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 Interim He In Health th Offi ficer Ala lameda Co County Public lic He Healt lth Departmen De ent Clin Clinical Prof ofessor Ped edia iatric In Infec ectious Dis Diseases Univ iversit ity of of Ca Cali lifornia ia, San Francis isco
Last Year: 2017-18 Influenza Season • High Severity & Long Duration Season • 1 st 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
Timing of Influenza in California – peaked in late December of 2017, earlier than previous years https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Influenza.aspx
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.
Flu Vaccine • 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. >37,000 vaccinations over past 4 years, at >90 sites http://www.acphd.org/clinics.aspx
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) 2016-17 Health Care Personnel Flu Vaccination Coverage 100 Percent Staff Vaccinated with Flu Vaccine 90 ◼ = Flu Community Immunity 80 Honor Society Member. 70 Coverage between 95-100% 60 vaccinated. ◼ = Flu Community Immunity 50 Honorable Mention Member. 40 Coverage between 90-94% 30 vaccinated. 20 ◼ = Flu Community Immunity 10 Hopeful Member. Coverage 0 between 80-89% vaccinated. ◼ = Flu Non-Immune Facility . Coverage less than 80% vaccinated. Hospital/Facility 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
Pertussis California is due for another Epidemic • Peak age: 14-17 year olds • Highest morbidity & mortality in infants 1 st death in • 2018 • 50-200 hosp/year • Alameda County • 267 cases as of 8/19/18 • > than all of 2014 (249)
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 outreach workers • Created a Field Operations Guide and followed Incident Command System (ICS) Principles
Hepatitis A Efforts With partners we…vaccinated 827 people! Visited 11 shelters, 6 encampments, 7 needle exchanges, 4 churches, 1 community event and 1 boys and girls club Put on 30 events Participating Organizations Shelter 37% Encampment 20% Needle Exchange 23% Churches 13% Other (Events, Clubs) 7% 1,202 total Average 45% 1869 Total vaccines given participation Encounters and distributed 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
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http://www.cairweb.org
Vaccine Allocation and Racial Equity
Percentage of Flu Vaccines Administered by Race/ Ethnicity (Ordered by Vaccine Allocation) 120.00% 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% 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
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