1. Use of the Health Alert Network for Communicating with Partners during an Influenza Epidemic in Arizona
Laura Erhart, Susan Goodykoontz, Joseph Urrea, John Nelson, Kathy Fredrickson, Bob England
Arizona Department of Health Services
National Immunization Conference, May 14, 2004

2. Outline Arizona’s Health Alert Network
State's needs during the flu season
Use of HAN for communicating with partners
Discussion
Objective: To describe the use of SIREN in facilitating communications with local health officials and the health community during the influenza season of

4. Health Alert Network Arizona Health Alert Network (HAN):
Coordinates public health communications to improve disease surveillance and public health response.
Secure Integrated Response Electronic Notification (SIREN) system:
Public Health Information Network (PHIN)-compatible component of the Health Alert Network
Functions as the communication tool:
Information dissemination
Alert notification
Platform for electronic disease surveillance
The Arizona Health Alert Network (or HAN) is funded through Bioterrorism Preparedness grants.
Its purpose is the coordination of public health communications to improve disease surveillance and public health response. The HAN utilizes various technologies to meet these communication needs for the state to coordinate with other agencies in public health efforts.
(•Individuals currently accessing SIREN include County Health Officers, local municipal representatives from Metropolitan Medical Response Systems, individuals from the Department of Emergency Management, the Department of Public Safety, the State Lab, the Samaritan Regional Poison Center, the Centers for Disease Control and Prevention, the Federal Bureau of Investigations, and the Department of Health and Human Services.)

6. SIREN: Information Dissemination
Day-to-day dissemination of health information:
Secure messaging
Posting information on secure SIREN web portals
Document sharing and management
Fax distribution
Conference bridge (48 lines)
Alert notification (currently four levels):
Health Notices
Health Updates
Health Advisories
Health Alerts
•The four notification levels break down as follows:
•Health Notice: provides general information regarding an incident or
situation; does not require immediate action.
•Health Update: provides updated information regarding an incident or
situation; unlikely to require immediate action.
•Health Advisory: provides important information for a specific incident or
situation; may not require immediate action.
•Health Alert: conveys the highest level of importance; warrants immediate
action or attention.

7. SIREN: Alert Notification
During an emergency situation, SIREN can be used for rapid and secure information transmission and alert notification. Alert notifications are handled via:
Telephone calls
Fax distribution
messaging
Capacity to read s over telephone
Pager notification
Web page updates
Public health directory with roles to alert
This system of communication can replace the individual s & calls that would otherwise be made.

8. December 2003: Widespread Flu Activity
AZ’s 1st lab-confirmed case mid-October
Activity levels increased through November
“Widespread” activity declared in AZ for week ending 12/6/2003 (shown here)
SIREN/HAN in place already. Dec 2003 had need to use it.
Post-Thanksgiving had first ped death, others reported nationwide.

9. Arizona Influenza Activity, 1997-2004
Widespread
Regional
Local
Sporadic
Season started much earlier than usual
Imperfect match of vaccine strain (H3N2 Fujian)
No activity

10. Media Attention 21 Nov 2003 5 Dec 2003 6 Dec 2003 7 Dec 2003
Not occurring in a vacuum:
Much public/media attention
Headlines show sequence of events; attention paid to issues
Demonstrates need for public health action & response: rapid distribution of up-to-date, accurate information to partners and stakeholders
7 Dec 2003

11. 12 Dec 2003
12 Dec 2003
14 Dec 2003

12. Communications Who develops the messages? Via what route?
Who should receive them?
What messages to send?

13. Internal Coordination
Messages drafted by:
Office of Infectious Disease Services
Office of Public Health Emergency Preparedness & Response
Immunization Program Office
Approved by State Epidemiologist or designee
All messages sent out by Health Alert Project Specialist

14. Communication Routes SIREN postings on secure website E-mails
Blast faxes
Conference calls
Health alerts
Other dissemination options available as mentioned before for higher priority events.

15. Public Health Groups E-mail/SIREN Local health officers
County epidemiologists
Directors of nursing
Immunization coordinators
Bioterrorism coordinators
Infection control practitioners (ICPs)
Infectious disease doctors
Fax/SIREN
Clinicians
Urgent care centers
Emergency rooms
Schools
U.S. Mail
Laboratory directors
Pathologists
Medical examiners
Long term care facilities
Other groups available but not used this season for flu messages
We communicated with several thousand people during the influenza season.

16. Messages
Surveillance info (first case, antigenic characterization, distribution across the state, activity levels)
Vaccine (supply, distribution, prioritization of vaccinations)
Clinical updates (including use of antivirals)
Laboratory testing (types of tests, collection of specimens)

17. Messages (continued)
Information for schools (messages for parents, control measures)
Pediatric flu-associated deaths (info, forms)
Requests for information (reports of early flu cases, pediatric flu deaths, activity level in facilities, etc.)

18. Discussion Benefits to using HAN for flu response
Timeliness of communications
Ease of sending additional information
Groups already organized by pre-defined public health roles (within health departments) or by job (ICPs, ID doctors, clinicians, etc.)
Capability for higher-level alerts if needed
Test of our system for emergency response

19. Lessons Two crucial elements:
Notification of local health departments before other partners
Internal coordination
Avoid duplication of efforts, mixed messages, or confusion
Public Health Incident Management System/ Incident Command System structure proposed for response
Contact listings must be kept up-to-date

20. Influenza Season Synopsis
Moderate season, not the severe epidemic or pandemic some predicted
5 influenza-associated pediatric deaths
Within “normal” ranges
Communication between state and local health departments and with other health entities was critical

21. Future Directions: West Nile
Expected to hit Arizona this summer
HAN/SIREN to be integral component of response