Pandemic 2009 H1N1 Influenza The San Diego Experience Wilma J. Wooten, M.D., M.P.H. Public Health Officer County Of San Diego Health and Human Services Agency Plan. Prepare. Protect.
Topic Areas San Diego Response San Diego Statistics What Went Well Opportunities
The First 2 Cases Today we report that we have confirmed two cases of swine influenza from children in California. CDC April 21, 2009
Actions Taken 1st Wave Implemented Incident Command Management System Community Epidemiology DOC Activated Pandemic Influenza Response Plan Activated EMS DOC (MOC) and HHSA DOC Collaborated with State and Federal officials Leveraged local partnerships Increased communications Deployed Strategic National Stockpile Proclaimed Local Emergency Discontinued June 8 th Plan. Prepare. Protect.
Community Outreach H1N1 Planning Sector Forums Identified over 20 different sectors Border Entities Businesses Colleges and Universities Community orgs Faith-based orgs City/County Government Healthcare (i.e., hospitals, clinics, providers) Law Enforcement (i.e., probations, sheriffs, DA, court) Legislators Media Military Schools (i.e., K-12, daycare, camps) Transportation Tribal entities
Actions Taken 2nd Wave Continued outreach efforts to sectors Disseminated information to targeted groups Legislators Camps Detention facilities Faith-based institutions Providers register on state website Vaccination distribution Oct 5 5K Oct 23 98K Oct 30 78K (unplanned) Activated HHSA DOC - Oct 23rd Implemented Public Education Campaign Nov 7 th Plan. Prepare. Protect.
H1N1 Data UPDATE Hospital cases Fatal cases CA SD Nov 21 Nov 25 Weekly Weekly 6,474 668 354 39* San Diego School Outbreaks 11.25.09 0 County issues weekly (Wednesday) press updates *San Diego County residents only
Who is Affected? Demographics as of November 25, 2009 Range of Ages 1 wks 93 yrs Average Age Average Age Hospitalized Average Age Deaths Average Time Between Onset of illness and death 26.2 years 31.5 years 44.2 years 11.3 days Hospitalized Cases: 14% less than 5, 32% between 5 and 24, 48% between 25 and 64 years of age; 7% 65 and over. Deaths: 3% less than 5, 8% between 5 and 24, 79% between 25-64 years of age; and 10% 65 and over. 8% associated with pregnancy, but 21% with no underlying medical conditions.
Who is Affected? Everyone is affected widespread! Patterns of severe cases for San Diego align with the CDC priority groups: - Pregnancy ( 3 cases or 8%) - Children (2 cases or 5%) - Adults 24-65 years of age with underlying medical conditions (31 or 79%) Those without underlying medical conditions are also affected (21%)
http://www.cdc.gov/flu/weekly/ Surveillance Pandemic Influenza A H1N1 virus is widespread in San Diego and California By week ending October 31 st (Wk 43), widespread in 48 states By week ending November 14 th (Wk 45), activity beginning to decrease with 43 states now reporting widespread activity Wk 45 Wk 43 Wk 37 Wk 33 Wk 39
Community Mitigation Non-pharmaceutical measures Preventive Measure Infection Control Measures Monitoring School Outbreaks Pharmaceutical measures Anti-viral medication
Vaccination Planning Expand PHC and CHC clinic hours for H1N1 vaccinations Conduct school-located vaccination in several districts throughout the county. Mass vaccination clinics (depending on vaccine availability)
Communication Strategies Communication Press releases, as indicated Press conference, as indicated Communication Documents Letters, Video Messages Expanded Tool Kits Newsletter Ambassadors Program Social Networking strategies County Television Network (CTN) County website: www.sdcounty.ca.gov Media Campaign PSAs (radio/tv), print ads, bus ads
Outreach Efforts Branded Look: The Flu & You Website Video Messages: YouTube Sector Forums: 200 presentations TD Ambassador Train-the-Trainer Program Public Requests for presentations Developed an extended Tool Kits for key sectors: K-12 Businesses and Employees Colleges and universities Community and Faith-based orgs Distributed Packets (PHO letter, guidelines, posters): Camps, Schools Detention facilities, Long-term care facilities, Faith-based institutions City managers, Legislators H1N1 Fliers and Posters: Top 10 Things, Seasonal/PanFlu Info Cards and Public education campaign early Nov
Communication Materials
What Went Well? Incident Command System (both waves) Surveillance System Sector Outreach Efforts Communication Strategies Branding, Media Campaign Video messaging Targeted info 211 (public info) Share Point Application Tracking cases (began in 1 st wave) Tracking vaccine given/left (2 nd wave)
Areas for Opportunities? Secure system to better track vaccine inventory to minimize staff time to count remaining vaccine Develop a deeper pool of employee Disaster Service Workers
Questions? Prevent. Protect. Prepare. Plan.