BUREAU OF EPIDEMIOLOGY

Michigan Office of the
Auditor General
Thomas H. McTavish, C.P.A.
Auditor General

EXECUTIVE DIGEST #3913198
BUREAU OF EPIDEMIOLOGY

INTRODUCTION
This report, issued in September 1999, contains the results of our performance audit of the Bureau of Epidemiology, Department of Community Health (DCH).

AUDIT PURPOSE
This performance audit was conducted as part of the constitutional responsibility of the Office of the Auditor General. Performance audits are conducted on a priority basis related to the potential for improving effectiveness and efficiency.

BACKGROUND
The mission of the Bureau is to provide information necessary for developing interventions, including policies and practices, that will improve the public's health through surveillance and analytic services.

The Bureau consists of three divisions: Communicable Disease Epidemiology, Epidemiology Services, and Environmental Epidemiology. Each of the divisions has specific goals and objectives that contribute to the overall Bureau mission.

The Bureau was appropriated $7.1 million for fiscal year 1998-99 and had 35 employees as of January 21, 1999.

AUDIT OBJECTIVES, CONCLUSIONS, AND NOTEWORTHY ACCOMPLISHMENTS
Audit Objective: To assess the Bureau's effectiveness in collecting epidemiological data and investigating potential health threats.

Conclusion: We concluded that the Bureau was generally effective in collecting epidemiological data and investigating potential health threats. However, we noted reportable conditions involving tuberculosis billing reimbursements and employee evaluations (Findings 1 and 2).

Noteworthy Accomplishments: In spring 1997, the Bureau was the first to identify the cause of the hepatitis A epidemic among Marshall area schoolchildren. The Bureau's identification prompted the nationwide recall of frozen strawberries, thereby reducing the risk of outbreaks nationwide. The strawberries were grown in Mexico, processed and frozen in a California plant, and distributed through the U.S. Department of Agriculture for school lunch programs and through distributors for commercial use.

In addition, in summer 1997, the Bureau implicated alfalfa sprouts as the cause of a multistate outbreak of E. coli O157:H7.

Audit Objective: To assess the Bureau's effectiveness in providing health-related information for developing interventions that will either protect or improve public health.

Conclusion: We concluded that the Bureau was generally effective in providing health-related information for developing interventions that will either protect or improve public health. However, we noted a reportable condition involving timely reporting (Finding 3).

Noteworthy Accomplishments: In 1998, Michigan was recognized by the Centers for Disease Control and Prevention as making significant progress in implementing the U.S. Public Health Service guidelines as a result of the activities and research performed by the Bureau. The Public Health Service guidelines recommend providing human immunodeficiency virus (HIV) counseling and voluntary testing for all pregnant women and using an antiretroviral drug among infected women and their infants. A study performed by the Bureau indicated that an increased number of HIV-infected pregnant women were being treated with zidovudine prophylaxis. This treatment resulted in a decrease in the number of exposed children becoming HIV infected, thereby demonstrating the success of perinatal HIV prevention efforts.

AUDIT SCOPE AND METHODOLOGY
Our audit scope was to examine the program and other records of the Bureau of Epidemiology. Our audit was conducted in accordance with Government Auditing Standards issued by the Comptroller General of the United States and, accordingly, included such tests of the records and such other auditing procedures as we considered necessary in the circumstances.

We examined the Bureau's records and activities for the period October 1, 1996 through January 31, 1999. Our audit procedures included reviewing the Bureau's mission statement and applicable statutes, policies, and procedures. Also, we interviewed DCH staff and Centers for Disease Control and Prevention personnel, and we surveyed local health department professionals, physicians, and medical laboratory professionals. In addition, we reviewed processes related to the receipt and processing of health-related data and information.

AGENCY RESPONSES AND PRIOR AUDIT FOLLOW-UP
Our audit report includes 3 findings and recommendations. The agency preliminary response indicated that DCH and the Bureau agree with all 3 findings and recommendations.

Two recommendations from the prior audit were within the scope of the current audit. We rewrote both recommendations for inclusion in this report.

Full Audit Report - #3913198 - BUREAU OF EPIDEMIOLOGY

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This page was created on 09/02/99.


INTRODUCTION This report, issued in September 1999, contains the results of our performance audit of the Bureau of Epidemiology, Department of Community Health (DCH).

AUDIT PURPOSE This performance audit was conducted as part of the constitutional responsibility of the Office of the Auditor General. Performance audits are conducted on a priority basis related to the potential for improving effectiveness and efficiency.

BACKGROUND The mission of the Bureau is to provide information necessary for developing interventions, including policies and practices, that will improve the public's health through surveillance and analytic services. The Bureau consists of three divisions: Communicable Disease Epidemiology, Epidemiology Services, and Environmental Epidemiology. Each of the divisions has specific goals and objectives that contribute to the overall Bureau mission. The Bureau was appropriated $7.1 million for fiscal year 1998-99 and had 35 employees as of January 21, 1999.

AUDIT OBJECTIVES, CONCLUSIONS, AND NOTEWORTHY ACCOMPLISHMENTS Audit Objective: To assess the Bureau's effectiveness in collecting epidemiological data and investigating potential health threats. Conclusion: We concluded that the Bureau was generally effective in collecting epidemiological data and investigating potential health threats. However, we noted reportable conditions involving tuberculosis billing reimbursements and employee evaluations (Findings 1 and 2). Noteworthy Accomplishments: In spring 1997, the Bureau was the first to identify the cause of the hepatitis A epidemic among Marshall area schoolchildren. The Bureau's identification prompted the nationwide recall of frozen strawberries, thereby reducing the risk of outbreaks nationwide. The strawberries were grown in Mexico, processed and frozen in a California plant, and distributed through the U.S. Department of Agriculture for school lunch programs and through distributors for commercial use. In addition, in summer 1997, the Bureau implicated alfalfa sprouts as the cause of a multistate outbreak of E. coli O157:H7. Audit Objective: To assess the Bureau's effectiveness in providing health-related information for developing interventions that will either protect or improve public health. Conclusion: We concluded that the Bureau was generally effective in providing health-related information for developing interventions that will either protect or improve public health. However, we noted a reportable condition involving timely reporting (Finding 3). Noteworthy Accomplishments: In 1998, Michigan was recognized by the Centers for Disease Control and Prevention as making significant progress in implementing the U.S. Public Health Service guidelines as a result of the activities and research performed by the Bureau. The Public Health Service guidelines recommend providing human immunodeficiency virus (HIV) counseling and voluntary testing for all pregnant women and using an antiretroviral drug among infected women and their infants. A study performed by the Bureau indicated that an increased number of HIV-infected pregnant women were being treated with zidovudine prophylaxis. This treatment resulted in a decrease in the number of exposed children becoming HIV infected, thereby demonstrating the success of perinatal HIV prevention efforts.

AUDIT SCOPE AND METHODOLOGY Our audit scope was to examine the program and other records of the Bureau of Epidemiology. Our audit was conducted in accordance with Government Auditing Standards issued by the Comptroller General of the United States and, accordingly, included such tests of the records and such other auditing procedures as we considered necessary in the circumstances. We examined the Bureau's records and activities for the period October 1, 1996 through January 31, 1999. Our audit procedures included reviewing the Bureau's mission statement and applicable statutes, policies, and procedures. Also, we interviewed DCH staff and Centers for Disease Control and Prevention personnel, and we surveyed local health department professionals, physicians, and medical laboratory professionals. In addition, we reviewed processes related to the receipt and processing of health-related data and information.

AGENCY RESPONSES AND PRIOR AUDIT FOLLOW-UP Our audit report includes 3 findings and recommendations. The agency preliminary response indicated that DCH and the Bureau agree with all 3 findings and recommendations. Two recommendations from the prior audit were within the scope of the current audit. We rewrote both recommendations for inclusion in this report.