2018 In Influenza Summit Alameda County Public Health Department - - PowerPoint PPT Presentation

2018 In Influenza Summit

Alameda County Public Health Department www.acphd.org/flu

In Infl fluenza Pertussis Hepatit itis A

Eric rica Pan, MD, MPH In Interim He Health th Offi ficer Ala lameda Co County Public lic He Healt lth De Departmen ent Clin Clinical Prof

• fessor

Ped edia iatric In Infec ectious Dis Diseases Univ iversit ity of

• f Ca

Cali lifornia ia, San Francis isco

Last Year: 2017-18 Influenza Season

• High Severity & Long Duration Season
• 1st season = “high severity” across all age groups
• Activity: Increased in Nov – peak Jan/Feb –high thru March
• Increased & widespread activity for the longest in recent years
• 19 weeks
• ILI peaked at 7.5% (highest since 2009 H1N1)
• Highest # of pediatric deaths reported (180)
• Local Impact
• CA 329 deaths (<65yo)
• 648 outbreaks
• Alameda County 9 deaths (<65yo)
• 35 outbreaks

https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Influenza.aspx Timing of Influenza in California – peaked in late December of 2017, earlier than previous years

Vaccine Match vs Efficacy:

• Strains typed =

matched vaccine

• Effectiveness:
• A+B: ~40%
• A H3N2: ~25%
• A H1N1: ~65%
• B: ~49%
• For kids:
• 6 mos - 8 yrs

(59%)

https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm

Risk Reduction – Car restraints

• Car seat reduces risk of death:
• infants (aged <1 year) by 71%
• toddlers (aged 1–4 years) by

54%

• Booster seat use reduces the

risk for serious injury by

• 4–8 years by 45%
• Seat belt use reduces the risk

for death and serious injury

• Older children & adults by ~1/2

Novel Influenza Strain

• 4 variant influenza A (HiN2v)

infections confirmed in CA

• The most recent onset of

variant influenza occurred in early August;

• No additional suspect cases

identified.

• Recommended for all persons >6mos of

age

• <1/2 of all people get vaccinated by

November

Clinics in Alameda County

• Community clinics serving county

residents.

• Access for persons who may not have

health plans or a primary care clinician.

http://www.acphd.org/clinics.aspx

>37,000 vaccinations over past 4 years, at >90 sites

Flu Vaccine

18-19 Flu Vaccine…LAIV is back

• 2018-19 Flu Vaccine contains:
• A/Michigan/45/2015 (H1N1)pdm09-like virus
• A/Singapore/INFIMH-16-0019/2016 A(H3N2)-like virus

(updated)

• B/Colorado/06/2017-like (Victoria lineage) virus

(updated)

• Quadrivalent (four-component) vaccines, which protect

against a second lineage of B viruses, are recommended to contain:

• the 3 viruses above, + B/Phuket/3073/2013-like

(Yamagata lineage) virus

• AAP recommends injectable as 1st choice for children
• “the most consistent protection against all strains of

the flu virus in recent years”

• LAIV –
• 2-49 yo
• Non-pregnant
• Not immunosuppressed

Influenza

Masking order within Alameda County and Bay Area was extended through April 30 (November 1 - April 30)

10 20 30 40 50 60 70 80 90 100

Percent Staff Vaccinated with Flu Vaccine Hospital/Facility

2016-17 Health Care Personnel Flu Vaccination Coverage

◼ = Flu Community Immunity

Honor Society Member. Coverage between 95-100% vaccinated.

◼ = Flu Community Immunity

Honorable Mention Member. Coverage between 90-94% vaccinated.

◼ = Flu Community Immunity

Hopeful Member. Coverage between 80-89% vaccinated.

◼ = Flu Non-Immune Facility .

Coverage less than 80% vaccinated.

Source: Influenza Vaccination Rates among Health Care Personnel in California General Acute Care Hospitals, 2016-2017, Table 1. https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/HCP_InfluenzaVac cReport2016_2017FinalApproved11.05.17.pdf

Pertussis

California is due for another Epidemic

• Peak age: 14-17

year olds

• Highest morbidity

& mortality in infants

• 1st death in

2018

• 50-200

hosp/year

• Alameda County
• 267 cases as of

8/19/18

• > than all of

2014 (249)

Pertussis

Prenatal Vaccines Prevent Infant Morbidity & Mortality

• Influenza and pertussis vaccines are recommended during every pregnancy,

regardless of prior receipt.

• Influenza vaccination during pregnancy is associated with:
• Lower risk of preterm delivery
• Higher infant birthweight
• Decreased risk of influenza in mother & infant
• Tdap should be administered during each pregnancy, preferably during weeks

27-36 gestation, regardless of history of prior receipt of Tdap.

• Giving Tdap earlier in the third trimester may maximize antibody transfer to

the infant

MMWR Recommendations and Reports 2018; 67:1-44

Pregnant women are not getting vaccinated….

• SF Bay Area/AlCo closer

to 73%

• % vaccinated only

slightly better for Flu

• 59% of women in CA
• 78% SF Bay Area
• Similar disparities

across Medi-Cal vs Private

• African-American

women vs other race/ethnicities

https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/MIHA-FactSheet2016.pdf

#1 Determinant of Maternal Vaccination?

Strong Recommendation from her Provider

Alameda County Wants to Emphasize….

• Pregnant women offered vaccine on site are more likely to be

immunized.

• We can offer Tdap vaccine to providers seeing Medi-Cal patients
• Are you currently recommending Tdap immunization to every

pregnant patient between 27-36 weeks gestation?

• How do you identify/flag/prompt when a pregnant patient is due for the

vaccine?

• Do you provide the immunization at your office and keep Tdap stocked?
• If you do not immunize at your office, where do you send patients? How do

you follow up?

• How do you document when a pregnant patient declines the Tdap vaccine?

Tdap Toolkit: http://eziz.org/resources/pertussis-promo-materials/prenatal-tdap/

Hepatitis A

Partnering with Community: Dec 2017-April 2018

• Developed handouts and Hep A

info

• Trained 22 PH staff and ~50
• utreach workers
• Created a Field Operations Guide

and followed Incident Command System (ICS) Principles

Put on 30 events

Visited 11 shelters, 6 encampments, 7 needle exchanges, 4 churches, 1 community event and 1 boys and girls club

Participating Organizations Shelter 37% Encampment 20% Needle Exchange 23% Churches 13% Other (Events, Clubs) 7%

Hepatitis A Efforts

With partners we…vaccinated 827 people!

1,202 total vaccines given and distributed 1869 Total Encounters Average 45% participation rate

New Collaborations

• Building on Hep A experience
• Influenza vaccine @ encampments & shelters
• Collaborative network has facilitated reaching the appropriate

stakeholders for naloxone distribution & info sharing

• New trainings at ACPHD to be better prepared for emergencies

2018 In Influenza Summit

Alameda County Public Health Department www.acphd.org/flu

Alameda County In Influenza Vaccine Distribution Program 2018-2019 2019

http://www.acphd.org/iz/projects/flu.aspx

http://www.acphd.org/iz/projects/flu.aspx

http://www.acphd.org/iz/projects/flu.aspx

http://www.cairweb.org

Vaccine Allocation and Racial Equity

0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00%

Percentage of Flu Vaccines Administered by Race/ Ethnicity (Ordered by Vaccine Allocation)

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or other Pacific Islander White Other More than 1 Race

2018 In Influenza Summit

Alameda County Public Health Department www.acphd.org/flu