1. 2009 H1N1 Response Public Health Preparedness for the City and County of Denver Charles Smedly Manager, Public Health Preparedness Denver Public Health

2. Flu Strains Circulating as of October 23, 2009 H1N1 is the dominant circulating strain throughout most of the world

3. Situational Awareness Week ending October 17 – Week 41

4. U.S. Hospitalizations & Death Cases Defined byHospitalizationsDeath Influenza and Pneumonia Syndrome 21,8232,416 Influenza Laboratory Tests 8,204411 Counts reset to zero on Aug 30, 2009 Data reported to CDC by October 20, 2009

5. Cases by Month in Colorado Updated 10/26/2009

6. Cases by Age: Statewide Updated 10/26/2009

7. Distribution of Cases: Metro Area Updated 10/26/2009

8. H1N1 Four Pillars of Action  Surveillance (situational awareness)  Domestic and Global  Health care system  Mitigation  Vaccination  Communication Mark Frank, MPH Influenza Coordination Unit 09/01/2009

9. How is Denver preparing? POD: Points of dispensing

10. Response and Preparedness Needs  Review lessons learned from 2007 POD Squad and 2008 Democratic National Convention  Enhanced management of medical surge  Increase communication to medically high-risk individuals  Need for early treatment  Need for vaccination  Educate public on when and where to seek care  Facilitate access to care for medically high-risk and under-insured populations Mark Frank, MPH Influenza Coordination Unit 09/01/2009

11. H1N1 Response  Clinician Guidance – Health Alert Network  Public Guidance  Vaccine: allocation, distribution, dispensing  SNS Stockpile: Deployment & Distribution  Surveillance: Strengthening systems to monitor H1N1 patterns, hospital & ICU utilization, vaccine uptake, vaccine adverse events

12.  Mitigating emergency department demand  Encourage primary care providers to treat people in office or by phone, but not to reflexively refer to emergency dept.  Develop self-triage guidelines to help people determine their own appropriate level of care  Preparing hospitals for surge in intensive care  Planning for adequate staff  Move patients to lowest level of care that is safe  Staff training/refresher on ventilators, including those already stockpiled Medical Care Mark Frank, MPH Influenza Coordination Unit 09/01/2009

13. 2009 H1N1 Influenza Vaccine  The U.S. Government providing vaccine at no cost to public health and providers  Public health departments are directing the distribution of H1N1 vaccine  Vaccine distribution includes public settings like school clinics or community centers and private settings like doctors offices or occupational clinics or pharmacies  Each county public health departments directing how H1N1 response will work in their county

14. ACIP-Recommended Initial Target Groups for 2009 H1N1 Vaccine  Pregnant women  Household and caregiver contacts of children younger than 6 months of age  Healthcare and emergency medical services personnel  Infants, children and young adults 6 months through 24 years of age  Persons 25 through 64 years who have high risk medical conditions

15. Planned Flu Vaccine Distribution in Denver  First phase: doses distributed to hospitals and clinics (for priority groups and healthcare workers) and private providers  Second phase: Public Health Clinics  Third phase: Community Health Clinics – large, priority groups, weekend clinics  Fourth phase: Regional public Points of Distribution (PODs) – NCR Public Health in collaboration with Kaiser

16. Communication Challenges  Motivation for vaccination highly dependent on risk perceptions and strength of provider endorsement  Seasonal flu often not seen as serious threat  Many medically high-risk persons do not self- identify  Recommendations for children and pregnant women generate heightened safety concerns  Multiple doses, combination of seasonal and 2009 H1N1 vaccine, access for priority groups Mark Frank, MPH Influenza Coordination Unit 09/01/2009

17. Presidential Declaration of a National Emergency  Utilize alternate care sites, modified patient triage protocols, patient transfer procedures  Waiver of sanctions for relocations and transfers that otherwise would violate the Emergency Medical Treatment and Labor Act (EMTALA)  Waiver of sanctions and penalties arising from noncompliance with certain Health Insurance Portability and Accountability Act (HIPAA) privacy regulations

18. Colorado Volunteer Mobilizer  Public health and medical volunteer system to enhance state’s ability to respond and recover from all types of emergencies  Colorado Volunteer Mobilizer improves public health ability to manage the many nurses, physicians, respiratory therapists, dentists, pharmacists and mental health counselors that could be needed for planned community events or public health emergencies  Since January 1st, the system has grown 29 % from 1400 approved volunteers to 1802 members https://covolunteers.state.co.us/VolunteerMobilizer/

19. 2009 H1N1 Events change…  Proportion of severe disease  Transmissibility  Antiviral resistance patterns  Vaccine effectiveness, safety, match, availability  Adjust plans based on data Mark Frank, MPH Influenza Coordination Unit 09/01/2009

20.  http://www.cdc.gov/H1N1Flu/ http://www.cdc.gov  http://www.pandemicflu.gov http://www.pandemicflu.gov  http://www.who.int http://www.who.int  http://www.flu.gov http://www.flu.gov  http://www.cdphe.state.co.us http://www.cdphe.state.co.us  http://www.denverhealth.org http://www.denverhealth.org  www.amafluhelp.org www.amafluhelp.org  www.H1N1responsecenter.com (Emery) www.H1N1responsecenter.com  Contact:  CDPHE: 303 - 692- 2000  CO HELP: 1- 877- 462 - 2911  Denver Public Health 303 – 602 – 3614 Charles Smedly Denver Public Health Charles.smedly@dhha.org Where can you learn more?

21. Who should get seasonal vaccine?  Anyone who wants to reduce likelihood of becoming ill with influenza  Recommended all children age 6 months through 18- years-old  Anyone 50-years or older  Anyone at risk of complications from influenza (asthma, heart disease, lung disease)  Anyone with weakened immune systems  Women who will be pregnant during influenza season  Anyone who lives with or cares for people at high risk for influenza-related complications (including health care providers)