Pandemic Influenza Preparedness US Department of Veterans Affairs

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Pandemic Influenza PreparednessUS Department of
Veterans Affairs
National Vaccine Advisory Committee
Pandemic Influenza Working Group Meeting
April 19, 2005

• Victoria Davey, RN, MPH
• Deputy Chief, Public Health
• Department of Veterans Affairs

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Missions of the Veterans Health Administration
Health care Education of providers Research
Emergency preparedness Pandemic flu preparedness
relates
to all VHA missions
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VA Medical Care

• 158 hospitals (18,828 beds, 5.4M BDOC)
• 132 nursing homes (33,408 ADC)
• 73 home care programs
• 43 domiciliary programs
• 206 veterans counseling centers
• 854 clinics (50 M outpatient visits)
• 186,600 employees (VHA)
• The largest integrated healthcare system in the
  US
  

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• With 1500 sites of care, VA
• delivers health care in nearly every
• community in the Nation. Thus, VA
• is a fine-meshed sieve for any
• infectious disease of public health
• significance. VA has to be
• prepared for everything.
• J. Perlin, Under Secretary for Health
• Forum on Microbial Threats - Board on Global
  Health
  
• Institute of Medicine
• Washington, DC June 16, 2004

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VHA StatisticsFiscal Year 2004

• 7.1 million total enrollees of 25 million US
  veterans
  
• 5.1 million patients treated
• 29 billion total budget
• 200 million 30-day equivalent Rxs dispensed
• 190 million lab tests performed

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Who Are VA Patients?

• Older - 49 over age 65
• Sicker - Compared to Age-Matched Americans
• 3 Additional Non-Mental Health Diagnoses
• 1 Additional Mental Health Diagnosis
• Poorer
• 70 with annual incomes
• 40 with annual incomes
• 31 have no health insurance

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Education of Health Care Providers
Affiliated with 107 of 125 U.S. Medical Schools
and 1,200 education institutions
84,510 total trainees (AY 2001)
VA has responsibility for the occupational hea
lth of trainees
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Research
FY04 1.5 billion research budget Mission imp
rove veterans health care Medical Research Rehab
ilitation Research Cooperative Studies (large mu
lti-center clinical trials) Health Services Resea
rch Accomplishments Invention of cardiac pacem
aker, CT technology First successful liver transp
lant, insulin pump Multi-center clinical trials
Tb, MI CHF tx, HTN, DM 2 Nobel Prize winners, 6
Lasker Awards
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Emergency Preparedness

• VA/DoD Contingency (PL 97-174) VA backs up DoD
  in event of war or national emergency involving
  armed conflict
  
• NDMS VA, HHS, DoD, FEMA (DHS) assists
  state/local govts with medical PH disasters
  and hospital capacity
  
• DEMPS VA part of Federal Response Plan when
  Presidential Disaster Declaration in made
  
• Ad hoc local responses to emergencies

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VA Pandemic Flu Preparedness

• Annual Influenza Vaccination Program
• Under Secretary for Healths Directive
• Resources to enhance vaccine uptake
• Performance measure
• Public Health Mission
• Oseltamivir stockpile
• Oseltamivir Concept of Operations Plan
• Respiratory Infectious Disease Emergency Plans
  and Operation Preparations (USH IL)
  

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VA Annual Influenza Vaccination Program

• Under Secretary for Health Directive
• Communicates priorities, implementation issues,
  clinical issues
  
• Flu vaccine coordinator appointed at each
  facility
  
• Flu vaccine resource toolkit distributed
  throughout system
  
• Flu vaccine supplies purchased/distributed
• Flu vaccine Performance Measures established and
  monitored

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VA Public Health Leadership

• Our Advisors
• VA Committee on Urgent Public Health Issues
• Natl committee of VA ID, infection control,
  public health, unions, occupational health,
  management, human resources, communications,
  security
• Summer/Fall 2004 - agreed that pandemic flu was a
  significant risk to veterans and VA health care
  system
  
• Supported VA oseltamivir stockpile
• Regular advisors on operational/implementation
  issues
  

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Oseltamivir Stockpile

• Fall 2004 VA purchased 5.75 million capsules
• Quantity based on supply needed for
• Treatment for 550 patients and staff
• Prophylaxis for 5000 patients and staff
• At 40 sites

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VA Oseltamivir StockpileConcept of Operations
Use Plan

• Stockpile divided in 7 geographically diverse
  locations
  
• Physically at VA Community Mail-Out Pharmacy
  Centers (200m Rxs/year)
  
• Plan to coordinate distribution with CDC/DoD
• depending on epidemiology
• Geographic targeting for isolated or limited
  outbreak/control
  
• Widespread distribution for treatment and
  prophylaxis
  
• VA will act to protect veterans health when
  needed
  
• prefers to work with CDC under the cooperative
  model of last years flu vaccine shortage

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Respiratory Infectious Disease Emergency Plans
and Operational Preparations USH Information
Letter

• Instructions to VA facilities
• Preparations/planning needed
• Pandemic responses
• Follow-up actions post event
• Areas of Preparations/Responses
• Communication
• Education
• Staffing and Human Resources
• Environmental, Facility, and Equipment
• Patient Care Management

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