1. The Louisiana Immunization Network for Kids Statewide (LINKS) System and Hurricanes Katrina and Rita: Unexpected Successes Frank J. Welch, MD Medical Director, LOPH Immunization Program

2. Overview History of LINKS LINKS in Preparedness Drills Hurricanes Katrina and Rita LINKS: Unexpected Successes

3. History of LINKS Statewide, Population Based Designed and supported by Scientific Technologies Corporation (STC) Full Production in 2001 Adult and Childhood immunizations Full spectrum of participation –Public sector –Pediatricians, Family Practice –Hospitals –Managed Care / Health Plans

4. LINKS Statistics 795 provider sites enrolled or in process –49 Hospitals –565 Private sites –5 HMO’s –146 Public Sites –30 School based health clinics 6,205 active LINKS users

5. LINKS Statistics Patients: 1,849,263 –0-2 yrs (104,522), 83% –2-6 yrs (273,016) –6-18 yrs (681,009) Vaccinations: 16,066,856 –0-2 yrs: 754,077 –2-6 yrs: 3,511,091 –6-18 yrs: 8,216,090

6. LINKS Statistics Real-time HL7 interface with Ochsner Foundation Hospital (one of the largest hospital in Louisiana), use LINKS exclusively Used to streamline annual Medicare billing for OPH Used by more than 500 school and Headstart nurses to report immunization status of children enrolled in annual assessments –Over 70,000 vaccinations have been added to LINKS

7. LINKS in Preparedness Efforts Smallpox Jan 2003 – Smallpox Campaign LINKS module created to collect professional and responder data, Bio- Prepared Response Professional PVS compatible Over 1400 First Responders inoculated

8. LINKS in Preparedness Efforts Mass Immunization Drills July 2003 – Bio-Terrorism Drill Combination of BT Response Capacity Drill and live immunization clinic –Tested all seven focus areas of LA’s BT Grant –Target a cohort to raise immunization rates –Multi-day effort (2.5 days)

9. LINKS in Preparedness Efforts Mass Immunization Drills All 9 Public Health Regions Participated 240K Reminder-recall postcards sent statewide 89 Sites participated Clinics set up as mass-vaccination sites

10. LINKS in Preparedness Efforts Mass Immunization Drills Full LINKS application used 11,320 patients received immunizations 24K immunizations administered and recorded 101,539 historical immunizations recorded Over 1,000 Office of Public Health staff participated Over 40 Private sector nurses participated Over 75 community volunteers participated Now an annual event, repeated 2004

11. LINKS in Preparedness Efforts Strategic National Stockpile Drill March 2004 – Strategic National Stockpile (SNS) Drill Plague Scenario Shreveport, LA Full State programmatic participation Planning Period was five months

12. LINKS in Preparedness Efforts Strategic National Stockpile Drill Mass Immunization Module used –modified to account for antibiotic distribution Over 900 patients received appropriate antibiotics Other tools used –GIS LA received Green Rating

13. Overview: Hurricane Katrina First made landfall as a Category 1 hurricane just north of Miami, Florida, on Thursday, August 25, 2005, then again on Monday, August 29, 2005, along the Central Gulf Coast near New Orleans, Louisiana, as a Category 4 storm. Resulted in breaches of the levee system that protected New Orleans from Lake Pontchartrain, and most of the city was subsequently flooded by the lake's waters. Most destructive and costliest natural disaster in the history of the United States.

14. Overview: Hurricane Rita As of October 19th, it was the second-most powerful hurricane of the season. After peaking in strength at 175 mph steady winds, it made landfall between Sabine Pass, Texas, and Johnson's Bayou, Louisiana, on September 24, 2005, as a Category 3 hurricane, with wind speeds of 120 mph. Post-landfall damage was extensive in the coastal areas in southwestern Louisiana and extreme southeastern Texas.

15. New Orleans Pre Hurricane Katrina

16. New Orleans Post Hurricane Katrina

17. Hurricane Katrina and Rita Quick Facts 1 million citizens evacuated, few with medical records 470,000 vehicles >300,000 homes uninhabitable >800,000 LA residents request federal assistance as of October 15, 2005, citing “displacement” 11 major hospitals lost completely, including two of the largest in LA

18. Hurricane Katrina and Rita Quick Facts 84,000 Housing Requests = 350,000 people 60,000 Official Shelters 100,000 in “Pop-Up” Shelters 400,000 Housed in Texas 41,000 Hotel Rooms = 150,000 people Workers/civilians on cruise ships 12,000 evacuated out of hospitals 22 million TONS of debris (World Trade Center = 1.5 million tons)

20. Hurricanes Katrina and Rita Displacement Displacement and Sheltering –Over 400 K displaced –X number of Shelters –Duration is unknown –Shelters close and reopen –Effects of water contamination unknown –Health Risks HepA/B Tetanus Influenza

21. Immunization Program Challenges –Central Office site in New Orleans flooded Relocated in Baton Rouge –Immunization Program office site intact, but post-hurricane no services –Of 3,100 Louisiana Office of Public Health employees Statewide, 1,474 are displaced –100% of Central Immunization Program staff displaced

22. Post Katrina and Rita : Immunization Program Response Sent Administrative team to State EOC in Baton Rouge Established temporary SNS/Immunization Program in Baton Rouge Establish vaccine clinic at the State EOC Reestablished VFC administrative and vaccine depot in Shreveport Receipt and distribution of SNS vaccine from Baton Rouge Key role in shelter strike team efforts

23. LINKS Unexpected Successes Fail-over system of LINKS –LINKS disaster recovery plan implemented in Summer of 2003—fail-over system deployed in Baton Rouge –Fail-over system activated immediately in Baton Rouge –LINKS continuously available to providers, without interruption in service

24. LINKS Unexpected Successes External Access to LINKS –LINKS accessed post-Katrina by every state in the Nation –746 Cities within U.S. –Canada, Mexico, Ecuador, Guatemala, UK –10 States used real-time HL-7 Interfaces –Over 55,000 successful out-of- state queries for records used for vaccination and school entry

25. LINKS Unexpected Successes Within Louisiana Access for Displaced Residents –Partnered closely with Dept of Ed for records –Continuity of care –prevented over- Immunization

26. LINKS Unexpected Successes Shelter Vaccination Efforts –LINKS used to input records on-site and paper records –Over 35,000 vaccinations given Influenza, Td, and HepA/B for adults All needed vaccinations for children –Transition to Primary Care Clinics

27. The River Center Shelter Baton Rouge Largest in the State –Over 5,000 evacuees –Two separate living locations –Two clinics Gymnasium – no internet Local Copy of LINKS Sixteen notebooks accessing two servers Secure, wireless access One day clinic –45 staff –Over 2,600 immunized –Over 6,000 immunizations

28. LINKS Unexpected Successes Responder Vaccinations –Provided technical assistance, vaccine and supplies to distribute Strategic National Stockpile vaccines –Hospitals, Strike Teams, DMAT teams, Private Providers, US Public Health Service Teams, University Teams –Provided over 110,000 tetanus doses –Vaccine Administered Reports submitted to public health, records put into LINKS

29. LINKS Summary and Thanks –8,500 medical volunteers –All 50 states –Organizations too numerous to list

30. LINKS "On behalf of the citizens of Louisiana, most especially those impacted by the catastrophic hurricanes Katrina and Rita, I thank you for your generous donation and offer of assistance in our time of need. You can not fully appreciate the invaluable part you played in helping us respond to the emergency vaccination needs of our citizens. With your assistance we were able to administer 50,000 flu shots to shelter residents and workers. Your hospital and state strike teams, donated vaccines and volunteers made all of this possible. We know from our LINKS registry that all 50 states provided health care to our evacuees. What a tremendous response of compassion and humanity! For this, the people of Louisiana are forever grateful. Please know that we are moving forward and planning for a great 2006. The state of Louisiana will come back better than before and as we ask for your continued support we also welcome you to visit our rebuilt and rejuvenated Louisiana! Sincerely, Kathleen Babineaux Blanco Governor, State of Louisiana"