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CREPC - DEMHS REGION 3 ESF 21 INDEPENDENT COLLEGES MEETING PANDEMIC INFLUENZA COLLBORATIVE PLANNING SAINT JOSEPH COLLEGE WEST HARTFORD, CT JULY 21, 2009 Steven J. Huleatt, MPH, RS Presentation Background Steven J. Huleatt, Director of Health West Hartford-Bloomfield Health District • Deputy Chair Emergency Support Function 8 – Public Health and Medical Care, Capitol Region Emergency Planning Committee, DEMHS Region 3 • Connecticut Department of Public Health Regional Liaison DEMHS Region 3 • Cities Readiness Initiative Project Director DEMHS Region 3 and Interim Program Coordinator Matthew Cartter, State Epidemiologist, Connecticut Department of Public Health • Thank you for his assistance and collaboration TOPIC TO BE COVERED AUTHORITY • FEDERAL • STATE • LOCAL STRATEGIC NATIONAL STOCKPILE CITIES READINESS INITIATIVE PANDEMIC INFLUENZA STRATEGIES NOVEL H1N1 Federal Agency Authority for Domestic Terrorism Department of Health and Human Services (HHS) U.S Food and Drug Administration (FDA) Department of Homeland Security (DHS) Federal Agency Authority Department of Health and Human Services (HHS) • Center for Disease Control and Prevention (CDC) Coordinating Office of Terrorism Preparedness and Emergency Response (COPTER) - Helps the nation prepare for and respond to urgent public health threats by providing strategic direction, coordination, and support for all of CDC’s terrorism preparedness and emergency response activities. Federal Agency Authority U.S. Food and Drug Administration (FDA) FDA has adopted five broad strategies for counterterrorism: • Awareness: Increasing awareness through collecting, analyzing, and spreading information and knowledge. • Prevention: Identifying specific threats or attacks that involve biological, chemical, radiological or nuclear agents. • Preparedness: Developing and making available medical countermeasures such as drugs, devices, and vaccines. • Response: Ensuring rapid and coordinated response to any terrorist attacks. • Recovery: Ensuring rapid and coordinated treatment for any illness that may result from a terrorist attack. Federal Agency Authority FDA • Regulatory Authority: Food Security Biological Agents Vaccines Drugs Federal Agency Authority Department of Homeland Security • In the event of a terrorist attack, natural disaster or other large-scale emergency, the Department of Homeland Security will provide a coordinated, comprehensive federal response and mount a swift and effective recovery effort. • The Department assumes primary responsibility for ensuring that emergency response professionals are prepared for any situation. Department of Homeland Security Federal Emergency Management Agency (FEMA) • Homeland Security Presidential Directive 5 National Response Framework National Incident Management System • Homeland Security Presidential Directive 8 Homeland Security Presidential Directive 5 (HSPD 5) HSPD 5 serves to enhance the ability of the United States to manage domestic incidents by establishing a single, comprehensive national incident management system. This management system is designed to cover the prevention, preparation, response, and recovery from terrorist attacks, major disasters, and other emergencies. The implementation of such a system would allow all levels of government throughout the nation to work efficiently and effectively together. The directive gives further detail on which government officials oversee and have authority for various parts of the national incident management system, as well making several amendments to various other HSPDs. - February 28, 2003 National Response Framework (NRF) The National Response Framework (NRF) presents the guiding principles that enable all response partners to prepare for and provide a unified national response to disasters and emergencies. It establishes a comprehensive, national, all-hazards approach to domestic incident response. The National Response Plan was replaced by the National Response Framework effective March 22, 2008. The National Response Framework defines the principles, roles, and structures that organize how we respond as a nation. The National Response Framework: • describes how communities, tribes, states, the federal government, private-sectors, and nongovernmental partners work together to coordinate national response; • describes specific authorities and best practices for managing incidents; and • builds upon the National Incident Management System (NIMS), which provides a consistent template for managing incidents. National Incident Management System (NIMS) While most emergency situations are handled locally, when there's a major incident help may be needed from other jurisdictions, the state and the federal government. NIMS was developed so responders from different jurisdictions and disciplines can work together better to respond to natural disasters and emergencies, including acts of terrorism. NIMS benefits include a unified approach to incident management; standard command and management structures; and emphasis on preparedness, mutual aid and resource management. Incident Command System NIMS establishes ICS as a standard incident management organization with five functional areas -- command, operations, planning, logistics, and finance/administration -- for management of all major incidents. To ensure further coordination, and during incidents involving multiple jurisdictions or agencies, the principle of unified command has been universally incorporated into NIMS. This unified command not only coordinates the efforts of many jurisdictions, but provides for and assures joint decisions on objectives, strategies, plans, priorities, and public communications. HSPD 8 Homeland Security Presidential Directive 8 establishes policies to strengthen the U.S. preparedness in order to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other emergencies. The directive requires a national domestic all-hazards preparedness goal, with established mechanisms for improved delivery of Federal preparedness assistance to State and local governments. It also outlines actions to strengthen preparedness capabilities of federal, state, and local entities. This is a companion directive to HSPD 5. - December 17, 2003 HSPD 21 It is the policy of the United States to plan and enable provision for the public health and medical needs of the American people in the case of a catastrophic health event through continual and timely flow of information during such an event and rapid public health and medical response that marshals all available national capabilities and capacities in a rapid and coordinated manner. October 18, 2007 State of Connecticut Public Health Preparedness Authority Office of the Governor Department of Public Health (DPH) • • • • Office of Public Health Preparedness Office of Local Health Administration State Laboratory Epidemiology Program Connecticut Department of Consumer Protection (DCP) Connecticut Department of Emergency Management and Homeland Security (DEMHS) Definition of a Public Health Emergency A Public Health Emergency is defined as an occurrence or imminent threat of a: communicable disease, except sexually transmitted disease contamination caused or believed to be caused by bioterrorism, an epidemic or pandemic disease [linkage to Critical Agent Listcategory A] natural disaster chemical attack or accidental release nuclear attack accident that poses a substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability. [Public Act No. 03-236, CT Public Health Emergency Response Act of 2003 (PHERA)] Connecticut Public Health Emergency Response Act (PHERA) In 2003, Connecticut enacted a law that makes sure that the Governor and all of the individuals that respond to the emergency: Can act without unnecessary delay Can take measures to protect the public’s health Authorities and provisions for action in the event of a public health emergency are delineated in the: Connecticut Public Health Emergency Response Act – or, PHERA. Immunity from Liability under PHERA PHERA also: Protects staff and volunteers from liability when they are acting on behalf of the state or local health department during a declared Public Health Emergency. Overview-Local Public Health in CT DPH Mass Dispensing Areas and DEMHS Planning Regions Connecticut, 2007 North Canaan Colebrook 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 Greenwich HD Stamford HD Norwalk HD Westport HD Danbury HD Bethel HD Newtown HD New Milford HD Torrington Area HD Fairfield HD Bridgeport HD Stratford HD Naugatuck Valley HD Pomperaug HD Waterbury HD Chesprocott HD Milford HD West Haven HD New Haven HD Quinnipiack Valley HD Guilford HD Meriden HD Wallingford HD Farmington Valley HD Bristol/ Burlington HD Southington HD New Britain HD Central Connecticut HD WH/ Bloomfield HD Hartford HD Windsor HD East Hartford HD Manchester HD North Central HD Chatham HD Middletown HD Ledge Light HD Uncas HD CT River Area HD Eastern Highlands HD Northeast HD Hartland Suffield Enfield Salisbury MDA Lead Health Number Department/ District Norfolk Granby Canaan East Granby Barkhamsted Winchester 24 Cornwall Simsbury 09 Sharon Bloomfield West Hartford Avon Harwinton Litchfield Kent Warren Morris Washington 08 Bethlehem Watertown New Milford 14 New Fairfield Brookfield 07 Seymour Stamford 01 Greenwich 02 04 03Norwalk Darien 13 Derby Monroe Sterling Hebron Sprague Lebanon 38 East Hampton 36 Voluntown Franklin Lisbon Colchester Middletown Durham 35 Haddam Preston North Stonington Salem East Haddam Montville Ledyard Hamden 12 10 North Branford 19 Orange 21 North Haven 20 18 Griswold Norwich Bozrah Middlefield 23 New Haven Shelton Easton New Canaan Scotland Canterbury Marlborough Wallingford WoodAnsonia bridge Redding Weston Plainfield Windham Portland 16 Bethany Bethel 06 34 Columbia Glastonbury Oxford Newtown Danbury Andover Meriden Southbury Beacon Falls Brooklyn Cromwell Cheshire Naugatuck Prospect Coventry Rocky Hill 22 Hampton Bolton 33 Berlin Waterbury Middlebury Bridgewater Wilton 26 Wolcott 15 Woodbury Roxbury 05 Britain Southington Sherman Ridgefield Bristol Thomaston Plymouth Manchester East Hartford Wethersfield 27 Newington New 28 Plainville Killingly Chaplin Mansfield 30 32 Farmington 25 Pomfret 40 Vernon South Windsor Hartford Burlington Willington Ashford Tolland 31 Putnam 41 Eastford Windsor 29 New Hartford Torrington Thompson Ellington East Windsor Canton Goshen Union Woodstock 34+ Windsor Locks Stafford Somers Chester Lyme Madison Deep River Killingworth Essex Clinton East Haven Guilford Branford 39 Old Saybrook Westbrook 37 Waterford East Lyme New London Groton Stonington Old Lyme Trumbull 17 11 Milford Fairfield Stratford Westport Bridgeport West Haven DEMHS Region 1 2 3 4 5 CT Local Public Health Preparedness Toolbox ASSESSMENTS: • Capacity/Inventory Assessment (2004) • Special Populations Assessment (2005) • Communication Assessment (2006) PLANS: • Public Health Emergency Response Plans (all hazard) (2005) • Smallpox Plans (2004) • Local Health Alert Networks (2005) • Quarantine and Isolation Guidelines (ongoing) • Risk Communication Plans (2005) • Mass Dispensing (2006) • Pandemic Flu (ongoing) TRAINING AND EXERCISING: • Staff Training (Public Health Preparedness 101) • Local Drills and Exercises • ICS/UCS/NIMS TECHNICAL ASSISTANCE REVIEWS (2008) EPIDEMIOLOGY AND SURVEILLENCE IN CT CDC CT DPH • CATEGORY 1 AND CATEGORY 2 REPORTABLE DISEASE LOCAL DUAL REPORTING REQUIREMENT • PHYSICIANS • LABORATORY Strategic National Stockpile Program (SNS) Mission • “To maintain a national repository of life-saving pharmaceuticals and medical materiel that will be delivered to the site of a chemical or biological terrorism event in order to reduce morbidity and mortality in civilian populations.” SNS Contents Pharmaceuticals Medical materiel Supplies Vaccines Antivirals Antitoxins SNS Operational Resources 12 hour push package Technical Advisory Response Unit (TARU) Vendor Managed Inventory (VMI) Vaccine management Rapid procurement Vendor Managed Inventory (VMI) Represents 97% of the SNS assets Maintained within the manufacturer’s control Product is “Federally Owned” not Guaranteed Access VMI in an Event Resupply the Push Package as products are issued Issue requested products quickly and directly to dispensing sites (PODs) Order supplies and have it shipped directly to the affected area if not stocked by the SNS Program Vaccine Management Separate program in the SNS Program Cold Chain Management Approved methods of transport Types of Vaccine: Anthrax, Smallpox with ancillary supplies, Immune Globulin Plasma and Botulism Antitoxin Distributing the SNS Materiel Interagency coordination: transport; security; vehicle drivers, fuel, repair, etc. Alternative modes of transport Staff skills Distribution planning and operations information Driver/vehicle identification Controlled substance chain of custody Local Receive, Store, Stage (RSS) Facility Location Facility Characteristics (12k square feet minimum, loading dock if ground transport) SNS Custody Transfer Staging and storing of SNS materiel Controlled substances Site security Local Receive, Store, Stage (RSS) Facility Location Facility Characteristics (12k square feet minimum, loading dock if ground transport) SNS Custody Transfer Staging and storing of SNS materiel Controlled substances Site security POD System Design Considerations Scale, type, location of threat Number of sites Location of sites Size of sites Site accommodations Transportation to sites Communications Number of Sites for Dispensing Do the math - for smallpox 1m in ten days equals 20 clinics 50k each or 40 clinics 25k each, etc. Smaller sites increase access, require more staff and security Larger sites less staff, require crowd and traffic control. Should be familiar, accessible, dispersed Staff the Dispensing Sites Managers Medical professionals - Pharmacists, MD’s, RN’s Public Safety and Security personnel Trained Volunteers - public sector staff, Red Cross, Salvation Army Untrained Volunteers - fraternal organizations, walk-ins Incident Command System Cities Readiness Initiative Threat and Vulnerability CRI Goal To provide mass prophylaxis to 100% of the identified population within 48 hours of the decision to do so. Anthrax Exposure: Proportion of Population Saved DELAY in Initiation DURATION of Campaign Immed. 1 Day 2 Days 3 Days 4 Days 5 Days 6 Days 7 Days 10 Days 7 Days 84% 78% 71% 62% 54% 45% 36% 28% 95% 91% 85% 78% 69% 59% 49% 39% 6 Days 97% 94% 89% 83% 75% 65% 54% 43% 5 Days 98% 96% 92% 87% 80% 71% 60% 49% 4 Days 99% 98% 95% 91% 85% 76% 66% 54% 3 Days 2 Days 100% 99% 97% 94% 89% 81% 72% 60% 100% 99% 98% 96 92% 86% 77% 66% 1 Day 100% 100% 99% 97% 94% 89% 82% 72% Total Staff Required to Prophylax 1 Million 6,000 4,000 STAFF Required 2,000 0 Based on Data from Weill Medical College of Cornell University 2 4 6 8 10 DURATION of Campaign (Days) 12 14 Reasons for the Cities Readiness Initiative Wide-spread dispersal is within current capabilities of terrorist groups Current plans are inadequate Potential for loss of life is catastrophic Objectives Strengthen preparedness capabilities of largely populated U.S. cities and their Metropolitan Statistical Areas Decrease the time it takes to dispense prophylaxis by increasing POD throughput and offering alternate modalities of dispensing To save lives CRI Planning Assumptions Response to an outdoor anthrax release drives planning Must offer prophylaxis to the “population at risk” within 48 hours to avert mass casualties In early hours of response, uncertainty in Epidemiological analysis & modeling likely to compel decision to offer broadly Modalities of Dispensing Pull vs. Push (Open and/or Closed) Traditional POD is cornerstone (Open Pull) 4 alternate modalities to complement PODs (Push) • Postal Plan – buys time, allows sheltering in place • MedKit – currently a research study • Pre-deployed community caches for large captive populations (closed) • Pre-event dispensing to first-responders (closed) What is influenza? An acute illness resulting from infection by an influenza virus Highly infectious Can spread rapidly from person to person Some strains cause more severe illness than others Need Innovative Measures Symptoms Generally of sudden onset Fever, headache, aching muscles, severe weakness Respiratory symptoms e.g. cough, sore throat, difficulty breathing How influenza spreads Easily passed from person to person through coughing and sneezing Transmitted through • breathing in droplets containing the virus, produced when infected person talks, coughs or sneezes • touching an infected person or surface contaminated with the virus and then touching your own or someone else’s face Incubation period of influenza Estimates vary The range described is from 1 to 4 days Most incubation periods are in the range of 2-3 days Influenza pandemics in last century Year Strain Name Number of confirmed human deaths (USA) Global deaths 1918-19 H1N1 “Spanish” Flu 650,000 20-40 million 1957-58 H2N2 “Asian” Flu 70,000 1 million 1968-69 H3N2 “Hong Kong” Flu 34,000 1 million Estimated Hospitalizations in Connecticut 20000 18000 Hospitalizations 16000 Minimum Most Likely Maximum 14000 12000 10000 8000 6000 4000 2000 0 15% 25% Gross Attack Rate 35% Estimated Outpatient Visits in Connecticut 1000000 900000 Outpatient Visits 800000 Minimum Most Likely Maximum 700000 600000 500000 400000 300000 200000 100000 0 15% 25% Gross Attack Rate 35% Is there a vaccine? Because the virus will be new, there will be no vaccine ready to protect against pandemic flu A specific vaccine cannot be made until the virus has been identified Cannot be predicted in same way as ‘ordinary’ seasonal flu ‘Ordinary’ flu vaccine or past flu jab will not provide protection Community Actions May Significantly Reduce Illness and Death Before Pandemic Vaccine is Available Early and Uniform / Coordinated Implementation of: Closing schools Keeping kids and teens at home Social distancing at work and in the community Encouraging voluntary home isolation by ill individuals Encouraging voluntary home quarantine by the household contacts Combine with Medical Countermeasures Treating the ill and providing targeted antiviral prophylaxis to household contacts enhances the effect Community Mitigation Goals 1. Delay disease transmission and outbreak peak 2. Decompress peak burden on healthcare infrastructure 3. Diminish overall cases and health impacts #1 Pandemic outbreak: No intervention #2 Daily Cases Pandemic outbreak: With intervention #3 Days since First Case Social Distancing and Infection Control Social Distancing “social measures to decrease the frequency of contact among people in order to diminish the risk of spread from communicable diseases” • Isolation, voluntary home quarantine • School closure • Workplace changes COOP (e.g. telecommuting) • Cancellation of public gatherings Infection Control “hygienic measures to decrease spread of infectious pathogens” • Facemasks and respirators, other PPE • Cough etiquette • Hand hygiene Containment Measures Isolation is the separation and restriction and movement or activities of ill infected persons (patients) who have a contagious disease, for the purpose of preventing transmission to others Quarantine is the separation and restriction of movement or activities of persons who are not ill but who are believed to have been exposed to infection, for the purpose of preventing transmission of disease. Individuals may be quarantined at home or in designated facilities Social Distancing Self-shielding refers to self-imposed exclusion from infected persons or those perceived to be infected (e.g., by staying home from work or school during an epidemic). Snow days are days on which offices, schools, transportation systems are closed or cancelled, as if there were a major snowstorm. Hurricanes and Pandemic Severity Pandemic Severity Index 1918 8 Category 5 Category 4 Category 3 Category 2 Category 1 Community Strategies by Pandemic Flu Severity (1) Pandemic Severity Index Interventions by Setting 1 2 and 3 4 and 5 Recommend Recommend Recommend Generally not recommende d Consider Recommend Child social distancing –dismissal of students from schools and school-based activities, and closure of child care programs Generally not recommende d Consider: ≤ 4 weeks Recommend: ≤ 12 weeks reduce out-of-school contacts and Generally not recommende Consider: Recommend: Home Voluntary isolation of ill at home (adults and children); combine with use of antiviral treatment as available and indicated Voluntary quarantine of household members in homes with ill persons (adults and children); consider combining with antiviral prophylaxis if effective, feasible, and quantities sufficient School – Community Strategies by Pandemic Flu Severity (2) Pandemic Severity Index Interventions by Setting 1 2 and 3 4 and 5 Generally not recommende d Consider Recommend Generally not recommende d Consider Recommend Generally not recommende d Consider Recommend Consider Recommend Workplace/Community Adult social distancing decrease number of social contacts (e.g., encourage teleconferences, alternatives to face-to-face meetings) – increase distance between persons (e.g., reduce density in public transit, workplace) – modify, postpone, or cancel selected public gatherings to promote social distance (e.g., stadium events, theater performances) – modify workplace schedules and practices (e.g., telework, – Generally not recommende Update on the epidemiology and clinical features of Novel H1N1 Joseph Bresee, MD Chief, Epidemiology and Prevention Branch Influenza Division, NCIRD Centers for Diseases Control and Prevention July 15, 2009 The contents of this presentation are those of the presenters and do not necessarily reflect the views of CDC MMWR Novel Influenza A (H1N1) Detected March 2009 • • • • • • • 2 cases of febrile respiratory illness in children in late March No common exposures, no pig contact Uneventful recovery Residents of adjacent counties in southern California Tested because part of enhanced influenza surveillance Reported to CDC as possible Novel influenza A virus infections Swine influenza A (H1N1) virus detected on April 15th,17th at CDC Both viruses genetically identical • Contain a unique combination of gene segments previously not recognized among swine or human influenza viruses in the US Confirmed and Probable Novel H1N1 Cases by Report Date 10 JUN 2009 (N=37,246) 40000 36000 32000 24000 20000 16000 12000 8000 4000 Week Ending Date 3Ju l 10 -J ul 24 -J un 16 -J un 6Ju n 10 -J un ay 30 -M ay 23 -M ay 16 -M 9M ay 11 -A pr 18 -A pr 25 -A pr 2M ay 4Ap r ar 0 28 -M Cases 28000 International Map Pandemic H1N1 – 10 JUL 2009 Epidemiology/Surveillance Pandemic H1N1 Hospitalizations Reported to CDC Clinical Characteristics as of 19 JUN 2009 (n=268) 100% 93% 83% 80% 54% 60% 40% 37% 36% 36% 40% 31% 31% 29% 24% 24% 20% ya lg ia R s hi no rrh ea So re th ro at H ea da ch e Vo m iti ng W he ez in g D ia rrh ea M hi lls C Fe ve r* C ou gh Fa tig SO ue B /w ea kn es s 0% Epidemiology/Surveillance Pandemic H1N1 Cases Rate per 100,000 Population by Age Group As of 09 JULY 2009 (n=35,860*) Rate / 100,000 Pop by Age Group 25 21.6 20 n=17829 17.2 15 n=3621 10 5.4 5 n=5774 3 n=1673 1.0 n=382 0 0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs ≥65 Yrs Age Groups *Excludes 1,386 cases with missing ages. Rate / 100,000 by Single Year Age Groups: Denominator source: 2008 Census Estimates, U.S. Census Bureau at: http://www.census.gov/popest/national/asrh/files/NC-EST2007-ALLDATA-R-File24.csv Epidemiology/Surveillance Hospitalizations per 100,000 Population in Age Group Pandemic H1N1 Hospitalization Rate per 100,000 Population by Age Group (n=3,779) as of 09 JULY 2009 4 3.8 3.5 3 n=799 2.5 2 1.7 1.5 n= 1417 1 0.5 1.2 0.8 0.9 n= 906 n=479 25-49 Yrs 50-64 Yrs n= 178 0 0-4 Yrs 5-24 Yrs ≥65 Yrs Age Group *Hospitalizations with unknown ages are not included (n=353) *Rate / 100,000 by Single Year Age Groups: Denominator source: 2008 Census Estimates, U.S. Census Bureau at: http://www.census.gov/popest/national/asrh/files/NC-EST2007-ALLDATA-R-File24.csv 27% 32% 25% 32% Pandemic H1N1 Hospitalizations Reported to CDC Underlying Conditions as of 19 JUN 2009 35% 30% (n=268) 20% hr on un ic oc C VD om * pr C hr om C on ur is ic re ed nt R en Sm al ok D is er .( st .I II& IV ) N eu O be ro si co ty g N ni eu tiv ro e m Di us s cu la rD is Pr eg na nt Se iz ur e D is C an ce r ia be te s Im m C D C a st hm O PD Prevalence, Hospitalized H1H1 Patients *Excludes hypertension Prevalence, General US Pop 4% 3% 1% 6% 1% 6% 0% 7% 0% 7% 8% 8% 9% A 18% 10% 0% 0% 7% 6% 4% 8% 5% 13% 10% 14% 15% 15% Pandemic H1N1 Cases by State Rate / 100,000 State Population As of 9 JUL 2009 Epidemiology/Surveillance Pandemic H1N1 – 9 JUL 2009 EDT Percentage of Visits for Influenza-like Illness (ILI) Reported by the US Outpatient Influenzalike Illness Surveillance Network (ILINet), National Summary 2008-09 and Previous Two Seasons 7 6 % of Visits for ILI 5 4 3 2 1 2/ 7 2/ 21 3/ 7 3/ 21 4/ 4 4/ 18 5/ 2 5/ 16 5/ 30 6/ 13 6/ 27 4 1/ 2 0 1/ 1 27 12 / 13 29 12 / 11 / 15 1 11 / 11 / 18 10 / 10 / 4 0 Week Ending Dates 2006-07† 2007-08† 2008-09 National Baseline † There was no week 53 during the 2006-07 and 2007-08 seasons, therefore the week 53 data point for those seasons is an average of weeks 52 and 1. Epidemiology/Surveillance A(Pandemic H1N1) 4500 A(Unable to Subtype) Number of Positive Specimens 76%* A(H3) 4000 55%* 80%* A(H1) 3500 37%* A(Subtyping not performed) 85%* 73%* B 3000 2500 2000 1500 70 66 62 58 54 50 46 42 38 34 30 26 22 18 14 10 6 2 -2 Percent Positive 81%* 72%* * Percentage of all positive influenza specimens that are Influenza A (Pandemic H1N1) or Influenza A (unable to subtype) for the week indicated 68%* 66%* 1000 500 Week ending 8/8 8/2 2 7/1 1 7/2 5 6/1 3 6/2 7 5/1 6 5/3 0 4/1 8 5/2 3/2 1 4/4 2/2 1 3/7 1/2 4 2/7 11 /1 11 /15 11 /29 12 /13 12 /27 1/1 0 10 /4 10 /18 0 Percent Positive Pandemic (H1N1) – 9 JUL 2009 U.S. WHO/NREVSS Collaborating Laboratories Summary, 2008-09 What’s Next Disease likely persists through summer in US, expected surge in fall Severity of Fall epidemic difficult to predict Southern Hemisphere being monitored for subtypes, spread, and severity Vaccine being Northern Hemisphere Southern Hemisphere Pandemic H1N1 Vaccine: Program Implementation Pascale Wortley, MD, MPH Immunization Services Division Centers for Disease Control and Prevention July 15, 2009 Vaccine purchase, allocation, and distribution Vaccine procured and purchased by US government Vaccine will be allocated across states proportional to population Vaccine will be sent to statedesignated receiving sites: mix of local health departments and private settings Vaccine planning assumptions: Vaccine available starting midOctober Initial amount: 40, 80, or 160 million doses over one month period Subsequent weekly production: 10, 20 or 30 million doses 2 doses required Preservative free single dose Vaccine planning assumptions: Planners should focus on the following populations: Students and staff (all ages) associated with schools (K-12) and children (age >6 m) and staff (all ages) in child care centers Pregnant women, children 6m-4yrs, new parents and household contacts of children <6 months of age Non-elderly adults (age <65) with Note: these are planning assumptions, ACIP will provide specific vaccination medicalrecommendations. conditions that increase risk of influenza Delivery model Public health-coordinated effort that blends vaccination in public healthorganized clinics and in the private sector (provider offices, workplaces, retail settings) Private sector providers who wish to administer H1N1 vaccine will need to enter into an agreement with public health in order to Public Health planning efforts Reaching out to private providers (defined broadly) to assess interest in providing H1N1 vaccine Retail sector, pharmacists may be involved Planning large scale clinics - Especially important for school-age children given limited private sector capacity Issues for administration in provider offices Storage capacity Administering according to recommended age groups Reporting doses administered early on Insurance reimbursement for administration Partnerships are Essential Local State Federal PANDEMIC RESOURCES http://www.pandemicflu.gov http://www.cdc.gov http://www.usda.gov http://www.nwhc.usgs.gov http://www.who.int http://www.dph.state.ct.us http://www.ct.gov/doag/site/default.asp http://www.dep.state.ct.us/ http://www.ct.gov/demhs/site/default.asp Questions? Steven J. Huleatt, MPH,RS Director of Health West HartfordBloomfield Health District [email protected]