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Influenza Pandemic 2009: Novel H1N1 Influenza and Virginia's Response

This article provides an update on the status of the 2009 influenza pandemic, clarifies current plans, and highlights the involvement of various stakeholders in the public health system. It also addresses key questions and concerns related to the H1N1 flu.

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Influenza Pandemic 2009: Novel H1N1 Influenza and Virginia's Response

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  1. INFLUENZA PANDEMIC2009 Novel H1N1 Influenza Bob Mauskapf Director, Emergency Operations

  2. Alice and Planning • Alice: • :Which way should I go?” • Cat: • “That depends on where you are going.” • Alice: • “I don’t know where I’m going!” • Cat: • “Then it doesn’t matter which way you go.”

  3. June 11, 2009 World now at the start of 2009 influenza pandemic Dr Margaret ChanDirector-General World Health Organization

  4. Goals • Brief update of current status/knowledge of the novel H1N1 flu • Clarify current plans • Retain your involvement as part of the public health system • Answer (and raise) questions

  5. The Public Health System Police EMS Corrections MCOs Health Department Philanthropist Churches Community Centers Nursing Homes Home Health Parks Doctors Schools Elected Officials Hospitals Mass Transit Environmental Health Civic Groups CHCs Fire Tribal Health Employers Laboratory Facilities Economic Development Drug Treatment Mental Health

  6. Virginia’s Response • Surveillance • Communication • Prevention/Vaccination • Mitigation • Medical Care/Surge

  7. International Co-circulation of Novel and Seasonal Influenza(As of October 30, 2009; posted October 30, 2009, 4:30 PM ET )

  8. VDH’s Communication Plan • The Foundation of our Preparedness and Response • One Voice – Consistent Messages • Multimodal effort to provide the public and key stakeholders with critical and timely information relevant to current needs • VDH enhanced H1N1 Public Inquiry Center: 1-877-275-8343 (1-877-ASK-VDH3)

  9. VDH Influenza Vaccination Plan • Continue to promote seasonal flu vaccination • Public/Private partnership to assure multiple sites of access by the public to H1N1 vaccine with emphasis on assuring vaccination of priority groups. • Private providers have the opportunity to vaccinate their usual patients/clients and healthcare workers for whom they are responsible • Local Health Departments focus on school immunization programs, vulnerable populations, large immunization clinics and any gaps in vaccination access • Track H1N1 vaccination with state’s immunization registry

  10. CDC Vaccination Priority Groups • Pregnant women • Those who live with or care for children younger than 6 months of age • Health care and emergency services personnel • Those 6 months - 24 years of age • Those 25 through 64 years with chronic health disorders or compromised immune systems. “The groups listed above total approximately 159 million people in the United States”

  11. H1N1 Vaccine Distribution in Virginia

  12. Components of Mitigation • Community Strategy for Pandemic Influenza Mitigation – Non Pharmacologic • Isolation and treatment • Antiviral Distribution • Quarantine, if appropriate • Likely unnecessary for this pandemic • Respiratory Protection and Social distancing

  13. Considerations for Mitigation under Current Conditions • Patient Care Evaluation/Testing: • 2009-2010 Influenza Season Triage Algorithm for Adults (>18 Years) With Influenza-Like IllnessOct 2 and for children Oct 16: • http://www.cdc.gov/h1n1flu/clinicians/pdf/adultalgorithm.pdf • http://www.cdc.gov/h1n1flu/clinicians/pdf/childalgorithm2.pdf • Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza SeasonSept 29 http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm Treatment and Prophylaxis: General Recommendationshttp://www.cdc.gov/h1n1flu/recommendations.htmSept 22 Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season Sept 17 http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm

  14. Considerations for Mitigation under Current Conditions • Infection Control/Respiratory Protection Planning • Institute of Medicine Report:http://www.nap.edu/catalog.php?record_id=12748 • CDC Response (Oct 14): • http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm • Exclusion/Social Distancing – www.cdc.gov/h1n1flu • Legal • Secretary of HHS Public Health Emergency Declaration- • April 26 • Presidential Declaration of National Emergency- Oct 24 • Commissioner’s Declaration of Public Health Emergency

  15. Consider Severity When Determining Response

  16. PANDEMIC SEVERITY INDEX

  17. Mitigation: Surge Conditions • Considerations • Treatment/Prophylaxis • Exclusion/Social Distancing • Respiratory Protection Planning • Legal

  18. Section 1135 (SSA) Waivers • Requires Secretary HSS Declaration of Public Health Emergency and a Presidential Emergency Declaration • Issued for defined area and defined time period upon petition • Allows relaxation of federal regulation related to Medicare, Medicaid, EMTALA, HIPAA, CHIP

  19. Additional Legal Aspects of Surge – Virginia Law Title 44 immunity: Public or private agencies and public or private employees or representative engaged in emergency activities are immune from liability for activities to comply with the disaster law, rule, regulation, or executive order when the Governor has declared a state of emergency . Va. Code § 44-146.13 et seq. This includes volunteers in state and local service who serve in a Medical Reserve Corps ( MRC).

  20. Va. Code § 44-146.23(c). Immunity from liability under Title 44 applies only in a declared emergency and for compliance with the disaster law, regulation, or executive order. Just like the PREP Act, willful misconduct is excluded from immunity.

  21. § 8.01-225.02. Certain liability protection for health care providers during disasters • A. In the absence of gross negligence or willful misconduct, any health care provider who responds to a disaster shall not be liable for any injury or wrongful death of any person arising from the delivery or withholding of health care when (i) a state or local emergency has been or is subsequently declared in response to such disaster, and (ii) the emergency and subsequent conditions caused a lack of resources, attributable to the disaster, rendering the health care provider unable to provide the level or manner of care that otherwise would have been required in the absence of the emergency and which resulted in the injury or wrongful death at issue. • B. For purposes of this section: • "Disaster" means any "disaster," "emergency," or "major disaster" as those terms are used and defined in § 44-146.16; and • "Health care provider" has the same definition as provided in § 8.01-581.1.

  22. Questions?

  23. Resources • Virginia Department of Health Website • www.vdh.virginia.gov • VDH Inquiry Center • 1-877-275-8343 (1-877-ASK-VDH3) • CDC H1N1 Website • www.cdc.gov/h1n1flu • DHHS Flu center: • http://www.flu.gov

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