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Objectives. We compared 3 methods for classifying methicillin-resistant Staphylococcus aureus (MRSA) infections as health care associated or community associated for use in public health surveillance. Methods. We analyzed data on MRSA infections reported to the Michigan Department of Community Health from October 1, 2004, to December 31, 2005. Patient demographics, risk factors, infection information, and susceptibility were collected for 2151 cases. We classified each case by the health care risk factor, infection-type, and susceptibility pattern methods and compared the results of the 3 methods. Results. Demographic, clinical, and microbiological variables yielded similar health care–associated and community-associated distributions when classified by risk factor and infection type. When 2 methods yielded the same classifications, the overall distribution was similar to classification by 3 methods. No specific combination of 2 methods was superior. Conclusions. MRSA categorization by 2 methods is more accurate than it is by a single method. The health care risk factor and infection-type methods yield comparable classification results. Accuracy is increased by using more variables; however, further research is needed to identify the optimal combination.

Objectives. We assessed state and local public health workforce characteristics by occupational category from 2010 to 2013. We also examined health department characteristics to determine whether workforce size and composition varied across these domains. Methods. We analyzed Association of State and Territorial Health Officials (2010, 2012) and National Association of County and City Health Officials (2010, 2013) profile study data, including 47 state health departments and 2005 and 1953 local health departments (LHDs) in 2010 and 2013, respectively. We determined number of workers and percentage of change by occupation, population size, geographic region, and governance structure. Results. The LHD workforce remained stable between 2010 and 2013. In states, the workforce decreased by 4%, with notable decreases in public information (−33%) and public health informatics (−29%); state health departments in small (−9%), New England (−13%), and centralized (−7%) states reported the largest decrease in number of workers. Conclusions. Study findings provide evidence of a shifting public health workforce profile, primarily at the state level. Future research should seek to explain changing workforce patterns and determine whether they are planned or forced responses to changing budgets and service priorities.

OBJECTIVES: Emergency contraceptive pill dispensation was estimated in Michigan Title X family planning programs. METHODS: Logistic regression and tobit estimation models were used to predict whether and to what extent emergency contraceptive pills are dispensed. RESULTS: Of the 53 programs studies, 32 dispensed emergency contraceptive pills, averaging fewer than one client per month. Total dispensation was skewed toward a few programs, and the contribution of health departments to this total was small. Emergency contraceptive pill services appeared to be randomly distributed across programs, although most dispenser reported having provided the pills for less than 12 months. CONCLUSIONS: Recent policy advances should lead to more consistent emergency contraceptive pill dispensation in Title X programs.

Objectives. We have described vaccine coverage of Michigan young adolescents immunized with tetanus, diphtheria, and pertussis; meningococcal conjugate; and human papillomavirus vaccines during 2006–2008. Methods. We obtained data from the Michigan Care Improvement Registry, a state-based immunization information system that included more than 57 million vaccination records. We examined 3 overlapping cohorts of 11- and 12-year-old children (n > 350 000 in each) to assess temporal trends in vaccination coverage, characteristics of those immunized, funding sources, and vaccination sites. Results. Vaccine uptake increased during 2006 through 2008, peaking in the summer months. More than half of children receiving more than 1 vaccine received the vaccines simultaneously. Older age, receipt of Medicaid, and prior completion of early childhood immunizations were associated with greater odds of vaccination. Conclusions. Vaccine coverage among Michigan young adolescents is increasing but continues to be relatively low. Coverage of 11- and 12-year-old children may improve with efforts to encourage vaccination at all health care visits, an increase in public funding in support of adolescent vaccination, and continued monitoring of adolescent vaccination levels through school-based assessments.

We examined the impact of the heptavalent pneumococcal conjugate vaccine (PCV7) on hospital discharge rates for invasive pneumococcal disease among Michigan children younger than 5 years old. After the introduction of PCV7, the hospital discharge rate for children younger than 1 years old was significantly lower than before introduction. We correlated the decreased rates with the introduction and rapid uptake of PCV7. Lack of change in the hospital discharge rates for other age groups likely represents a slower uptake of PCV7 compared with that for children aged younger than 1 year.