1. City of Amarillo Department of Public Health and the Expansion of Adult Vaccines through DSRIP Casie Stoughton, MPH, BSN, RN, CPH February 19, 2016

2. Quick Facts: Programs  Communicable/Infectious Disease Investigations and Reporting  HIV/STD Services  Immunization Clinic  Public Health Preparedness  Refugee Health Screening  Tuberculosis screening, treatment and control  Health Promotions  Amarillo Hospital District Quality Assurance Liaison for Indigent Care  Community engagement

3. Epidemiology and Communicable Disease Reporting  Investigate outbreaks of communicable and infectious diseases  Response efforts include field samples, testing and contact interviews  Report lab-confirmed cases to DSHS and CDC  Advise hospitals, school districts, long-term care facilities and individual healthcare providers on these diseases and conditions  Coordinate public health advisories and alerts to the public  Collaborate with Animal Management and Welfare, Environmental Health, Emergency Management and other agencies to assure the public’s health  Advise on appropriate treatment and prophylaxis of conditions  Botulism  Ebola  Rabies

4. Table 1. Summary of Notifiable Conditions Reported in Potter/Randall Counties for 2013-2014: * Influenza is lab-confirmed only and represents “season-to-date” cases (counting from previous October) rather than year-to-date. * 2013 Influenza data as of 6.2.14 * 2014 data provisional and subject to change POTTER COUNTY 2013 2014 RANDALL COUNTY 2013 2014 TOTAL 2013 TOTAL 2014 VACCINE PREVENTABLE DISEASES: Pertussis (Whooping Cough)117681715 Varicella (Chickenpox)7230102 ENTERIC DISEASES: Campylobacteriosis10328281860 Cryptosporidiosis011314 Escherichia coli, Shiga toxin-producing111223 Salmonellosis1216719 35 Shigellosis002020 VIRAL HEPATITIS: Hepatitis A, acute010304 Hepatitis B, perinatal10717 Hepatitis C, chronic or resolved22513836 261174 INVASIVE DISEASES: Botulism202040 Legionellosis030306 Streptococcus pneumonia, invasive disease11105131623 VECTOR-BORNE & ZOONOTIC DISEASES: West Nile Virus, fever10171227 TUBERCULOSIS: Active1615 Latent132290 SEXUALLY TRANSMITTED DISEASES: AIDS7604710 Chlamydia1286116445038517361549 Gonorrhea454546132144586690 HIV107551512 Syphilis23168103126 INFLUENZA Influenza A – Rapid Test17054053 Influenza B – Rapid Test800720

5. HIV Prevention/STD Clinic  Tested 1,250 people for HIV in 2014  Distributed 85,000 condoms  Performed 2,117 STD exams and treatments  Provide risk-reduction counseling and case management  Receive $321,994 in grant support

6. Immunizations  In 2014, the Immunization program gave 10,404 shots to 3,944 to children and adults.  Rotavirus  DTaP, Tdap, Td (tetanus, diphtheria and pertussis)  IPV  Pneumococcal  Hepatitis A and B  Hib (Haemophilus influenza B)  MMR  Varicella (chickenpox)  Meningococcal  HPV  Influenza  We receive $261,049 grant from the Texas Department of State Health Services to provide these immunizations  Perform daycare and school immunization record audits  Community outreach and verification of immunization records to maintain up-to-date information in the state immunization registry (ImmTrac)  Texas Vaccine for Children program (TVFC)

7. Public Health Preparedness  All-hazards planning for protecting public health  Examples:  Gave over 10,000 shots in H1N1 pandemic  Deployment of SNS  Botulism  Ebola  Plan and exercise mass vaccination/mass distribution of meds  SNS Coordination  Receive $245,000 in grant support.

8. Refugee Health  Amarillo is an international resettlement community for refugees  Two resettlement agencies accept primary refugees into Amarillo (Catholic Charities and Refugee Services of Texas)  400 primary refugees are screened each year for communicable and infectious diseases while linking them to primary care services  Provided 4,550 shots to 1,986 children and adults.  We receive $471, for staffing costs, medical supplies, laboratory charges, interpreting fees and immunizations

9. Tuberculosis  15 active TB cases in 2014  Requires directly-observed therapy (DOT) for minimum 6 months  Execute control orders for voluntary isolation and quarantine  In-depth case management  243 Latent TB infections  9 months of antibiotic therapy, additional toxicity screening  $93,093 in grant support both State and Federal

10. Community Health  MEND childhood obesity prevention project  Public Health Accreditation  Community Health Assessment  Community Health Improvement Plan  Amarillo Bi-City-County Health District Board  Amarillo Hospital District Board of Managers  Reporting on Indigent Care Quality/Access  County Health Rankings  Texas County Fact Sheets  CDC Reports on Behavioral Risk Factor Surveillance Study (BRFSS)

11. MEND Spring: Town Club 9 enrolled 5 completed Wesley CC 13 enrolled 6 completed Summer: Wesley CC 11 enrolled 6 completed Fall: HPCH 4 enrolled total of 11 children participating Maverick 7 enrolled Wesley CC 12 enrolled Power Church 6 enrolled MEND Results: Physical activity increased by 5 hours per week Screen time and sedentary activity decreased by 3.5 hours per week Children who were having sugar sweetened beverages a few times per day decreased from 13% to 2% Children eating 4-5 fruits and vegetables per day increased from 9% to 24%  Harrington Cancer and Health Foundation  Texas Tech School of Medicine  Wesley Community Center  Power Church High Plains Children‘s Home Maverick Boys and Girls Club United Way of Amarillo and Canyon MEND – Mind, Exercise, Nutrition, Do It!

12. State and Federal Grants GrantCost $471,088 $261,049$334,617 $210,250$244,481 $111,744$181,373 $248,133$316,748$39,844 $49,269$69,535 $60,187$170,767$52,888$82,500 Total: $1,586,952 Total: $1,963,841

13. Public Health Funding $1,540,775 $3,220,878 $2,147,249 Total: $6,908,902

14. DSRIP Immunizations Ink Life TourWomen’s ShelterLow Income HousingLocal Schools Make-A-Wish Car ShowSenior Citizens’ CenterUnited Supermarkets Tri-State FairEl dia de la mujerToot N’ TotumAMW Vaccination Clinic Farm and Ranch ShowHIV/STD PartnershipTexas Tech

15. Metrics and Milestones  DY4 Goal,4700 shots  3,491 doses  1522 people

16. 12.4 Pneumonia vaccine 65+, does patient have a history or documentation of receiving a PPSV23 vaccination? Baseline – 66% YES DY4 60% YES 40% no – 30% received a pneumonia vaccine in clinic

17. 12.6 Influenza vaccine Did the patient have a flu shot in the last 12 months or did they receive one today? 12.6 Influenza vaccine Baseline – 29.4% YES DY3 – 91% YES DY4 – 90% YES 10% no 1.9 % medical contraindication 14% vaccine unavailable 5% received the flu vaccine 75% declined

18. 12.10 Up-to-date Is patient up to date with the following immunizations: 1 Td in the last 10 yrs, 1 influenza in last 12 months 2 doses Varicella or hx of disease, 65 and older has had a PPSV23, 12.10 Patient up-to-date when they came to clinic Baseline – 31% YES DY4 – 14% YES 86% - no – 21% brought up-to-date in clinic

19. Questions?