2009 H1N1 Response

Public Health Preparedness

for the City and County of Denver

Charles Smedly

Manager, Public Health Preparedness

Denver Public Health

Flu Strains Circulating as

of October 23, 2009 H1N1 is the dominant circulating strain throughout most of the world

Situational Awareness

Week ending October 17 – Week 41

U.S. Hospitalizations & Death

Cases Defined by Hospitalizations Death

Influenza and Pneumonia Syndrome

21,823 2,416

Influenza Laboratory Tests

8,204 411

Counts reset to zero on Aug 30, 2009

Data reported to CDC by October 20, 2009

Cases by Month in Colorado

Updated 10/26/2009

77166

224

59127 134 110

206

423

1078

0

200

400

600

800

1000

1200

Jan

Feb

Mar

Ap

r

May

Jun

Jul

Au

g

Sep Oct

Statewide Flu Cases By Month Through October 26

Cases by Age: Statewide

544

449

161

536 528

276104

0

100

200

300

400

500

600

S1

Age Group

Statewide Flu Cases by Age Group

Updated 10/26/2009

Distribution of Cases: Metro Area

314377

108 24

457

113

296

214

050

100150200250300350400450500

AD

AM

S

AR

AP

AH

OE

BO

UL

DE

RB

RO

OM

FIE

LD

DE

NV

ER

DO

UG

LA

S

EL

PA

SO

JEF

FE

RS

ON

Metro Area Flu Cases - January to Present

Updated 10/26/2009

H1N1 Four Pillars of Action

Surveillance (situational awareness) Domestic and Global Health care system

Mitigation Vaccination Communication

Mark Frank, MPH Influenza Coordination Unit 09/01/2009

How is Denver preparing?

2009 H1N1 – Expanded OperationsRevision Date: 08 08 2009

Incident Commander

DPH

Policy Group

· DPH - C. Urbina· DEH - N. Severson· OEM – D. Alexander

Public Information (JIC)

DPH – D. MartinezDEH – M. Hughes

OperationsSection

DPH

PlanningSection

DPH

LogisticsSection

OEM

Supply UnitOEM

Provider-based PODsDPH

Epidemiology and

SurveillanceDPH

Situational Awareness

DPH

Local Transfer Point (LTP)

DEH

Public PODsDPH

Distribution GroupTBD

Finance & Admin Section

DEH

Resource UnitDPH

Facilities UnitOEM

` Field investigations

DPH

School and facility

technical assistance

DPH

Isolation and quarantine

DPH

CDPHE Joint Operations Center

POD: Points of dispensing

Response and Preparedness Needs

Review lessons learned from 2007 POD Squad and 2008 Democratic National Convention

Enhanced management of medical surge Increase communication to medically high-risk

individuals Need for early treatment Need for vaccination

Educate public on when and where to seek care Facilitate access to care for medically high-risk

and under-insured populations

Mark Frank, MPH Influenza Coordination Unit 09/01/2009

Mitigating emergency department demand Encourage primary care providers to treat people in

office or by phone, but not to reflexively refer to emergency dept.

Develop self-triage guidelines to help people determine their own appropriate level of care

Preparing hospitals for surge in intensive care Planning for adequate staff Move patients to lowest level of care that is safe Staff training/refresher on ventilators, including those

already stockpiled

Medical Care

Mark Frank, MPH Influenza Coordination Unit 09/01/2009

2009 H1N1 Influenza Vaccine

The U.S. Government providing vaccine at no cost to public health and providers

Public health departments are directing the distribution of H1N1 vaccine

Vaccine distribution includes public settings like school clinics or community centers and private settings like doctors offices or occupational clinics or pharmacies

Each county public health departments directing how H1N1 response will work in their county

ACIP-Recommended Initial Target Groups for 2009 H1N1 Vaccine

Pregnant women Household and caregiver contacts of children

younger than 6 months of age Healthcare and emergency medical services

personnel Infants, children and young adults 6 months

through 24 years of age Persons 25 through 64 years who have high

risk medical conditions

Planned Flu Vaccine Distribution in Denver

First phase: doses distributed to hospitals and clinics (for priority groups and healthcare workers) and private providers

Second phase: Public Health Clinics

Third phase: Community Health Clinics – large, priority groups, weekend clinics

Fourth phase: Regional public Points of Distribution (PODs) – NCR Public Health in collaboration with Kaiser

Communication Challenges

Motivation for vaccination highly dependent on risk perceptions and strength of provider endorsement Seasonal flu often not seen as serious threat Many medically high-risk persons do not self-

identify Recommendations for children and pregnant

women generate heightened safety concerns Multiple doses, combination of seasonal and

2009 H1N1 vaccine, access for priority groups

Mark Frank, MPH Influenza Coordination Unit 09/01/2009

Presidential Declaration

of a National Emergency Utilize alternate care sites, modified

patient triage protocols, patient transfer procedures

Waiver of sanctions for relocations and transfers that otherwise would violate the Emergency Medical Treatment and Labor Act (EMTALA)

Waiver of sanctions and penalties arising from noncompliance with certain Health Insurance Portability and Accountability Act (HIPAA) privacy regulations

Colorado Volunteer Mobilizer

Public health and medical volunteer system to enhance state’s ability to respond and recover from all types of emergencies

Colorado Volunteer Mobilizer improves public health ability to manage the many nurses, physicians, respiratory therapists, dentists, pharmacists and mental health counselors that could be needed for planned community events or public health emergencies

Since January 1st, the system has grown 29 % from 1400 approved volunteers to 1802 members

https://covolunteers.state.co.us/VolunteerMobilizer/

2009 H1N1Events change…

Proportion of severe diseaseTransmissibilityAntiviral resistance patternsVaccine effectiveness, safety, match, availabilityAdjust plans based on data

Mark Frank, MPH Influenza Coordination Unit 09/01/2009

http://www.cdc.gov/H1N1Flu/ http://www.pandemicflu.gov http://www.who.int http://www.flu.gov http://www.cdphe.state.co.us http://www.denverhealth.org www.amafluhelp.org www.H1N1responsecenter.com (Emery) Contact:

CDPHE: 303 - 692- 2000 CO HELP: 1- 877- 462 - 2911 Denver Public Health 303 – 602 – 3614

Charles SmedlyDenver Public Health

Charles.smedly@dhha.org

Where can you learn more?