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Health and Medical Subpanel Pan Flu Advisory Committee

Health and Medical Subpanel Pan Flu Advisory Committee. Karen Remley, MD, MBA, FAAP State Health Commissioner Mark J. Levine, MD, MPH Deputy Commissioner, Emergency Preparedness January 12, 2010 Virginia Housing Center. The 2009 H1N1 influenza pandemic in Virginia.

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Health and Medical Subpanel Pan Flu Advisory Committee

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  1. Health and Medical SubpanelPan Flu Advisory Committee • Karen Remley, MD, MBA, FAAP • State Health Commissioner • Mark J. Levine, MD, MPH • Deputy Commissioner, Emergency Preparedness • January 12, 2010 • Virginia Housing Center The 2009 H1N1 influenza pandemic in Virginia

  2. U.S. Department of Health and Human Services H1N1 Response Pillars • Surveillance • Communication • Vaccination • Mitigation • Virginia addition • Direct Medical Care / Surge

  3. Surveillance:Monitoring Flu Activity in Virginia • ED/UC visits for flu-like illness (ILI) • By age group, region • Lab surveillance • Outbreaks reported • Deaths confirmed* • School absences* • School and day care closures* * New for 2009 H1N1

  4. Visits for ILI, Virginia

  5. ILI Visits by Age Group

  6. Laboratory Surveillance • Reports to VDH from all sources • DCLS • Private laboratories • Sentinel providers (ED, hospital, MD practice) • 3428 positive flu results have been reported since August 1, 2009 • 3418 (99.7%) are 2009 H1N1 or A/unknown • The other 10 were: one H3 in October, 2 seasonal H1 in August, 3 seasonal A in Oct and 1 in December, and 2 B in August and 1 in October.

  7. Lab Surveillance

  8. Deaths • 35 deaths confirmed to have 2009 H1N1 influenza • Ages 6-83 • 32 adults • 3 children • 1 pregnant or post-partum • 34 with underlying medical conditions* *chronic lung, metabolic, renal, cardiovascular disease; obesity; immunosuppression

  9. School Absences * * *Day before holiday

  10. Special Studies • VDH is also participating in special data collection projects led by CDC: • Death case series • Hospitalized patient case series • Severely ill pregnant women • Peramivir recipients • Guillian-Barre syndrome

  11. Influenza other than H1N1 • Rare reports of seasonal influenza A and B so far in 2009-2010 • Very few seen in Virginia • No sustained transmission in U.S. to date • WHO has no reports of seasonal influenza activity to date during 2009-2010 flu season

  12. H5N1 (Avian Flu)- Cumulative data • 2009 activity seen in: • Cambodia (2 cases), • China (8 cases, 2 deaths) • Egypt (40 cases, 5 deaths) • Indonesia (24 cases, 22 deaths) • Vietnam (6 cases, 5 deaths)

  13. H1N1 Communications:A critical pillar with three key components Prevent

  14. H1N1 Communications: Audiences • CDC • State Agencies and Local Governments • Governor and Senior Leadership • Maryland and DC Health Leadership • Healthcare facilities • Clinical Community • Schools and Universities • Prisons and Jails • Press • Public • High Priority Groups • Vulnerable Populations

  15. H1N1 Communications: • Phases • 1. Crisis Communications- credible, timely, accurate • 2. Disease education and prevention campaign • 3. Vaccination campaign • Overarching theme of education, collaboration and partnerships • Establish VDH as trusted source of information

  16. Information Sources:H1N1GET1 websitePhone line 877-1-ASK-VDH3Opened 4/0989% of calls were from the general public88% phone, 12% emailVolume peak >700 calls/day84% in reference to vaccine

  17. Information Sources • Press Conferences> 15 • Press Releases- >15 • Media Briefings by phone- >15 • Meetings/Lectures to various groups > 90 • local and state level • School nurses, PTA, local government, Grand Rounds • AARP- magazine and Internet

  18. Targeted communications- over 400 • Schools- parents • Employers • Executive, Legislative and Judicial Branch of State Government • Virginia Federal Congressional Delegation • Other state agencies • Tribal leaders • Home school community • Private Schools • Constituent responses

  19. Internal Communications • Local Health Director Conference calls • Polycom with relevant staff • Daily Senior Leadership meetings • Weekly Governor’s report

  20. “Dear Colleague” Letters • Forum for sharing actionable information using four pillars approach including CDC updates • DHP emergency contact information- over 120,000 providers • MD, other clinical specialty organizations distribute • 23 letters to date

  21. Frederick G. Hayden, MD Professor of Internal Medicine and Pathology, Division of Infectious Diseases University of Virginia Health Systems Thomas M. Kerkering, MD Chief of Infectious Diseases Virginia Tech, Carilion School of Medicine Edward C. Oldfield, III, MD Chief of Division of Infectious Disease Eastern Virginia Medical School Donald Poretz, MD, FACP, IDSA Clinical Professor of Medicine, MCV School of Medicine And Georgetown University School of Medicine Richard P Wenzel, MD, MSc Chair of Internal Medicine Virginia Commonwealth University School of Medicine Michael B. Edmond, MD, MPH, MPA Chair of the Division of Infectious Disease Virginia Commonwealth University Health System James L. Pearson, DPh, BCLD Director, Division of Consolidated Laboratories Department of General Services Ronald B. Turner, MD Professor of Pediatrics Associate Dean for Clinical Research Department of Pediatrics University of Virginia School of Medicine Mark J. Levine, MD, MPH Deputy Commissioner of Emergency Preparedness & Response Programs Virginia Department of Health Diane Helentjaris, MD, MPH Deputy Director, Office of Epidemiology Virginia Department of Health James E. Burns, MD, MBA Deputy Commissioner of Public Health Virginia Department of Health Karen Remley, MD, MPH, FAAP Commissioner Virginia Department of Health Health Commissioner’s Infectious Disease Advisory Committee

  22. Health Commissioner’s Primary Care Advisory Group

  23. Vaccination media campaign • Television and Cable- >10,000 plays • Radio- >4,750 plays • Internet 3,7 million impressions • Bus and Rail boards- 185 • Movie theaters- 260 • Media Buy share with DC/MD for NOVA

  24. Vaccine information - Google Flu Vaccine Locator • Allows users to find vaccination locations by ZIP code

  25. H1N1 Vaccine Development

  26. H1N1 Vaccine Planning- High Priority Groups • CDC- Advisory Committee on Immunization Practices- September 2009 Pregnant women Household contacts and caregivers of infants <6 mo of age Healthcare and EMS personnel All persons 6 mo – 24 years of age Persons 25 – 64 years of age who have health conditions associated with higher risk of medical complications from influenza Up to 4.1 million Virginians in these categories

  27. H1N1 Vaccine Planning • Vaccine free in all settings • All supplies provided • Private Providers can charge administration fee • States to determine allocation and documentation process Established 2006 August 2009 75 users including MDs, Hospitals January 2010 2,732 users including MDs, Hospitals and Pharmacies

  28. Vaccination Campaign Tenets • Combined Public/Private • Focus on priority groups with special attention pregnant women • Local Health Departments- School age large scale vaccination plans • Documentation to occur through VIIS with minimal information- Name, DOB, vaccine type and lot number

  29. Vaccine Distribution Process Orders < 100 doses Internal Distributor (GIV) Vaccinators National Distributor (McKesson) Vaccine Manufacturers Vaccinators Orders ≥ 100 doses

  30. VDH Guiding principles for vaccine allocation • strive to be fair and ethical throughout the vaccination campaign. • focus on CDC’s target groups. • partner with thousands of public and private vaccinators in communities throughout the Commonwealth. • rely on the judgment of the vaccine providers in the healthcare community to help it reach CDC’s target groups.

  31. VDH Guiding principles for vaccine allocation • Local health departments (LHs) will work with these partners to assure that all persons have an opportunity to be vaccinated. • There will be no charges for any H1N1 vaccinations administered by or under the supervision of LHDs. • All persons, regardless of whether they live in Virginia or not, will be provided H1N1 vaccine by any LHD once the vaccine is available to the general public through pharmacies and other retail outlets. • The specific focus of LHD’s vaccination efforts will include their own patients and staff, CDC’s target groups, as well as assuring that vulnerable populations have access to the vaccine.

  32. Variables affecting allocation process • Flow of vaccine from manufacturers and CDC • Formulation of available vaccine • Reliability of the distribution process from manufacturer to patient • Provider preferences (patient population, formulation, storage capacity, staff capacity)

  33. Guiding principles for reaching target groups • Focus on: • High-risk for hospitalization and death from flu • Act as source for outbreaks in high-risk group settings • Easily accessible through specific providers

  34. Vaccine Administration sites • MD offices • Local Health Depts. • Schools • Hospitals • Malls • Stores • Zoo • Etc…….

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