Panhandle Health District Disease Surveillance Summary 2009

1. Panhandle Health District Disease Surveillance Summary2009 Epidemiology Services Team Randi Lustig, Program ManagerDave Hylsky, EHS Epi, Enteric/VectorJeff Lee, PHEP Epi, Emerging Infections Mary Petty, Nurse Epi, TB, VPD

2. Monitor health status of community Diagnose and investigate health problems and hazards in the community Inform, educate, and empower people about health issues. Mobilize community partnerships Develop policies and plans that support individual and community health efforts Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure a competent public health workforce Evaluate effectiveness, accessibility, and quality of personal and population-based health services Research for new insights and innovative solutions to health problems. 10 Core Functions of Public Health

3. Boundary Bonner Idaho Health Districts Kootenai Benewah Benewah Shoshone District 1 Latah Latah Clearwater District 2 Nez Perce District 3 Lewis District 4 District 5 Idaho District 6 District 7 Lemhi Adams Valley Valley Washington Custer Clark Fremont Payette Boise Gem Jefferson Madison Teton Canyon Butte Ada Blaine Bonneville Camas Elmore Bingham Lincoln Gooding Caribou Minidoka Power Jerome Bannock Owyhee Twin Falls Cassia Bear Lake Oneida Franklin

4. Panhandle Health District Mission Statement To prevent disease, disability and premature death; to promote healthy lifestyles; and to protect the health and quality of the environment.

5. Randi Lustig RN, BS, M.Ed.Epidemiology Program Manager • Outbreak & Intervention Coordinator • Immunization Program Manager • Satellite office supervisor • Contract manager • Team Chairperson

6. Vectorborne Rabies, West Nile, Lyme Disease, Relapsing Fever Enterics: Food and Waterborne E.Coli, Crypto, Salmonella, Campy, Botulism, Norovirus Food Establishment Inspections Lab Track Collection, Packaging, Shipping & Tracking specimens bound for Idaho Bureau of Labs David Hylsky, REHS Sr. Environmental Epidemiologist

7. Jeff Lee, RNPreparedness Epidemiologist • Emerging Infectious Diseases & Category A Bio-Terrorism Agents • Anthrax, Plague, Smallpox, Tularemia, Hemorrhagic Fever, Botulism • Active Influenza Surveillance • Public Health Preparedness Planning, Coordination, and Exercises • Epi Informatics • NEDSS, HAN, Epi X, OMS Administrator • Create and maintain databases and analysis packages

8. Alliances & Networking North Idaho Rural Health Consortium School Nurses Kootenai Medical Center Infection Control Committee Vaccine Preventable Diseases, and…. Pertussis, Measles, Rubella, Meningitis Hepatitis A,B, and C Perinatal Hepatitis B program HIV Surveillance Tuberculosis Mary Petty, RN, BSNNurse Epidemiologist

14. 5-Year Comparison of Top 10 Reported Diseases of 2009

15. #1 Chlamydia 593 Reported Cases

19. #2 Hepatitis C 99 Reported Cases

22. #3 H1N1 Influenza 51 Reported Cases

23. Confirmed Suspect Different Diagnosis Didn’t seek medical care Just the Tip of the Iceberg

24. 2009 H1N1 Outbreak Panhandle Health District4/24/09 to 12/31/09 • 51 lab confirmed cases • 27 (53%) males • 24 (47%) females (8 pregnant) • Median Age = 28 years (range 2mos – 76Y) • Mean incidence of 6.6 cases/month • Incidence rate = 24.5/100,000 population • 19 hospitalizations • 1 death

25. Summary of Symptoms for Lab Confirmed Cases • Fever ≥ 100º F – 82% • Ranged 100º - 105.2º • Mean temp – 102.1º • Cough – 78% • Sore throat – 69% • Shortness of breath – 55% • Approximately 25% reported vomiting • Other sx were reported by < 50% of cases

26. Hospitalized Cases • n = 19 • 8 (42%) females (1 pregnant) • 11 (58%) males • Ages ranged 1y – 76y (Median age = 50y) • Median hospital stay = 4 d (range <1- 40d) • 7 (37%) required ICU • 6 (32%) required mechanical ventilation

27. Hospitalized Cases • 15 (79%) had 1 or more pre-existing chronic health conditions • Asthma or other lung disease – 68% • Metabolic diseases – 26% • Heart disease – 16% • Other chronic disease not specified – 26% • People with chronic underlying health conditions were 16 times more likely to be hospitalized (OR 16.3) than those who reported no previous health issues

34. Public Health Intervention and Community Containment • Communication • 20 press releases (168 individual articles in various media) • 16 health alert messages (1912 cumulative recipients) • >3700 H1N1 specific hotline calls received (non-appointment) • PHD website • School closures and exclusions • Coordinated with school nurses and administrators • Provided guidelines for exclusion and closure thresholds • Antivirals • PHD responsible for cache and SNS stock • 976 adult and pediatric doses distributed to local pharmacies • Vaccine • 18,000 doses delivered to hospitals and physicians • 27,774 doses administered by PHD • 61 mass clinics in 5 counties • 156 school clinics (96 schools)

35. Interesting Scenarios • A group of 105 church members travel in 2 buses, from San Diego to Bonners Ferry, doing good deeds along the way. • Assist the elderly with paint & construction projects. • H1N1 travels with them • A local summer camp entertains high school students from Washington, Florida, and California. • Assist with Habitat for Humanity, visiting nursing homes to read to the elderly, and assist in daycares. • H1N1 travels with them.

36. The Bus Group • Of the 105, 1 was confirmed to be traveling with H1N1. • 5 of the group were children under 5, including at least 1 infant. • 49 were sick and were seen by a private physician at no charge. • 7 Tested positive for Influenza A • 4 confirmed at H1N1.

37. The Summer Camp Groups • 4 Confirmed cases emerged (3 campers, 1 counselor). • Sick campers were grouped together. • Antivirals were used for treatment and prevention of disease spread.

38. #4 Elevated Blood Lead 48 Reported Cases

42. #5 Campylobacteriosis 37 Reported Cases

46. #6 Gonorrhea 25 Reported Cases

50. #7 Salmonellosis 16 Reported Cases