Volume III Issue III | May 2018
A Monterey County Health Department bi-monthly newsletter summarizing national, state, and local public health-related issues for county providers.
In this Issue: Important Contacts: Communicable Disease Updates Communicable Disease 1. Commonly Reported in 2017 Unit 2. Vaccines Phone: (831) 755-4521 3. STD Fax: (831) 754-6682 4. Tuberculosis Health Officer Chronic Disease Updates Phone: (831) 755-4585 1. Prevention First 1305 Update After Hours: (831) 755-5100 2. Diabetes 3. Opioid Safety Tuberculosis Control Unit 4. Heart Health Phone: (831) 755-4593 5. Grant Opportunities Fax: (831) 796-1272 6. Upcoming Conferences 7. Upcoming Webinars Environmental Health 8. Subscriber's Corner Consumer Protection Phone: (831) 755-4540
Communicable Disease Updates
Commonly Reported Communicable Diseases in 2017 Vaccines
New Shingles Vaccine: What You Need to Know
Shingles vaccination is the only way to protect against shingles and postherpetic neuralgia (PHN), the most common complication from shingles. The CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine called Shingrix®, separated by 2 to 6 months, to prevent shingles and the complications from the disease.
Shingrix provides strong protection against shingles and PHN. Two doses of Shingrix is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated. Shingrix is the preferred vaccine, over Zostavax®, a shingles vaccine in use since 2006. Shingrix is available in Monterey County. If you do not provide immunizations in your clinic, please refer your patients to the Health Map Vaccine Finder website (https://vaccinefinder.org/) to identify a location near them offering the vaccine.
STDs
Concerning Increase in Syphilis in Women and in Congenital Syphilis: An Update for Monterey County Health Care Providers
Early syphilis (primary, secondary, and early latent) has been increasing in Monterey County since 2010. In 2017, there were 70 cases of newly diagnosed early syphilis reported among Monterey County residents (compared to 1 reported case in 2009). From 2012 to 2014, the annual number of reported early syphilis cases among women in California more than doubled from 248 cases to 594. The annual number of reported congenital syphilis in California cases more than tripled during the same period, from 30 to 100. Three cases of congenital syphilis have been reported in Monterey County since 2015. No congenital syphilis cases had been reported in Monterey County in the 15 years prior to 2015.
Recommendations for Providers:
Test for syphilis. Syphilis serology testing should include a rapid plasma regain (RPR) with titer that reflexes to a treponemal test if the RPR is reactive. o Pregnant women should be screened for syphilis at their first prenatal care visit. Testing should be repeated during the third trimester and at delivery for women who are at high risk for syphilis. o Sexually active gay, bisexual, and other men who have sex with men should be screened annually or sooner following disclosure of high risk sexual activity.
Follow the Centers for Disease Control and Prevention’s (CDC’s) guidelines for treatment. Detailed guidelines are available here. o All providers are encouraged to treat patients and their partners in their practice. Family PACT, Medi-Cal, and private insurances normally cover testing and treatment for syphilis. o Call the Health Department’s Communicable Disease Unit (831-755-4521) to check for prior testing and treatment history. If there is no new exposure and no four-fold increase in titer, it may not be necessary to treat.
All patients with syphilis should be tested for HIV if not already known to be HIV-infected. Nearly half of reported early syphilis cases among men who have sex with men in Monterey County were also HIV positive. o Sexually active gay, bisexual, and other men who have sex with men with syphilis who are HIV-negative should be evaluated for HIV pre-exposure prophylaxis (PrEP) and prescribed PrEP if appropriate. Contact the Monterey County’s HIV Programs for guidance on PrEP screening and prescribing (831-755-4626).
Promptly report all suspected syphilis cases to the Health Department’s Communicable Disease Unit (phone: 831-755-4521; fax: 831-754-6682).
STD Treatment Questions? There's an App for That
The Centers for Disease Control and Prevention’s STD Treatment Guide app puts up-to-date treatment information at your fingertips. Download the 2015 STD Treatment (Tx) Guide app, an easy-to-use reference that combines information from the STD Treatment Guidelines as well as MMWR updates, and features a streamlined interface so providers can access treatment and diagnostic information. The free app is available for Apple devices and Android devices.
Tuberculosis
Interactive Core Curriculum on Tuberculosis: What the Clinician Should Know The Interactive Core Curriculum on Tuberculosis: What the Clinician Should Know provides clinicians and other public health professionals with information on diagnosing and treating latent TB infection and TB disease. The target audience of the course is clinicians caring for people with or at high risk for TB disease. This free, on-demand training, is available here.
Continuing education (CE) is offered free of charge for various professions based on approximately 3.5 hours of instruction. To receive CE credit/contact hours, you must complete an exam and course evaluation. A minimum score of 70% is necessary to receive credit/contact hours. Upon successful completion of the course, exam, and evaluation, your CE certificate will be issued by CDC Training and Continuing Education Online.
Chronic Disease Updates
Prevention First Monterey County Project
In this quarter, the Prevention First Monterey County (PFMC) team is working with Intrepid Ascent to plan for an Electronic Health Record (EHR) Learning Action Network (LAN) meeting with representatives from the major safety-net organizations to discuss EHR best-practices, population health, and next steps locally. As an update to the February Community Health Worker/Promotores LAN event, we would like to share that a CHW certificate program is in the planning phase at Cabrillo College in Santa Cruz County. An advisory committee has been developed to move this project forward with the intention to offer the CHW certificate program by 2019. Lastly, the PFMC team is finalizing their work on a Team Based Care Resource Report that will be made available through the PFMC website and posted in the July MCHD Provider Bulletin. Stay tuned!
Learn more about the PFMC project and access additional resources here
If you have any questions about the PFMC project, please contact Prevention First Project Coordinator, Kymber Senes.
Diabetes
Solera Health Launches MedicareDPP.org
The site's goal is to increase awareness of and participation in diabetes prevention programs by making it easy for Medicare beneficiaries to learn their risk for type 2 diabetes, and if eligible, find and participate in a local diabetes prevention program that fits their needs and preferences. MedicareDPP.org will allow Medicare beneficiaries to: Verify health plan eligibility Confirm MDPP qualification (and capture blood test data) Access a diverse network of MDPP suppliers and enroll in the class that best meets their needs Clinician Overview: Solera Network Learn more
American Medical Association-Prediabetes Screening and Referral in CMS Quality Payment Program
Medicare offers new ways for health systems to potentially benefit financially from the work at the provider level for at-risk patients to prevent the onset of type 2 diabetes. Two AMA- suggested population-health Improvement Activities (IAs)—glycemic screening services and glycemic referring services—have been added to available options for physicians participating in the Medicare Quality Payment Program’s Merit-based Incentive Payment System (MIPS). L earn more
Opioid Safety
Addressing the Unique Challenges of Opioid Use Disorders in Women
Women’s biological differences may influence susceptibility to substance abuse, which could have implications for prevention and treatment. In order to identify and treat women most at risk, health care providers must be able to recognize and consider these differences. Learn how to best address the complexities of opioid use disorder among women as speakers discuss ways to effectively care for and provide preventative services to female patients who struggle with the disease. Hot Training Topic: Women and Opioids Content from CDC Learning Connection Newsletter, May , 201 8
Opioid Safety: Interactive Training Series for Providers
Earn FREE continuing education (CE) credit with this interactive, web-based training that features self-paced learning, case-based content, knowledge checks, and integrated resources to help healthcare providers gain a deeper understanding of the "Applying CDC's Guideline for Prescribing Opioids" interactive training series. Content from CDC COCA Learn Newsletter, April 30, 201 8
Assessing and Addressing Opioid Use Disorder-Applying CDC Guidelines for Prescribing
Take CDC’s "Assessing and Addressing Opioid Use Disorder” course to learn about clinical tools that can help in risk assessment and clinical decision making, and earn free CE. Content from CDC COCA Learn Newsletter, April 30, 201 8
Heart Health
Million Hearts: National Stroke Awareness Month 2018: Stroke Can Happen to Anyone at Any Time
New data show that after decades of decline, progress in preventing stroke deaths has slowed. And in many cases, the prevalence of stroke risk factors is increasing among younger and middle-aged adults. This is disturbing, because about 80% of strokes are preventable. During National Stroke Awareness Month, CDC’s Division for Heart Disease and Stroke Prevention will focus on increasing awareness among adults ages 35 to 64 of stroke risk factors, signs, and symptoms. Stroke survivor stories will highlight important messages and inspire action. Help them spread the word by sharing the messages and resources here.
Grant Opportunities
Transforming Clinical Practice Initiative
In September 2015, the National Rural Accountable Care Consortium received a Centers for Medicare & Medicaid Innovation (CMMI) grant to assist more than 7,000 small safety net practices in the transition from fee-for-service payment models to value-based payment models. The no-cost program provides: help to set up clinic on-site billable care coordination programs (includes IT/data analytics infrastructure and 24-hour nurse advice line), redesigning practice workflows to manage population health and measure quality, prepare the ambulatory practice to be a Patient Centered Medical Home, and, increase revenue through improved primary care and billing. Learn more and apply
Upcoming Conferences
APHA 2018: "Creating the Healthiest Nation: Health Equity Now"
Save the Date. Don't miss the biggest public health event of the year! APHA 2018 will take place at the San Diego Convention Center.
Conference Dates: November 10 - 14, 2018.
Registration and housing will open in June 2018.
Upcoming Webinars
Health Resources and Service Administration–Telemedicine 101 for Tribal Organizations
The practice and delivery of health care is changing, with an emphasis on improving quality, safety, efficiency, and access to care. Telemedicine can help you achieve these goals. HRSA and the Southwest Telehealth Resource Center invite you to a webinar on the implementation and practice of telemedicine. When: Tuesday, May 22, 2018 Time: 11am to 12pm Register here
Comprehensive Medication Management: A Win-Win Collaboration
The California Department of Public Health will be hosting a webinar on Thursday, May 31st in partnership with Healthy Hearts California members, featuring information on incorporating pharmacists with care teams. Healthy Hearts California and other community partners are invited to join us for a discussion on why comprehensive medication management is important, what it looks like in the real-world and who has done it successfully in California. When: Thursday, May 31, 2018 Time: 1p.m. to 2p.m. Register here
A Leopard without spots: Clinical Diagnosis of Rocky Mountain Spotted fever Rocky Mountain spotted fever (RMSF), a life-threatening and rapidly progressive tickborne disease, is caused by infection from the bacterium Rickettsia rickettsii. Infection begins with non-specific symptoms like fever, headache, and muscle pain, but unmitigated damage to the vascular endothelium quickly results in organ failure, necrosis, and ultimately death. Early clinical diagnosis is key—as treatment within the first 5 days of illness has been associated with lower mortality. Additionally, newer diagnostics are now available that can aid in early detection. RMSF is a recently-emerging pathogen in Arizona and along the U.S.-Mexico border region. Case fatality rates in these regions have been extremely high and closely tied to widespread tick and free-roaming dog populations. During this COCA call, clinicians discussed the detection, diagnosis, and epidemiology of RMSF.
This free, archived Clinician Outreach and Communication Activity (COCA) webinar can be accessed here. Directions for obtaining free CEs are available on the same site.
Subscriber's Corner
Monterey Bay Independent Physician Association (MBIPA) Consensus Statement
MBIPA is dedicated to welcoming a collaborative avenue for health care professionals to re-evaluate the extensive issues involved in the care and health of our community.
Non specific back pain is prevalent in over 85% of patients treated in a primary care setting and although frequent, there may still be challenges in establishing an ideal treatment plan. Below is a consensus statement that may be useful in treating acute non-traumatic low back pain.
Evaluation and Treatment of Acute Non-Traumatic Low back Pain
If you would like to contribute to the next Provider Bulletin, please send your requests by July 9, 2018.
Contact Norma Cabriales Gutierrez for more information at [email protected]
Thank you for reading this edition of the MCHD Provider Bulletin
If you need help or have any questions please contact our PIO, Karen Smith [email protected]
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