Pandemic Influenza Update

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


www.fighttheflula.com

◦ Public◦ Provider◦ Updates

◦ 1.4M visits◦ 5.3M pageviews


http://www.fighttheflula.com/

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


Epidemiological surveillance◦ Outbreak: first case◦ Pandemic: syndromes, changes and trends

Clinical protocol Weekly Influenza Surveillance Report Hotline

◦ May 2009 100-200 calls/day


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


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 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


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”


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


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


LINKS: H1N1 Mass Immunization Module◦ Registration◦ Profile◦ Communication◦ Documentation◦ Utilization◦ Reordering◦ Adverse events follow up◦ Lab test follow up


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


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


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


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


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


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


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


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

Documents

Pandemic Influenza Update