Report: Alaska among states criticized for infectious disease prevention, control

thanlon@adn.comDecember 17, 2013 

A new national report card took Alaska to task for not requiring hospitals to report when they make patients sick with infectious diseases, but lauded the state for covering HIV screenings under Medicaid.

In a state-by-state ranking announced Tuesday morning by the Trust for America's Health and the Robert Wood Johnson Foundation, two nonprofits that focus on public-health issues, Alaska scored 50 percent for overall control and prevention of infectious diseases. While a 5 of 10 is typically a failing mark, only 16 states and Washington, D.C., surpassed Alaska's rating.

The state scores were based on 10 key indicators identified by the nonprofits as critical to protecting people against outbreaks.

Alaska joined 14 states with five points. New Hampshire had the highest score at eight, and three states, Georgia, Nebraska and New Jersey, tied for the lowest score, two.

Jeffrey Levi, executive director of Trust for America's Health, said the report sheds light on public-health vulnerabilities. He said a combination of outdated systems, widespread budget cuts and limited resources hamper the nation's ability to protect people against infectious diseases from salmonella to seasonal influenza to HIV.

"I think the general conclusion I would draw is that fighting these diseases requires constant vigilance," Levi said. "There are gaps in almost every state's ability to respond."

The report was released Tuesday morning in a teleconference with reporters across the country.

Here's where the report said Alaska fell short:

Health care-associated infections: The state does not require health-care facilities to report health care-associated infections like MRSA, the antibiotic-resistant disease. Thirty-five states and Washington, D.C., have such systems in place, the report said. About one in every 20 hospitalized patients will get infected in the hospital, according to the report.

But change is coming to Alaska. New regulations that take effect Dec. 29 that mandate a reporting program in the state, according to Michael Cooper, infectious disease program manager with the state Department of Health and Social Services. Hospitals already report these infections to a tracking system at the federal level with the U.S. Centers for Disease Control and Prevention. But state access to these records have been a battle with health providers since 2006, who fear that the state's small population could make for statistical spikes and make people worried that conditions are worse than they really are, Cooper said.

"It's always a bit difficult to get hospitals and health-care facilities to open up their books and share their rates of infections," Cooper said.

Flu vaccine: Alaska vaccinated 39.7 percent of residents older than 6 months during the 2012-13 flu season. The state did not meet the CDC's recommendation that 50 percent of residents in that age group be vaccinated. Twelve states met the goal.

"From my perspective, the biggest priorities in the coming year or years would be to improve our immunization coverage rates," said Dr. Joe McLaughlin, state epidemiologist. "We're the northern-most state in the country and we know that influenza season is long during our cold winters up here,"

Whooping cough vaccine: About 79 percent of children between 19 months and 35 months old received vaccination for whooping cough (pertussis) in Alaska. The U.S. Department of Health and Human Services wants 90 percent to be vaccinated. Only two states and Washington, D.C., met that goal.

Alaska reported 356 cases of whooping cough during the 2012 outbreak, according to the state epidemiology agency. There have been 304 cases reported in 2013.

HPV vaccine: Alaska does not require teens to get the human papilloma virus vaccination, fund HPV vaccination efforts or educate the public about the vaccine, according to the report. HPV is the most common sexually transmitted virus in the United States, according to the CDC. It leads to 20,000 new cases of cancer in women and 12,000 new cases of cancer in men each year, the report said. The vaccine is recommended, but not required, in Alaska, Cooper said. He said public health nurses recommend the vaccine on an individual basis. The state applied for federal grant money for HPV vaccination outreach last year but did not get the grant, he said.

Ability to handle surge: Alaska's public health lab does not have a plan or the capability to handle a significant surge in testing (over 300 percent) for a six- to eight-week period, the report said. Such a surge might occur in an epidemic.

Here's where Alaska met key indicators:

Funding: State funding for the Department of Health and Human Services increased from $55.6 million for fiscal year 2011 to $59.3 million for fiscal year 2012, according to Kerre Shelton, director of the Alaska Division of Public Health. Sixteen other states received increased or maintained levels of health department funding.

Alaska received the highest level of federal public health spending per person for fiscal year 2012 at $53.07, according to the report. The report said the average was $19.54 per person. Some of the federal funding is based on need, population and competitive grants, the report said.

"For us it costs more to do business up here," said Shelton said.

Climate change: The report said Alaska and 14 other states completed a climate change adaptation plan that focuses on planning for infectious diseases that could emerge with changing temperatures or weather patterns, the report said.

Timely transportation: Alaska's public health lab has the ability to transport samples at all hours, every day of the year. Most states, 46, and Washington, D.C., also have a transportation plan in place.

Continuity of operation plan: Alaska and 26 states tested their ability to operate in an emergency situation, like flood or earthquake, in a real event or exercise in the past year.

HIV screening: Alaska covers HIV screening under Medicaid. Medicaid in 31 other states and Washington, D.C., cover HIV too. CDC estimates that 18 percent of those with HIV did not know of their infection as of 2009, according to report.

Reach Tegan Hanlon at thanlon@adn.com or 257-4589.

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