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Pandemic Influenza Update. Stacy Stevens Hall, RN MSN [email protected] Center for Community Preparedness June 2010. Disclosure. I have no financial interests or other relationship with manufacturers of commercial products, suppliers of commercial services, or commercial supporters. - PowerPoint PPT Presentation
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Pandemic Influenza Update
Stacy Stevens Hall, RN [email protected]
Center for Community PreparednessJune 2010
Disclosure I have no financial interests or other
relationship with manufacturers of commercial products, suppliers of commercial services, or commercial supporters.
My presentation will not include any discussion of the unlabeled use of a product or a product under investigational use.
Pandemic Influenza Preparedness Federal Evaluation Process and Results Overview of H1N1 Response Activities 2010 Federal Evaluation of H1N1 After
Action Review Process Planning for 2010 - 2011 Future Preparedness and Evaluation
Today’s Presentation
Initially, OPH Immunization Program activity HHS Pandemic Influenza Plan, 2005
◦ HHS Strategic Plan◦ HHS Public Health Guidance for State and Local
Partners Pandemic Influenza funding in CDC’s Public
Health Emergency Preparedness Cooperative Agreement 2005 - 2007
Evaluation Process began in 2008
Pandemic Influenza Preparedness
Phases, Stages and Intervals
Recognition
654321WHO Phase
Pandemic PeriodPandemic Alert PeriodInter-Pandemic
Period
CDCInter-vals
DecelAccel ResolutionPeakInitiationInvestigation
6543210
RecoverySpread Throughout United States
First Human Case in N. Am.
Widespread Outbreaks Overseas
Confirmed Human
Outbreak Overseas
Suspected Human
Outbreak Overseas
New Domestic Animal
Outbreak in At-Risk CountryUSG
Stage
“Quench”
“Mitigate”
“Contain”
Severity Index of Pandemics
Purpose to prepare for, respond to and recover from an influenza pandemic
National Strategy for Pandemic Influenza: Implementation Plan and evaluation tools
Evaluation by 15 USG Departments, Agencies and Offices by Strategic Goals◦ A Ensure COOP of State Agencies and Government
(6)◦ B Protect Citizens (15)◦ C Sustain/Support Critical Infrastructure Sectors and
Key Resources (7)
National Guidance
2008 Federal Evaluation
http://www.azdhs.org/pandemicflu/pdf/Final_HHS_Operational_Plan_Grades_1.20.09.pdf
How we planned When it happened What we’re learning OPH Activities by Target Capabilities
◦ Communication ◦ Public Information◦ Epidemiology◦ Laboratory◦ Community Mitigation◦ Medical Countermeasure
Antiviral medications Vaccine
Overview of H1N1 Response
March 2009: ILI, severe pneumonia outbreak April 10-May 11 with increased hospitalizations of young adults with an unusual and nonsubtypeable influenza A virus in Mexico
April 17, 2009: First lab confirmed cases of H1N1 viruses in Southern California
April 26, 2009: US DHS declares public health emergency
April 28, 2009: LA receives Strategic National Stockpile
June 11, 2009: WHO declares H1N1 “pandemic” June 19, 2009: All US states and territories report ILI
activity
H1N1 Background
World Health Organization actively monitoring the progress of the pandemic with 214 countries impacted
Overall pandemic influenza virus transmission remains low
Active, but declining transmission of pandemic influenza virus in Southeast Asia and Caribbean
Southern hemisphere no evidence to suggest that winter influenza season has begun
Current Influenza Situation
ILI doctor visits below baseline Hospitalizations returned to expected levels Deaths attributed to pneumonia and influenza is
normally seen during summer Most states reporting no or sporadic activity as
typical for non-pandemic years Majority of influenza viruses continues to be
2009 H1N1 influenza A Viruses remain similar to the virus chosen for
the 2009 H1N1 vaccine Remain susceptible to oseltamivir and zanamivir
Pandemic in United States
http://www.cdc.gov/h1n1flu/update.htm
Update LA Stats◦ 2,409 lab confirmed cases◦ Week 15 extrapolated data estimated
292,000 cases
Hospitalized: 641 Related deaths: 53
H1N1 vaccine doses 491,131 LA allocation 1,673,700
Pandemic in Louisiana
http://www.fighttheflula.com/index.cfm? md=static&tmp=forHCProvid
Incredible interest in the H1N1 story at the beginning of the outbreak
Intense scrutiny at the beginning of the vaccination campaign
Diminished interest in H1N1 once vaccination campaign went public
Media Frenzy!
Official national conference calls and briefs National organizations and associations State DHH OPH Brain Trust conference calls with
notes shared State coordination with agencies, associations,
organizations, etc Regional video conferences Pandemic Influenza Summits Regional coordination with Regional Coordinators,
associations, calls, meetings, presentations, updates…
Communication
Bureau of Media and Communications coordinated public information◦ >60 press releases◦ Weekly “fight the flu” update◦ Flyers for campaigns◦ 2 TV PSA’s: ran 20 weeks◦ 3 radio PSA’s: ran 20 weeks◦ PSA which ran at high-school
sporting events statewide◦ Reviewed internal and external
partner materials
Pandemic in Louisiana
www.fighttheflula.com
◦ Public◦ Provider◦ Updates
◦ 1.4M visits◦ 5.3M pageviews
Pandemic in Louisiana
Flu Shot Locator• Statewide internet database of public
providers of H1N1 vaccine (Dec 15)• 4,000 visitors, 10,000 pageviews
H1N1 Health Alert Network◦ Spring 2009: 55◦ Fall/Winter 2009: 12◦ 2010: 4
Pandemic in Louisiana
Epidemiological surveillance◦ Outbreak: first case◦ Pandemic: syndromes, changes and trends
Clinical protocol Weekly Influenza Surveillance Report Hotline
◦ May 2009 100-200 calls/day
Pandemic in Louisiana
OPH Laboratory Sample Testing Protocol (April 2009)◦ Versions 1,2,3,4,5◦ Syndromic testing
OPH Laboratory ◦ 7,015 samples
May (2,696), Oct (779), Sept (698)◦ Antiviral resistance testing (CDC)◦ 1.5M equipment◦ 2 additional staff◦ >10,000 man-hours
Testing, data entry, reporting, communications
Pandemic in Louisiana
Community Mitigation Efforts◦ Hand hygiene, cough etiquette, stay home if
sick guidance◦ Initially, school closure and public gathering
recommendations from the Louisiana Office of Public Health
◦June 2009 Recommendations continued to evolve with
very few school, work place and public gathering closures
Pandemic in Louisiana
Pandemic in Louisiana Medication in State Antiviral Cache
◦ Secure, climate controlled location within Louisiana
◦ Full allocation purchase received in May 2007◦ Additional funding for
pediatric medication which were received in April 2009
◦ Portion used for Community Pharmacy Network during H1N1 response
* Children can also be treated with portion of adult dose
Pandemic in Louisiana Strategic National Stockpile received on April 28,
2009 Coordinated with response partners Distributed on April 30 – May 1, 2009 OPH executive leadership determined receiving
locations◦ Pre-positioned allocation◦ Created local stockpiles◦ Initial guidance for use provided◦ Continuing guidance for storage,
rotation and expiration◦ Communication will continue as the situation
evolves
Pandemic in LouisianaFederal antivirals come with guidance and short
expiration dates ~50 hours assets distributed:◦ 50% (93,366 regimens) shared by 120 Tier 1
hospitals◦ 40% (74,693 regimens) shared by 132 Tier 2
hospitals and 291 nursing homes◦ 10% (18,673 regimens) shared by 23 Federally
Qualified Health Centers, Department of Corrections, military and federally recognized Indian Tribes with infirmaries
◦ PPE allocated to limited number of sites in each region
Immunization Program◦ LINKS: Implemented Mass Immunization module◦ New Providers: 2,200 registered◦ Vaccine orders: Vaccine for Children model◦ Distribution/delivery: Central >100 doses◦ Accountability: doses administered◦ Adverse Events: validation
◦ Only additional clerical/warehouse staff
Pandemic in Louisiana
Providers: ◦ 2,200 registered ◦ 1,425 Active
◦ Public: 250 Parish Health Units, Federally Qualified Health Centers,
Rural Health Centers, Department of Corrections
◦ Private Private providers: 1,000 VFC providers: 350 Community pharmacies: 300
Vaccination Campaign
Training◦ LINKS Users (most used full LINKS)
175 Public 350 VFC
◦ Non-LINKS Users (most used new module) 1,200 others Strike teams at Point of Dispensing Sites
◦ Reluctance of providers and public◦ Perception of “new vaccine”
Vaccination Campaign
Differed from seasonal vaccine priority groups
Initial Priority Groups (October 12-December 31, 2009)◦ Pregnant women◦ Caregivers of infants <6mo◦ All children aged 6mo-24 yrs◦ Healthcare workers/EMS◦ Adults 25-64yrs with chronic illnesses
NOT in Priority Groups◦ All first responders◦ Seniors with chronic illnesses◦ All seniors
Vaccination Campaign
Vaccines◦ 5 manufacturers◦ 9 preparations
Intranasal Intramuscular
Pediatric Single use adult Multi dose vials
Each with specific indications◦ Vaccine preparations and availability led to
confusion for providers and public
Vaccination Campaign
LINKS: H1N1 Mass Immunization Module◦ Registration◦ Profile◦ Communication◦ Documentation◦ Utilization◦ Reordering◦ Adverse events follow up◦ Lab test follow up
Vaccination Campaign
New partnerships are good….◦ Outreach, planning, coordination, organization,
strategies, roles, responsibilities, beta testing…◦ H1N1 needed immediate and unconventional
partnerships
Pharmacist Vaccinators◦ Louisiana Board of Pharmacy◦ Vaccination by protocol◦ 270 community pharmacists
◦ Both H1N1 and Seasonal
Vaccination Campaign
Campaign Rollout◦ Predicted
1st doses mid October 100 million doses by January 1, 2010
◦ Actual 1st doses by mid October 25% of predicted in Oct/November 57% of predicted in December
◦ Challenges◦ Slow rollout of vaccine
Vaccination Campaign
Public Health Effort◦ All Parish Health Units
22 Westaff Temps◦ 126 Nurses◦ 41 Administrative◦ 19 Program Monitor/Coordinator◦ 545 Volunteers◦ Challenges◦ Alternate model of delivery
Free to providers Requesting providers to give to all persons
Vaccination Campaign
School Campaign◦ 1963 Schools (DOE) with varying levels of participation
Self sufficient Strike Teams, even some as open Point of Dispensing Sites Educational packets with community based use of Parish
Health Units and private providers
Private Schools Educational packet with most using community based
resources
◦ Expanded partnerships in short period of time with evolving roles and responsibilities
Vaccination Campaign
Coordination with Department of Social Services for Foster/Day Care/Child Care Centers ◦ >150,000 Children◦ Educational campaign
Letters to EVERY child Web messages
◦ Vaccination resources
Vaccination Campaign
Spring “Closeout”◦ Last “push” for vaccination◦ Focus on high risk groups◦ Media event◦ Health Unit open clinics◦ Outreach clinics
Vaccine Campaign Conclusion
Summary◦ Reluctance of providers, healthcare professionals and
public◦ Internet rumors
◦ LINKS completed 3 reminder recall campaigns
◦ Initially, available vaccine didn’t match priority groups◦ Formulation changes◦ Vaccine recalls◦ Expiration date changes
Vaccination Campaign
Preparedness Grants: Public Health Emergency Response Cooperative Agreement
◦ PHER 1,2 $ 7,481,583 Aug 9, 2009 Epidemiology and Laboratory
◦ PHER 3 $12,130,180 Sept 25, 2009 Vaccination Campaign
Pandemic in Louisiana
Incompatibility of grant funding process with response actions◦ Many actions that the grant was intended to fund
were in process or over before funding was awarded
◦ Limited options for vaccination campaigns
Funding
◦ Seasonal influenza vaccine will contain 2009 H1N1 component
◦ Federal Government will NOT purchase the vaccine this year
◦ State will not have free vaccine or host mass vaccination campaigns
◦ NOW is the time to order vaccine for next season◦ Advisory Committee on Immunization Practices is
expanding the recommendation for annual influenza vaccination to all people aged 6 months and older
Planning for 2010 -2011
9 Regional After Action Conferences 9 Regional After Action Reports with
Improvement Plans State DHH OPH After Action Conference on
June 24, 2010 State DHH OPH After Action Report-
Improvement Plan 9 Regional Corrective Action Plans State Corrective Action Plan
Evaluation Process
After Action Review met exercise requirements for 2009-2010 with required HSEEP documentation
Public Health Emergency Preparedness Cooperative Agreement
Strategic National Stockpile and Cities Readiness Initiative Emphasis on Lessons Learned and Best Practices
Annual Evaluation due date of November 30, 2010 Guidance with evaluation tools expected soon
Preparedness and Evaluation
Many lessons from H1N1 response for future pandemic planning
Pandemic planning was VERY effective and will continue
Response was HUGE public health and community success
Don’t let your guard down
Conclusion