What to know
The Interstate Communication Control Record (ICCR) is a resource to help STI programs confidentially share information between domestic jurisdictions to conduct public health prevention activities. STI ICCR points of contact are available for each U.S. funded project area and all provinces in Canada. HIV ICCR contacts are also included.
Background
For several decades, the ICCR has been used as a resource for STI programs to systematically maintain confidentiality while sharing client information between domestic jurisdictions to conduct public health prevention activities. ICCR facilitates data sharing to ensure at-risk or people with infections are offered STI prevention services outside of the initiating jurisdiction. This includes the confidential follow-up of exposed sex partners, people with infections who need treatment or other services, and others in need of STI prevention services.
ICCR Point of Contacts
Send contact updates to std_pchd@cdc.gov.
The ICCR document consists of a roster of STI prevention program points of contact (POCs) in the United States, Puerto Rico and the U.S. Virgin Islands, as well as directly-funded cities. These POCs have been authorized by their STI program directors to accept and share confidential public health information from one jurisdiction to another so that individuals in need of prevention services may be reached promptly, professionally, and confidentially.
The Council of State and Territorial Epidemiologists (CSTE) approved a position statement in 2003 (03-ID-10) clarifying processes to be used by health departments in determining residence for disease reporting purposes. The position statement also specifies which jurisdiction should take responsibility for reporting cases to CDC through the National Notifiable Diseases Surveillance System (NNDSS) when they are determined to live out of jurisdiction at the onset of illness. Rules guiding decisions for persons on vacation, homeless persons, people with multiple residences, students, military personnel, persons in jails/institutions and foreign nationals are described. Also included in this position statement are rules clarifying appropriate values for the 'IMPORTED' variable in the core National Electronic Telecommunications System for Surveillance (NETSS) record. This document is a useful reference for most of the situations commonly encountered in STI surveillance.
Confidentiality
Health Departments should consult and follow the recommendations in the Data Security and Confidentiality Guidelines to ensure confidentiality is protected and maintained across jurisdictions.
Communications between public health jurisdictions, including the protection of confidential information, is the responsibility of each project area. Information sharing between jurisdictions should be limited to the ICCR Coordinators to ensure confidentiality is maintained. Moreover, the Data Security and Confidentiality Guidelines recommend that written data sharing plans serve as a starting point for discussion about data sharing between public health programs.
Having a plan in writing can also formalize procedures and help resolve any conflicts. (See page 7 of the Data Security and Confidentiality Guidelines.) CDC is not directly involved in the sharing of confidential data through ICCR. Health departments should work collaboratively to protect confidentiality across jurisdictions.
Health departments should refer to the Data Security and Confidentiality Guidelines for additional guidance when transmitting confidential information by fax machine (see appendix F, "Guidelines for the Use of Facsimile Machines") or traditional mail (see Standard 4.3 on p. 26).
Regardless of the mechanism, confidential public health information should be shared securely and promptly to ensure public health follow-up is timely and confidential wherever it occurs.
Tip
How to use the ICCR POC document
ICCR should be used to identify and confidentially contact POCs in other jurisdictions to inform them about individuals in their jurisdiction in need of STI prevention services. Examples of when ICCR may be used to conduct out of jurisdiction (OOJ) activities include individuals living in another state who either a) tested positive for an STI or b) was named as a sex partner of someone with an infection.
When cross-jurisdictional public health follow-up is needed, staff should:
- Gather all pertinent locating, medical, and risk information of the person in need of services and share it confidentially with their jurisdiction's ICCR POC.
- The initiating ICCR POC will then contact the ICCR POC in the receiving jurisdiction. The ICCR can help to identify the receiving POC, the acceptable mechanism for information sharing, and type of investigations that are accepted.
Through these established points of contact, jurisdictions may share data efficiently and confidentially.
The following examples are for illustrative purposes only. Final dispositions should be shared with the initiating project area whenever practical.
Positive syphilis laboratory result
A positive laboratory test, absent any treatment or diagnostic information, should be forwarded from the project area where the test was performed to the patient's resident project area. Patient contact should follow the receiving project area's standard protocols and procedures. Any resultant morbidity lies with the resident project area.
Example: John Doe is seen by a health care provider in Worchester, Massachusetts, and lives in Hartford, Connecticut. A positive RPR and FTA are reported to the Massachusetts STI prevention program. No treatment or history exists in Massachusetts. The Massachusetts STI program should forward the positive serology results to the Connecticut STI prevention program for follow-up as per Connecticut's standard protocols. If a new case of syphilis, morbidity belongs to Connecticut.
Positive chlamydia and/or gonorrhea laboratory result
A positive laboratory test, with or without treatment or diagnostic information, should be forwarded from the project area where the test was performed to the patient's resident project area. Patient contact should follow the receiving project area's standard protocols and procedures. Morbidity lies with the resident project area.
Example: Jane Doe is seen by a health care provider in Milwaukee, Wisconsin, and lives in Chicago, Illinois. A positive GC NAAT is reported to the Wisconsin STI Prevention program. Treatment is verified. The Wisconsin STI prevention program should forward the positive GC NAAT result and treatment information to the Chicago STI prevention program for follow-up as per Chicago's standard protocols. Morbidity belongs to Chicago. Data sharing process remains the same if treatment was not provided; information should be forwarded to the Chicago STI prevention program for follow-up as per their protocols. Morbidity still belongs to Chicago.
Diagnosed case of syphilis
A confirmed case of syphilis (positive laboratory plus verified treatment and diagnosis) should be forwarded from the project area where the case was diagnosed and treated to the patient's resident project area. Initiating project area should note the need (or not) for interview and partner services. Patient contact should follow the receiving project area's standard protocols and procedures. Any resultant morbidity lies with the resident project area.
Example: John Smith is diagnosed with secondary syphilis and appropriately treated in Washington, DC, and lives in Potomac, Maryland. The DC STI prevention program should forward all necessary case information to the Maryland STI prevention program for follow-up as per Maryland's standard protocols. Morbidity lies with Maryland.
Partner services
Partner information should be forwarded from the project area where the information was gathered to the partner's resident project area. Follow-up will proceed according to the receiving project area's standard protocols as reflected in this document (some project areas will NOT accept partners to CT or GC).
Example: Jane Smith is named as a contact to an early-latent case of syphilis in New Orleans, Louisiana. Jane lives in Dallas, Texas. The Louisiana STI prevention program should forward all necessary information to provide partner notification services to Jane to the Texas STI prevention program.