CREPC - DEMHS REGION 3ESF 21 INDEPENDENT COLLEGES MEETING

PANDEMIC INFLUENZA COLLBORATIVE PLANNING

SAINT JOSEPH COLLEGEWEST HARTFORD, CT

JULY 21, 2009Steven 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 List- category 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)]

ConnecticutPublic 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 delayCan 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 Liabilityunder 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 RegionsConnecticut, 2007

Kent

Sharon

Stafford

Killingly

NorfolkSalisbury

Litchfield

NewtownLyme

Lebanon

Guilford

Suffield

Goshen

Tolland

Granby Woodstock

Haddam

New Milford

Cornwall

Danbury

Pomfret

Ashford

Union

Hebron

Montville

Enfield

Oxford

Ledyard

Groton

Mansfield

Plainfield

Berlin

Salem

Colchester

Avon

Thompson

Greenwich

Wilton

Glastonbury

Madison

Bristol

Coventry

Griswold

Canaan

Stamford

Shelton

East Haddam

Preston

Easton

Hartland

Torrington

Ellington

Hamden

Southbury

Voluntown

Redding

Fairfield

Warren

Windsor

Middletown

Somers

Cheshire

Stonington

Simsbury

Canterbury

Wallingford

NorwichWoodbury

Sterling

Waterford

Eastford

Ridgefield

Canton

Monroe

Willington

Milford

Brooklyn

Washington

North Stonington

Colebrook

Roxbury

Killingworth

Harwinton

Southington

Winchester

Burlington

Morris

Durham

Meriden

Windham

Barkhamsted

Portland

New Hartford

Bozrah

Wolcott

Waterbury

Norwalk

Hampton

Watertown

Weston

Trumbull

Bethel

Putnam

Old Lyme

Bethany

ChaplinVernon

Branford

Farmington

Lisbon

Bloomfield

Franklin

Plymouth

Manchester

Clinton

Orange

Bolton

Columbia

Westport

Chester

South Windsor

Essex

Darien

Andover

Bethlehem

Seymour

Sprague

Naugatuck

North Canaan

Cromwell

EastLyme

EastHampton

Sherman

Hart-ford

Stratford

Scotland

Brookfield

EastWindsor

NewFairfield

Marlborough

NorthBranford

New Canaan

Middlebury

NorthHaven

NewHaven

Prospect

WestHartford

Wood-bridge

Bridgeport

Westbrook

Bridgewater

EastHartford

EastGranby

Rocky Hill

Deep River

Newington

Middlefield

OldSaybrook

NewBritain

Plain-ville

EastHaven

Thomaston

Wethersfield

West Haven

Derby

Ansonia

BeaconFalls

WindsorLocks

NewLondon

09

41

38

24

37

40

34+

35

08

21

36

14

39

0720

1306

33

16

12

04

28

31

10

25

02

29

01

26

03

05

23

15

34

22

32

17

19

11

27

18

DEMHS Region12345

MDA Lead HealthNumber Department/ District

01 Greenwich HD02 Stamford HD03 Norwalk HD04 Westport HD05 Danbury HD06 Bethel HD07 Newtown HD08 New Milford HD09 Torrington Area HD10 Fairfield HD11 Bridgeport HD12 Stratford HD13 Naugatuck Valley HD14 Pomperaug HD15 Waterbury HD16 Chesprocott HD17 Milford HD18 West Haven HD19 New Haven HD20 Quinnipiack Valley HD21 Guilford HD22 Meriden HD23 Wallingford HD24 Farmington Valley HD25 Bristol/ Burlington HD26 Southington HD27 New Britain HD28 Central Connecticut HD29 WH/ Bloomfield HD30 Hartford HD31 Windsor HD32 East Hartford HD33 Manchester HD34 North Central HD35 Chatham HD36 Middletown HD37 Ledge Light HD38 Uncas HD39 CT River Area HD40 Eastern Highlands HD41 Northeast HD

30

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 InitiativeThreat and Vulnerability

CRI Goal

To provide mass prophylaxis to 100% of the identified population within 48 hours of the decision to do so.

7 Days1 Day 2 Days 3 Days 4 Days 5 Days 6 DaysImmed.

10 Days 84% 78% 71% 62% 54% 45% 36% 28%7 Days 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 100% 99% 97% 94% 89% 81% 72% 60%2 Days 100% 99% 98% 96 92% 86% 77% 66%

1 Day 100% 100% 99% 97% 94% 89% 82% 72%

DELAY in Initiation

DURATIONof Campaign

Anthrax Exposure: Proportion of Population Saved

Based on Data from Weill Medical College of Cornell University

STAFFRequired

DURATION of Campaign(Days)

Total Staff Required to Prophylax 1 Million

2 4 6 8 10 12 140

2,000

4,000

6,000

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)

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

What is influenza?

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

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

Influenza pandemics in last century

Estimated Hospitalizations in

Connecticut

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

15% 25% 35%Gross Attack Rate

Hos

pita

lizat

ions

MinimumMost LikelyMaximum

Estimated Outpatient Visits in Connecticut

0

100000

200000

300000

400000

500000

600000

700000

800000

900000

1000000

15% 25% 35%Gross Attack Rate

Out

patie

nt V

isits

MinimumMost LikelyMaximum

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 AvailableEarly 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 Goals1. Delay disease transmission and outbreak peak2. Decompress peak burden on healthcare infrastructure3. Diminish overall cases and health impacts

DailyCases

#1

#2

#3

Days since First Case

Pandemic outbreak:No intervention

Pandemic outbreak:With intervention

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 3Category 2

Category 1

Community Strategies by Pandemic Flu Severity (1)

Pandemic Severity Index

Interventions by Setting 1 2 and 3 4 and 5

Home

Voluntary isolation of ill at home (adults and children); combine with use of antiviral treatment as available and indicated

Recommend Recommend Recommend

Voluntary quarantine of household members in homes with ill persons (adults and children); consider combining with antiviral prophylaxis if effective, feasible, and quantities sufficient

Generally not recommende

dConsider Recommend

School

Child social distancing–dismissal of students from schools and school-based activities, and closure of child care programs

Generally not recommende

dConsider:≤ 4 weeks

Recommend:≤ 12 weeks

–reduce out-of-school contacts and community mixing

Generally not recommende

dConsider:≤ 4 weeks

Recommend:≤ 12 weeks

Community Strategies by Pandemic Flu Severity (2)

Pandemic Severity Index

Interventions by Setting 1 2 and 3 4 and 5

Workplace/CommunityAdult social distancing

–decrease number of social contacts (e.g., encourage teleconferences, alternatives to face-to-face meetings)

Generally not recommende

dConsider Recommend

–increase distance between persons (e.g., reduce density in public transit, workplace)

Generally not recommende

dConsider Recommend

–modify, postpone, or cancel selected public gatherings to promote social distance (e.g., stadium events, theater performances)

Generally not recommende

dConsider Recommend

–modify workplace schedules and practices (e.g., telework, staggered shifts)

Generally not recommende

dConsider Recommend

July 15, 2009

Joseph Bresee, MDChief, Epidemiology and Prevention Branch

Influenza Division, NCIRDCenters for Diseases Control and Prevention

Update on the epidemiology and clinical features of Novel H1N1

The contents of this presentation are those of the presenters and do not necessarily reflect the views of CDC

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

MMWR

Confirmed and Probable Novel H1N1 Cases by Report Date

10 JUN 2009 (N=37,246)

0

4000

8000

12000

16000

20000

24000

28000

32000

36000

40000

Week Ending Date

Cas

es

International MapPandemic H1N1 – 10 JUL 2009

Epidemiology/Surveillance Pandemic H1N1 Hospitalizations Reported to CDC Clinical Characteristics as of 19 JUN 2009 (n=268)

83%

54%

40% 37% 36% 36%31% 31% 29%

24% 24%

93%

0%

20%

40%

60%

80%

100%

Fever*

Cough

SOB

Fatigu

e/wea

knes

sChil

lsMya

lgias

Rhinor

rhea

Sore t

hroat

Heada

che

Vomitin

gW

heez

ingDiar

rhea

Epidemiology/Surveillance Pandemic H1N1 Cases Rate per 100,000 Population by Age

GroupAs of 09 JULY 2009 (n=35,860*)

17.2

21.6

5.4

31.0

0

5

10

15

20

25R

ate

/ 100

,000

Pop

by

Age

Gro

up

0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs ≥65 YrsAge Groups

n=17829

*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

n=3621

n=5774

n=1673n=382

3.8

1.7

0.8 0.91.2

0

0.5

1

1.5

2

2.5

3

3.5

4

0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs ≥65 Yrs

Age Group

Hos

pita

lizat

ions

per

100,

000

P

opul

atio

n in

A

ge G

roup

n=799

n= 1417

n= 906

n= 178

n=479

Epidemiology/SurveillancePandemic H1N1 Hospitalization Rate per 100,000

Population by Age Group (n=3,779) as of 09 JULY 2009

*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

32%

32%

15%

14%

13% 10%

9% 8% 7% 7% 6% 6%

7%

18%

8%

27%

0% 4%3%6%4%

8% 0% 0% 1% 1%

0%5%

10%15%20%25%30%35%

Prevalence, Hospitalized H1H1 Patients Prevalence, General US Pop

Epidemiology/Surveillance Pandemic H1N1 Hospitalizations Reported to

CDC Underlying Conditions as of 19 JUN 2009

(n=268)

*Excludes hypertension

Pandemic H1N1 Cases by StateRate / 100,000 State Population

As of 9 JUL 2009

0

1

2

3

4

5

6

7

Week Ending Dates

% o

f Vis

its fo

r ILI

2006-07† 2007-08† 2008-09 National Baseline

Epidemiology/SurveillancePandemic H1N1 – 9 JUL 2009 EDT

Percentage of Visits for Influenza-like Illness (ILI) Reported by the US Outpatient Influenza-like Illness Surveillance Network (ILINet), National Summary 2008-09 and Previous Two

Seasons

† 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/SurveillancePandemic (H1N1) – 9 JUL 2009

U.S. WHO/NREVSS Collaborating Laboratories Summary, 2008-09

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Week ending

Num

ber o

f Pos

itive

Spe

cim

ens

-22610141822263034384246505458626670

Per

cent

Pos

itive

A(Pandemic H1N1)

A(Unable to Subtype)

A(H3)

A(H1)

A(Subtyping not performed)

B

Percent Positive

* Percentage of all positive influenza specimens that are Influenza A (Pandemic H1N1) or Influenza A (unable to subtype) for the week indicated

37%*

55%*

68%*

73%*

81%*

80%*

85%*

76%*

72%*

66%*

What’s Next

Northern Hemisphere

Southern Hemisphere

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 readied

Surveillance continuing

Pascale Wortley, MD, MPH

Immunization Services DivisionCenters for Disease Control and

Prevention

July 15, 2009

Pandemic H1N1 Vaccine: Program Implementation

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 state-designated receiving sites: mix of local health departments and private settings

Vaccine planning assumptions:

Vaccine available starting mid-October

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

syringes for young children and pregnant women

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 medical conditions that increase risk of influenza

Health care workers and emergency services personnel

Note: these are planning assumptions, ACIP will provide specific vaccination recommendations.

Delivery model Public health-coordinated effort that

blends vaccination in public health-organized 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 receive vaccine

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

Local State

Federal

Partnerships are Essential

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,RSDirector of Health West Hartford-

Bloomfield Health Districtsteveh@westhartford.org