P URPOSE To engage the Henry County Health Department and local public health system partners in performance improvement of:  Essential Service 1 Monitoring Health Status to Identify Community Health Problems  Essential Service 2 Diagnosing /Investigating Health Problems and Health Hazards in the Community O BJECTIVES To implement continuous quality improvement processes to improve local surveillance and reporting by:  Application of problem solving techniques, such as root cause analysis, to identify solutions.  Improving process and timeliness for daily data collection from local school partners to identify possible disease outbreaks in real-time.  Development of state-of-the-art technology to support an enhanced local communication system. P ROGRAM P HASES Creating the Vision: a Real-Time Local Surveillance System Building Infrastructure: establishing a systematic process in collaboration with system partners. Real-Time PH Surveillance: daily data collection and analysis of county-wide school absenteeism. Improving Local PH Practice: investigating and responding to public health threats in a more timely manner. Sustaining Efforts to Improve Population Health: to create healthier communities using real-time community health data. P ROCESS Henry County Health Department convened health department staff and local partners to identify strategies for operationalizing a real-time local surveillance system in the county. The primary activity for the pilot was to implement daily student illness reporting by community schools, including number of students and cause of absenteeism by type of illness. Data was aggregated on a daily basis, and used in conjunction with Emergency Department surveillance for early detection and response to communicable diseases. O UTCOME  Winter, : Monitoring and early detection of Fifth's Disease outbreak in 10 schools. Prevention strategies implemented in partnership with school administrators to alert pregnant staff members about the risks and prevention of transmission of this disease.  April, 2009: 1st grade classes from each of the 5 school corporations visited a family farm for an agriculture education day. Within 5 days, two 7 year olds from different school corporations were diagnosed with E. Coli infections. We monitored lab reports, contacted providers and school nurses and were able to determine we only had 2 cases within 72 hours of notification of the first case. Confirmation of related cases with Indiana State Department of Health and CDC testing.  April-May 2009: Daily monitoring of Influenza like Illness and potential H1N1 cases in the county as a result of the daily school absenteeism reporting as a real-time local level surveillance program. Daily communication provided to local public health system partners to report real-time community health data. H ENRY C OUNTY H EALTH D EPARTMENT N EW C ASTLE, I NDIANA A N I NDIANA MLC3 P ERFORMANCE I MPROVEMENT P ROJECT Doug Mathis, MA, BS Gary Maitlen, BS John Miller, MD Deb Koester, DNP, MSN, RN P ARTICIPATING C OMMUNITY S CHOOLS Blue River School Corp Charles A. Beard School Corp New Castle School Corp Shenandoah School Corp South Henry High School Corp Creating the Vision for a Healthier Community Developing Approaches to Real-Time Public Health Surveillance Sustaining Efforts to Use Data to Improve Outcome Enhancing Local Public Health Practice Health Improvement Process 13 cases of Henry County residents presented with ILI in regional ERs over the previous 5 days, and the median age of these patients is 18. The median age for ILI patients for the Henry County residents during February and March was 12. This flu season was much harder on 0-4 year olds and younger school age children than adults and senior citizens. National public health experts believe that important key to understanding if H1N1 will progress into a more serious problem will unfold during the flu season for the Southern Hemisphere, and that region will soon enter its flu season. The CDC/NACCHO/ASTHO state the H1N1 virus is very unusual. Its particular genetic combination of virus segments has not been recognized before anywhere. Assay kits from CDC have been received by 68 laboratories in 42 states, including Indiana. Beginning today, ISDH is able to complete H1N1 testing that was previously performed by CDC. If you would like assistance in transporting samples to ISDH, the Henry County Health Department can assist. Please call Doug at or for questions. It is likely the samples would need to be ready in the morning for transport to ISDH. An excellent link to take a look at today is A H1N1 Case Definition Suspect Case The patient presents with signs and symptoms characteristic of influenza (fever >100 degrees Fahrenheit with cough or sore throat), AND a)Has had a positive test result for influenza A, OR b)Has traveled to another state or country with confirmed cases of swine influenza within 7 days of illness, OR c)Has been in contact with someone ill with a suspected, probable, or confirmed case of the current outbreak strain within 7 days of illness. Probable Case Meets definition of suspect case AND Lab test positive for influenza A, untypable. Confirmed Case Meets probable case definition AND Confirmed positive for A/H1N1/North America/Human influenza. Definition of close contacts: A person who has the following relationship with a confirmed case: 1. Household/roommates 2. Significant Others 3. Co-workers/Classmates working within 3 feet 4. Daycare contacts 5. Healthcare providers Web Based Reporting # of Henry County residents presenting with ILI symptoms in IN ERs # of Henry County residents w/ lab confirmed influenza A or B, not H1N1 4/30/ /1/ /2/ /3/ /4/ Community School Reporting Reports of ILI from school nurses (High, Moderate, Low) 4/29/2009 Low 4/30/2009 Low 5/1/2009 Low 5/2/2009 N/A 5/3/2009 N/A Indiana State Department of Health No update, yet from ISDH regarding their conference call with CDC. As of yesterday morning’s 10:58am IHAN notice, Indiana has 22 probable samples pending with ISDH. We could have as many as 9 cases confirmed in District 6 over the next few days. ISDH states 95% of pending cases have been concerned, while CDC/NACCHO states the percentage is 99%. ISDH is asking that clinicians stick to the case definition for submission samples to “maximize the effectiveness and efficiency of its surveillance.” ISDH also reminds us to complete the entire lab submission form as incomplete forms only delay the process. The form and instructions may be found at ISDH continues to provide a call center staffed by physicians, available for questions from health care providers only. Providers with specific clinical questions should call from 8:00-4:45, Monday-Friday. Center for Disease Control (CDC) CDC continues to take aggressive action to respond to an expanding outbreak caused by H1N1 (swine flu). CDC’s response goals are to: (1) Reduce transmission and illness severity; and (2) to provide information to help health care providers, public health officials and the public address the challenges posed by this emergency. CDC continues to issue and update interim guidance daily in response to the rapidly evolving situation. School closure continues to be a hot topic. The CDC is offering social media updates at World Health Organization (WHO) The World Health Organization (WHO) pandemic phase is still at 5. According to the WHO definition of phase 5, the virus has caused sustained community level outbreaks in at least two countries in one WHO region. At phase 5 a pandemic is considered imminent. The death toll for Mexico has been adjusted to a tremendous degree as have the WHO figures. As of 6:00 GMT 5May2009, 21 countries have 1,124 cases of laboratory confirmed H1N1, with Mexico accounting for 25 of the 26 deaths worldwide. For the WHO update on H1N1, visit Henry County Health Department For local updates, you may call our office at or or Doug Mathis at We do not have any suspect cases in Henry County to our knowledge. If the probable cases in our district become positive, I am strongly considering opening up an after hour call “center” as this development may alarm some people. I will advise later. We continue to look into activating our Medical Reserve Corps to help us with planning and preparation at this point. If you have interest in learning more about this federal program, visit and if you are interested in joining the local effort, Gary Maitlen in our office at It looks like many schools are dealing with strep throat today. Henry County, Indiana Daily Community Health Profile – 5May office, cell,