Bob Mauskapf

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INFLUENZA PANDEMIC 2009 Novel H1N1 Influenza

• Bob Mauskapf
• Director, Emergency Operations

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Alice and Planning

• Alice
• Which way should I go?
• Cat
• That depends on where you are going.
• Alice
• I dont know where Im going!
• Cat
• Then it doesnt matter which way you go.

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World now at the start of 2009 influenza pandemic
June 11, 2009

• Dr Margaret ChanDirector-General
• World Health Organization

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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

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The Public Health System
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Virginias Response

• Surveillance
• Communication
• Prevention/Vaccination
• Mitigation
• Medical Care/Surge

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International Co-circulation of Novel and
Seasonal Influenza(As of October 30, 2009
posted October 30, 2009, 430 PM ET )
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VDHs 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)

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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 states immunization
  registry

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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

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H1N1 Vaccine Distribution in Virginia
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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

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Considerations for Mitigation under Current
Conditions

• Patient Care
• Evaluation/Testing
• 2009-2010 Influenza Season Triage Algorithm for
  Adults (gt18 Years) With Influenza-Like Illness
  Oct 2 and for children Oct 16
• http//www.cdc.gov/h1n1flu/clinicians/pdf/adultalg
  orithm.pdf
• http//www.cdc.gov/h1n1flu/clinicians/pdf/childalg
  orithm2.pdf
• Interim Recommendations for Clinical Use of
  Influenza Diagnostic Tests During the 2009-10
  Influenza Season Sept 29
• http//www.cdc.gov/h1n1flu/guidance/diagnostic_tes
  ts.htm
• Treatment and Prophylaxis
• General Recommendations
  http//www.cdc.gov/h1n1flu/recommendations.htm
  Sept 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_me
  ssages.htm

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Considerations for Mitigation under Current
Conditions

• Infection Control/Respiratory Protection Planning
• Institute of Medicine Report http//www.nap.edu/c
  atalog.php?record_id12748
• CDC Response (Oct 14)
• http//www.cdc.gov/h1n1flu/guidelines_infection_co
  ntrol.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
• Commissioners Declaration of Public Health
  Emergency

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Consider Severity When Determining Response
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PANDEMIC SEVERITY INDEX
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Mitigation Surge Conditions

• Considerations
• Treatment/Prophylaxis
• Exclusion/Social Distancing
• Respiratory Protection Planning
• Legal

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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

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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).

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• 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.

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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.

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Questions?
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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