Public Health Preparedness for Pandemic Influenza
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1 Public Health Preparedness for Pandemic Influenza Mosier Hall N202 Kansas State University July 24, 2014, 10:00 a.m. Healthy people in a healthy community
2 Contact Information Jason Orr Public Health Emergency Preparedness Coordinator Riley County Health Department 2030 Tecumseh Road, Manhattan, Kansas Office (785) Ext Brenda Nickel, M.S., R.N. (preceptor) Director Riley County Health Department 2030 Tecumseh Road, Manhattan, Kansas Office (785) Ext Healthy people in a healthy community
3 Presentation Overview Experiences with local public health system State and local health departments Public health emergency preparedness Background on pandemic preparedness Pandemic influenza National preparedness and response strategies Surveillance strategies Summary of Field Experience Objectives and activities Local perceptions on preparedness Conclusions and Recommendations MPH Curricula Healthy people in a healthy community
4 Local Public Health System Healthy people in a healthy community
5 Vision: Healthy people in a healthy community 10 Essential Public Health Services 1. Monitor the health of the community Core Functions of Public Health Assessment 2. Diagnose & investigate health problems 3. Develop policies that protect and promote the health of the community Policy Development 4. Mobilize community partnerships 5. Inform, educate, & empower people 6. Enforce laws & regulations Assurance 7. Link to/provide health services 8. Assure a competent workforce 9. Evaluate quality of services & programs 10. Research for new insights into improving health (System Management) Healthy people in a healthy community
6 The Public Health System
7 State Health Departments Largely regulatory and liaison roles State Health Officer follows public health legal authorities; some delegation to Local Health Officers The bridge between localities and Federal agencies Awardees for Federal grant funds Subawardees (LHDs, Hospitals) apply for allocations
8 Local Health Departments Provides services to jurisdiction to meet essential public health functions Keep public health in focus via partnerships, linking to care, prevention activities, and providing to the underserved Boots on the ground
9 Riley County Health Department
10 Riley County Health Department PHEP Coordinator ( est. Oct 2012 ) Public Health Emergency Preparedness (PHEP) Capabilities Emergency Support Function 8 Health & Medical Northeast [KS] Healthcare Coalition Planning Committee: stockpiling, hazard vulnerability analysis Wildcat Region PHEP RCHD Epi Team
11 Pandemic Preparedness Healthy people in a healthy community
12 Pandemic Influenza
13 Risk of Pandemic Not a question of IF but a question of WHEN. Influenza: A vs B vs C Influenzavirus A: most virulent and mutable Influenzavirus B: moderately virulent/mutable Influenzavirus C: infrequent Emerging strains are reportable, if confirmed. Annual: 3-5 million severe cases, thousand deaths
14 Spread of Pandemic Emergence of virulent strain Antigenic shift Zoonotic transmission Wavelike tendency (6-8 wk.) Widespread outbreaks Resource allocation & mobilization issues Healthy people in a healthy community
15 Response Strategies
16 National Strategies National Strategy for Pandemic Influenza (2005) Implementation Plan for the National Strategy for Pandemic Influenza HHS Pandemic Influenza Plan (2005) Strategic Plan Public Health Guidance for State and Local Partners HHS Agencies Operational Plans Pandemic and All-Hazards Preparedness Act (2006) Biomedical Advanced Research and Development Authority (BARDA) Emergency Support Function (ESF)-8 support Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) funding Pandemic and All-Hazards Preparedness Reauthorization Act (2013) Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) funding reauthorization
17 Emergency Support Function 8 Health & Medical The nation and each state, county, and (sometimes) city has an emergency operations plan Annexes allow for function-specific information Assessment of public health/medical needs Public health and medical information Health surveillance Blood and blood products Food safety and security Behavioral health care Vector control Mass fatality management, victim identification, and decontaminating remains Veterinary medical support
18 CDC Preparedness Capabilities Standards CDC developed 15 capabilities as national public health preparedness standards Each standard comes equipped with: Functions: critical elements of capability Performance Measures: guides for completion Tasks: steps to complete functions
19 CDC Preparedness Capabilities Standards Biosurveillance Public Health Laboratory Testing Public Health Surveillance and Epidemiological Investigation Incident Management Emergency Operations Coordination Surge Management Fatality Management Mass Care Medical Surge Volunteer Management Information Management Emergency Public Information and Warning Information Sharing Community Resilience Community Preparedness Community Recovery Countermeasures and Mitigation Medical Countermeasure Dispensing Medical Materiel Mangt. & Dist. Non-Pharmaceutical Interventions Responder Safety and Health
20 Local Strategies Kansas Pandemic Influenza Preparedness and Response Plan (KDHE) Kansas Response Plan Biological Incident Annex (Att. 1) Riley County Emergency Operations Plan Emergency Support Function 8 Annex Health & Medical Riley County Health Department Emergency Operations Plan Biological Incident Annex Community Disease Containment Annex
21 Surveillance Strategies
22 National Integration Virological Surveillance (laboratory) 85 World Health Organization (WHO) Collaborating Laboratories 60 National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories CDC FluView Outpatient Illness Surveillance (providers) U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) 2,900 outpatient healthcare providers ILI Activity Indicator Map Healthy people in a healthy community
23 National Integration Mortality Surveillance 122 Cities Mortality Reporting System Influenza-Associated Pediatric Mortality Surveillance System Elevated: st. dev. above national baseline Hospitalization Surveillance (hospitals) Influenza Hospitalization Surveillance Network (FluSurv-NET) SARI cases (reliable due to lab results) Summary of the Geographic Spread of Influenza State and Territorial Epidemiologists Reports
24 Kansas Department of Health and Environment Bureau of Epidemiology and Public Health Informatics (BEPHI) Infectious Disease Epidemiology & Response (IDE&R) Disease reporting, investigation EpiTrax
25 Field Experience Healthy people in a healthy community
26 Goals of Field Experience Short Term: To develop a report by end of summer which may communicate medical surge vulnerabilities (HVA) of Riley County, outline current capacities (resources) and capabilities (evaluations) within the jurisdiction, and summarize any recommendations for improvement. Long Term: Countywide improvement in preparedness and self-efficacy to respond to a large-scale public health emergency.
27 Learning Objectives 1. (Completed) Understand public health agencies within Riley County and collaborating jurisdictions a) LPHSA, ESF-8, Wildcat Region PHEP 2. (Completed) Understand existing emergency standards and evaluation tools for preparedness and response a) Target & Core Capabilities, Project Public Health Ready, Public Health Accreditation Board, Preparedness Capabilities 3. (Unable to Execute) Determine use of Riley County's Hazard Vulnerability Analysis within context of field work 4. (Completed) Become familiar with Riley County response capacities (comparison-contrast with other systems) 5. (Completed) Apply MPH curricula topics to activities
28 Activities Performed 1. (Completed) Compile list of key public health stakeholders to be affected by a medical surge 2. (Completed) Determine Riley County public health response capacities a) ESF-8 activities, Northeast [KS] Healthcare Coalition 3. (Partially Completed) Evaluate Riley County by available capability standards a) Riley County EOC (2013 KDA FAD Exercise), LPHSA 4. (Partially Completed) Assess Riley County vulnerability to medical surge 5. (Partially Completed) Perform systematic review on basis of research question developed
29 Activities Performed (LPHSA)
30 Activities Performed (Vulnerability) Wildcat Region has an atypically mobile population (student and military) Riley County s population significantly grows for special events Basketball home game attendance (12,000 coliseum capacity) Football home game attendance (50,000 stadium capacity) Pott. Co. Country Stampede (approx. 50,000 per day, 4 days) Fake Patty s Day (unknown; may be 10,000-50,000 persons) K-State s Biosecurity Research Institute (BRI), Veterinary Diagnostic Lab (VDL), and future National Bio and Agro- Defense Facility (NBAF) may increase risks General planning, training, coordination difficulties
31 Activities Performed (interviews, 2009 H1N1 pandemic) 2009 H1N1 Influenza Pandemic Michael McNulty, KDHE Homeland Security Coordinator Cary Herl, RCHD Medical Director & local physician Michelle Rutherford, RCEMS Assistant Director General understandings: 2009 H1N1 outbreaks were not as bad as potential Kansas response was overreaction ; plan very robust and needed to be scaled Communications (internal & public) needed to be improved Coordination of service delivery proved difficult
32 Activities Performed (interviews, 2009 H1N1 pandemic) High-profile: tendency to affect younger, healthier populations Summary of Kansas Activity 1,201 Total Confirmed Cases of H1N1 115,318 nationally confirmed H1N1 cases within pandemic Probably higher; Wyandotte & Johnson counties only instructed testing of hospitalized patients 29 deaths attributed to H1N1 (several young, healthy people) 3,433 nationally confirmed deaths contributed to pandemic
33 Activities Performed (interviews, 2009 H1N1 pandemic) Pandemic Year(s) Virus type Seasonal flu Annual InfluenzavirusA (H3N2, H1N1) and InfluenzavirusB Spanish flu InfluenzavirusA (H1N1) Estimated Infection Rates (worldwide) 5 15% (340 million 1 billion) 33% (500 million) Estimated Deaths (worldwide) 250, ,000 per year Case Fatality Rate (worldwide) <0.1% million >2.5% Swine flu InfluenzavirusA (H1N1) > 622,482 (lab-confirmed) 14,286 (ECDC-confirmed) 18,036 (WHO-confirmed) 0.03%
34 Healthy people in a healthy community
35 Products Developed 1. (Completed) List of public health stakeholders to be affected by a medical surge 2. (Partially Completed) Evaluation of Riley County by pertinent capability standards 3. (Completed) MPH Report on Riley County's vulnerability to medical surge and the available public health response capabilities 4. (Partially Complete) Systematic review of literature pertaining to a medical surge caused by increases in influenza-like illness in Kansas
36 Conclusions and Recommendations Healthy people in a healthy community
37 Conclusions A pandemic (or at least a smattering of virulent outbreaks) is just on the horizon. Emergency response agencies are excellent within their own domain. Riley County disease identification, epidemiology, and investigation was found to be a strength. Riley County emergency response agencies work well together. The public health system (as a whole) is not prepared or capable of addressing complex public health emergencies. Emergency preparedness funding decreases.
38 County Recommendations An update of Riley County Hazard [Vulnerability] Analysis may be performed to address public health risks. Any one of the available public health capability tools may be used to evaluate the Riley County public health system. Focused planning could be performed on Riley County s vulnerability to medical surge, to include alternate care site facility considerations, medical materials/countermeasures, and support.
39 Other Recommendations The partially complete systematic review could be continued by a future team.
40 MPH Curricula Healthy people in a healthy community
41 Most Beneficial Courses HMD 720 Administration of Healthcare Organizations Healthcare system agencies Factors and trends in healthcare Epidemiology/Immunology BIOL 670 Immunology DMP 754 Intro. to Epidemiology Disease-Specific Courses BIOL 530 Pathogenic Microbiology DMP 770 Emerging Diseases Healthy people in a healthy community
42 MPH Program Opportunities Need more opportunities to bring MPH students together (0-1 CRHR course) Job opportunities available with masters Practical opportunities to use techniques & skills Epidemiology, statistics, or other analytical techniques to prepare for public health research (ES#10) Internships/projects (paid or unpaid) with local public health Peer mentoring in course selection
43 Questions? Healthy people in a healthy community
44 Acknowledgements to my wonderful committee and preceptor!!! Healthy people in a healthy community
45 Thank you!! Healthy people in a healthy community
Master of Public Health Field Experience Report
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