Healthy People 2000 Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Area 20: Immunization and Infectious Diseases

I. Special Populations/Eliminating Disparities

• Any actions taken should include sensitivities to cultural issues.
• Goal should be to eliminate disparities.
• Eliminating disparities requires information management for immunizations.
• Adults should be a target population for immunizations.
• Programs should cover working poor, to eliminate gaps between Medicaid and private insurance.
• A goal of 100% elimination must take into consideration that a percentage of people will refuse vaccine when offered.

II. Fan Framework

• Immunization topic is a health systems delivery issue; therefore, the type practitioner most appropriate to provide these services must be considered.
• Immunization may fit best under Public Health Infrastructure. Immunization seems to fit in all four enabling goals.
• The inter-related nature of Immunization and Infectious Diseases was discussed.

III. Duplicating Objectives

• Cross-reference rather than include duplicative objectives in more than one section.
• Hepatitis B virus (HBV) is in the occupational section. HBV should remain in both places (20.3 and 10.5).

IV. Measurable/Developmental Objectives

• There are priority infectious disease issues that may not be measurable in the present, but are significant public health issues. In instances such as this, developmental objectives are very important.
• If developmental objectives are included, they could serve as a guide to States as to where to devote resources in developing baselines, data sets (e.g., antibiotic resistance, inappropriate antibiotic use, and flu immunizations in episodic care settings).

V. General Discussion and Suggestions for Objectives

• Health care providers should take advantage of patients being in hospitals and provide appropriate immunizations and other preventive measures while they are under care. Baseline measures are needed to determine the utility of this strategy.
• Suggested Objective: Increase to x% the number of hospitals having policies involving standing orders for appropriate immunization of flu and pneumococcal disease (and DTP?) prior to discharge. Possible data sources: NHAMES (National Hospital Ambulatory Care Survey)--NCHS; DEEDS (Emergency Department Surveillance System)
• Suggested Objective: Create an objective on preferential reimbursement for pneumococcal and flu shots. (background: Medicaid does not reimburse on top of office visit for administration of shots. 20.14 addresses primary care providers, but that may be restrictive--include other providers)
• Suggested Objective: Create an objective on vaccine injuries and safety of vaccines.

VI. Discussion on Present Objectives

Objective 20.1

Hepatitis A virus (HAV) is included in 20.3. In adolescents, HAV could be included with HBV since they are on the same schedule.

Haemophilus influenzae (Hib) should be included as well.

Suggestion: add varicella for health care workers.

Objective 20.2

Revise to take into consideration normal fluctuations.

Measures of morbidity as well as mortality should also be included.

Can days of school lost, particularly during influenza season, be measured?

Suggested objective: (Early warning system for flu pandemic) 50% of States have a mechanism in place to have data collection system operationalized quickly in case of pandemic.

Objective 20.3

Targets need to be revised. Are the numbers reported the actual numbers or increased to reflect under-reporting?

Hepatitis C virus is under reported. A better data source for incidence is needed.

Suggestion: Explain how targets are derived.

Objective 20.5

Surgical-site infections suggestions:

• Decrease to rate less than or equal to the National Nosocomial Surveillance System (NNIS) mean for each type of procedure in each category.
• Decrease device-associated infections to a rate less than or equal to the NNIS mean for urinary tract infections.
• Set an objective that 100% of States will have data systems for this.

Objective 20.6

How can State health departments impact this objective?

What guidance should practitioners be given to help determine which objectives are priorities, particularly from a perspective of dedicating resources?

Suggestion: Eliminate typhoid fever as a target.

Objective 20.7

Suggestions: Phrase in terms of immunization rates. Revise taking into consideration Haemophilus influenzae (Hib).

Objective 20.8

No data since baseline.

Suggestions:

Develop a process objective focused on developing a reporting system for infectious diseases in child care settings.

Encourage sick-child care facilities (this should go in clinical prevention section).

Objective 20.9

Consider the issue of antibiotic resistance.

Objective 20.10

Is this realistically measurable?

Not a good measure, targets issues of morbidity, instead of only mortality (see earlier suggestion).

Objective 20.11

Suggestion: Targets should be antigen specific

Objective 20.12

Revise rabies objective in consideration of current rabies issues.

Objectives 20.14 and 20.15

Do not limit to "primary care providers." Broaden to include other practitioners, including physicians in episodic care settings and pharmacies.

Objective 20.15

A suggestion was made for preferential reimbursement for this objective.

Objective 20.19

Include other diagnostic areas, including rapid diagnostics.

Include a separate objective regarding State laboratories and health departments.

Objective 10.5

Objective should be measured as a rate instead of incidence.

Chapter 18

An objective, related to the safety of the blood supply, should be included in the infectious disease chapter.

Additional Suggestion

For organisms such as E. coli, pulsed-field gel electrophoresis (PFGE) should be used for cluster identification. Perhaps this suggestion should be included in both food and infectious disease sections.

Participants

Christopher Benjamin, Facilitator, National Center for Infectious Diseases, Centers for Disease Control and Prevention
Carlos Alonso, National Immunization Program, Centers for Disease Control and Prevention
Mike Claphan, American Osteopathic Association
Caryl Collier, RN, MPH, CIC, Association for Professionals in Infection Control and Epidemiology, Inc.
Sharon Hammerich, American Pharmaceutical Association
Martin Landry, National Immunization Program, Centers for Disease Control and Prevention
Rosemary Ramsey, National Center for Infectious Diseases, Centers for Disease Control and Prevention
David Slobodkin, MD, MPH, Cook County Hospital
Jerilyn Thornburg, Health Resources and Services Administration
Sarah Wiley, National Center for Infectious Diseases, Centers for Disease Control and Prevention