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Stacy Stevens Hall, RN MSN stacy.hall@la.gov Center for Community Preparedness June 2010 Slide 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. Slide 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 Slide 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 CDCs Public Health Emergency Preparedness Cooperative Agreement 2005 - 2007 Evaluation Process began in 2008 Slide 5 Slide 6 Slide 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) Slide 8 http://www.azdhs.org/pandemicflu/pdf/Final_HHS_ Operational_Plan_Grades_1.20.09.pdf Slide 9 Slide 10 How we planned When it happened What were learning OPH Activities by Target Capabilities Communication Public Information Epidemiology Laboratory Community Mitigation Medical Countermeasure Antiviral medications Vaccine Slide 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 Slide 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 Slide 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 Slide 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 Slide 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 Slide 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 Slide 17 Bureau of Media and Communications coordinated public information >60 press releases Weekly fight the flu update Flyers for campaigns 2 TV PSAs: ran 20 weeks 3 radio PSAs: ran 20 weeks PSA which ran at high-school sporting events statewide Reviewed internal and external partner materials Slide 18 www.fighttheflula.com www.fighttheflula.com Public Provider Updates 1.4M visits 5.3M pageviews Slide 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 Slide 20 Epidemiological surveillance Outbreak: first case Pandemic: syndromes, changes and trends Clinical protocol Weekly Influenza Surveillance Report Hotline May 2009 100-200 calls/day Slide 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 Slide 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 Slide 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 Slide 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 Slide 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 Slide 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 Slide 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 Slide 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 Slide 29 Differed from seasonal vaccine priority groups Initial Priority Groups (October 12-December 31, 2009) Pregnant women Caregivers of infantsSlide 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 Slide 31 LINKS: H1N1 Mass Immunization Module Registration Profile Communication Documentation Utilization Reordering Adverse events follow up Lab test follow up Slide 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 Slide 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 Slide 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 Slide 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 Slide 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 Slide 37 Spring Closeout Last push for vaccination Focus on high risk groups Media event Health Unit open clinics Outreach clinics Slide 38 Summary Reluctance of providers, healthcare professionals and public Internet rumors LINKS completed 3 reminder recall campaigns Initially, available vaccine didnt match priority groups Formulation changes Vaccine recalls Expiration date changes Slide 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 Slide 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 Slide 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 Slide 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 Slide 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 Slide 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 Dont let your guard down