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 over 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? Report to local health jurisdiction where case resides http://www.acphd.org/communicable-disease/disease-reporting-and-control
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 of 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 • Virologic testing for pts with ILI (>1/wk): • 9 in Alameda County – @ beginning, peak, • Report weekly: and end of flu – # patients with ILI season – # patients seen – severe disease • <30 min/week – 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
HCW flu vaccine rates http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2013.htm
Alameda County/City of Berkeley Health Officer Order • 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
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
Pediatric Flu Vaccination Rates in Alameda County Source: California IZ Registry * 100 90 80 70 60 % of 50 Children Vaccinated 45.9 44.8 44.6 43.8 43.3 40 40.1 39 36 34.9 30 32.6 32.6 20 21.8 10 0 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 Age Group by Year *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 90 80 81 77 76 75 74 74 70 73 72 70.7 68 66 66 60 % UTD 60 60 59 58 at 24 50 52 2009 months 2011 46 40 2014 4:3:1 30 series 20 10 0 Total White Hispanic Black Asian Other/Unknown Race by Year
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 5 th grade students
Take Home Messages • Report to and work with public health to: – Conduct routine surveillance – Be on the lookout for outbreaks and unusual occurrences – 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!)
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