report

Fiscal Year 15-16	1st Quarter			2nd Quarter			3rd Quarter			4th Quarter			Year Total
Category	In House	Out-reach	Total	In House	Out-reach	Total	In House	Out-reach	Total	In House	Out-reach	Total	In House	Out-reach	Total
# of client visits	22	5	27	23	9	32							45	14	59
# Cerro Gordo residents	22	3	25	20	7	27							42	10	52
# negative results	22	5	27	23	9	32							45	14	59
# positive results	0	0	0	0	0	0							0	0	0
indeterminate	0	0	0	0	0	0							0	0	0

HIV Testing Gender

Fiscal Year 15-16	1st Quarter			2nd Quarter			3rd Quarter			4th Quarter			Year Total
Category	In House	Out-reach	Total	In House	Out-reach	Total	In House	Out-reach	Total	In House	Out-reach	Total	In House	Out-reach	Total
Male	14	4	18	14	8	22							28	12	40
Female	8	1	9	9	1	10							17	2	19
Total	22	5	27	23	9	32							45	14	59

HIV Testing Age

Fiscal Year 14-15	1st Quarter			2nd Quarter			3rd Quarter			4th Quarter			Year Total
Category	In House	Out-reach	Total	In House	Out-reach	Total	In House	Out-reach	Total	In House	Out-reach	Total	In House	Out-reach	Total
12-19	3	0	3	1	0	1							4	0	4
20-29	8	2	10	12	8	20							20	10	30
30-39	4	2	6	6	1	7							10	3	13
40-49	5	0	5	2	0	2							7	0	7
>49	2	1	3	2	0	2							4	1	5
Total	22	5	27	23	9	32							45	14	59
Age Range	18-72	21-57	18-72	15-66	21-35	15-66							15-72	21-57	15-72

STD Clinic

STD testing services continue for Cerro Gordo County residents. A total of 26 clients were tested this quarter at the Cerro Gordo County Department of Public Health. 2 client(s) received testing at the Cerro Gordo County Jail.
3 Urogenital Chlamydia, 0 Urogenital gonorrhea, 1 syphilis, 0 hepatitis B, 0 herpes 0 Oral chlamydia, 0 Oral gonorrhea, 1 Rectal Chlamydia, and 0 Rectal gonorrhea tests returned positive this quarter.
0 client(s) received a test of cure for gonorrhea.
7 clients were treated for STD’s this quarter either because they were symptomatic, epi linked, or had a positive test result.

Fiscal Year 15-16	1st Quarter			2nd Quarter			3rd Quarter			4th Quarter			Year Total
Category	Pos.	Neg.	Total	Pos.	Neg.	Total	Pos.	Neg.	Total	Pos.	Neg.	Total	Pos.	Neg.	Total
Urogenital Chlamydia	2	24	26	3	23	26							5	47	52
Urogenital Gonorrhea	0	26	26	0	26	26							0	52	52
Syphilis	2*	24	26	1	23	24							3	47	50
Hepatitis B	0	11	11	0	7	7							0	18	18
Herpes	0	2	2	0	1	1							0	3	3
Oral Chlamydia	0	6	6	0	4	4							0	10	10
Oral Gonorrhea	0	6	6	0	4	4							0	10	10
Rectal Chlamydia	1	1	2	0	1	1							1	2	3
Rectal Gonorrhea	0	2	2	0	1	1							0	3	3
Gonorrhea Test of Cure	0	0	0	0	0	0							0	0	0
Total Tests	5	102	107	4	90	94							9	192	201

*One syphilis test had a positive result; however this was a re-test of a previous positive. This re-test was qualitatively positive (which was expected) but the quantitative result indicated treatment was successful.

Syphilis Treatment and Follow-up

Fiscal Year 2015-16	1st Quarter	2nd Quarter	3rd Quarter	4th Quarter	Fiscal Year Total
New Cases	1	1			2
Retests	1	0			1
Treatments	1	1			2
Female	0	0			0
Male	2	1			3
MSM	2	0			2

STD Clinic

Fiscal Year 15-16	1st Quarter			2nd Quarter			3rd Quarter			4th Quarter			Year Total
Age	Male	Female	Total	Male	Female	Total	Male	Female	Total	Male	Female	Total	Male	Female	Total
13-19 yrs.	1	3	4	1	1	2							2	4	6
20-29 yrs.	7	4	11	11	9	20							18	13	31
30-39 yrs.	4	3	7	34	2	36							38	7	45
40-49 yrs.	3	4	7	1	1	2							4	5	9
>49 yrs.	1	0	1	1	0	1							2	0	2
Age Unknown	0	0	0	0	0	0							0	0	0
Gender Totals	16	14	30	48	13	61							64	29	93

STD Testing Gender
Condom Distribution

Targeted Population	Venues/Locations	1st Quarter
1st Quarter	Cerro Gordo County Department of Public Health, FLYS, Wellsource	6300
2nd Quarter	Cerro Gordo County Department of Public Health, DHS, NIACC,	7040
3rd Quarter
4th Quarter
Year Total		13,340

PREP Activities

PREP Students and Dosages

Fiscal Year 15-16	1st Quarter	2nd Quarter	3rd Quarter		4th Quarter	Year Total*
TOP Program	Alt HS	Alt HS		Alt HS	Alt HS	Alt HS
Male	5	6				6
Female	20	24				24
Transgender						0
Total TOP Students	25	30				30
Total TOP Doses	25	225				250
Wise Guys Program	FLYS	FLYS		FLYS	FLYS	FLYS
Male	0	0				0
Female	0	0				0
Transgender	0	0				0
Total Wise Guys Students	0	0				0
Total Wise Guys Doses	0	0				0

DPS Activities

CTR Services
CTR testing and vaccine services continued at the jail on a monthly basis.
The Disease Prevention Specialist offered presentations to students at the NIACC dorms on HIV and STDs. The Resident Assistant at the dorm then distributed 250 testing brochures to dorm residents. A condom dispenser is available by the student mail boxes and has been STD Services
STD Services
Presentations on STDs and contraceptives were given to students at FLYS.
The DPS attended webinars on Tests of Public Health Significance and a training webinar on the Scrip Tracker Program, as well as a DPS meeting in Des Moines.
PREP Services
TOP (Teen Outreach Program) classes through the PREP Grant continued at the Alternative High School. Topics covered this quarter were goal setting, romantic relationships, pregnancy probability and teen pregnancy, and contraception. Service learning projects were also planned for the second semester. This quarter the students heard a presentation about the risks of tobacco use provided by the Tobacco Coordinator at CGPH. The students then created posters which were hung by the lunch room for Red Ribbon Week.
The DPS provided an interview for KIMT on Teaching Sex Ed.
Podcasts and webinars attended by the DPS include, “Communicating about Health with LGBTQ Youth,” “Helping Teens Transition from Pediatrics to Adult-centered Care,” and “Teen Health: Preventing and Promoting Healthy Youth.”

Iowa Cancer Consortium Grant

Through the ICC grant, we continue to collaborate with five Mercy clinics to utilize IRIS in determining those who are in need of HPV vaccine. The clinics compete with each other to increase HPV vaccination rates during the quarter. The table below shows five clinics (including our health department), and increases made during the second quarter.

Clinic	Baseline	October	November	December	Total Increase
Clinic 1	43.2%	46.60%	48.40%	50.20%	7%
Clinic 2	48.1%	49.60%	51.80%	52.20%	4.1%
Clinic 3	27.7%	28.40%	30.30%	31.50%	3.8%
Clinic 4	34.9%	42.50%	42.30%	39.90%	5%
Clinic 5	38.5%	44.00%	44.20%	42.50%	4%
Clinic 6	31.2%	31.80%	30.60%	32.20%	1%

HPV series completion (3 doses of vaccine) for all six clinics was 117 patients.
HPV doses administered in all six clinics was 515 doses, of which 23% resulted in series completion.

Empowerment Grant

With the Empowerment grant we continued to focus providing letters to guardians of 0-36 month olds they are due for vaccinations. The health department is working with seven Mercy clinics and one medical provider to collaborate to decrease the number of children who are under immunized. Listed below are the stats showing where each clinic stands with under immunized patients.

Calling The Shots under-immunized rates

Clinic	October	November	December
Clinic A	10.00%	10.00%	0.00%
Clinic B	24.70%	23.70%	23.08%
Clinic C	21.40%	24.50%	29.60%
Clinic D	13.40%	14.04%	14.31%
Clinic E	8.20%	6.50%	8.90%
Clinic F	33.30%	15.80%	22.22%
Clinic G	8.50%	9.50%	8.30%
Clinic H	41.70%	33.33%	33.33%

Public Health Emergency Preparedness Grant

During the second quarter, a lot of time has been spent on mass care planning. The AIDEP service manager serves on a committee in which an overall county plan mass care plan is being developed. Within the overall county plan, public health will incorporate our special needs sheltering annex. The health department will take the lead in providing care to those who have specific needs within a shelter environment. A large portion of time has also been spent preparing for a full scale exercise that will take place May 19th, involving many partners and communities within the county.

ACUTE INFECTIOUS DISEASE, EPIDEMIOLOGY & PREPAREDNESS

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