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Stacy Stevens Hall, RN MSN Center for Community Preparedness June 2010.

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Presentation on theme: "Stacy Stevens Hall, RN MSN Center for Community Preparedness June 2010."— Presentation transcript:

1 Stacy Stevens Hall, RN MSN stacy.hall@la.gov Center for Community Preparedness June 2010

2  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.

3  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

4  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

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7  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)

8 http://www.azdhs.org/pandemicflu/pdf/Final_HHS_ Operational_Plan_Grades_1.20.09.pdf

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10  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

11  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

12  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

13  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 http://www.cdc.gov/h1n1flu/update.htm

14  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 http://www.fighttheflula.com/index.cfm? md=static&tmp=forHCProvid

15  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

16  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…

17  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

18  www.fighttheflula.com www.fighttheflula.com ◦ Public ◦ Provider ◦ Updates ◦ 1.4M visits ◦ 5.3M pageviews

19 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

20  Epidemiological surveillance ◦ Outbreak: first case ◦ Pandemic: syndromes, changes and trends  Clinical protocol  Weekly Influenza Surveillance Report  Hotline ◦ May 2009 100-200 calls/day

21  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

22  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

23  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

24  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

25 Federal 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

26  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

27  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

28  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”

29  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

30  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

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

32  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

33  Campaign Rollout ◦ Predicted  1 st doses mid October  100 million doses by January 1, 2010 ◦ Actual  1 st doses by mid October  25% of predicted in Oct/November  57% of predicted in December ◦ Challenges ◦ Slow rollout of vaccine

34  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

35  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

36  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

37  Spring “Closeout” ◦ Last “push” for vaccination ◦ Focus on high risk groups ◦ Media event ◦ Health Unit open clinics ◦ Outreach clinics

38  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

39  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

40  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

41 ◦ 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

42  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

43  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

44  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


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