Transcript Slide 1

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%
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da
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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]