H1N1 Swine Influenza 200910

1
H1N1 (Swine) Influenza 2009-10

• Weld County Department of Public Health
  Environment
• School Outreach Meeting
• August 11, 2009

2
(No Transcript)
3
AGENDA

• Welcome and introductions
• Background
• Continuity Planning Keeping Schools Open
• School Influenza Surveillance and Dismissal
• Priority Groups for H1N1 Vaccination
• Possible Immunization Campaign Scenarios
• School Input
• Next Steps

4
Background

• What is novel H1N1 (swine flu)?Novel H1N1
  (referred to as swine flu early on) is a new
  influenza virus causing illness in people. This
  new virus was first detected in people in the
  United States in April 2009. This virus is
  spreading from person-to-person worldwide,
  probably in much the same way that regular
  seasonal influenza viruses spread. On June 11,
  2009, the World Health Organization (WHO)
  signaled that a pandemic of novel H1N1 flu was
  underway.

5
Background - continued

• Why is novel H1N1 virus sometimes called swine
  flu?This virus was originally referred to as
  swine flu because laboratory testing showed
  that many of the genes in this new virus were
  very similar to influenza viruses that normally
  occur in pigs (swine) in North America. But
  further study has shown that this new virus is
  very different from what normally circulates in
  North American pigs. It has two genes from flu
  viruses that normally circulate in pigs in Europe
  and Asia and bird (avian) genes and human genes.
  Scientists call this a "quadruple reassortant"
  virus.

6
Background - continued

• Is novel H1N1 virus contagious?CDC has
  determined that novel H1N1 virus is contagious
  and is spreading from human to human.
• How does novel H1N1 virus spread? Spread of
  novel H1N1 virus is thought to occur in the same
  way that seasonal flu spreads. Flu viruses are
  spread mainly from person to person through
  coughing or sneezing by people with influenza.
  Sometimes people may become infected by touching
  something such as a surface or object with
  flu viruses on it and then touching their mouth
  or nose.
• What are the signs and symptoms of this virus in
  people?The symptoms of novel H1N1 flu virus in
  people include fever, cough, sore throat, runny
  or stuffy nose, body aches, headache, chills and
  fatigue. A significant number of people who have
  been infected with this virus also have reported
  diarrhea and vomiting. Severe illnesses and death
  has occurred as a result of illness associated
  with this virus.

7
A total of 6,506 hospitalizations and 436 deaths
associated with novel influenza A (H1N1) viruses
have been reported to CDC. (Week 30 8/6/09)
8
(No Transcript)
9
Continuity Planning for Schools

• For Pandemic Influenza

10
Planning Assumptions

• Absentee Rates up to 25
• Possible School Closures
• Disruption in Supplies and Services
• Disruption in Educational Service Delivery

11
Continuity Planning Essentials

• What are your essential services?
• How many people, and of what credentialing, does
  it take?
• Who could be cross-trained?
• Succession Planning
• Alternative Schedules?
• Telecommuting
• Home schooling

12
Continuity Planning Essentials

• Alternate Suppliers?
• Communication Planning
• Staff leave policies
• http//www.fema.gov/doc/government/coop/
• coop_plan_blank_template.doc
• http//www.ready.gov/business/_downloads/
• sampleplan.pdf

13
School Surveillance and Dismissal

• Jo Peden, MS Epidemiologist
• Jill Burch, BSN-Public Health Nurse

14
Influenza-Like-Illness (ILI) Reporting for Schools

• School surveillance program Local Health
  Department (WCDPHE) based
• Provide tools for schools to track ILI
• Recruiting schools to volunteer to report
  influenza like illness (ILI) absences.
• Monitor for ILI fever of 100 degrees or higher
  with a cough or sore throat.

15
Influenza-Like-Illness (ILI) Reporting for
Schools continued

• Feed information back to schools
• Possible examples
• Graphs
• Tables
• What would you like?

16
Purpose Monitor for ILI

• Determine local outbreak status
• Track progression/containment
• Advise regarding local decisions
• Monitor effectiveness of prevention and control
  strategies
• Keep as uncomplicated as possible

17
Influenza-Like Illness (ILI) Outbreak
Surveillance Form for School
18
Daily Aggregate Influenza-Like Illness (ILI)
Reporting Form for Schools
19
Weekly Aggregate Influenza-Like-Illness (ILI)
Reporting Form for Schools

• Please fill table in daily

20
School Surveillance Program

• Local Health Department (WCDPHE) Recruiting
  schools to volunteer to report influenza like
  illness (ILI) absences
• Please contact
• Jo Peden, Regional Epidemiologist
  jpeden_at_co.weld.co.us
• [phone] ext 2348

21
School Focus Areas

• Disease prevention and control
• Educational activities aimed at hand hygiene,
  cough etiquette, Flu symptom recognition for
  parents, students and staff.
• Early identification of students and staff with
  influenza- like- illness (ILI).
• Frequent communication with Public Health about
  ILI in school.

22
School Dismissal? What? Why? When?

• Primary message is for schools to stay open
• Flexible decision making based on the local
  situation
• Definitions

23
What is the difference between a school dismissal
and school closure?

• A school closure means closing the school and
  sending all the students and staff home. In a
  school dismissal, the school may stay open for
  staff while the children stay home.
• Keeping school facilities open allows teachers to
  develop and deliver lessons and materials and
  other staff to continue to provide important
  services.

24
School Dismissal Monitoring

• CDC and Department of Education collaboration
• School dismissal monitoring 2009-2010 school
  year
• System will assist overall situational awareness
  about impact on students and teachers nationally
• Monitor school response with CDC guidance to
  assess need for change in H1N1 disease control
  measures.
• www.cdc.gov/FluSchoolDismissal Submit form
  either electronically or print and fax to CDC at
  770-488-6156
• Please, also submit it to WCDPHE

25
Being Prepared. Working Together

• Use surveillance, disease occurrence, school
  function in decision making
• Frequent communication between local public
  health and local school districts.
• For this to work we ask schools how it would work
  to change voice message systems to reflect ILI
  symptoms

26
Priority Groups for Immunization

• Mark E. Wallace, MD, MPH
• Executive Director

27
The groups recommended to receive the novel H1N1
influenza vaccine include

• Pregnant women because they are at higher risk of
  complications and can potentially provide
  protection to infants who cannot be vaccinated

28
The groups recommended to receive the novel H1N1
influenza vaccine include

• Household contacts and caregivers for children
  younger than 6 months of age because younger
  infants are at higher risk of influenza-related
  complications and cannot be vaccinated.
  Vaccination of those in close contact with
  infants less than 6 months old might help protect
  infants by cocooning them from the virus

29
The groups recommended to receive the novel H1N1
influenza vaccine include

• Healthcare and emergency medical services
  personnel because infections among healthcare
  workers have been reported and this can be a
  potential source of infection for vulnerable
  patients. Also, increased absenteeism in this
  population could reduce healthcare system
  capacity

30
The groups recommended to receive the novel H1N1
influenza vaccine include

• All people from 6 months through 24 years of age
• Children from 6 months through 18 years of age
  because we have seen many cases of novel H1N1
  influenza in children and they are in close
  contact with each other in school and day care
  settings, which increases the likelihood of
  disease spread, and

31
The groups recommended to receive the novel H1N1
influenza vaccine include

• All people from 6 months through 24 years of age
• Young adults 19 through 24 years of age because
  we have seen many cases of novel H1N1 influenza
  in these healthy young adults and they often
  live, work, and study in close proximity, and
  they are a frequently mobile population and,

32
The groups recommended to receive the novel H1N1
influenza vaccine include

• Persons aged 25 through 64 years who have health
  conditions associated with higher risk of medical
  complications from influenza.

33
Vaccine prioritization

• There is some possibility that initially the
  vaccine will be available in limited
  quantities. In this setting, the following groups
  receive the vaccine before others
• pregnant women,
• people who live with or care for children younger
  than 6 months of age,
• health care and emergency medical services
  personnel with direct patient contact,
• children 6 months through 4 years of age, and
• children 5 through 18 years of age who have
  chronic medical conditions.

34
2009-2010 H1N1 Immunization Campaign

• Possible Scenarios

35
Emergency Immunization Campaign

• Weld County has a plan for the mass distribution
  of pharmaceuticals to the public Point of
  Dispensing (POD) Plan.
• Utilizes designated facilities (schools,
  community centers, churches) as sites for the
  public to receive immunizations or medications.
• Staffed by community members, public health, and
  volunteers.
• Assumed operational over a short span of time.

36
Seasonal Flu Immunization Campaign

• Flu vaccine obtained through Physicians Offices,
  Retail Stores, Public Health Clinics.
• Staffed by the facilitys employees or sponsor
  agency employees.
• Operational over the season.
• Fee charged.

37
Blend of These Campaigns

• Utilize all the venues of a seasonal flu
  campaign.
• Utilize the POD model for vaccination clinics
  at schools
• Enlist school nurses to assist in delivery of
  vaccine.
• Augment staffing as needed with volunteers.
• Amount of vaccine allocated to each venue
  coordinated through Public Health.

38
What to Consider

• Consolidate school sites.
• One school for each major area?
• Primary schools channel to a secondary school?
• What staffing can schools provide for
  immunization delivery?
• Combine resources?
• Public Messaging

39
School Input

• What challenges do you see as schools?
• How can we best work together to address this
  challenge and protect children?
• What information would help you?
• http//www.co.weld.co.us/redesign/health/
• What resources can we share?
• Other issues?

40
Next Steps

• Twice monthly health department H1N1 planning
  meetings
• Monthly Epi Team meeting at health department
• Follow-up meeting?

41
Thank you!

• Weld County Department of Public Health
  Environment