Pandemic InfluenzaPandemic InfluenzaAn Immunization An Immunization

PerspectivePerspective

NACCHO Preparedness Committee NACCHO Preparedness Committee MeetingMeeting

Memphis, TNMemphis, TN4-5 April 20064-5 April 2006

Framework for Discussion Framework for Discussion

LHD preparedness leaders should provide LHD preparedness leaders should provide states and CDC with input on where effort states and CDC with input on where effort should be placed – guidance needs of local should be placed – guidance needs of local partners; research needs; communication needspartners; research needs; communication needs

Balancing need for clear guidance to ensure Balancing need for clear guidance to ensure consistent approach vs being too restrictive consistent approach vs being too restrictive

Policy must not be set that is too restrictive – it Policy must not be set that is too restrictive – it must allow for local flexibility but this is a tough must allow for local flexibility but this is a tough balance to get – it raises key issues but does balance to get – it raises key issues but does not offer solutionsnot offer solutions

Guidance Guidance

Detailed operational plan and protocols for contact management Detailed operational plan and protocols for contact management (e.g., Q vs symptom monitoring, AV PEP) stratified by – WHO (e.g., Q vs symptom monitoring, AV PEP) stratified by – WHO phase; geographic proximity of outbreak; recognition at airport vs phase; geographic proximity of outbreak; recognition at airport vs once in the communityonce in the community

Recommendations for facilities to lodge people under Q; how best Recommendations for facilities to lodge people under Q; how best to do medical monitoring of contactsto do medical monitoring of contacts

Criteria for when to transition from case-based approach to Criteria for when to transition from case-based approach to community measurescommunity measures

Guidance for home careGuidance for home care Guidance on epi and other criteria for when to implement Guidance on epi and other criteria for when to implement

community measures such as school closures, canceling public community measures such as school closures, canceling public events/gatheringsevents/gatherings

Flexibility for different settings (urban v rural)Flexibility for different settings (urban v rural)

Research NeedsResearch Needs Better characterization of avian-strain influenza Better characterization of avian-strain influenza

transmission (period of contagiousness, droplet vs transmission (period of contagiousness, droplet vs aerosol)aerosol)

Develop and pilot test epi protocols to assess these Develop and pilot test epi protocols to assess these factors during seasonal influenza so ready to go at start factors during seasonal influenza so ready to go at start of pandemicof pandemic

Data on transmission of pandemic strain will help guide Data on transmission of pandemic strain will help guide decisions re: isolation/Q/usefulness of community decisions re: isolation/Q/usefulness of community measuresmeasures

Plan now for epi studies that will be needed during the Plan now for epi studies that will be needed during the pandemic to assess efficacy of containment measures – pandemic to assess efficacy of containment measures – protocols (sampling strategies, analytic approach); protocols (sampling strategies, analytic approach); template surveillance forms; get state & local PH input template surveillance forms; get state & local PH input into feasibility of conducting these types of studiesinto feasibility of conducting these types of studies

Research NeedsResearch Needs

Does wearing masks in public make a Does wearing masks in public make a difference? Need for science-based difference? Need for science-based recommendationsrecommendations

Determining measures to limit Determining measures to limit transmission in households?transmission in households?

Looking at impact of school breaks on Looking at impact of school breaks on transmission of seasonal influenzatransmission of seasonal influenza

Role of environmental decontamination?Role of environmental decontamination?

Communications NeedsCommunications Needs

Need to develop concise consistent messages Need to develop concise consistent messages for multiple audiences – general public and its for multiple audiences – general public and its diversity; media; government decision makersdiversity; media; government decision makers

Address misconceptionsAddress misconceptions Set expectations on what will and won’t be doneSet expectations on what will and won’t be done Conduct focus groups to measure public Conduct focus groups to measure public

knowledge and practices re: likely community knowledge and practices re: likely community measures (respiratory etiquette/hand hygiene) measures (respiratory etiquette/hand hygiene) that will work during an emergencythat will work during an emergency

Communications NeedsCommunications Needs

Need to determine best messages and Need to determine best messages and methods for preparing the public for the methods for preparing the public for the long-term community resiliency that will be long-term community resiliency that will be needed throughout the pandemic – needed throughout the pandemic – especially public health resiliency and how especially public health resiliency and how to say those things to get people to to say those things to get people to prepare for it and get through the prepare for it and get through the emergencyemergency

Other IssuesOther Issues

Need to develop consistent approach to Need to develop consistent approach to alternate standards of carealternate standards of care

Prepare public/media/policymakers ahead Prepare public/media/policymakers ahead of timeof time

It would help to know what’s in the It would help to know what’s in the pandemic operational plans – not knowing pandemic operational plans – not knowing what’s coming is a problem because state what’s coming is a problem because state & local PH may be working on things that & local PH may be working on things that may already exist may already exist

Other IssuesOther Issues

The epi should be prioritized because The epi should be prioritized because those data will guide local interventions those data will guide local interventions and recommendations. Flu is very and recommendations. Flu is very nonspecific and LHDs may have to nonspecific and LHDs may have to change the symptoms that they want to change the symptoms that they want to hear from physicians/hospitals so that they hear from physicians/hospitals so that they aren’t overwhelmed with tons of fever-aren’t overwhelmed with tons of fever-backache reports. So how do they narrow backache reports. So how do they narrow it down to help them pinpoint highly it down to help them pinpoint highly suspect cases? suspect cases?

OtherOther

We need to be clear about what we want to do with our We need to be clear about what we want to do with our disease prevention strategies and figure out how disease prevention strategies and figure out how surveillance can support those efforts/goals. surveillance can support those efforts/goals.

That will help guide LHDs re: which symptoms they want That will help guide LHDs re: which symptoms they want to have reported. to have reported.

Is your goal to find EVERY case? If your goal/strategy is Is your goal to find EVERY case? If your goal/strategy is to lower the size of the epi curve and mitigate the to lower the size of the epi curve and mitigate the epidemic (recognizing that you can’t stop it), then you epidemic (recognizing that you can’t stop it), then you need surveillance that tells you that information – you need surveillance that tells you that information – you won’t need info on every individual because you’re not won’t need info on every individual because you’re not concerned about every individual. concerned about every individual.

Other IssuesOther Issues

Integrated surveillance – human and Integrated surveillance – human and animal surveillance. animal surveillance.

The planning process is the model and not The planning process is the model and not the plan itself – because you build the the plan itself – because you build the robust and sustainable relationships within robust and sustainable relationships within the planning/preparedness processes. the planning/preparedness processes. (Refer to the Eisenhower quote in your (Refer to the Eisenhower quote in your folder.)folder.)

2005 Profile of Local Health 2005 Profile of Local Health Departments StudyDepartments Study

NACCHO EH&BT Committee MeetingNACCHO EH&BT Committee Meeting

April 4, 2006April 4, 2006

2005 National Profile of Local 2005 National Profile of Local Health Departments StudyHealth Departments Study

Census – includes all LHDs in U.S.Census – includes all LHDs in U.S. Three prior studiesThree prior studies

Conducted in 1989, 1992-93, and 1995-96Conducted in 1989, 1992-93, and 1995-96 First National Profile to be conducted First National Profile to be conducted

as web-based surveyas web-based survey CDC is primary funderCDC is primary funder

NLM and HRSA support for specific analysesNLM and HRSA support for specific analyses

2005 Profile Questionnaire2005 Profile Questionnaire

Structured as Core and ModulesStructured as Core and Modules

Core questionnaire sent to every LHDCore questionnaire sent to every LHD N = 2864N = 2864

Three different modules Three different modules Each sent to sample of ~550 LHDsEach sent to sample of ~550 LHDs Stratified by population servedStratified by population served

Topics in Profile CoreTopics in Profile Core

GovernanceGovernance Population servedPopulation served FinancesFinances Characteristics of top Characteristics of top

executiveexecutive LPHA workforceLPHA workforce

Activities and services Activities and services providedprovided

Community health Community health assessment & assessment & improvementimprovement

Information Information technologytechnology

Topics in Profile ModulesTopics in Profile Modules

Detailed information on:Detailed information on: FinancesFinances LPHA workforceLPHA workforce Community health Community health

assessment & assessment & improvementimprovement

Information technologyInformation technology

Additional Topics:Additional Topics: Performance Performance

improvementimprovement Emergency preparednessEmergency preparedness PartnershipsPartnerships Policy-making and Policy-making and

advocacyadvocacy Addressing health Addressing health

inequitiesinequities

Overall Response Rate = 80%Overall Response Rate = 80%

LA

ID

AZ

UT

MT

WY

NM

CO

AL

FL

SC

TN

KY

INOH

NC

SD

KS

NE

MN

WI

IA

IL

MO

AR

MS

OK

ND

OR

CA NV

WA

TX

MI

GA

AK

HI

PA

ME

VA

NY

CT

WV

MD NJ

VTN H

M A

D E

RI

Final Response Rates to 2005 National Profileof Local H ealth Departments S tudy

Dark Green = 100%Med Green = 90 - 99%Lt Green = 80 - 89%Lt Orange = 70 - 79%Med Orange = 60 - 69%Dark Orange < 60%

Preview of 2005 Profile DataPreview of 2005 Profile Data

Data collection completed in November Data collection completed in November 20052005

Data cleaning recently completedData cleaning recently completed Analysis has just begunAnalysis has just begun Report of findings expected in mid-2006Report of findings expected in mid-2006

IMPORTANT NOTE: IMPORTANT NOTE: Data presented are preliminary Data presented are preliminary

Percentage of LHDs involved in regulation, Percentage of LHDs involved in regulation, inspection or licensing activitiesinspection or licensing activities

Health-related facilitiesHealth-related facilities 30%30%

Food processingFood processing 30%30%

Mobile homesMobile homes 29%29%

Housing inspectionsHousing inspections 28%28%

Solid waste disposal sitesSolid waste disposal sites 28%28%

Solid waste haulersSolid waste haulers 27%27%

Tobacco retailersTobacco retailers 21%21%

Cosmetology businessesCosmetology businesses 11%11%

Milk processingMilk processing 9%9%

Food serviceFood service 76%76%

Swimming poolsSwimming pools 67%67%

Septic tanksSeptic tanks 65%65%

School/daycareSchool/daycare 65%65%

Private drinking waterPrivate drinking water 57%57%

Lead inspectionLead inspection 53%53%

Hotels/motelsHotels/motels 49%49%

Campgrounds/RVsCampgrounds/RVs 39%39%

Smoke-free ordinancesSmoke-free ordinances 37%37%

Public drinking waterPublic drinking water 30%30%

LHD Provision of Environmental Health Services – Direct or ContractLHD Provision of Environmental Health Services – Direct or Contract

Organizations Providing Environmental Health Services

Amount of BT Funding LHDs Receive from CDCAmount of BT Funding LHDs Receive from CDC

27%

42%

22%

4%

3%

2%

$0

$1-$100,000

$100,001-$500,000

$500,001-$1,000,000

$1,000,001-$10,000,000

>$10,000,000

n=1,877

Amount of BT Funding LHDs Receive from HRSAAmount of BT Funding LHDs Receive from HRSA

84%

10%

4%

1%

1%

0%

$0

$1-$100,000

$100,001-$500,000

$500,001-$1,000,000

$1,000,001-$10,000,000

>$10,000,000

n=1,127

Percentage of LHDs Reporting Selected Emergency Percentage of LHDs Reporting Selected Emergency Preparedness (EP) Activities (in past 12 months)Preparedness (EP) Activities (in past 12 months)

ActivityActivity %age%ageParticipated in drills or exercisesParticipated in drills or exercises 92%92%

Developed or updated written emergency planDeveloped or updated written emergency plan 90%90%

Provided EP training to staffProvided EP training to staff 71%71%

Assessed EP competencies of staffAssessed EP competencies of staff 65%65%

Reviewed relevant legal authoritiesReviewed relevant legal authorities 65%65%

Participated in an actual PH emergencyParticipated in an actual PH emergency 37%37%

None of the aboveNone of the above 2%2%

How are Profile Data Used?How are Profile Data Used?

By LHDs to benchmark and advocateBy LHDs to benchmark and advocate By state and federal agencies to better By state and federal agencies to better

understand LPH practiceunderstand LPH practice By policymakers addressing LPH issuesBy policymakers addressing LPH issues By NACCHO staff to support programs for By NACCHO staff to support programs for

LHDsLHDs By researchers exploring specific By researchers exploring specific

hypotheseshypotheses

Stay tuned for more informationStay tuned for more information

State-specific data files will be made State-specific data files will be made available soon available soon

National report will be published in mid-National report will be published in mid-20062006 Free copy for all Profile respondentsFree copy for all Profile respondents