H1N1 Outbreak:Lessons Learned and

Preparation for the Next Pandemic

Thursday, April 15, 2010

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PresentersDonna M. Barry, MSN, APN, FN-CSA, Nurse

Practitioner and the Director of the University Health Center at Montclair State University

Anita L. Barkin, Dr.P.H., M.S.N., C.R.N.P., Director of Carnegie Mellon University Student Health Services

Michael Mardis, Ph.D., Dean of Students & Associate Vice President for Student Affairs at the University of Louisville

Dennis K. Sullivan, Assistant Director of Environmental Health and Safety, University Emergency Manager and adjunct faculty in the University of Louisville School of Public Health and Information Sciences

OutlineH1N1 Activity

InternationalNationalCollege and UniversityRegional

Pre H1N1 Planning assumptionsOn point or not

National Activity

H1N1 is still circulating and seasonal flu is quiet

Disease rates are lower than in the fall

Causing more disease in the southeast

Hospitalizations are due to H1N1

Statistics as of 4/3/2010~ 60 million Americans infected

~ 265,000 hospitalizations

~ 12,000 deaths 90% under the age of 65 (5 times higher than seen

with seasonal flu)

~122 million doses of vaccine have been shipped

Regional and Local ActivityRegional

Georgia, Alabama, South Carolina

LocalArkansas, Louisiana, Mississippi, North

Carolina, Tennessee, VirginiaHawai’i, New Mexico, Puerto Rico

GeorgiaIncrease in flu-related hospitalizations

More than seen since October

Adults with chronic illnesses like diabetes, heart disease

Not immunized with H1N1 vaccine

Virus has not changed

Vaccine is effective

What’s Next?Third wave remains uncertain

Concern that disease among those unvaccinated with chronic illness will continue to cause unnecessary hospitalization and death

Vaccine in fall with be trivalent

Vaccinate now with H1N1 to protect until the fall vaccine is available

Pre H1N1 Pandemic Influenza Planning Assumptions

Will arrive with little warning, likely from overseas• Little time to act

Simultaneous outbreaks throughout US

The severity may not be immediately known

Duration weeks to months

Pre H1N1 Pandemic Influenza Planning Assumptions

• Large numbers affected• Millions infected thus far

• Disproportionately affecting the young

• Decisions will be made on the basis of local conditions• Guidance from the CDC/WHO

• Vaccine delayed• Will probably have vaccine by late fall

Pre H1N1 Planning Assumptions

High absenteeism

Difficult to impossible to travel

Disruptions and shortages of fuel, food stuffs, health care

Antiviral agents in short supply

Responding to the Second Wave• Less about campus evacuation and body bags

• more about caring for ill students in the residential population

• providing support for students living in the community

• Developed new criteria for student life, academic and business decision making• Number of students, staff and faculty ill• Severity of illness

Public Health Strategy Goes Live

Slow down the spread in order to preserve resources (health care, critical services, supplies)

Lessons Learned• Plan format should:

Follow ICS response structureIdentify leadership and roles before an

incidentTrain all decision makers in ICS format

Flow from institution’s Emergency Operations PlanAnnex of overall EOPSame structure as all other EOP annexesSeamless coordination with outside agencies

Lessons Learned• Unlink plan to WHO phases

• All “outbreak” approach a.k.a. all-hazards • Plan needs to be adaptable to any level of public

health incident• Flexibility with plan response is critical to

success

• Don’t plan on lead time• Virus hit quick and hard with both waves• Eliminate time frames expected to be ready for

onset or next level of plan/response

Lessons LearnedIntegrate “triggers” in plan that will

determine next response actionDisease extent

What is its “acuity” level and risk factors to campus community?

What is extent of campus “high risk” population and vulnerability to the disease?

Disease severity How easy does it spread and can we contain it?

Absentee rate Establish parameters that trigger when to close offices,

cancel events, cancel classes, institute quarantine actions

Lessons Learned• Expertise based

• CDC and state health guidelines should be foundation for response

• Direct link to public health emergency notice monitoring for campus health services

• Development of expert based knowledge by health services administrators

• Redundancy • Prevention• Response• Communication

Lessons LearnedTraining drills/Tabletop exercises

Critical to effective, knowledgeable responseAll player approach

Isolation and QuarantineMultiple, effective mechanisms usedRely on fundamental health principles and

institutional capabilities

Lessons LearnedTransparency of communication paid off

Students, staff, parents, alumni all benefitedInternal communications among ICS teamExternal communications using multiple formsAcademic Affairs response

Stockpiling paid offEfforts devoted to prevention and responseShortages had strong impact on control of

virus

Lessons Learned

Vaccination effortsToo much, too lateVaccine form made a difference in availability

and student responseThe impact of YouTube and the media

Lessons Learned

“ Some things are in our control….

…and some things are not.”

University of LouisvilleEmerging Disease Planning Groups

Planning and CoordinationInfection Control Policies and

ProceduresPoint of DistributionContinuity of Student LearningCommunications Planning

PlanningGroups developed objectives and they were

adopted by Coordination Group

Individual Groups consisted of a diverse group from the campus community

Groups initially were to meet on a weekly basis, but that was pushed back due to a flash flood that damaged almost 80 buildings

Isolation StrategiesEmployee medical certification for absence

was suspended until further reviewIll students were instructed to stay homeFaculty were asked provide consideration for

ill studentsResidential Life isolation

Return home if within an hourMoving roommatesProviding food service

Prevention StrategiesEducation (Communications Strategy)

Hand sanitizer

Stockpiling supplies

VaccinationSeasonal Flu vaccinationH1N1 Vaccination

Communication/PreventionDedicated Website

http://louisville.edu/update/flu/Regular updatesAbout H1N1Tips for flu preventionFlu Shots at UofL Consent form onlineFAQ for students, faculty, and staffLinks to CDC and Flu.gov

Communication/PreventionVideo from High Profile students

Handbills with information and prevention

Targeted emails to the selected populations students living on campus, health science students, parents

Emails to the campus communityReferring them to the website for more info

Hand SanitizerProvided (funded) mainly by the central

Administration, but a number of units added units in their areas. (Res Life, Food Service)

Purchased 800 mountable units and several thousand desktop/pocket bottles (.5-12 ounces)

Provided an average of 100 containers weekly, costing $49k over 14 weeks

Stockpiled SuppliesRubber gloves – 8,000 pairs (2k of each size)

N-95 Masks – 6,000

Surgical Masks - 8,000

Disposable Gowns - 1,000

12 oz Hand Sanitizer - 200

Seasonal VaccineFree to all students, faculty and staff; $5.00

for family membersAdministered 6,000 doesFunded by Provost’s OfficePrevious year only administered 2,500Administered

Two campus health officesVaccination day in each dorm4 vaccination days at various locations

Campus H1N1 VaccinationsOperated minipods

Only cost was salaries HSC (healthcare) 600 doses (mixed), 120

minutesHSC (healthcare) 600 doses (mixed), 120

minutesBelknap (students) 600 doses (flumist), 240

minutesBelknap (anyone) 1,000 doses (mixed), 5 hours

U of L’s Planning Fall Kick-off meeting was day before our

Flood

Vaccine distribution plan was joint effort by DEHS and SPHIS

2 MPH and an Engineering graduate students did much of the planning

Immediately began developing plans to administer 30-50K doses of vaccine

Local Health DepartmentDid not have a plan in place for conducting

a mass vaccination POD

U of L had plans and logistics in place, ready to deliver vaccine to 30,000

Health Department asked the University for Help

A two page MOU turned into a 17 page contract

The PlanHold a community-wide H1N1 mass

immunization point of dispensing.

H1N1 vaccines were administered via one of two methods: (1) a drive-thru or (2) a walk-up process.

Injectable and intranasal vaccines were available.

Vaccine recipients chose which method they preferred.

Pod ResultsTotal Hours of Operation – 19

Totals vaccinated – 19,079Day 1 – 12,613Day 2 – 6,466Walkthru – 6,342Drivethru – 12,737

Avg. 1004 vaccinations/hour

Cost-effectivenessOverall cost was $13.35 per immunization

administered. Costs were significantly higher for the walk-

up method ($29.61/immunization administered) (Does not include public transportation costs)

Drive-thru method($5.58/immunization administered)

ResultsOn average, the drive-thru strategy provided

400 additional immunization per hour (796 vs. 396).

For 10 hours of the POD, about 50% of people handled in walk-up tent were “forced” to choose that option.

The drive-thru strategy was the least expensive method and was the process of choice by more than 60% of the citizens coming to the event for immunization.

Questions? Donna M. Barry,

barryd@mail.montclair.edu

Anita L. Barkin, ab4x@andrew.cmu.edu

Michael Mardis, m.mardis@louisville.edu

Dennis K. Sullivan, dksull01@gwise.louisville.edu