Project Immunize Virginia

Diane Helentjaris, MD, MPHDirector, Office of H1N1 ResponseVirginia Department of Health

March 25, 2010West Henrico Health Department

H1N1 – the Virginia Experience

20th Century Influenza Pandemics

1918-1919: Spanish Flu (H1N1)

1957-1958: Asian Flu (H2N2)

1968-1969: Hong Kong Flu (H3N2)

20-100 million deaths worldwide

675,000 U.S. deaths

1-4 million deaths worldwide

70,000 excess U.S. deaths

1-4 million deaths worldwide

34,000 excess U.S. deaths

Credit: U.S. National Museum of Health and Medicine

Rapid Spread

April 2009: First U.S. cases

April 26,2009: U.S. declares public health emergency.

May 1, 2009: First Virginia cases

May 2009: Outbreak at VA university

June 2009:World Health Organization declares a pandemic

H1N1 Response Pillars

•Surveillance•Communication •Mitigation•Direct Medical Care /

Surge•Vaccination

Surveillance in Virginia

Percent of ED and Urgent Care Visits for ILI by Month, April 2009 – September 2009

Percent of ED and Urgent Care Visits for ILI by Month, October 2009 – January 2010

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Week Ending Date

Pe

rce

nt

of

Vis

its

fo

r IL

I

0-4 5-24 25-49 50-64 65+ All Ages

Percent of Emergency Department and Urgent Care Visits for Influenza-like Illness (ILI)by Age Group, Virginia, 2008-09 and 2009-10 Influenza Seasons

ILI Visits by Age Group

School Absenteeism

Average Daily Public School Absenteeism by Region, Virginia, 2009-10 School Year

0

2

4

6

8

10

12

14

16

Week Ending Date

Per

cen

t A

bse

nt

Central Eastern Northern Northwest Southwest

Lab SurveillancePositive Laboratory Reports* and ILI Visits

by Week, Virginia, 2008-09 and 2009-10 Influenza Seasons

0

100

200

300

400

500

600

700

800

900

1000

10/4

/200

8

10/1

8/20

08

11/1

/200

8

11/1

5/20

08

11/2

9/20

08

12/1

3/20

08

12/2

7/20

08

1/17

/200

9

1/31

/200

9

2/14

/200

9

2/28

/200

9

3/14

/200

9

3/28

/200

9

4/11

/200

9

4/25

/200

9

5/9/

2009

5/23

/200

9

6/6/

2009

6/20

/200

9

7/4/

2009

7/18

/200

9

8/1/

2009

8/15

/200

9

8/29

/200

9

9/12

/200

9

9/26

/200

9

10/1

0/20

09

10/2

4/20

09

11/7

/200

9

11/2

1/20

09

12/5

/200

9

12/1

9/20

09

1/2/

2010

Week Ending Date

Nu

mb

er o

f P

osi

tive

Lab

s R

epo

rts

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Per

cen

t o

f V

isit

s w

ith

ILI

B A/Unknown A Seasonal** A/H1, Seasonal A/H3 2009 H1N1 ILI Activity

*Positive laboratory reports are presented by week of specimen collection. Data are added as new test results become available; therefore, information for the most recent week will always be incomplete.

** 'A Seasonal' indicates a positive Influenza A finding that is negative for Novel H1N1 with no further subtyping.

H1N1 Deaths

37 deaths confirmed to have 2009 H1N1 influenza• Ages 6-83

• 34 adults• 3 children

• 1 pregnant or post-partum• 36 with underlying medical conditions

H1N1 Communications:A critical pillar with three key components

Prepare Respond

Prevent

VDH Inquiry Center

877-1-ASK-VDH3

Vaccine information - Google Flu Vaccine Locator

Allows users to find vaccination locations by ZIP code

Vaccination media campaign

“Dear Colleague” Letters

Positive Laboratory Isolates and ILI Reports by Week in Virginia,2008-2009 Influenza Season

0

20

40

60

80

100

120

Week Ending Date

Nu

mb

er o

f P

osi

tive

Lab

s

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Per

cen

t IL

I

2009 H1N1

A/H3

A/H1, Seasonal

A/Unknown

B

ILI Activity

Reaches over 120,000 licensed professionals

Health Commissioner’s Infectious Disease Advisory Committee

Frederick G. Hayden, MDProfessor of Internal Medicine and Pathology, Division of Infectious DiseasesUniversity of Virginia Health Systems

Thomas M. Kerkering, MDChief of Infectious DiseasesVirginia Tech, Carilion School of Medicine

Edward C. Oldfield, III, MDChief of Division of Infectious Disease Eastern Virginia Medical School

Donald Poretz, MD, FACP, IDSA Clinical Professor of Medicine, MCV School of MedicineAnd Georgetown University School of Medicine

Richard P Wenzel, MD, MSc Chair of Internal MedicineVirginia Commonwealth University School of Medicine Michael B. Edmond, MD, MPH, MPAChair of the Division of Infectious Disease Virginia Commonwealth University Health System

James L. Pearson, DPh, BCLD Director, Division of Consolidated LaboratoriesDepartment of General Services

Ronald B. Turner, MDProfessor of PediatricsAssociate Dean for Clinical ResearchDepartment of PediatricsUniversity of Virginia School of Medicine

Mark J. Levine, MD, MPHDeputy Commissioner of Emergency Preparedness & Response ProgramsVirginia Department of Health

Diane Helentjaris, MD, MPHDeputy Director, Office of EpidemiologyVirginia Department of Health

James E. Burns, MD, MBADeputy Commissioner of Public HealthVirginia Department of Health

Karen Remley, MD, MPH, FAAPCommissionerVirginia Department of Health

Direct Medical Care /Surge

• Treatment and infection control information

• State antiviral stockpile• Hospital bed tracking

Mitigation

Vaccination

Seasonal Influenza Vaccine Timetable

H1N1 Vaccine Development

Vaccination Campaign Tenets

•Fair and ethical•Public and Private partnership •Focus initially on priority groups•Virginia Immunization Information System required•Distribute 100% of Allocated Vaccine

Targeted Vaccination and After Action Analysis

Vaccination Strategy

First of Regular Shipments (Bolus)

Pre-campaign shipments for most at risk

School Based Clinics

LHD Clinics

Private Providers

and Pharmacies

Community Mass Vax EventsVac

cine

Dos

es

Adm

inis

tere

d

Targeted Outreach to Specific Groups

The most at risk

Children 6 months to 18 years; their caregivers

General Public

1st Drip Phase I Phase IIApprox. Date

Healthcare Providers

Vaccine Allocation Variables

AvailabilityFormulationDistributionPreferences

Results

H1N1 Vaccine Administered in VirginiaDate: 03/24/10

Preservative-free vaccine

Preservative-containing vaccine

Intranasal vaccine (LAIV)

Total

Public providers

56,150 1,102,980

391,110 1,550,240

Private providers

254,740 1,507,830

268,950 2,031,520

Other providers

6,470 288,260 28,940 323,670

Total 317,360 2,899,070

689,000 3,905,430

H1N1 Doses Administered by Public and Private Sectors by Week Reported, Cumulative, Reported as of 2/23/2010, (N=1,599,367)

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

Reporting Date

Num

ber

of H

1N1

Dos

es

Public Doses Administered (Webvision and Fairfax)

Private Doses Administered (VIIS and Paper)

Vaccine Distribution by Provider Type

Friday of Week Doses Provider Types Start Receiving Doses

10/2/09 48,400 Hospitals, Health Departments

10/9/09 137,750 EMS, OB/GYNs, Pediatrics, Health Centers, K-12

10/16/09 95,660 Family Medicine

10/23/09 99,570 Internal Medicine

10/30/09 267,900 Colleges

11/6/09 318,400 Urgent Care, Correc. Facilities, LTC

11/13/09 63,500

11/20/09 317,700

11/27/09 204,350

12/4/09 254,050

12/11/09 356,250

12/18/09 314,100 Occ. Health, Pharmacies, Comm. Vaccin.

12/25/09 746,710

1/1/2010 618,550

Vaccination – School-age children

H1N1 Immunization Rates by Age, Public and Private Sectors, Reported through 2/23/2010

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85+

Age in Years

Imm

uniz

atio

n R

ate

0 to 4 (11.6% two doses, 20.0% only one, 31.6% at least one)

5 to 18 (25.5% fully immunized)

19 to 24 (8.8% overall)

25 to 64 (12.9% overall)

65+ (18.2% overall)

Note: Stripes and solids make a stacked bar. Stripes indicate ages 6 months to 9 years recommended to receive two doses that have received one dose. Solid shading indicates those who are fully immunized. Approximately 158,663 persons aged 6 months to 9 years have received two doses for an overall rate of 15.6%. Persons aged greater than 85 are reported as age 85+.

H1N1 Vaccine Doses Administered in the Public and Private Sectors by Age, Reported as of 2/23/2010 (N=1,599,367), Cumulative

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Age in Years

# D

oses

Public Doses Administered, recorded in Webvision andFairfax (N=834,032)

Private Doses Administered, VIIS and Paper(N=765,335)

Conclusions

•Partnerships key

•School-based vaccinations effective

ResourcesVirginia Department of Health Web site:

www.vdh.virginia.gov; www.H1N1Get1.com Toll-free VDH Inquiry Center:

1-877-ASK-VDH3 (1-877-275-8343)Google Flushot Locator

www.google.com/flushot

CDC H1N1 Web site:www.cdc.gov/h1n1flu

U.S. Dept. of Health & Human Services Flu center:www.flu.gov

Acknowledgements

VDH staffCDCCDC Public Health Image LibraryGoogle