MA Region 4A H1N1 Response

1. MA Region 4A H1N1 Response Lessons Learned Presented by: Liisa Jackson MA Region 4A MRC Coordinator

2. H1N1 Timeline 2009-2010 • April - reports of H1N1 fatalities in Mexico and United Stated • May to June: prevention campaign • July: news of the vaccine development • August to October: education about H1N1 vaccine production and distribution • October to March: H1N1 clinics

3. April: News of H1N1 fatalities The World Health Organization on Wednesday raised its pandemic alert to 5, its second-highest level, warning of widespread human infection from the swine flu outbreak that originated in Mexico.

4. May to June: Educational efforts about the disease itself and the values of inoculation

5. July to October: H1N1 vaccine production and distribution • Difficulties in procuring vaccinations • Delays in production vaccine and then the logistics of distributing it focused attention on the status of government efforts on several fronts

6. Planning H1N1 clinics: • Reviewing your Emergency Dispensing Site Plans • Bringing H1N1 response partners together • Identifying target and Priority Groups • Identifying vaccinations provided by Private Sector Partners • Planning Public Vaccination Clinics

7. Planning H1N1 clinics: • Coordination of Vaccine Distribution • Vaccination of Healthcare Workers and EMS • Vaccination of School-aged Children • Hard-to-reach and Vulnerable Populations • Communications • Doses Administered Tracking

8. November to March: H1N1 clinics

9. Vaccination Success Seasonal: 60% Vaccinated (MA) vs. 36% in country as a whole H1N1: 36% Vaccinated (MA) vs. 21% in country as a whole 86 million received vaccine nationwide 2 million doses (at least) administered in MA

10. 3.7 Million Doses Distributed in MA • 1.5 Million doses to public sites • 919,000 to Boards of Health • 177,000 to Community Health Centers • 2.2 Million doses to private sites • 43,000 to Obstetricians • 553,000 to Pediatric Services • 504,000 to Private Hospitals

11. H1N1 Doses Administered

12. Lexington Vaccination Clinics

13. November 22, 2009, an EDS style H1N1 Influenza Clinic • H1N1 Flu Vaccine H1N1 Flu Mist • 0 years - 3 years 20 23 • 4 years- 5 years 30 47 • 6 years - 12 years 132 181 • 13 years - 18 years 82 43 • 19 years - 29 years 9 2 • 30 years - 39 years 32 19 • 40 years - 49 years 57 29 • 50 years - 59 years 51 0 • 60 years - 69 years 26 na • 70 years - 79 years 6 na • 80 years - 89 years 2 na • 90 years - 99 years 0 na • Totals: 447 344 • Total Vaccinated: 791

14. HINI Vaccination December 2nd, 2009

15. HINI Vaccination December 2nd, 2009 • Age Group H1N1Shot H1N1Mist • 0 years-3 years 14 26 • 4 years-5 years 17 33 • 6 years-12 years 103 206 • 13 years-18 years 378 377 • 19 years-29 years 35 23 • 30 years-39 years 28 14 • 40 years-49 years 92 35 • 50 years-59 years 68 2 • 60 years-69 years 41 0 • 70 years-79 years 11 1 • 80 years-89 years 2 0 • 90 years-99 years 0 0 • Total 789 717 • Total vaccinated: 1506

16. January 2010 Influenza Vaccination Clinic Results

17. January 2010 Influenza Vaccination Clinic Results • Age Group H1N1 Injection H1N1 Intranasal • 0 years-3 years 10 18 • 4 years-5 years 10 29 • 6 years-12 years 36 88 • 13 years-18 years 12 16 • 19 years-29 years 10 6 • 30 years-39 years 44 24 • 40 years-49 years 142 76 • 50 years-59 years 159 2 • 60 years-69 years 115 0 • 70 years-79 years 88 0 • 80 years-89 years 42 0 • 90 years-99 years 5 0 • Total 673 259 • Total vaccinated: 932

18. Total large clinics • 4 clinics • 4,665 vaccinations which is a 549% increase over last year (approximately 850 vaccinations last year) • 1166 vaccinations per clinic • Ages = few months to over 90 years old

19. What we learned: • The initial response to the H1N1 outbreak showed strong coordination and communication and an ability to adapt to changing circumstances from U.S. officials, but it also showed how quickly the nation's core public health capacity would be overwhelmed if an outbreak were more severe or widespread.

20. H1N1 tested our capabilities • H1N1 is a real-world test of our initial emergency response capabilities -- all of the planning and preparations have paid off. We are significantly ahead of where we were afew years ago

21. H1N1 showed our weakness • However, the outbreak also revealed serious gaps in our nation's preparedness for pandemic flu and other public health emergencies • Showed us where we need to improve our capacity and response

22. Region 4A MRC Hero: Mary Hilli “Mary is a huge asset to the community and region, and has been an amazing leader.  As the Health Director I could not ask for a more dedicated volunteer.  As you are aware the work load of local public health is vast, if it weren't for those like Mary the MRC program would not exist.  Mary works tirelessly as Chair of the MCC/MRC.” Kevin Sweet Maynard Health Director “Mary goes over and above the call of duty - she is fantastic and the chair of Maynard's MRC.”Tammy Murphy Maynard MRC Executive Committee

23. Questions and Comments Liisa Jackson MA Region 4A Medical Reserve Corps Volunteer Coordinator # 774-278-0059 LiisaJackson@comcast.net Thank you all so much we couldn’t have covered 60% of our population without the help of the Medical Reserve Corps Volunteers!

24. MRC Hot Wash

25. H1N1 clinic MRC hot wash topics: • Emergency preparedness training • H1N1 education • Planning the H1N1 clinics • Recruiting volunteers for the Flu Clinics • Job Action Sheets/Assignments

26. H1N1 clinic MRC hot wash: • H1N1 Clinic pre-registration for patients • H1N1 Clinic set up • H1N1 Clinic operations • H1N1 Clinic break down

27. H1N1 clinic MRC hot wash: • Debrief • After action • Suggestions

28. Questions and Comments Liisa Jackson MA Region 4A Medical Reserve Corps Volunteer Coordinator # 774-278-0059 LiisaJackson@comcast.net

29. Thank you all so much! We couldn’t have the H1N1 clinics without the MRC volunteers!!!!!

30. National Lessons Learned

31. Lessons from the Frontlines • Investments in pandemic planning and stockpiling antiviral medications paid off; • Public health departments did not have enough resources to carry out plans; • Response plans must be adaptable and science-driven; • Providing clear, straightforward information to the public was essential for allaying fears and building trust; • School closings have major ramifications for students, parents and employers;

32. Lessons from the Frontlines • Sick leave and policies for limiting mass gatherings were also problematic; • Even with a mild outbreak, the health care delivery system was overwhelmed;  • Communication between the public health system and health providers was not well coordinated; • WHO pandemic alert phases caused confusion; and • International coordination was more complicated than expected.

33. To further strengthen preparedness • Maintaining the Strategic National Stockpile -- making sure enough antiviral medications, vaccinations, and equipment are available to protect Americans, which includes replenishing the stockpile when medications and supplies are used; • Vaccine development and production -- enhancing the biomedical research and development abilities of the United States to rapidly develop and produce a vaccine;

34. To further strengthen preparedness • Vaccinating all Americans -- ensuring that all Americans would be able to be inoculated in a short period of time; • Planning and Coordination -- improving coordination among federal, state, and local governments and the private sector preparedness and planning activities on an ongoing basis, including taking into account how the nature of flu threats change over time;

35. To further strengthen preparedness • Global coordination -- building trust, technologies, and policies internationally to encourage science-based, consistent decision making across borders during an outbreak; • Resources -- providing enough funding for the on-the-ground response, which is currently under funded and overextended;

36. To further strengthen preparedness • Workforce -- stopping layoffs at state and local health departments and recruiting the next generation of public health professionals; • Surge capacity -- improving the ability for health providers to manage a massive influx of patients; and • Caring for the uninsured and underinsured -- ensuring that all Americans will receive care during an emergency, which limits the spread of the contagious disease to others, and making sure hospitals and health care providers are compensated for providing care

37. Questions and Comments • Liisa Jackson MA Region 4A Medical Reserve Corps Volunteer Coordinator • # 774-278-0059 • LiisaJackson@comcast.net