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 2 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: 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: Report overview 3

COMMUNICABLE DISEASE 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 4

COMMUNICABLE DISEASE 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 5

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 6

COMMUNICABLE DISEASE Report Outline: Detail Section 5: Data summaries by population  Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography Report overview 7

COMMUNICABLE DISEASE Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: 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 8

COMMUNICABLE DISEASE Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, Report overview 9

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 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 11 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 months living below poverty received the recommended vaccination coverage compared to their peers nationally. During , 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 , 73% of adults ages 65 and older had ever received a pneumonia vaccination. 13 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 , 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. 14 Key points

COMMUNICABLE DISEASE Immunization among youth 15

COMMUNICABLE DISEASE Vaccination coverage with recommended series among children ages months, Wisconsin and United States, 2011 Source: National Immunization Survey for Children, Immunization among youth 16

COMMUNICABLE DISEASE Vaccination coverage with selected vaccines among adolescents ages 13-17, Wisconsin and United States, 2011 Source: National Immunization Survey for Teens, Note: * To protect against tetanus, diphtheria, and pertussis. ** To protect against meningococcal disease. Immunization among youth 17

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, Note: * To protect against tetanus, diphtheria, and pertussis. ** To protect against meningococcal disease. 18

COMMUNICABLE DISEASE Immunization among older adults 19

COMMUNICABLE DISEASE Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by sex, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Immunization among older adults 20

COMMUNICABLE DISEASE Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by race/ethnicity, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 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 21

COMMUNICABLE DISEASE Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Immunization among older adults 22

COMMUNICABLE DISEASE Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by level of urbanization, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Immunization among older adults 23

COMMUNICABLE DISEASE Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by disability status, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Immunization among older adults 24

COMMUNICABLE DISEASE Incidence of communicable diseases 25

COMMUNICABLE DISEASE Wisconsin bill passed Menactra licensed Booster dose recommended Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Meningococcal disease cases, Wisconsin, Incidence of communicable disease 26

COMMUNICABLE DISEASE Meningococcal disease by race/ethnicity, crude rate per 100,000, Wisconsin, Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Note: Data were not available for Hispanics. Incidence of communicable disease 27

COMMUNICABLE DISEASE 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, , (n=10 cases) Source: Clifford Grammich, Kirk Hadaway, Richard Houseal, Dale E. Jones, Alexei Krindatch, Richie Stanley, and Richard H. Taylor 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 28

COMMUNICABLE DISEASE Incidence of invasive Streptocococcus pneumoniae and group B streptococcal (GBS) disease, Wisconsin, Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Incidence of communicable disease 29

COMMUNICABLE DISEASE Confirmed cases of Streptocococcus pneumoniae and group B streptococcal (GBS) disease, rate per 100,000, by race/ethnicity, Wisconsin, Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Note: Data were not available for Hispanics. 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, Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Note: Data were not available for other races/ethnicities. 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. Incidence of communicable disease 32

COMMUNICABLE DISEASE Chronic hepatitis B cases by race/ethnicity, Wisconsin, Source: Wisconsin Electronic Disease Surveillance System (WEDSS), Note: Includes chronic hepatitis B virus cases, confirmed or probable. 33 Incidence of communicable disease

COMMUNICABLE DISEASE Tuberculosis cases by race/ethnicity and foreign-born status, Wisconsin, Source: Wisconsin Electronic Disease Surveillance System (WEDSS), Incidence of communicable disease 34

COMMUNICABLE DISEASE References 1.University of Wisconsin Population Health Institute. County Health Rankings, Center for Urban Population Health. Milwaukee Health Report, LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 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– Wisconsin Department of Health Services (DHS). Healthiest Wisconsin Centers for DiseaseControl and Prevention (CDC). How Vaccines Prevent Disease Healthy People Immunization and Infectious Disease CDC. Preteen and Teen Vaccines. parents.htmlhttp:// parents.html 35 References

COMMUNICABLE DISEASE 9.Pediatrics. Middle School Vaccination Requirements and Adolescent Vaccination Coverage full.pdfhttp://pediatrics.aappublications.org/content/early/2012/05/02/peds full.pdf 10.Centers for Medicare and Medicaid Services. Immunizations. zations/ zations/ 11.Wisconsin Department of Health Services (DHS). Meningococcal Disease Factsheet DHS. Wisconsin Epi Express, April WEE0420.pdf WEE0420.pdf 13.National Foundation for Infectious Disease. Meningococcal Vaccination: Improving Rates in Adolescents and Reducing Racial, Ethnic and Socioeconomic Disparities CDC. Active Bacterial Core Surveillance (ABCs): Emerging Infections Program Network Wisconsin Department of Health Services. Haemophilus influenzae CDC.The Pink Book: Haemophilus influenzae Type b Pediatrics. Haemophilus influenzae Type b Disease Among Amish Children in Pennsylvania: Reasons for Persistent Disease References

COMMUNICABLE DISEASE 18.Wisconsin Department of Health Services. Streptococcus pneumoniae, Invasive (Pneumococcal disease) Wisconsin Department of Health Services. Group B Streptococcal Infections (GBS), Invasive: 20.CDC. The Pink Book: Pneumococcal disease American Journal of Public Health. Socioeconomic and Racial/Ethnic Disparities in the Incidence of Bacteremic Pneumonia Among US Adults CDC. Group B Strep Prevention in Newborns The Mayo Clinic. Group B strep disease. strep/DS01107/DSECTION=risk-factorshttp:// strep/DS01107/DSECTION=risk-factors 24.CDC. Perinatal Group B Streptococcal Disease After Universal Screening Recommendations—United States, 2003— Wisconsin Department of Health Services. Influenza (Flu) World Health Organization (WHO). Hepatitis B WHO. Tuberculosis (TB) References

COMMUNICABLE DISEASE Links to additional reports and resources Wisconsin Immunization Program: National Immunization Survey: Wisconsin Department of Health Services: Invasive bacteria Links

COMMUNICABLE DISEASE 39 Contacts Bureau of Communicable Diseases and Emergency Response Division of Public Health Wisconsin Department of Health Services Immunizations: Stephanie Schauer, PhD Wisconsin Immunization Program Epidemiologist Dan Hopfensperger Wisconsin Immunization Program Director Invasive Bacterial Disease: Susann Ahrabi-Fard, MS Communicable Disease Epidemiologist Influenza: Tom Haupt, MS Influenza Surveillance Coordinator Wisconsin Department of Health Services Tuberculosis: Lorna Will, RN, MA Director Tuberculosis Control Program Wisconsin Department of Health Services Contacts