Project Immunize Virginia
Diane Helentjaris, MD, MPHDirector, Office of H1N1 ResponseVirginia Department of Health
March 25, 2010West Henrico Health Department
H1N1 – the Virginia Experience
20th Century Influenza Pandemics
1918-1919: Spanish Flu (H1N1)
1957-1958: Asian Flu (H2N2)
1968-1969: Hong Kong Flu (H3N2)
20-100 million deaths worldwide
675,000 U.S. deaths
1-4 million deaths worldwide
70,000 excess U.S. deaths
1-4 million deaths worldwide
34,000 excess U.S. deaths
Credit: U.S. National Museum of Health and Medicine
Rapid Spread
April 2009: First U.S. cases
April 26,2009: U.S. declares public health emergency.
May 1, 2009: First Virginia cases
May 2009: Outbreak at VA university
June 2009:World Health Organization declares a pandemic
H1N1 Response Pillars
•Surveillance•Communication •Mitigation•Direct Medical Care /
Surge•Vaccination
Surveillance in Virginia
Percent of ED and Urgent Care Visits for ILI by Month, April 2009 – September 2009
Percent of ED and Urgent Care Visits for ILI by Month, October 2009 – January 2010
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Week Ending Date
Pe
rce
nt
of
Vis
its
fo
r IL
I
0-4 5-24 25-49 50-64 65+ All Ages
Percent of Emergency Department and Urgent Care Visits for Influenza-like Illness (ILI)by Age Group, Virginia, 2008-09 and 2009-10 Influenza Seasons
ILI Visits by Age Group
School Absenteeism
Average Daily Public School Absenteeism by Region, Virginia, 2009-10 School Year
0
2
4
6
8
10
12
14
16
Week Ending Date
Per
cen
t A
bse
nt
Central Eastern Northern Northwest Southwest
Lab SurveillancePositive Laboratory Reports* and ILI Visits
by Week, Virginia, 2008-09 and 2009-10 Influenza Seasons
0
100
200
300
400
500
600
700
800
900
1000
10/4
/200
8
10/1
8/20
08
11/1
/200
8
11/1
5/20
08
11/2
9/20
08
12/1
3/20
08
12/2
7/20
08
1/17
/200
9
1/31
/200
9
2/14
/200
9
2/28
/200
9
3/14
/200
9
3/28
/200
9
4/11
/200
9
4/25
/200
9
5/9/
2009
5/23
/200
9
6/6/
2009
6/20
/200
9
7/4/
2009
7/18
/200
9
8/1/
2009
8/15
/200
9
8/29
/200
9
9/12
/200
9
9/26
/200
9
10/1
0/20
09
10/2
4/20
09
11/7
/200
9
11/2
1/20
09
12/5
/200
9
12/1
9/20
09
1/2/
2010
Week Ending Date
Nu
mb
er o
f P
osi
tive
Lab
s R
epo
rts
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
Per
cen
t o
f V
isit
s w
ith
ILI
B A/Unknown A Seasonal** A/H1, Seasonal A/H3 2009 H1N1 ILI Activity
*Positive laboratory reports are presented by week of specimen collection. Data are added as new test results become available; therefore, information for the most recent week will always be incomplete.
** 'A Seasonal' indicates a positive Influenza A finding that is negative for Novel H1N1 with no further subtyping.
H1N1 Deaths
37 deaths confirmed to have 2009 H1N1 influenza• Ages 6-83
• 34 adults• 3 children
• 1 pregnant or post-partum• 36 with underlying medical conditions
H1N1 Communications:A critical pillar with three key components
Prepare Respond
Prevent
VDH Inquiry Center
877-1-ASK-VDH3
Vaccine information - Google Flu Vaccine Locator
Allows users to find vaccination locations by ZIP code
Vaccination media campaign
“Dear Colleague” Letters
Positive Laboratory Isolates and ILI Reports by Week in Virginia,2008-2009 Influenza Season
0
20
40
60
80
100
120
Week Ending Date
Nu
mb
er o
f P
osi
tive
Lab
s
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Per
cen
t IL
I
2009 H1N1
A/H3
A/H1, Seasonal
A/Unknown
B
ILI Activity
Reaches over 120,000 licensed professionals
Health Commissioner’s Infectious Disease Advisory Committee
Frederick G. Hayden, MDProfessor of Internal Medicine and Pathology, Division of Infectious DiseasesUniversity of Virginia Health Systems
Thomas M. Kerkering, MDChief of Infectious DiseasesVirginia Tech, Carilion School of Medicine
Edward C. Oldfield, III, MDChief of Division of Infectious Disease Eastern Virginia Medical School
Donald Poretz, MD, FACP, IDSA Clinical Professor of Medicine, MCV School of MedicineAnd Georgetown University School of Medicine
Richard P Wenzel, MD, MSc Chair of Internal MedicineVirginia Commonwealth University School of Medicine Michael B. Edmond, MD, MPH, MPAChair of the Division of Infectious Disease Virginia Commonwealth University Health System
James L. Pearson, DPh, BCLD Director, Division of Consolidated LaboratoriesDepartment of General Services
Ronald B. Turner, MDProfessor of PediatricsAssociate Dean for Clinical ResearchDepartment of PediatricsUniversity of Virginia School of Medicine
Mark J. Levine, MD, MPHDeputy Commissioner of Emergency Preparedness & Response ProgramsVirginia Department of Health
Diane Helentjaris, MD, MPHDeputy Director, Office of EpidemiologyVirginia Department of Health
James E. Burns, MD, MBADeputy Commissioner of Public HealthVirginia Department of Health
Karen Remley, MD, MPH, FAAPCommissionerVirginia Department of Health
Direct Medical Care /Surge
• Treatment and infection control information
• State antiviral stockpile• Hospital bed tracking
Mitigation
Vaccination
Seasonal Influenza Vaccine Timetable
H1N1 Vaccine Development
Vaccination Campaign Tenets
•Fair and ethical•Public and Private partnership •Focus initially on priority groups•Virginia Immunization Information System required•Distribute 100% of Allocated Vaccine
Targeted Vaccination and After Action Analysis
Vaccination Strategy
First of Regular Shipments (Bolus)
Pre-campaign shipments for most at risk
School Based Clinics
LHD Clinics
Private Providers
and Pharmacies
Community Mass Vax EventsVac
cine
Dos
es
Adm
inis
tere
d
Targeted Outreach to Specific Groups
The most at risk
Children 6 months to 18 years; their caregivers
General Public
1st Drip Phase I Phase IIApprox. Date
Healthcare Providers
Vaccine Allocation Variables
AvailabilityFormulationDistributionPreferences
Results
H1N1 Vaccine Administered in VirginiaDate: 03/24/10
Preservative-free vaccine
Preservative-containing vaccine
Intranasal vaccine (LAIV)
Total
Public providers
56,150 1,102,980
391,110 1,550,240
Private providers
254,740 1,507,830
268,950 2,031,520
Other providers
6,470 288,260 28,940 323,670
Total 317,360 2,899,070
689,000 3,905,430
H1N1 Doses Administered by Public and Private Sectors by Week Reported, Cumulative, Reported as of 2/23/2010, (N=1,599,367)
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
Reporting Date
Num
ber
of H
1N1
Dos
es
Public Doses Administered (Webvision and Fairfax)
Private Doses Administered (VIIS and Paper)
Vaccine Distribution by Provider Type
Friday of Week Doses Provider Types Start Receiving Doses
10/2/09 48,400 Hospitals, Health Departments
10/9/09 137,750 EMS, OB/GYNs, Pediatrics, Health Centers, K-12
10/16/09 95,660 Family Medicine
10/23/09 99,570 Internal Medicine
10/30/09 267,900 Colleges
11/6/09 318,400 Urgent Care, Correc. Facilities, LTC
11/13/09 63,500
11/20/09 317,700
11/27/09 204,350
12/4/09 254,050
12/11/09 356,250
12/18/09 314,100 Occ. Health, Pharmacies, Comm. Vaccin.
12/25/09 746,710
1/1/2010 618,550
Vaccination – School-age children
H1N1 Immunization Rates by Age, Public and Private Sectors, Reported through 2/23/2010
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85+
Age in Years
Imm
uniz
atio
n R
ate
0 to 4 (11.6% two doses, 20.0% only one, 31.6% at least one)
5 to 18 (25.5% fully immunized)
19 to 24 (8.8% overall)
25 to 64 (12.9% overall)
65+ (18.2% overall)
Note: Stripes and solids make a stacked bar. Stripes indicate ages 6 months to 9 years recommended to receive two doses that have received one dose. Solid shading indicates those who are fully immunized. Approximately 158,663 persons aged 6 months to 9 years have received two doses for an overall rate of 15.6%. Persons aged greater than 85 are reported as age 85+.
H1N1 Vaccine Doses Administered in the Public and Private Sectors by Age, Reported as of 2/23/2010 (N=1,599,367), Cumulative
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Age in Years
# D
oses
Public Doses Administered, recorded in Webvision andFairfax (N=834,032)
Private Doses Administered, VIIS and Paper(N=765,335)
Conclusions
•Partnerships key
•School-based vaccinations effective
ResourcesVirginia Department of Health Web site:
www.vdh.virginia.gov; www.H1N1Get1.com Toll-free VDH Inquiry Center:
1-877-ASK-VDH3 (1-877-275-8343)Google Flushot Locator
www.google.com/flushot
CDC H1N1 Web site:www.cdc.gov/h1n1flu
U.S. Dept. of Health & Human Services Flu center:www.flu.gov
Acknowledgements
VDH staffCDCCDC Public Health Image LibraryGoogle