1. An Enhanced System for Monitoring Influenza and Pneumonia Deaths in Pennsylvania during the 2009- 2010 H1N1 Novel Influenza Pandemic Marina O. Matthew, RHIA Pennsylvania Department of Health Bureau of Health Statistics and Research

2. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 The Keystone State Population in 2008: 12,448,279 Population 65+: 1,941,000+ 2 nd largest percentage of elderly behind Florida; Rural Population: 3,700,000 Area: 45,888 square miles 67 counties If DE was a county in PA, it would rank 4th

3. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Pennsylvania Firsts Nation’s Capitol York High speed multi lane highway the PA turnpike Hospital Pennsylvania Hospital, Philadelphia Banana Split Latrobe, PA- 1904

4. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Rankings Rank first in the country in: Mushroom production State Game Lands and licensed hunters Scrapple production Potato Chip and Pretzel Production

5. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Background Mortality tracking important modality for defining the severity of seasonal influenza Influenza mortality surveillance is traditionally done using the 122 Cities Mortality Reporting System (National MRS) at CDC Compiles summary mortality data by age group for all causes and Pneumonia and Influenza (P&I) Occurs weekly by fax or voice mail Six cities in PA participate Allentown, Erie, Philadelphia, Pittsburgh, Reading, Scranton

6. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Issues with the National MRS Registrar District Coverage Areas only total 23% of PA population and does not include major rural areas of the state Delay in receiving the data – since only submitted weekly No consistency of data submitted Some sites provide data on all death records submitted Some provide data only on the deaths that occur in the city in which the office is located Some provide data only on deaths of residents of the reporting city Some provide the data only on deaths that occurred in the county in which the city is located Some only provide data on deaths that are registered with the local registrar in that city

7. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Alternative Mortality Reporting System to Address the H1N1 Pandemic In May 2009, PA implemented a facsimile-based system for reporting of deaths in ten sentinel sites by local registrars and branch offices Includes the six Pennsylvania cities involved in the national MRS Covers 27.4% of population (16% increase over national MRS)

9. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Local Registrars Entered into formal letters of engagement with the six (6) local registrars Provided those without equipment a combined fax and scanner machine to allow for daily reporting Compensated at $100/month plus $1.00 for each record that had to be faxed/scanned Maximum of $4999.99 for each local registrar

10. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Responsibilities of 10 Sentinel Sites Review all records received on a daily basis Any death records with the following words were to be faxed or emailed within one (1) day of receipt Pneumonia Influenza Flu H1N1 Swine Complete and fax or scan in a daily report listing the number of deaths by age category in addition to the P&I deaths.

12. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Costs of Alternate System Funding through Office of Public Health Preparedness Relatively inexpensive Scanners were $100 - only purchased for 4 of the 6 local registrars. No equipment needed for the branch offices Total cost to registrars thus far: $4575.00 (May 2009- February 2010) No monthly payments to branch offices Staff time 30 minutes per day to process records and daily reports 30 minutes per week to update spreadsheets and maps

13. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 Results: May 2009-February 2010 22,828 deaths reported 6.3% were P&I Of the P&I deaths: 40.3% of records were received within 2 days after death; 77.4% within 4 days after death In contrast, CDC MRS system reports were received 7-14 days after death Detected peak of P&I deaths in PA in 2010 one week before the National MRS.

16. Gateway to the Future: Improving the National Vital Statistics System St. Louis, MO June 6 th – June 10 th, 2010 For More Information Marina O. Matthew, RHIA Director, Division of Statistical Registries Bureau of Health Statistics and Research 555 Walnut Street, 6 th Floor Harrisburg, PA 17101 (717) 783-2548 mmatthew@state.pa.us Website: www.health.state.pa.us