PROGRAM GOALS: To minimize new vaccine preventable and sexually transmissible diseases, their crippling effects and subsequent cost to the community.

PROGRAM OBJECTIVES: Increase number of gonorrhea and syphilis patients seen by 155 (from 1,850 to 2,200 annually). Increase number of persons given immunizations by 10% (from 11,215 to 12,500 annually). Increase number of individual doses of vaccine given from 45,690 to 46,3(10 in the next year. Proportion of goal being meet; 95% of annual goal for current fiscal year. Only 45% of 1982 five year planning goal. This deficiency is due to lack of funds to buy hepatitis-B vaccine; inability to detect chlamydia infection by laboratory' testing, lack of data systems to track all children and ensure their complete immunization by 18 months of age, lack of staff to monitor licensed day care centers and homes registered to care for children. The most important deficiency is of lack of an additional PHN PERSONNEL: 1 Part-time STD physician specialist, 1 PHN supervisor, I VD investigator, 3 LVNs, I community service aide, 3 clerks.

FACILITIES: At least one additional office in clinical area to allow private interviews with patients plus additional file storage area. Current space will be sufficient once all files are transferred to computerized dala base. This will take approximately 3 years with current staff.

RESULTS in last FY and current FY to date: Syphilis cases increased 28% from 227 008 primary and secondary) to 271 (P & S). Gonorrhea cases decreased from 1,278 to 1,019 (minus 23%). in January 1984 an additional investigator was provided by the state to detect unrecognized cases and assist in tracking down contacts. The investigator was relocated after 6 months but a replacement has been promised. Lack of staff kept us from providing clinics each day. By working with city and county school systems more than 99.5c/,. of children have been immunized against preventable childhood diseases. Despite this, a major measles epidemic occurred in the community with 176 validated cases, mainly in grades 9 and 10. A sero-survey of 1,805 senior and junior high school children was conducted showing immunity over 95%, prior to widespread disease, Lack of staff continue to prevent immunization of all children by 18 months of age. A team of MDs, PHNs, sanitarians, and epidemiologists investigated a hepatitis-A outbreak in a day care center. Thirty one violations of hygiene and child care were discovered. Lack of staff prevent the regular inspection of the 185 day care centers and 245 registered homes for hygienic standards. The majority of disease investigations are for enteric diseases, many of which are associated with improper disposal of disposable diapers. Most others arc due to lack of hygiene during sexual acts.

AIDS: Special funds from CDC allowed hiring of an additional PHN for confidential screening, evaluation, and counseling of persons at high risk for AIDS as well as community education, effective May 1985.

EFFECT OF REDUCED FUNDING: Reduction in numbers of immunization putting community at greater risk for disease outbreaks. Increased spread of STDs including AIDS. Increase in PPNG-GC.