Use of the Health Alert Network for Communicating with Partners during an Influenza Epidemic in Arizona Laura Erhart, Susan Goodykoontz, Joseph Urrea, John Nelson, Kathy Fredrickson, Bob England Arizona Department of Health Services National Immunization Conference, May 14, 2004

Outline Arizona’s Health Alert Network State's needs during the 2003-04 flu season Use of HAN for communicating with partners Discussion Objective: To describe the use of SIREN in facilitating communications with local health officials and the health community during the influenza season of 2003-2004.

Health Alert Network Arizona Health Alert Network (HAN): Coordinates public health communications to improve disease surveillance and public health response. Secure Integrated Response Electronic Notification (SIREN) system: Public Health Information Network (PHIN)-compatible component of the Health Alert Network Functions as the communication tool: Information dissemination Alert notification Platform for electronic disease surveillance The Arizona Health Alert Network (or HAN) is funded through Bioterrorism Preparedness grants. Its purpose is the coordination of public health communications to improve disease surveillance and public health response. The HAN utilizes various technologies to meet these communication needs for the state to coordinate with other agencies in public health efforts. (•Individuals currently accessing SIREN include County Health Officers, local municipal representatives from Metropolitan Medical Response Systems, individuals from the Department of Emergency Management, the Department of Public Safety, the State Lab, the Samaritan Regional Poison Center, the Centers for Disease Control and Prevention, the Federal Bureau of Investigations, and the Department of Health and Human Services.)

SIREN: Information Dissemination Day-to-day dissemination of health information: Secure e-mail messaging Posting information on secure SIREN web portals Document sharing and management Fax distribution Conference bridge (48 lines) Alert notification (currently four levels): Health Notices Health Updates Health Advisories Health Alerts •The four notification levels break down as follows: •Health Notice: provides general information regarding an incident or situation; does not require immediate action. •Health Update: provides updated information regarding an incident or situation; unlikely to require immediate action. •Health Advisory: provides important information for a specific incident or situation; may not require immediate action. •Health Alert: conveys the highest level of importance; warrants immediate action or attention.

SIREN: Alert Notification During an emergency situation, SIREN can be used for rapid and secure information transmission and alert notification. Alert notifications are handled via: Telephone calls Fax distribution E-mail messaging Capacity to read e-mails over telephone Pager notification Web page updates Public health directory with roles to alert This system of communication can replace the individual emails & calls that would otherwise be made.

December 2003: Widespread Flu Activity AZ’s 1st lab-confirmed case mid-October Activity levels increased through November “Widespread” activity declared in AZ for week ending 12/6/2003 (shown here) SIREN/HAN in place already. Dec 2003 had need to use it. Post-Thanksgiving had first ped death, others reported nationwide.

Arizona Influenza Activity, 1997-2004 Widespread Regional Local Sporadic Season started much earlier than usual Imperfect match of vaccine strain (H3N2 Fujian) No activity

Media Attention 21 Nov 2003 5 Dec 2003 6 Dec 2003 7 Dec 2003 Not occurring in a vacuum: Much public/media attention Headlines show sequence of events; attention paid to issues Demonstrates need for public health action & response: rapid distribution of up-to-date, accurate information to partners and stakeholders 7 Dec 2003

12 Dec 2003 12 Dec 2003 14 Dec 2003

Communications Who develops the messages? Via what route? Who should receive them? What messages to send?

Internal Coordination Messages drafted by: Office of Infectious Disease Services Office of Public Health Emergency Preparedness & Response Immunization Program Office Approved by State Epidemiologist or designee All messages sent out by Health Alert Project Specialist

Communication Routes SIREN postings on secure website E-mails Blast faxes Conference calls Health alerts Other dissemination options available as mentioned before for higher priority events.

Public Health Groups E-mail/SIREN Local health officers County epidemiologists Directors of nursing Immunization coordinators Bioterrorism coordinators Infection control practitioners (ICPs) Infectious disease doctors Fax/SIREN Clinicians Urgent care centers Emergency rooms Schools U.S. Mail Laboratory directors Pathologists Medical examiners Long term care facilities Other groups available but not used this season for flu messages We communicated with several thousand people during the influenza season.

Messages Surveillance info (first case, antigenic characterization, distribution across the state, activity levels) Vaccine (supply, distribution, prioritization of vaccinations) Clinical updates (including use of antivirals) Laboratory testing (types of tests, collection of specimens)

Messages (continued) Information for schools (messages for parents, control measures) Pediatric flu-associated deaths (info, forms) Requests for information (reports of early flu cases, pediatric flu deaths, activity level in facilities, etc.)

Discussion Benefits to using HAN for flu response Timeliness of communications Ease of sending additional information Groups already organized by pre-defined public health roles (within health departments) or by job (ICPs, ID doctors, clinicians, etc.) Capability for higher-level alerts if needed Test of our system for emergency response

Lessons Two crucial elements: Notification of local health departments before other partners Internal coordination Avoid duplication of efforts, mixed messages, or confusion Public Health Incident Management System/ Incident Command System structure proposed for response Contact listings must be kept up-to-date

Influenza Season Synopsis Moderate season, not the severe epidemic or pandemic some predicted 5 influenza-associated pediatric deaths Within “normal” ranges Communication between state and local health departments and with other health entities was critical

Future Directions: West Nile Expected to hit Arizona this summer HAN/SIREN to be integral component of response