H1N1 in Massachusetts:

1. H1N1 in Massachusetts: A Review of the Impact, the Response and Lessons for the Future January 15, 2010

2. Why This Matters

3. When it Hits, it Hits Fast Planning is needed ahead of time to be minimize impact

4. When H1N1 hit, it hit quickly and with a good deal of uncertainty

5. While initial fears were unfounded: The toll in the U.S. was high • Cases: Almost one in five Americans had the H1N1 flu – or about 57 million people. • Hospitalizations: About 250,000 people were hospitalized due to H1N1. • Deaths: An estimated 12,000 people died from H1N1. Three and half times more children died in this flu outbreak than a usual seasonal flu outbreak.

6. And it could have been higher:There just isn’t any way to know ahead of time

7. The Solution: Prepare for any possibility

8. Necessary Tasks to Prepare for a Pandemic • Monitoring and analyzing cases and outbreaks • Preventing infection thru multiple approaches • Administering of a vaccine • Educating of the public/media coverage • Insuring access to needed clinical care • Distributing medications to clinicians

9. Our Planning Had Been Tested by Previous Emergencies • Anthrax, 2001 • Katrina, 2006 • Ice Storms, 2008

10. So How Did We Do in H1N1?

11. Laboratory Sciences and Case Surveillance

12. The Hinton Laboratory Confirmed the Early H1N1 Cases • Testing of samples from hospitals gave an early picture of who was ill with flu • Massachusetts was an early CDC approved site for confirmatory testing

13. Epidemiologists traced the cases: Percentage of Influenza-Like Illness Visits Reported by Sentinel Provider Sites – Massachusetts (as of 2/4/10) November February May Source: Massachusetts Immunization Program

15. Preliminary Data Massachusetts Department of Public Health February 2010, Do Not Distribute

16. Access to Medical Care

17. Strong Links to Clinicians on the Front Lines • Specialized guidelines developed • Regular conference calls • Active leadership of Mass. Medical Society, Academy of Pediatrics, Mass. Hospital Assoc. and Mass League of CHCs

18. Guaranteeing Appropriate Care • Planning to insure that medications & supplies are available where needed • Encouraging flu care at home for most/avoidance of unneeded MD visits • 1.2 million copies of “Flu Care at Home” distributed

19. Medication Distribution from State/Fed. Stockpile:Antivirals and Personal Protective Equipment--spring, 2009

20. Vaccination

21. 2009 – 2010 Seasonal Flu Vaccine National supply earlier than usual but arriving in stages–full amount by Nov. MDPH distributed 10% more than last season Unprecedented demand led to shortages in seasonal vaccine. Emphasis on traditional risk groups

22. Target Groups for H1N1 Vaccine(per ACIP) Pregnant women Household and caregiver contacts of children <6 months of age Health care and emergency medical services personnel Children from 6 months through 18 years Persons aged 19-24 – 2nd tier Persons aged 25 through 64 years who have specified medical conditions – 2nd tier

23. Federal Government Funds Vaccination Efforts • DPH receives federal funding for vaccination efforts • Local/regional health coalitions received grants and prepare to respond • Vaccine to be offered for free

24. Expanding the Ranks of the Vaccinators • The Massachusetts Public Health Council passed emergency regulations allowing the following to vaccinate (if properly trained/overseen): • Paramedics • Pharmacists (for those 12 years above) • Dentists • Nursing students • Medical students

25. But then the vaccine didn’t come in the quantities needed

26. It finally arrived…and clinicians, local public health & schools responded • Total number of vaccine clinics in Mass.– approximately 1,500 • Total vaccine administered – more than 2 million doses (about 1/3 of the Mass. residents were vaccinated) • 39% of children were vaccinated in MA. vs. 28% nationwide by end of Dec. • 28% of the initial priority group adults were vaccinated in MA. by the end of Dec. vs. 16% nationwide

27. Community Mitigation

28. Key Activities - Schools • Working with schools around key actions: • Health hygiene • Screening of ill students • Communicating with parents • Remaining open • Understanding and complying with guidance • Partnering with DESE – hiring a specialized staff person

29. Many school closed in the spring- fewer in the fall • 44 schools & pre-schools closed in the spring of 2009 • 7 schools & pre-schools closed in the fall of 2009

30. Parents’ Agreement with School Closure Decision % of parents* saying… Strongly agree Somewhat agree Somewhat disagree Strongly disagree % of parents* saying there was a time since the start of the school year that they felt their child’s school should have closed due to H1N1 but did not No Yes *Among parents in high closure areas who experienced a school closure (n=523) 30 Harvard Opinion Research Program, Harvard School of Public Health, November 19-December 9, 2009.

31. Parents’ Satisfaction with School Closure Information % of parents* saying… Very satisfied Somewhat satisfied Not very satisfied Not at all satisfied *Among parents in high closure areas who experienced a school closure (n=523) 31 Harvard Opinion Research Program, Harvard School of Public Health, November 19-December 9, 2009.

32. Communication Planning

33. Built on a long tradition of awareness

34. Sometimes with misinformation

35. Sometimes with lots of misinformation

36. Statewide Communication Effort • Use public information campaign on vaccination, prevention and mitigation • Tailor messages to key, at risk populations • Insure multi-lingual effort • Create “ReadyCam” capacity • Use web site, blog and twitter • Prioritize media relations

37. Flu Facts Campaignin multiple languages

38. Federal Materials Availablewith focus on particular target groups

39. Educational materials distributed

40. There were some particular characteristics of interest

41. The young were especially affected

42. People of color were particularly affected

46. New ways to communicate were used

47. We Blogged • Total Views 4/26 – 6/25: • 128,900 • Average per day prior to 4/26/09: • 184 • Average per day from 4/26/09: • 2148

48. Specialized Materials Were Developed for Multiple Audiences in Multiple Languages General Public – 15 languages Parents and Families Specific populations: e.g., pregnant women Clinicians and health care providers Schools and child care professionals Colleges and universities Employers Shelters and congregate facilities Summer camps

49. We Broke New Ground in Communications Efforts • 458,000 visitors to our H1N1 web pages - 3,000 daily visitors • 2,000 followers on Twitter • 1,000 organizations either order materials • Cable TV videos programs on 170 stations • 30 second spots played at movie theatres and retail check-out monitors • Videos produced in 6 languages/written material in 15 languages • Regular specialized “ethnic” media work

50. There was a noticeable increase in preventive behaviors