2018 Influenza Summit. Alameda County Public Health Department

Transcription

1 2018 Influenza Summit Alameda County Public Health Department

2 Influenza Pertussis Hepatitis A Erica Pan, MD, MPH Interim Health Officer Alameda County Public Health Department Clinical Professor Pediatric Infectious Diseases University of California, San Francisco

3 Last Year: Influenza Season High Severity & Long Duration Season 1 st season = high severity across all age groups Activity: Increased in Nov peak Jan/Feb high thru March Increased & widespread activity for the longest in recent years 19 weeks ILI peaked at 7.5% (highest since 2009 H1N1) Highest # of pediatric deaths reported (180) Local Impact CA 329 deaths (<65yo) 648 outbreaks Alameda County 9 deaths (<65yo) 35 outbreaks

4 Timing of Influenza in California peaked in late December of 2017, earlier than previous years

5 Vaccine Match vs Efficacy: Strains typed = matched vaccine Effectiveness: A+B: ~40% A H3N2: ~25% A H1N1: ~65% B: ~49% For kids: 6 mos - 8 yrs (59%)

6 Risk Reduction Car restraints Car seat reduces risk of death: infants (aged <1 year) by 71% toddlers (aged 1 4 years) by 54% Booster seat use reduces the risk for serious injury by 4 8 years by 45% Seat belt use reduces the risk for death and serious injury Older children & adults by ~1/2

7 Novel Influenza Strain 4 variant influenza A (HiN2v) infections confirmed in CA The most recent onset of variant influenza occurred in early August; No additional suspect cases identified.

8 Recommended for all persons >6mos of age <1/2 of all people get vaccinated by November Clinics in Alameda County Community clinics serving county residents. Access for persons who may not have health plans or a primary care clinician. Flu Vaccine >37,000 vaccinations over past 4 years, at >90 sites

9

10 18-19 Flu Vaccine LAIV is back Flu Vaccine contains: A/Michigan/45/2015 (H1N1)pdm09-like virus A/Singapore/INFIMH /2016 A(H3N2)-like virus (updated) B/Colorado/06/2017-like (Victoria lineage) virus (updated) Quadrivalent (four-component) vaccines, which protect against a second lineage of B viruses, are recommended to contain: the 3 viruses above, + B/Phuket/3073/2013-like (Yamagata lineage) virus AAP recommends injectable as 1st choice for children the most consistent protection against all strains of the flu virus in recent years LAIV 2-49 yo Non-pregnant Not immunosuppressed

11 Percent Staff Vaccinated with Flu Vaccine Influenza Masking order within Alameda County and Bay Area was extended through April 30 (November 1 - April 30) Health Care Personnel Flu Vaccination Coverage = Flu Community Immunity Honor Society Member. Coverage between % vaccinated. = Flu Community Immunity Honorable Mention Member. Coverage between 90-94% vaccinated. = Flu Community Immunity Hopeful Member. Coverage between 80-89% vaccinated. = Flu Non-Immune Facility. Coverage less than 80% vaccinated. Hospital/Facility Source: Influenza Vaccination Rates among Health Care Personnel in California General Acute Care Hospitals, , Table 1. creport2016_2017finalapproved pdf

12 Pertussis

13 California is due for another Epidemic Pertussis Peak age: year olds Highest morbidity & mortality in infants 1 st death in hosp/year Alameda County 267 cases as of 8/19/18 > than all of 2014 (249)

14 Prenatal Vaccines Prevent Infant Morbidity & Mortality Influenza and pertussis vaccines are recommended during every pregnancy, regardless of prior receipt. Influenza vaccination during pregnancy is associated with: Lower risk of preterm delivery Higher infant birthweight Decreased risk of influenza in mother & infant Tdap should be administered during each pregnancy, preferably during weeks gestation, regardless of history of prior receipt of Tdap. Giving Tdap earlier in the third trimester may maximize antibody transfer to the infant MMWR Recommendations and Reports 2018; 67:1-44

15 Pregnant women are not getting vaccinated. SF Bay Area/AlCo closer to 73% % vaccinated only slightly better for Flu 59% of women in CA 78% SF Bay Area Similar disparities across Medi-Cal vs Private African-American women vs other race/ethnicities

16 #1 Determinant of Maternal Vaccination? Strong Recommendation from her Provider

17 Alameda County Wants to Emphasize. Pregnant women offered vaccine on site are more likely to be immunized. We can offer Tdap vaccine to providers seeing Medi-Cal patients Are you currently recommending Tdap immunization to every pregnant patient between weeks gestation? How do you identify/flag/prompt when a pregnant patient is due for the vaccine? Do you provide the immunization at your office and keep Tdap stocked? If you do not immunize at your office, where do you send patients? How do you follow up? How do you document when a pregnant patient declines the Tdap vaccine? Tdap Toolkit:

18 Hepatitis A

19 Partnering with Community: Dec 2017-April 2018 Developed handouts and Hep A info Trained 22 PH staff and ~50 outreach workers Created a Field Operations Guide and followed Incident Command System (ICS) Principles

20 Hepatitis A Efforts With partners we vaccinated 827 people! Visited 11 shelters, 6 encampments, 7 needle exchanges, 4 churches, 1 community event and 1 boys and girls club Put on 30 events Participating Organizations Shelter 37% Encampment 20% Needle Exchange 23% Churches 13% Other (Events, Clubs) 7% 1,202 total vaccines given and distributed 1869 Total Encounters Average 45% participation rate

21 New Collaborations Building on Hep A experience Influenza encampments & shelters Collaborative network has facilitated reaching the appropriate stakeholders for naloxone distribution & info sharing New trainings at ACPHD to be better prepared for emergencies

22 2018 Influenza Summit Alameda County Public Health Department

23 Alameda County Influenza Vaccine Distribution Program

24

25

26

27

28 Vaccine Allocation and Racial Equity

29 Percentage of Flu Vaccines Administered by Race/ Ethnicity (Ordered by Vaccine Allocation) % % 80.00% 60.00% 40.00% 20.00% 0.00% American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or other Pacific Islander White Other More than 1 Race

30

31 2018 Influenza Summit Alameda County Public Health Department