Service Area Strategic Plan
5/23/2013   6:32 am
Department of Health (601)
Biennium:
Service Area 1 of 1
Local Communicable Disease Investigation, Treatment, and Control (601 440 14)
Description

The local health department’s Communicable Disease Prevention, Investigation, Treatment and Control services work with partners to prevent, detect, assess, respond, treat and control communicable diseases, emerging infections and terrorism related illnesses. These activities are performed in accordance with guidance, policies and procedures of Virginia Department of Health’s Surveillance and Investigation, Immunization, Sexually Transmitted Disease, HIV/AIDS, Tuberculosis, and Newcomer Health programs.

Local Health Department Communicable Disease Services include:
Disease prevention services, Disease surveillance to detect the occurrence of disease as quickly as possible,
Consultation and technical assistance to health care providers, schools and institutions, Media relations, press releases and education material, Development of disease-specific emergency response plans,
Health screenings for refugees, Disease record management, Outbreaks and individual disease investigations,
Disease exposure notification and counseling services, Monitoring for and responding to emerging infections and terrorism-related illnesses, Clinical diagnoses and treatment of communicable diseases (including STD, HIV/AIDS and Tuberculosis), Medical treatment case management, and Assist providers in reporting vaccine adverse events.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    These services directly align with the mission of the Virginia Department of Health to promote and protect the health of Virginians by preventing the spread of communicable diseases. By collaborating with community partners and coordinating services with the Virginia Department of Health, local health departments directly provide prevention marketing and disease intervention through appropriate use of therapeutic and regulatory strategies.
  • Describe the Statutory Authority of this Service
    Chapter 2 of Title 32.1 of the Code of Virginia pertains to the reporting and control of diseases.
    Articles 1 through 3.1 of that Chapter define the authority for this particular Service Area and include reporting of disease, investigation of disease, disease control measures, isolation of persons with communicable diseases, and control of rabies.
    § 32.1-36 of the Code of Virginia and 12 VAC 5-90-80 and 12 VAC 5-90-90 of the Board of Health Regulations for Disease Reporting and Control mandate reporting of specific diseases.
    § 32.1-37.2 requires that partner notification services (partner counseling and referral services) be offered
    to individuals who test positive for HIV.
    § 32.1-39 provides for STD surveillance, investigation of reports, and conducting counseling and contact
    tracing (partner notification).
    § 32.1-46 provides for the immunization of children against certain diseases in accordance with regulations
    established by the Board of Health and the implementation of a statewide immunization registry.
    Title 23, Chapter 1, §23-7.5 requires full time students enrolling in public institutions to be immunized
    against certain diseases in accordance with the recommendations of the American College Health Association.
    § 32.1-57 through 32.1-60 requires Sexually Transmitted Disease examination, testing, and treatment.
    § 32.1-64 requires treatment for opthalmia neonatorum.
    § 32.1-43. Authorizes the State Health Commissioner to require quarantine, isolation, immunization,
    decontamination, or treatment of any individual or group of individuals when he determines any such
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
City/County Governments 132 132
College & University students 323,931 323,931
Day Care Enrollees (average monthly census) 17,300 17,300
Hospitals 94 94
Incarcerated Population 55,436 55,436
Laboratories 183 183
Licensed Veterinarians 3,500 3,500
Local Health Department Clinic patients 170,431 7,712,091
Local Health Departments 119 119
Nursing Facilities and Assisted Living Facilities 605 605
Physicians 21,000 21,000
Schools (school age children) 1,204,808 1,204,808
State Legislators 140 140
Vector Control 17 17

Anticipated Changes To Agency Customer Base
External (economical, political, technological) pressures may decrease customer’s access to care, increase
cost of care, and cause a change in customer base.

Growing numbers of foreign borne residents will create more culturally diverse populations which may
impede traditional methods of health care delivery and likely present communication challenges.

Displacement due to revitalizing urban areas and land development will result in shifts in geographic
location of target populations that may result in barriers to outreach and health care access.

Access to health information via the internet will increase customer’s knowledge.

Emerging infections, particularly infections from foreign countries, will change the characteristics of our traditional customer base.

Better disease surveillance techniques will increase the number of customers who will benefit from public
health services.
Partners
Partner Description
[None entered]
Products and Services
  • Factors Impacting the Products and/or Services:
    Assessments of community health needs are continuous. Services will adapt as gaps in health care are identified.
    Decrease in or consistent level funding in service areas prevent service expansion or cessation of services.
    Access to care is affected by increasing costs, transportation and limited services
    Immigration of foreign-born persons will cause adaptations to language and cultural barriers
    Enhanced diagnostic technologies identify more diseases and therefore increase demand of communicable disease services.
    Enhanced data management products will permit health departments to monitor disease trends and to respond appropriately.
    Ease of, and expanded global travel enhances opportunities for exposure to diseases from many foreign countries.
  • Anticipated Changes to the Products and/or Services
    Assessments of community health needs are continuous. Services will adapt to gaps in health care and external pressures.
    Immigration of foreign-born persons will require service areas to obtain multi-lingual capabilities.
    Enhanced screening of female clinic patients for sexually transmitted diseases that contribute to infertility
    Changes in technology will affect costs and availability.
    Changes in priorities as disease trends change and new threats emerge.
    Legislative mandates may alter funding source priorities.
    Changes in environment and human behaviors that promote disease transmission.
    Advanced technology permits early access to information of potential disease spread within the Commonwealth.
    Sharing resources with public health partners as required to meet threatening situations.
  • Listing of Products and/or Services
    • Prevention Services Risk reduction counseling Education Health alerts Partner notification Surveillance: Receiving reports from physicians, hospitals, and laboratories about people diagnosed with a disease of public health importance; Monitoring the occurrence of disease in animals and environmental contamination that could potentially lead to illness in humans; Screening at-risk populations for disease Tracking trends in daily utilization of medical care by reviewing data from emergency departments, provider insurance claims, and pharmaceutical sales to detect unusual occurrences of illness; Compiling statistics to identify trends and patterns of disease in populations to detect outbreaks or other disease events. Confirm disease report meets case definition of diagnosis Consultation and technical assistance. Work closely with health care providers to effectively manage their patients. Advise local and state governments regarding policies and regulations that can interrupt the spread of disease. Recommend procedures and policies to hospitals and residential care facilities, including prisons and jails, to prevent the spread of communicable diseases. Conduct training for care providers on disease identification, treatment and management. Monitor and assist day care, schools and colleges with disease prevention and outbreak response. Assist employers in preventing communicable diseases from entering the workplace. Media relations, press releases and education material to inform the public about the diseases we track. Diagnosis and Treatment Diagnostic and laboratory support Disease treatment Prophylaxis of exposed contacts and treatment of infected individuals Treatment case management, including Directly Observed Therapy for Tuberculosis B patients Immunizations to exposed or at-risk persons Pharmaceutical services for treating communicable diseases in outbreak situations. Disease exposure notification services (patient counseling, interviewing, contact notification and partner referral) Disease-specific emergency response plans. Enhanced surveillance methods will help identify and respond to behavioral and co-morbidity indicators of disease transmission. Monitoring and issuing advisories for environmental exposures, such as marine beach waters. Informational notices to local health departments and other medical care partners about new diseases occurring that have the potential to affect the health of our citizens. (This has occurred with Sudden Acute Resperatory Syndrome, monkeypox, and anthrax, for example). Outbreak response teams. Collaborations with community-based organizations to educate populations, identify infected person and refer to appropriate care providers.
Finance
  • Financial Overview
    The primary sources of funding for Local Communicable Disease Prevention, Investigation, Treatment and Control are general fund appropriations for local health departments and nongeneral fund local budget matching requirements, patient and revenue. Local government cooperative budget match payments are based on a percentage of the general fund contribution provide to each local health department. Nongeneral funding also includes some federal funding and grant funding obtained by health departments from outside sources.
  • Financial Breakdown
    FY 2011    FY 2012
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $6,828,791 $11,453,667    $6,828,791 $11,453,667
    Change To Base -$73,690 $0    -$73,690 $0
               
    Service Area Total   $6,755,101  $11,453,667     $6,755,101  $11,453,667 
Human Resources
  • Human Resources Overview
    [Nothing entered]
  • Human Resource Levels
    Effective Date      
    Total Authorized Position level null    
    Vacant Positions null    
    Current Employment Level 0.0    
    Non-Classified (Filled)    
    Full-Time Classified (Filled)    breakout of Current Employment Level
    Part-Time Classified (Filled)    
    Faculty (Filled)    
    Wage    
    Contract Employees    
    Total Human Resource Level 0.0   = Current Employment Level + Wage and Contract Employees
  • Factors Impacting HR
    [Nothing entered]
  • Anticipated HR Changes
    [Nothing entered]
Service Area Objectives
 
  • Prevent syphilis transmission in Virginia.
    Objective Description
    Interrupting the transmission of infectious disease (disease intervention) requires rapidly identifying and notifying people exposed to a disease. Upon notification, exposed individuals can take appropriate actions to prevent infection, avoid further transmission of disease or reduce complications. The indicies collected by this objective will be used by managers to monitor quality input and outcome indicators. Infectious syphilis is an ulcerative infection that facilitates easy transmission to a sex partner(s) and permits inoculation of other diseases such as human immunodeficiency virus (HIV). Delayed or lack of treatment can cause conditions affecting the skin, bones, central nervous system and heart. In addition, women with untreated syphilis may experience complications during pregnancy.
    Alignment to Agency Goals
    • Agency Goal: Prevent and control the transmission of communicable diseases and other health hazards.
    Objective Strategies
    • Local health departments will partner with medical providers to prevent the transmission of syphilis by: o Accurately diagnosing and treating syphilis o Rapidly reporting syphilis cases o Quickly locate and interview syphilis cases o Identify all exposed contacts o Locate and refer all contacts for appropriate medical care as rapidly as possible. o Submit timely and complete activity data to the State health department registry.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Percent of early syphilis cases successfully interviewed within seven days
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      71.5
      Date:
      12/31/2004

      Measure Baseline Description: Percent

      Measure Target Value:
      82
      Date:
      6/30/2012

      Measure Target Description: Percent

      Data Source and Calculation: The STD*MIS database managed by the Virginia Department of Health’s Division of Disease Prevention reports monthly the number of early syphilis (ES) assigned for investigation, the number of these ES cases interviewed (Ix) and the number of the interviews performed within 7 days of assignment. The calculation is: 1) # of ES cases Ix’d / # of ES cases Ix’d within 7 calendar days

    • Percent of individuals exposed to early syphilis cases in which disease intervention is achieved.
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      54
      Date:
      12/31/2004

      Measure Baseline Description: Percent

      Measure Target Value:
      75
      Date:
      6/30/2012

      Measure Target Description: Percent

      Data Source and Calculation: Data for this measure is entered from paper records into the STD*MIS database, which is managed by the Virginia Department of Health’s Division of Disease Prevention. The database will report the number of ES cases interviewed (Ix) and a summation of the partner and cluster dispositions. The calculation is: (# of ES contacts and clusters infected and treated + # of ES contacts and clusters preventatively treated) / # of ES cases interviewed

    • Percent of early syphilis cases appropriately treated within seven days of diagnosis.
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      74
      Date:
      12/31/2004

      Measure Baseline Description: Percent

      Measure Target Value:
      86
      Date:
      12/31/2012

      Measure Target Description: Percent

      Data Source and Calculation: Data for this measure is entered from paper records into the STD*MIS database, which is managed by the Virginia Department of Health’s Division of Disease Prevention. The database will report the number of ES cases appropriately treated (Rx) and the number of ES cases reported to determine the percent of cases appropriately treated in seven days or less from the date of the specimen collection, when the patient was prophylactically treated. The calculation is: # of ES cases Rx’d <= 7 days / # of ES cases reported

  • Increase the proportion of patients with Latent tuberculosis (LTBI) who complete an adequate and appropriate course of preventive treatment.
    Objective Description
    Tuberculosis is an airborne disease that is transmitted from person to person. Transmission can occur when a patient with tuberculosis disease of the lungs coughs tuberculosis bacteria into the air. A person in close contact with the patient can breathe the tuberculosis bacteria into his lungs and become infected. That person may also develop active tuberculosis, and may transmit infection to others, or may develop latent infection – i.e., tuberculosis infection without acute symptoms and cannot be transmitted. The person with latent infection may develop (active, and potentially infectious) tuberculosis later in life. One of the best methods to decrease the incidence of new Tuberculosis cases is to provide prompt and complete treatment of persons with latent Tuberculosis infection so they do not develop active Tuberculosis later.
    Alignment to Agency Goals
    • Agency Goal: Prevent and control the transmission of communicable diseases and other health hazards.
    Objective Strategies
    • The local health departments will increase the proportion of patients who complete adequate and appropriate LTBI cases by: Ensuring that the correct medications are prescribed in the correct doses Ensuring the patient knows how to obtain all medications as prescribed. Ensuring the patient is monitored and assessed at least monthly Directly Observed Preventive Therapy is administered to high risk close contacts (small children HIV infected) Timely and complete activity data to the State health department.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Percentage of infected contacts of infectious tuberculosis cases start a course of preventive treatment for LTBI that complete the treatment regimen.
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Maintain
      Measure Baseline Value:
      72.4
      Date:
      12/31/2002

      Measure Baseline Description: Percent

      Measure Target Value:
      72.4
      Date:
      6/30/2012

      Measure Target Description: Percent

      Data Source and Calculation: Contacts are identified, evaluated, and started on treatment if appropriate. Clients who start treatment are followed until treatment is completed or stopped by client or health care providers. The number of those starting treatment is compared to the number who complete. Data are collected from contact investigation forms that are maintained at the local health department level and are then aggregated into a state report according to a schedule determined by the Centers for Disease Control and Prevention. These reports are completed annually and are submitted for publication no later than August 15th. of each year. Two year lag in data submitted to allow sufficient time for all identified infected contacts to complete treatment.


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