H1N1 Pandemic Year In Review April 2009 - February 2010
History and Planning: 2001 Winnebago County Health Department (WCHD) receives a state grant to develop a bio-agent preparedness plan alongside community partners. 2004 WCHD receives national recognition as Project Public Health Ready through NACCHO (one of only 11 health departments nationwide to receive first round certification). 2006 Pandemic Influenza Plan developed (one of the first state-wide). 2008 Pandemic Influenza Plan expanded to All-Hazards format & receives recognition by NACCHO as a Public Health Ready recertification site (only 1 of 4 health departments in the country). Plan tested with a Full-Scale Exercise including over 300 participants from 15 local, state & federal agencies. 2009 In April, Mexican Health Officials report cases of influenza with chief complaints of fever & cough. Several days later, Texas & California report similar cases. In May, WCHD received verification of the first positive H1N1 case within our county. The Pandemic Influenza Plan was implemented upon confirmation; calling together preventive, containment & control measures, prophylaxis & treatment for exposed cases, in addition to a mass-vaccination program. Case Review: Below is the epidemic curve of all H1N1 cases from Winnebago County residents. 2
Case Review (continued) As of February 27, 2010 the WCHD had received 234 confirmed 2009 H1N1 test results. Of these confirmed, 54% were in patients under the age of 25. This data mirrors the national trend. There were also 161confirmed hospitalized H1N1 cases. The mean, median and age range are shown below. 2009 H1N1 Age Profile Mean Median Range Confirmed Cases n=234 27.67 20.5 1 mo to 85 y Hospitalized Cases n=161 33.87 37 1 mo to 85 y Deaths n=5 46.40 47.00 7 y to 81 y As shown, the H1N1 pandemic was more prevalent in those younger than 25. The below figure gives the percentage of cases and hospitalizations per 100,000 population. Age Range Total Cases n / % Rate per 100,000 Total Hosps n / % Rate per 100,000 0-4 45 / 19% 218.35 27 / 17% 131.01 5-17 62 / 26% 114.68 27 / 17% 49.94 18-44 54 / 23% 49.05 39 / 24% 35.43 45-64 55 / 24% 72.30 50 / 31% 65.73 65+ 18 / 8% 45.67 18 / 11% 45.67 Total 234 / 100% 77.39 161 / 100% 53.62 3
School Absenteeism - School Absenteeism rates were a useful tool for monitoring influenza activity. Since a large percentage of the at-risk population fell within the school-age range, this tracking method proved the most useful. The first chart shows the northern districts compared to the Rockford District 205. The peak for the northern districts was during week 41, while it occurred during week 43 for Rockford District 205. Another tool utilized in the monitoring of H1N1 activity was Influenza-Like Illness (ILI) reporting a collection of Sentinel-Site reports showing the number of patients who presented with symptoms of fever, cough and sore throat. A weekly visualization of ILI incidence is shown in the graph to the left. While there was a small rise in the data around week 18, there was a very large peak beginning around week 40. This peak lasted until around week 47. Since then, data have fallen back to below the Epidemic values but remain above the seasonal baseline. 4
Vaccination Program The mass vaccination program was a public-private partnership, targeting those who were considered at risk, meaning they were within the targeted age range (6 months to 24 years) or had any number of selected medical conditions such as asthma, diabetes or were pregnant. Overall, Winnebago County providers administered nearly 60,000 H1N1 vaccines. The pie graph shows the percentage of vaccine distributed by community partners and WCHD. Mass-vaccination programs began in mid-november, once vaccine supplies were made available from the Centers of Disease Control and Prevention and the Illinois Department of Public Health. Assessment Overall, Winnebago County experienced 234 H1N1 Influenza illnesses from April 2009 to February 2010, with a majority of those cases occurring in those under the age of 25. When compared to state-wide data, Winnebago County (53.62 hospitalizations per 100,000 population) saw higher H1N1 prevalence than the State of Illinois (23.21 hospitalizations per 100,000 population). 5
Photo Courtesy CDC/ Judy Schmidt Assessment (continued) With elevated prevalence of illnesses, it was important to work alongside the various community partners to slow the spread of the H1N1 Influenza. Health care providers were seeing elevated numbers of patient visits, running additional tests, and admitting more patients. While the pandemic continued, local media partners aired public service announcements and generated media stories to keep the public well-educated throughout the duration. In total, 28 News Releases were generated in partnership with the local hospital Public Information Officers. Over 1,300 radio and television ads ran throughout the course of the pandemic, in addition to 90 articles in the Rockford Register Star and the distribution of over 20,000 handouts. Signs were also placed at the CherryVale Mall, the Chicago-Rockford International Airport and on selected Rockford Mass Transit District buses. Numerous groups assisted in the planning, preparation and execution of the vaccination clinics. 6
What s in the Future? Currently, WCHD staff is utilizing After Action Reviews in order to evaluate the strengths and weaknesses of the current response plans, and to assess the opportunities and threats presented by the H1N1 pandemic influenza outbreak. Using this evaluation process, the health department will work through intra-agency collaboration to update the Emergency Operations Plan. This will also strengthen community preparedness for response to future public health emergencies. We continue to monitor and report (on a weekly basis) the current seasonal influenza data. An updated Training and Exercise Plan is being prepared, to include large-scale trainings and exercises involving the entire Northern Illinois region. Preparations are being made to apply the lessons learned from the H1N1 pandemic to the following flu season to include obtaining and distributing the flu vaccine in an effective manner. Public Health Administrator Mike Bacon being interviewed by Mike DeDoncker from the Rockford Register Star at a Heartland Church clinic 7
Our Appreciation The Winnebago County Department of Public Health would like to thank all of the public and private community partners, consortium members and volunteers who assisted during this past year. There are too many to list by name, but your preparation for and responsiveness to the 2009 H1N1 Influenza pandemic was an essential factor in protecting the health of our community. Public Health is what we do collectively to assure conditions in which our residents can be healthy 401 Division Street Rockford, IL 61104 815-720-4000 www.wchd.org H1N1 Year in Review - April 2010