The LHD should have a role in the practice’s development and/or implementation. Additionally, the practice should demonstrate broadbased involvement and participation of community partners (e.g., government, local residents, business, healthcare, and academia). If the practice is internal to the LHD, it should demonstrate cooperation and participation within the agency (i.e., other LHD staff) and other outside entities, if relevant. An effective implementation strategy includes outlined, actionable steps that are taken to complete the goals and objectives and put the practice into action within the community.
Enter the LHD and Community Collaboration related to your practice
Oakland County’s HAV outbreak response began in August 2016. Awareness and prevention education efforts continue throughout the broad community with collaboration from community partners to target vaccination efforts in high-risk populations despite Oakland County being recently removed as an outbreak jurisdiction.
OCHD’s outbreak response objectives included:
- Provide vaccination and education opportunities to targeted, high-risk populations
- Increase overall awareness about the HAV outbreak and infection prevention
The criteria for those who received the practice included individuals identified as high risk for contracting hepatitis A and those at greatest risk for potentially spreading Hepatitis A, such as food handlers. Those who are thought to be at greater risk in this outbreak setting include individuals with a history of injection and non-injection drug use, those experiencing homelessness, in transient housing, incarceration and those persons in direct contact with high risk individuals. Coordination and collaboration within OCHD and among community partners was imperative. This coordination allowed for a timely, effective response to exposure incidents and the overall outbreak.
A strong and vital partnership was formed between Oakland County Jail (OCJ), Oakland County Sheriff’s Office (OCSO), and OCHD Public Health Nursing Unit. Vaccination outreach was and continues to be provided each weekday morning at the Oakland County Jail. A list of inmates who have entered the jail within the previous 24 hours or over the weekend are identified and provided to the Public Health Nurse to begin facilitating a vaccination opportunity. This timeframe criteria allows the greatest number of inmates to be reached before they are released. Inmates are transported to the jail clinic where they attend an education session with a Public Health Nurse where information regarding Hepatitis A, the recent outbreak and the increased risk associated with incarceration is discussed. The Public Health Nurse’s role is critical in relationship building with inmates, as trust is imperative to removing potential barriers to vaccination. Inmates are afforded an opportunity to ask questions and express any concerns. Many inmates believe the government is a harmful entity and the experienced nurses have developed an ability to gain trust in a short amount of time to remove barriers to vaccination and maximize vaccine uptake. The inmate’s electronic immunization record is reviewed to determine eligibility. Inmates who have previously been vaccinated against Hepatitis A are reassured that they are protected. Inmates who are eligible for either a first or second dose vaccination are offered the Hepatitis A vaccination.
Equally important is the relationship forged with Oakland County Sheriff Deputies and jail leadership. Leadership at the jail has been extremely supportive, while deputies and jail staff work seamlessly with OCHD staff to transport and care for inmates.
Oakland Community Health Network (OCHN), the county’s public mental health system, was also an important partner. Staff from OCHD and OCHN worked to coordinate prevention messaging and distribute educational materials at service provider locations. OCHN was essential in fostering OCHD’s connections with local substance use disorder treatment centers to provide vaccination to a high-risk population.
Collaboration between different units within the health division was also essential to prevent the spread of HAV cases and secondary exposures. Key units included Communicable Disease, Public Health Nursing, Environmental Health, Emergency Preparedness, Central Support Services, and Health Education. The Communicable Disease Unit (CD) consists of public health nurses, epidemiologists, and clerical staff who work together and handle reporting and surveillance of hepatitis A cases. Additionally, the CD unit may be involved in vaccination efforts. HAV cases were classified by epidemiologists who account for a variety of factors including laboratory results, general symptoms, and client risk factors. Upon the presence of a positive HAV case or exposure to a confirmed case of hepatitis A, an investigation begins with reports from healthcare facilities and the collection of basic patient information before being sent to OCHD’s Public Health Nurses. The public health nurses are pivotal in case investigations, as they collect information quickly and educate the patient to prevent secondary transmission to close contacts. The epidemiologists and public health nurses then began identifying potential sources of disease transmission, and coordinating the response to prevent secondary exposures. These efforts often involve employees working overtime and weekends to ensure individuals can receive vaccination within 14 days of their exposure
The response to prevent the spread of hepatitis A and secondary exposures also included coordination with OCHD’s Environmental Health Services, Emergency Preparedness, Central Support Services, and Health Education units. Environmental Health Sanitarians conducted inspections at food establishments where large exposures occurred and delivered educational materials to managers. Food service managers and staff at affected locations collaboratively adhered to Health Division guidance and engaged in proper precautionary measures at their establishments. Sanitarians were also instrumental in holding educational workshops for food service managers about ways to prevent foodborne illnesses especially Hepatitis A. All educational materials, social media campaigns and advertising were created by Health Education staff with input from Communicable Disease, Public Health Nursing, Environmental Health, Central Support Services and Administration. Further, staff from all disciplines within the Health Division were called upon to assist in various roles during large vaccination outreach efforts such as when an exposure occurred at a large Michigan based festival in August 2018 and OCHD rapidly coordinated to vaccinate festival staff, volunteers and direct contacts.
Lastly, OCHD worked closely with Michigan Department of Health and Human Services (MDHHS) to monitor the outbreak. OCHD Emergency Preparedness staff was the designated lead to submit weekly situation reports to MDHHS to measure response efforts. Health Education, Public Health Nursing, and Emergency Preparedness staff worked cohesively to report the reach of communication efforts, vaccination clinic outcomes, and any notable barriers to response. In addition, multiple OCHD staff participated in weekly conference calls with affected jurisdictions. Conference calls facilitated by MDHHS offered an opportunity to learn how other counties were combatting the outbreak and share our response activities.
As proven in the collaborative response described above, OCHD values the importance of collaboration to prevent disease and improve health. Community stakeholders are engaged routinely through coalition efforts, emergency response planning, routine meetings, and communication methods so they are easily called upon to assist and provide resources within the partnership to address and prevent emerging issues such as the hepatitis A outbreak. Key stakeholders such as OCHN, OCSO, mental health and substance use treatment providers, and homeless shelters are active partnership members which made for steady communication, collaboration, and coordination.
The Hepatitis A outbreak response effort was partially supported by grant funding from MDHHS. The total grant funding amount of $203,000 supported internal and outreach Hep A vaccination clinics, staffing and supplies such as Immunoglobulin, biologics units, portable coolers, wagons, office supplies and storage cabinet. The funding was also used to help support an awareness campaign that included mailing educational materials to restaurants, bus and mobile advertisement, paid social media content, and printed educational materials.
Fiscal Year 2018
Program Costs:
- Salaries/Fringe Benefits - Partial funding of vaccination outreach staff $67,034
- Advertising/Postage – Bus & billboard, social media boosts & mailings $34,718
- Printing/Translation of Printed Materials – Printed educational materials $8,160
- Supplies – Supplies to support vaccination outreaches $26,071
- Equipment – Biologic refrigeration units, portable coolers, wagons, etc. $39,642
- All Other Costs – Insurance, indirect, administrative overhead, etc. $26,627
In addition to the funding from MDHHS, Oakland County used locally funded positions to provide vaccines, coordinate community outreaches, develop educational materials, create marketing campaigns and provide administrative oversight of the funding and staff.