Bonnie j. sorensen , md, mba Volusia county health department January 31, 2013

1. DUVAL TB RESPONSE:COMMUNICATING DURING A CRISIS Bonnie j. sorensen, md, mbaVolusia county health departmentJanuary 31, 2013 Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

2. Outline / Objectives • What is TB? • Duval TB Response • Incident Command • Public Information • Accomplishing the mission • Lessons learned for public health response Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

3. What is TB? • TB: short for Tuberculosis • Globally, kills more people than HIV/AIDS • Nationally on the decline Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

4. Global Hot Spots Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

5. National TB Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

6. National Cases of TB Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

7. TB Transmission • Spread through coughing by air droplets Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

8. TB • Once infected, may have inactive (latent TB infection-LTBI) or active TB disease Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

9. TB Symptoms Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

10. How is TB Treated? • Treatment of active cases requires months of antibiotics, not just 10 days • TB drugs are old, subject to shortage • Latent TB requires months of lesser doses of same antibiotics to kill hibernating TB germ Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

11. Treatment of TB Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

12. TB Funding • TB allocation in the past across Florida related to five-year average number of active cases • Duval had decreasing numbers of cases over last five years, yet “one of the most extensive TB outbreaks that CDC has been invited to…both in terms of its size and rapid growth.” (FL0046, that is) Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

13. Duval County’s TB History Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

14. TB Genotyping • TB Genotyping is also known as Spligotyping or DNA fingerprinting • 2005 - CDC initiates Universal TB Genotyping Program • 2007 - Florida begins participation in Universal TB Genotyping Program Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

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16. Duval’s TB Response Efforts • Between July 12 and December 31, 2012: • 4,067 individuals tested with T Spot • Four active cases discovered by screen, others reported by docs/hospitals • 476 individuals had LTBI (12% positive) • All active cases treated; nearly all LTBI cases offered treatment to cure their TB • 559 active, LTBI cases currently managed Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

17. City Divided by Zone for Case Management Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

18. Jacksonville’s System of Services for Homeless • The good news: extensive meals/showers/clothing/beds in Jacksonville • The challenge: dormitory style, 60 bunk beds in one room and face-to-face sleeping arrangements Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

19. Jacksonville’s System of Services for Homeless, cont’d. • The good news: a shared database among shelters in the city • Another challenge: multiple aliases used by homeless lessens value of database Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

20. Jacksonville’s System of Services for Homeless, cont’d. • And more good news: the reluctance of shelters to deny anyone a bed • And another challenge: coughing all night into shared air Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

21. Jacksonville’s System of Services for Homeless, cont’d. • The good news: • Excellent cooperation among providers - the Jacksonville Community TB Coalition and health department • More challenges: • Available personnel to test every client seeking a bed • Renewing 4,000 shelter clearance cards when they began expiring in 2013 Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

22. TB, The Homeless, and Shelter Guidelines • TB, if untreated, can kill people • Homeless people are at high risk for TB • Guidelines are tools to help shelters: • ID clients who may have TB • Refer people with TB symptoms to health care • Regularly test people we serve • Ensure annual testing of staff, volunteers • Identify ways to minimize risk of TB in facilities Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

23. Quote “In order to create a completecommunity for our homeless population, they need a TB-free environment.”Cindy FunkhauserCEO IM Sulzbacher Center Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

24. Incident Command System • ICS was vital in managing TB response • Assigned as Incident Commander in Sept of 2012 • ICS experience included: • E. coli outbreak at petting zoos • H1N1 • Numerous hurricanes, disasters Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

25. Public Information The public wants information NOW Community concern Am I in danger of getting TB? Media calls intensify Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

26. Public Information, cont’d. • Ability to communicate timely, accurate and accessible information on the incident’s cause, size and current situation to the public, responders, internal and external stakeholders. Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

27. Public Information Team • Florida Department of Health, Office of Communications • Duval County Health Department PIO • Volusia County Health Department PIO Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

28. Risk Communication Strategies and Resources • Development of core messages • Identification of Subject Matter Experts, Spokespersons to deliver messaging • Outreach to local governmental, state legislative representation, local organizations • Weekly TB Update press calls • Weekly data updates sent to media • DOH Information Management Unit • Virtual Joint Information Center (V-JIC) • Public Records specialists Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

29. Risk Communication Strategies and Resources, cont’d. • Availability for in-person interviews • Monthly Jacksonville TB Coalition updates • Surgeon General Symposium on Crisis and Risk Communications in Public Health for community partners, public and media • Risk communications training for all CHDs Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

30. Mission Accomplished • By the Numbers: • 24 weeks of ICS in Duval in 2012 • 77 percent of the 2,100 priority contacts located • 100 percent of TB cases treated, 90 plus percent of LTBIs • Media appreciated regular updates, efforts continue Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

31. Lessons Learned • ICS works for prolonged cluster investigations-mimics pandemic response • Integrated Florida DOH critical to address non-disaster events • Important to build media relationships in advance of emergency • Consistency of messages across CHDs in terms of reporting cases/contacts Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

32. Public Health at Work Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

33. Public Health at Work, cont’d. Innovation tCollaborationtAccountabilitytResponsivenesstExcellence

34. Questions? Bonnie Sorensen, MD, MBA Volusia County Health Department Bonita_Sorensen@doh.state.fl.us Innovation tCollaborationtAccountabilitytResponsivenesstExcellence