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

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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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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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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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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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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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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

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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

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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

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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

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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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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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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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Immunization among older adults

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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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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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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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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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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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Incidence of communicable diseases

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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

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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

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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

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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

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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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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

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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

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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

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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

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Contacts

Bureau of Communicable Diseases and Emergency ResponseDivision of Public HealthWisconsin Department of Health Services

Immunizations:

Stephanie Schauer, PhDWisconsin Immunization Program EpidemiologistEmail: Stephanie.Schauer@dhs.wisconsin.gov

Dan Hopfensperger Wisconsin Immunization Program Director Email: Dan.Hopfensperger@dhs.wisconsin.gov

Invasive Bacterial Disease:

Susann Ahrabi-Fard, MSCommunicable Disease EpidemiologistEmail: Susann.AhrabiFard@dhs.wisconsin.gov

Influenza:

Tom Haupt, MSInfluenza Surveillance CoordinatorWisconsin Department of Health ServicesEmail: Thomas.Haupt@dhs.wisconsin.gov

Tuberculosis:

Lorna Will, RN, MA Director Tuberculosis Control Program Wisconsin Department of Health ServicesEmail: Lorna.Will@dhs.wisconsin.gov

Contacts