The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic Global Challenges, Global Solutions: Workshop Summary (2010) / Chapter Skim
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A3 The Spring 2009 Influenza A H1N1 Outbreak: A Local Public Health Perspective
A3 The Spring 2009 Influenza A H1N1 Outbreak: A Local Public Health Perspective
Pages 120-136
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From page 120... ...
presenting to local emergency departments (EDs) based on syndromic surveillance system data ranged from 200 to 375 percent greater than that during the 2008-2009 seasonal influenza outbreak and averaged 500 percent higher than pre-outbreak levels.
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APPENDIX A 121 180 160 Number of confirmed cases 140 Died Not Hospitalized 120 Hospitalized 100 80 60 40 20 0 Apr 25, 09 May 02, 09 May 09, 09 May 16, 09 May 23, 09 May 30, 09 Jun 06, 09 Jun 13, 09 Jun 20, 09 Jun 27, 09 Jul 04, 09 Jul 11, 09 Jul 18, 09 Jul 25, 09 Week ending FIGURE A3-1 Laboratory-confirmed 2009-H1N1 influenza A infections by age, April July 2009, King County, Washington. Figure A3-1 R01627 300 uneditable bitmapped image text replaced 250 200 Count 150 100 50 0 01/03/09 01/17/09 01/31/09 02/14/09 02/28/09 03/14/09 03/28/09 04/11/09 04/25/09 05/09/09 05/23/09 06/06/09 06/20/09 Week ending <2 years 2-4 years 5-17 years 18-44 years 45-64 years 65+ years FIGURE A3-2 Emergency department visits for influenza-like illness, January 1, 2009, through June 20, 2009, King County, Washington.
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Until recently, school absenteeism reporting has been a passive, manual system, in which school personnel are requested to report weekly absenteeism. Participation in this system has been variable and inconsistent across King County's 19 public school districts (with 525 schools)
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Sustained media attention and reports of school closures raised public anxiety and likely contributed to a surge in outpatient medical visits for ILI and a large volume of phone calls to both the health department and healthcare facilities. Healthcare providers reported large numbers of patients presenting for care in EDs and primary care settings with mild illnesses.
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More efficient and less labor-intensive surveillance and reporting mechanisms at the local level that take advantage of existing electronic databases would be useful both in routine practice and during health emergencies. Routine collection of information relevant to health disparities including socioeconomic factors such as health insurance coverage, homelessness, primary language spoken, and other social and demographic variables would allow a better understanding of disease risk factors including racial and ethnic data, but requires additional resources.
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From page 125... ...
Differences in respirator policies among healthcare facilities led to inconsistent rates of equipment usage such that a small number of local healthcare facilities requested a large proportion of the regional stockpile of N95 respirators. Clinicians and healthcare facilities also reported shortages of commercial rapid influenza diagnostic test kits.
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HMAC, working through our King County Healthcare Coalition,20 a collaboration between public health and regional healthcare system stakeholders to foster healthcare system emergency preparedness, promptly mobilized hospitals to prepare to implement pandemic response plans and successfully facilitated redistribution of scarce medical supplies among regional hospitals and when necessary through provision from the strategic national stockpile (SNS) and/or the county stockpile.
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King County previously purchased a local antiviral drug stockpile that together with the federal stockpile is sufficient to treat at least 25 percent of the local popu lation; however, few other local health jurisdictions in Washington did so and no others have met the target for 25 percent population coverage. In order to ensure timely access to treatment before the national pharmaceutical stockpile was available locally, King County provided oseltamivir from the local stockpile to community locations.
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could play a potentially important role but may not be prepared at this time coordinate such a response with local public health agencies or to respond to unanticipated surge in demand for treatments. School Closures and Community Mitigation Measures On April 29th the first probable cases of 2009-H1N1 influenza A were announced in King County, including cases in school-aged children.
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Significant local capacity and resource issues remain that must be addressed in order to provide meals to low-income children during school closures for 2009-H1N1 influenza A Because ILI was widespread in the community and the majority of cases were likely not diagnosed and reported, and because most cases appeared com parable to seasonal influenza, we discontinued the policy of reactive school closures locally on May 5th.
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Strategies for successful implementation of both proactive and reactive school closures should be incorporated into pandemic and other health emergency plans, including improved coordination and implementation of school closures by public health, school, and local emergency management agencies. Distinguishing between school closure and dismissal of classes should also be considered to allow administrative and other social services functions at schools to continue during health emergencies.
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H1N1 Vaccination Program The need to rapidly plan and implement a large-scale vaccine distribution and administration system severely taxed local public health capacity. In King County, 724 health care providers and/or vaccination clinic sites enrolled to provide H1N1 vaccine compared with 240 for our preexisting local Vaccines for Children (VFC)
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Vaccine supply shortfalls further complicated local vaccine delivery and public messaging. Optimistic national forecasts for vaccine availability raised expectations among the public and influenced public health vaccination program strategy.
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In order to manage enrollment of new vaccination providers; provide technical support to participating healthcare providers; conduct necessary oversight and management of vaccine ordering, delivery, and utilization; and continue routine VFC program operations for all other recommended vaccines that healthcare providers must continue to administer during this time, more than 16 new full-time staff were required. As with other public health surge staffing, finding appropriately trained and experienced staff to supplement the small core of public health program experts is difficult if not impossible on short notice.
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With these resources, we were able to develop capacity in a number of areas critical to effective outbreak and health emergency response that were essential to our 2009-H1N1 influenza A outbreak response. Examples include creation and staffing of a regional Healthcare Coalition to coordinate public health and healthcare system preparedness planning and develop community-wide medical surge capabilities; the capability to activate and manage alternate care facilities; establishing a toll-free public hotline incorporating nurses on-site as well as an external nurse consultation line; and integration of public health preparedness activities with those of organizations serving vulnerable populations (including development of a communication tool to rapidly connect with these critical partners during disasters)
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Inadequate long-term sustainable funding for both core public health and health emergency preparedness undermines the ability of local communities to adequately prepare for and respond to large-scale health emergencies of any type. Acknowledgments The author gratefully acknowledges the ongoing work of many colleagues at Public Health–Seattle and King County responding to the 2009-H1N1 influenza A outbreak, and all who reviewed this manuscript and/or provided valuable comments, including James Apa, Atar Baer, Julia Byrd, Joe Cropley, Cynthia Dold, Carina Elsenboss, Paul Etkind, David Fleming, Tao-Sheng Kwan Gett, Michael Loehr, Jennifer Lloyd, Pegi McEvoy, Shelly McKeirnan, Margaret Neff, Betsy Pesek, David Ralphs, Krista Rietberg, Anne Shields, Mark Tonelli, and Diane Young.
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2009. SHEA position statement: interim guidance on infection control precautions for novel swine-origin influenza A H1N1 in health care facilities, http://www.shea-online.org/Assets/files/policy/061209_H1N1_Statement.pdf (accessed October 29, 2009)
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