Wisconsin Department of Health Services
January 2014 P-00522F
Healthiest Wisconsin 2020 Baseline and Health Disparities Report
Communicable Disease Prevention and Control
COMMUNICABLE DISEASE
Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities
Report • Healthiest Wisconsin 2020 objectives and indicators• Rationale• Key points
Data• Immunization among youth• Immunization among older adults• Incidence of communicable diseases
References
Links to additional reports and resources
Contacts
Chapter Outline
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Chapter outline
COMMUNICABLE DISEASE
Report Overview
• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf
• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.
• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.
• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
Report overview
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Report Format
Full Report• Format: PDF • Intended use: reference document
Chapters• Format: Annotated PowerPoint slide set• Intended uses: presentations to
– Decision-makers– Service providers– Community leaders– The public
Sample annotated slide
Report overview
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Report Outline
Executive Summary
Section 1: Introduction
Section 2: Demographic overview
Section 3: Health focus areas
Section 4: Infrastructure focus areas
Section 5: Data summaries by population
Section 6: Technical notes
Report overview
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COMMUNICABLE DISEASE
Report Outline: Detail
Section 3: Health focus areas
• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure
Section 4: Infrastructure focus areas• Access to health care
Report overview
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COMMUNICABLE DISEASE
Report Outline: Detail
Section 5: Data summaries by population
Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics
People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography
Report overview
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COMMUNICABLE DISEASE
Data notes
• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
• The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution.
• Population estimates that are considered unreliable are excluded.
• Misclassification of racial/ethnic groups may affect the accuracy of rates.
• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.
Report overview
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COMMUNICABLE DISEASE
Factors that influence health
Social determinants
of health
Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach
Report overview
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COMMUNICABLE DISEASE
Healthiest Wisconsin 2020 objectives and indicators
Objective 1
By 2020, protect Wisconsin residents across the life span from vaccine-preventable diseases through vaccinations recommended by the U.S. Advisory Committee on Immunization Practices (ACIP).
Objective 1 Indicator
• Proportion of population fully immunized according to ACIP recommendations among children aged 0-12 years, teens aged 13-17 years, and adults aged 18 years and older.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Communicable Disease Focus Area Profile.10
HW2020 objectives
COMMUNICABLE DISEASE
Objective 2
By 2020, implement strategies focused to prevent and control reportable communicable diseases and reduce disparities among populations with higher rates.
Objective 2 Indicator
• Population-specific incidence rates of reportable conditions by race and ethnicity, sexual identities and orientations, gender identities, educational or economic status, and other characteristic associated with health disparities.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Communicable Disease Focus Area Profile.
Healthiest Wisconsin 2020 objectives and indicators
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HW2020 objectives
COMMUNICABLE DISEASE
Rationale
• Communicable diseases (infectious diseases) are illnesses caused by bacteria, viruses, fungi, or parasites that may be transmitted from human to human or from animal to human.
• Advances in clean water, refrigeration, and sanitation, and the development of safe and effective vaccines, have greatly reduced the threat of communicable diseases; however, common diseases still cause outbreaks and new communicable diseases emerge.
• Vaccines protect more than the individual immunized; they prevent the spread of disease within the population. With persistently low adult immunization rates, new efforts are needed to encourage vaccination across the life span and increase access in all communities to eliminate disparities in immunization rates.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Communicable Disease Focus Area Profile.12
Rationale
COMMUNICABLE DISEASE
Key points
Immunization
• In 2011, for most age groups, vaccination rates for children living in Wisconsin were comparable to or higher than those of children nationally.
o A higher percentage of Wisconsin children ages 19-35 months living below poverty received the recommended vaccination coverage compared to their peers nationally.
• During 2009-2011, 65% of adults ages 65 and older received an influenza (flu) vaccination in the previous 12 months.
o Low-income seniors had lower flu vaccination rates compared to middle- and high-income seniors.
• During 2009-2011, 73% of adults ages 65 and older had ever received a pneumonia vaccination.
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Key points
COMMUNICABLE DISEASE
Key findings
Incidence of disease
• Since 2002, the incidence of meningococcal disease in Wisconsin has declined; however, disparities exist by race/ethnicity.
• During 2007-2010, the rates of infection of both Streptococcis pneumonieae and group B streptococcal (GBS) among Blacks and American Indians were considerably higher than among Whites.
• During 2012, Blacks in Wisconsin had a higher rate of influenza hospitalization compared to other racial/ethnic groups.
• Asians have the highest rates of Hepatitis B and Tuberculosis of any racial/ethnic group in Wisconsin.
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Key points
COMMUNICABLE DISEASE
Immunization among youth
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Vaccination coverage with recommended series among children ages 19-35 months, Wisconsin and United States, 2011
Source: National Immunization Survey for Children, 2011.
Immunization among youth
Total At or above poverty Below poverty0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
79% 79% 87%73% 76% 70%
WisconsinUnited States
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COMMUNICABLE DISEASE
Vaccination coverage with selected vaccines among adolescents ages 13-17, Wisconsin and United States, 2011
Source: National Immunization Survey for Teens, 2011.Note: * To protect against tetanus, diphtheria, and pertussis. ** To protect against meningococcal disease.
Immunization among youth
TDaP* MenACWY** HPV, 1 or more HPV, 3 or moreTotal Female only
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
90% 75% 66% 46%78% 71% 53% 35%
WisconsinUnited States
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COMMUNICABLE DISEASE
Vaccination coverage with selected vaccines among adolescents ages 13-17, by federal poverty level (FPL), Wisconsin and the United States, 2011
Immunization among youth
Source: National Immunization Survey for Teens, 2011.Note: * To protect against tetanus, diphtheria, and pertussis. ** To protect against meningococcal disease.
At or above FPL
Below FPL At or above FPL
Below FPL
Tdap ≥ 1 MenACWY
0%10%20%30%40%50%60%70%80%90%
100%
91% 81% 73% 81%80% 74% 71% 69%
WisconsinU.S.
Perc
ent
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COMMUNICABLE DISEASE
Immunization among older adults
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COMMUNICABLE DISEASE
Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by sex, 2009-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 landline-cellphone combined dataset.
Immunization among older adults
Flu vaccination in past 12 months Ever received pneumonia vaccination0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
65% 73%63% 68%66% 76%
TotalMaleFemale
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COMMUNICABLE DISEASE
Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by race/ethnicity, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Immunization among older adults
Flu vaccination in past 12 months Ever received pneumonia vaccination0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
67% 72%57% 64%66% 70%69% 75%
WhiteBlackHispanicAmerican Indian
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COMMUNICABLE DISEASE
Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by household income, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Immunization among older adults
Flu vaccination in past 12 months Ever received pneumonia vaccination0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
60% 69%68% 73%73% 65%
Low income (<$20,000)Middle income ($20,000-$74,999)High income ($75,000+)
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COMMUNICABLE DISEASE
Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by level of urbanization, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Immunization among older adults
Flu vaccination in past 12 months Ever received pneumonia vaccination0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
70% 74%67% 71%65% 71%
Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties
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COMMUNICABLE DISEASE
Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by disability status, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Immunization among older adults
Flu vaccination in past 12 months Ever received pneumonia vaccination0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
65% 68%70% 78%
No disabilityDisability
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COMMUNICABLE DISEASE
Incidence of communicable diseases
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COMMUNICABLE DISEASE
2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
10
20
30
40
50
60
Year
Num
ber o
f cas
es
Wisconsin bill passed
Menactra licensed
Booster dose recommended
Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System.
Meningococcal disease cases, Wisconsin, 2002-2011
Incidence of communicable disease
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COMMUNICABLE DISEASE
Meningococcal disease by race/ethnicity, crude rate per 100,000, Wisconsin, 2007-2011
Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System.Note: Data were not available for Hispanics.
Meningococcal disease0.00
0.20
0.40
0.60
0.80
1.00
1.20
0.32 1.00 0.15 0.74
White Black
Asian American Indian
Rate
per
100
,000
pop
ulati
on Incidence of communicable disease
27
COMMUNICABLE DISEASE
30%
70%
Non-AmishAmish
Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System.
Haemophilis influenzae type B (Hib) cases in Amish and non-Amish children <5 years old, Wisconsin, 2002-2011, (n=10 cases)
Source: Clifford Grammich, Kirk Hadaway, Richard Houseal, Dale E. Jones, Alexei Krindatch, Richie Stanley, and Richard H. Taylor. 2012. 2010 U.S. Religion Census: Religious Congregations & Membership Study. Association of Statisticians of American Religious Bodies.
Amish residents by county, Wisconsin, 2010
Incidence of communicable disease
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Rate of Amish residentsper 1,000 population
1 - 11
12 - 26
27 - 57
94
COMMUNICABLE DISEASE
Incidence of invasive Streptocococcus pneumoniae and group B streptococcal (GBS) disease, Wisconsin, 2002-2011
Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System.
Incidence of communicable disease
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2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
100
200
300
400
500
600
700
Streptococcus pneumoniaeStreptococcal disease, group B (GBS)
Num
ber o
f cas
es
COMMUNICABLE DISEASE Confirmed cases of Streptocococcus pneumoniae and group B streptococcal (GBS) disease, rate per 100,000, by race/ethnicity, Wisconsin, 2007-2011
Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System.Note: Data were not available for Hispanics.
Streptococcus pneumoniae Streptococcal disease, group B0
2
4
6
8
10
12
14
16
18
7.0 4.014.4 6.92.8 1.517.0 10.0
White Black
Asian American Indian
Rate
per
100
,000
pop
ulati
on Incidence of communicable disease
30
COMMUNICABLE DISEASE Incidence of and mortality from invasive group B streptococcal (GBS) disease among infants less than 90 days old, by race/ethnicity, rates per 100,000 live births, Wisconsin, 2002-2011
Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System.Note: Data were not available for other races/ethnicities.
Incidence Mortality0
20
40
60
80
100
120
140
38 3130 16
White Black
Rate
per
100
,000
live
birt
hs Incidence of communicable disease
31
COMMUNICABLE DISEASE
Influenza hospitalizations by race/ethnicity, rate per 100,000, Wisconsin, 2012
Source: Wisconsin Department of Health Services, Bureau of Communicable Diseases and Emergency Response, Wisconsin hospital inpatient database (unpublished data).Note: Racial groups include Hispanics.
Influenza hospitalizations0
2
4
6
8
10
12
14
4.9 12.4 4.5 7.8 1.5
White Black
Hispanic Asian
American Indian
Rate
per
100
,000
pop
ulati
on Incidence of communicable disease
32
COMMUNICABLE DISEASE
Chronic hepatitis B cases by race/ethnicity, Wisconsin, 2010-2012
Source: Wisconsin Electronic Disease Surveillance System (WEDSS), 2010-2012.Note: Includes chronic hepatitis B virus cases, confirmed or probable.
American Indian, 0.3%
Asian; 42.8%Black, 15.7%
Hispanic; 2.3%
White; 18.4%
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Incidence of communicable disease
COMMUNICABLE DISEASE
Tuberculosis cases by race/ethnicity and foreign-born status, Wisconsin, 2006-2012
Source: Wisconsin Electronic Disease Surveillance System (WEDSS), 2010-2012.
Incidence of communicable disease
White Black Hispanic Asian American Indian0
20
40
60
80
100
120
140
160
180
Foreign-Born, Not RefugeeForeign-Born RefugeeU.S. Born
Num
ber o
f cas
es
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COMMUNICABLE DISEASE
References1. University of Wisconsin Population Health Institute. County Health Rankings, 2013.
http://www.countyhealthrankings.org/our-approach 2. Center for Urban Population Health. Milwaukee Health Report, 2011.
http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf 3. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health
Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
4. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/
5. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf
6. Centers for DiseaseControl and Prevention (CDC). How Vaccines Prevent Disease. http://www.cdc.gov/vaccines/vac-gen/howvpd.htm#why
7. Healthy People 2020. Immunization and Infectious Disease. http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=23
8. CDC. Preteen and Teen Vaccines. http://www.cdc.gov/vaccines/who/teens/for-parents.html
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References
COMMUNICABLE DISEASE
9. Pediatrics. Middle School Vaccination Requirements and Adolescent Vaccination Coverage. http://pediatrics.aappublications.org/content/early/2012/05/02/peds.2011-2641.full.pdf
10. Centers for Medicare and Medicaid Services. Immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/index.html?redirect=/immunizations/
11. Wisconsin Department of Health Services (DHS). Meningococcal Disease Factsheet. http://www.dhs.wisconsin.gov/publications/P4/P42072.pdf
12. DHS. Wisconsin Epi Express, April 2011. http://www.dhs.wisconsin.gov/communicable/WiEpiExpress/PDFfiles/2011WEE/2011WEE0420.pdf
13. National Foundation for Infectious Disease. Meningococcal Vaccination: Improving Rates in Adolescents and Reducing Racial, Ethnic and Socioeconomic Disparities. http://stopmeningitis.nfidinitiatives.org/professional-resources/meningococcal-cta.pdf
14. CDC. Active Bacterial Core Surveillance (ABCs): Emerging Infections Program Network. http://www.cdc.gov/abcs/reports-findings/survreports/mening10.html
15. Wisconsin Department of Health Services. Haemophilus influenzae. http://www.dhs.wisconsin.gov/immunization/hib.htm
16. CDC.The Pink Book: Haemophilus influenzae Type b. http://www.cdc.gov/vaccines/pubs/pinkbook/hib.html
17. Pediatrics. Haemophilus influenzae Type b Disease Among Amish Children in Pennsylvania: Reasons for Persistent Disease http://pediatrics.aappublications.org/content/108/4/e60.full.pdf
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References
COMMUNICABLE DISEASE
18. Wisconsin Department of Health Services. Streptococcus pneumoniae, Invasive (Pneumococcal disease). http://www.dhs.wisconsin.gov/publications/p4/p42093.pdf
19. Wisconsin Department of Health Services. Group B Streptococcal Infections (GBS), Invasive: http://www.dhs.wisconsin.gov/publications/p4/p42049.pdf
20. CDC. The Pink Book: Pneumococcal disease. http://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html
21. American Journal of Public Health. Socioeconomic and Racial/Ethnic Disparities in the Incidence of Bacteremic Pneumonia Among US Adults. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936986/
22. CDC. Group B Strep Prevention in Newborns. http://www.cdc.gov/groupbstrep/about/prevention.html
23. The Mayo Clinic. Group B strep disease. http://www.mayoclinic.com/health/group-b-strep/DS01107/DSECTION=risk-factors
24. CDC. Perinatal Group B Streptococcal Disease After Universal Screening Recommendations—United States, 2003—2005. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5628a1.htm
25. Wisconsin Department of Health Services. Influenza (Flu) http://www.dhs.wisconsin.gov/communicable/influenza/
26. World Health Organization (WHO). Hepatitis B. http://www.who.int/mediacentre/factsheets/fs204/en/
27. WHO. Tuberculosis (TB). http://www.who.int/topics/tuberculosis/en/
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References
COMMUNICABLE DISEASE
Links to additional reports and resources
• Wisconsin Immunization Program: http://www.dhs.wisconsin.gov/immunization/index.htm
• National Immunization Survey: http://www.cdc.gov/nchs/nis.htm
• Wisconsin Department of Health Services: Invasive bacteria. http://www.dhs.wisconsin.gov/communicable/InvasiveBacteria/Index.htm
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Links
COMMUNICABLE DISEASE
39
Contacts
Bureau of Communicable Diseases and Emergency ResponseDivision of Public HealthWisconsin Department of Health Services
Immunizations:
Stephanie Schauer, PhDWisconsin Immunization Program EpidemiologistEmail: [email protected]
Dan Hopfensperger Wisconsin Immunization Program Director Email: [email protected]
Invasive Bacterial Disease:
Susann Ahrabi-Fard, MSCommunicable Disease EpidemiologistEmail: [email protected]
Influenza:
Tom Haupt, MSInfluenza Surveillance CoordinatorWisconsin Department of Health ServicesEmail: [email protected]
Tuberculosis:
Lorna Will, RN, MA Director Tuberculosis Control Program Wisconsin Department of Health ServicesEmail: [email protected]
Contacts