Flu & You Local Public Health Perspective Flu Summit 9/17/14 - - PowerPoint PPT Presentation

Flu & You – Local Public Health Perspective

Flu Summit 9/17/14 Erica Pan, MD, MPH, FAAP

Director, Division of Communicable Disease Control & Prevention Deputy Health Officer Alameda County Public Health Department

Associate Clinical Professor, Pediatric Infectious Diseases

Overview & Learning Objectives

• Learn to contact local public health for

disease reporting & lab testing

• Learn about recent CA & AlCo flu

epidemiology & vaccination rates

• Describe the impact of Healthcare Worker

Flu vaccination policies

• Learn about Alameda County Public

Health efforts to prevent flu & other VPD

Case presentation

• 76 yo M with diabetes presents with fever

to 103, cough, and URI sxs worsening

• ver the last 2-3 days

– Febrile on PE, RR 28, O2 Sat 88% on RA – CXR with bilateral diffuse opacities

• Recently traveled to Saudi Arabia,

returned 7 days ago

Case reporting & testing

• Call Infection Control
• Alameda County Public Health Dept
• Discuss & consult on case
• Collect specimens
• Submit to public health lab

How/where to report?

http://www.acphd.org/communicable-disease/disease-reporting-and-control

Report to local health jurisdiction where case resides

What to report?

ICU/Fatal Influenza Reporting < 65 years

• Lab-confirmed influenza in fatal cases <=65

years old (Mandated Title 17, H&S Code)

• Lab-confirmed influenza in pts <=65 yo in ICU

(voluntary)

Outbreaks or unusual occurrence

• In institution with >=1 case of lab confirmed flu in the setting
• f a cluster (>=2) of ILI within a 72h period
• In institution or congregated living setting associated with

hospitalization or fatalities

• Assessed as having public health importance
• eg travel to area with novel flu, close swine/avian/camel contact

ACPHD Health Alerts

http://www.acphd.org/health-alerts.aspx

Flu 2013-2014

Flu 2013-2014

• Who was most affected?

–60% of flu-associated hospitalizations in 18-64 yo –Rates highest among people >=65

• 2nd highest - 50 to 64 yo

–rates > than during 2009 pandemic

http://www.cdc.gov/flu/pastseasons/1314season.htm

Up to Date: “Seasonal influenza in children: Clinical features and diagnosis”

http://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html

California Influenza Surveillance

• Clinical ILI activity

– CDC ILI Net Surveillance – sentinel providers – Kaiser Permanente hospitalization data – Severe (ICU) and fatal influenza cases <age 65 years – California Emerging Infections Program: Flu- associated hospitalizations – Outbreaks

• Laboratory activity

– Sentinel Laboratories (influenza and RSV detections) – Respiratory Laboratory Network – CA and CDC public health labs

Slide adapted from Dr. Janice Louie, CA Department of Public Health

Percentage of Influenza-like Illness Visits Among Patients Seen by California Sentinel Providers, 2009–2014

As of Week 11: 3/9/14 - 3/15/14

Sentinel Surveillance Providers

• 244 statewide
• 9 in Alameda County
• Report weekly:

– # patients with ILI – # patients seen

• <30 min/week
• Virologic testing for

pts with ILI (>1/wk):

– @ beginning, peak, and end of flu season – severe disease – recent overseas travel – outbreak setting – vaccinated

www.cdph.ca.gov/programs/dcdc/Pages/CaliforniaSentinelProviderProgram.aspx

Percentage of Influenza Detections in Respiratory Laboratory Network and Sentinel Laboratories, 2009–2014

Health Care Worker Flu Vaccination

Why is it important?

• CDC, ACIP, and HICPAC, all recommend

health care workers (HCW) get flu vaccine annually

• Protects HCWs
• Protects patients @ high risk and/or that can’t

be immunized

• Reduces flu infection and absenteeism

among HCWs

• Prevents outbreaks and patient mortality
• Economic benefits to the institution, health

care insurers

http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2013.htm

HCW flu vaccine rates

• March 28, 2012: Memorandum

– Dr. Muntu Davis, Health Officer, Alameda County – Strongly recommending that all health care facilities implement policies of mandatory influenza vaccination or masking

• October 1, 2012: Mandate

– Dr. Muntu Davis, Health Officer, Alameda County – Dr. Janet Berreman, Health Officer, City of Berkeley – Requiring all licensed health care facilities to implement a policy of mandatory influenza vaccination or masking – Ongoing unless rescinded or modified

• August 28, 2013: Mandate updated

– Facilities with >90% vaccination rates no longer exempt – Ongoing unless rescinded or modified

Alameda County/City of Berkeley Health Officer Order

October 2012 mandate & FAQs

Slide created by Roza Tammer – Cal EIS Fellow 2012-2013

Alameda County Evaluation

• Gathered data from 19 acute care inpatient facilities

(14 facility “groups”)

• Overall increase in HCW influenza vaccination rates

– 2011/12 influenza season:

• Zero facility groups reported a 90% or greater influenza

vaccination rate in HCWs

• Median HCW vax rate 74% (52-87%)

– 2012/13 influenza season:

• Eight facility groups reported a 90% or greater influenza

vaccination rate in HCWs

• Median HCW vax rate 93% (72.6-95.5%)
• Valuable facility-level input incorporated into updated

LHO order

Slide created by Roza Tammer – Cal EIS Fellow 2012-2013

ALAMEDA COUNTY IMMUNIZATION RATES

21.8 45.9 44.8 43.8 32.6 44.6 32.6 34.9 39 36 40.1 43.3 10 20 30 40 50 60 70 80 90 100 2011-2012 2012-2013 2013-2014 2011-2012 2012-2013 2013-2014 2011-2012 2012-2013 2013-2014 2011-2012 2012-2013 2013-2014 3 to 4 years old 5 to 11 years old 12-14 years old 3 to 14 years old % of Children Vaccinated Age Group by Year

Pediatric Flu Vaccination Rates in Alameda County

Source: California IZ Registry *

*Number of children who have a visit (=any vaccine in CAIR) within the previous 3 years previous to the ending of vaccine flu season. At least 2 vaccines received.

Expanded Kindergarten Retrospective Survey 2014

• 1352 blue cards
• 21 randomly selected schools
• Kindergarteners in Fall 2013
• UTD IZ @ 2yo = (4 DTP, 3 Polio, 1MMR)
• 72% immunization coverage @ 2 yo
• Healthy People 2020 goal: 80%

EKRS By Year, 2009, 2011,2014

70.7 81 75 66 74 59 58 68 66 46 60 52 72 73 77 60 76 74 10 20 30 40 50 60 70 80 90 Total White Hispanic Black Asian Other/Unknown 2009 2011 2014

Race by Year % UTD at 24 months 4:3:1 series

Immunization Activities

• Distribute ~20,000 flu vaccine doses to >

100 partner agencies

• >20 flu vaccine clinics across the county
• Improve conditional entrants rates
• Revitalize IPAC
• School Based Flu Vaccine Clinics

Pilot: Fall 2013

Vaccines to Oakland pre-K through 5th grade students

Take Home Messages

• Report to and work with public health to:

– Conduct routine surveillance – Be on the lookout for outbreaks and unusual

• ccurrences

– Report & Test for emerging infectious diseases – Exchange information about scope of situation, clinical profile, and appropriate infection control/disease containment

• Flu still causes severe disease – often in healthy, young

patients – every year

• We need to do more to increase our flu vaccination rates
• Get your flu vaccine! (and your patients and loved ones,

too!)